What's New in CPRS GUI v.28 (OR*3.0*280)

Additive Frequency in Infusion Orders

•	Ordering Infusions

•	Copying, Changing, or Renewing Continuous Infusion Orders

Blood Bank

•	Description of the items on the dialog

•	New screen capture of the dialog and note about surgeries that do not require blood

Changes to Medication Route

•	Medication route explanations for several kinds of orders:

o	Inpatient Medications (simple dose)

o	Inpatient Medications (complex dose)

o	Outpatient Medications (simple dose)

o	Outpatient Medications (complex dose)

Changing a Note Title and Retaining the Text

•	Added instructions on retaining text while changing a note title.

CPRS Time Out

•	Added a line about the Close CPRS button.

Event-Delayed Orders

•	Added a note that who can manually release delayed orders is controlled by a key or a parameter.

Labs: Most Recent Selection

•	The Most Recent selection now has buttons that are named and some other items that were added.

Medications

•	Date Range displayed on Meds Tab

•	Added a Release Hold section for the Meds tab

Notifications

•	Remove Pending Notifications Warning

Order Checking

•	Site-Defined Clinical Reminder Order Checks were added to CPRS. This allows sites to define their own order checks by defining Clinical Reminders terms and rules, and then the order check text that should display to the user when the term is present or the rule is met.

•	Local Order Checks have some new order checks and new dialogs.

Orders

•	Changed “Give additional dose now” note and screen capture:

o	Ordering Inpatient Medications (Simple Dose)

o	Ordering inpatient Medications (Complex Dose)

o	Placing Intermittent Infusion Orders

•	Added a comment telling users that the quantity field may reset:

o	Ordering Complex Inpatient Medications

o	Ordering Complex Outpatient Medications

Patient Record Flags

•	The Patient Record Flags dialog was updated. The number of items is listed after the Category label for each category.

Primary Care Button

•	Associate Provider has been added to the display when the Primary Care button is selected.

Printing in CPRS

•	CPRS now uses the same printer you printed to last until you change it or log our and log back in. On log out, it will revert to the default printer.

Tools

•	CPRS Tools number of items increased and ability to use submenus

VistaWeb Button

•	The VistaWeb button will now change colors, displaying blue text on the button when remote data is available.


What's New in CPRS GUI v.27n (OR*3.0*296)
What's New in CPRS GUI v.27.90 (OR*3.0*296)

Alerts/Notifications

•	Corrected Notification necessary to receive Lab Results when available.

Combat Veteran Markers

•	Combat Veteran Markers were added to several places in CPRS.

Infusion Order Dialog

•	Changing IV Type from Continuous to Intermittent affects what fields are available.

•	Changing IV Type from Intermittent to Continuous affects what fields are available.

VBECS

•	Made minor changes to the VBECS for default number of days for Type and Screen to be valid and other minor changes.


What's New in CPRS GUI v.27 (OR*3.0*243)

CCOW (Context Management)

•	Joining Context and Breaking Context – Added notes to let users know that the Rejoin Context menu item will not be available after a context error occurs until the user logs out and then back into CPRS.

CPRS Dates and Times

•	Entering Dates and Times into CPRS – This topic tells users how dates and time can be entered into CPRS.

Font Sizes in CPRS

•	Changing the Font Size – This topic now includes the advice that for font sizes larger than 18 point, user should take advantage of magnification software.

Graphing

•	Graphing (overview) – Added some changes to definitions found on this page. References to comments and free-text on the graphs.

•	Graphing: Starting CPRS Graphing – updated the graphic and added some information to this page.

•	Graphing: Exporting Data – This feature enables users to export graphing data to an Excel spreadsheet automatically.

Health Summary

•	Viewing a Health Summary – Included the errors that display when the HDR cannot be reached. CPRS will also display error text after the name of facilities listed when the user selects the Remote Data button when it is active (blue text displayed).

Infusion Orders

•	Infusion Orders Overview – To address a patient safety issue, CPRS changed to use the term Infusions for various orders that used to be under IV Fluids because some of these items were not given intravenously. This section introduces the idea of continuous and intermittent infusion orders.

•	Placing Continuous Infusion Orders – This topic tells users how to order continuous infusion orders.

•	Placing Intermittent Infusion Orders – This topic tells users how to order intermittent infusion orders.

Inpatient Medications

•	Ordering Inpatient Medications (simple dose) – made several changes.

Medications Tab

•	Sorting the Medications View – New methods of sorting Medication information on the Meds tab.

•	Other Medication Actions – This topics tells users how the right-click action on the Meds tab works when the user right-clicks and items are highlighted or when no items are highlighted. There is a note also about and “invalid pharmacy number” error that occurs infrequently.

Mental Health Assessments Requirements for a User

•	Using Mental Health Assessments in CPRS – Details what must be in place to make use of the new Mental Health items.

New Blood Bank Software (VBECS ordering)

•	Blood Products (Overview) – CPRS has introduced a new dialog that will be activated by another patch to enable the users to order blood products and diagnostic tests. This topic describes the new dialog.

•	Ordering Blood Components and Diagnostic Tests – Steps on how to order these items.

Notifications

•	Processing Notifications – Added a note about what happens when a user tries to process notifications from patients with sensitive records.

Patient Inquiry

•	Additional Patient Information – Next of kin and cell phone information are now in the demographic information available in CPRS.

Patient Record Flags

•	Viewing Patient Record Flags – Category I Patient Record Flags display with different colors, text size, and blinks. The changes are meant to differentiate Category I flags from Category II flags.

Patient Selection

•	Selecting a Patient – Added a note that when a user is typing in the patient’s name or social security number, CPRS will not automatically select a patient name until a unique match is found.

Refresh Patient Information (Encounter Location Switching)

•	Refresh Patient Information – Added a brief description of a new dialog that enables users to choose where the orders should be created if the patient moves while the chart is open, but the user has not written orders yet.

Remote Data

•	Choosing RDV or VistaWeb to View Remote Data – How the user chooses which method to choose has changed. Now the user will choose each time because two buttons now exist.

•	Remote Data – New screen capture showing buttons and changes to reflect the new buttons.

•	Remote Order Checking – A change was made to the message that informs the user the check on done on local data only.

•	Viewing a Report – Slight change to instructions because of changes to the buttons.


What's New in CPRS GUI v.26 (OR*3.0*215)

Remote Data

•	Remote Data View (Overview) – Added information about users being able to use Remote Data Views or VistaWeb to view remote data.

•	Choosing RDV or VistaWeb to View Remote Data – Instructions for how to change the user’s remote data viewing preference between RDV and VistaWeb.

•	Viewing Remote Data – Added some information about using VistaWeb.

Vitals Enhancements

•	Vitals – The Vitals Lite package included in CPRS has its own help file that is activated from the Vitals Lite screen by choosing Help | Quick Reference.

Outpatient Meals

•	Ordering Diets and Outpatient Meals – Overview information about outpatient meals.

•	Ordering Outpatient Recurring Meals – Instructions for recurring meals.

•	Ordering Outpatient Special Meals – Instructions for a one-time meal written for the current day.

•	Ordering Outpatient Tubefeeding Meals

•	Ordering Outpatient Meal Early/Late Trays

•	Ordering Outpatient Meal Isolations/Precautions

Patient Record Flags

•	Patient Record Flags: Overview – This topic now contains information about the linking of flag actions to individual progress notes.

•	Viewing Patient Record Flag notes may be viewed directly from the Patient Record Flag popup.

Patient Insurance and My HealtheVet Information Button

•	Patient Insurance and My HealtheVet Information – can be accessed using either the button on the patient information bar or from the View menu.


Outpatient Meals

Outpatient Recurring Meals

Recurring meals for outpatients might be ordered if a patient comes to a clinic regularly for treatment during meal times.

Special Meals

Users order special meals for a meal that must be ordered today and is a one-time occurrence instead of a recurring meal.

Outpatient Tubefeeding Diet Orders

Outpatient tubefeeding orders must be associated with a recurring meal. If no recurring meal has been ordered for the selected patient, CPRS displays a message informing the user and the user cannot order tubefeeding.

Early / Late Tray Outpatient Meal Order

Outpatient early/late tray orders must be associated with a recurring meal. If no recurring meal has been ordered for the selected patient, CPRS displays a message informing the user and the user cannot order the early/late tray.


Vitals Lite

Access Vitals Lite the same as before by clicking in the vitals data on the CPRS cover sheet.

CPRS uses the new Vitals Lite dialog to enter the following vitals and measurements:

•	Blood pressure

•	Central venous pressure

•	Circumference/girth

•	Height

•	Pain

•	Pulse

•	Pulse oximetry

•	Respiration

•	Temperature

•	Weight


Choosing RDV or VistaWeb to View Remote Data

Previously, a user would set their preference to use either VistaWeb or Remote Data Views. This was set once and then stayed until the user changed the preference. This changed in CPRS v.27 so that both ways of retrieving remote data are now available through buttons that are below the menu bar: VistaWeb and Remote Data.

Because users choose their method of viewing remote data at the time they go to find the data, there is no longer a way to permanently set the remote data method using the Tools | Options… menu item. The tab now only has a description of how to select the option.

Related Topics

Remote Patient Data Overview

Viewing Remote Data


Add a Comment to a Problem
Adding a Comment to a Problem

To add a comment, use these steps:

1.	Click Add comment.

2.	Enter your annotation in the dialog that appears (up to 60 characters).

3.	Click OK.


Adding to Existing Progress Notes (addendum)

CPRS enables you to make addenda to Progress Notes. After reviewing a Progress Note, you may want to add comments to the note.

You can create multiple addenda to a single Progress Note if you choose.

To place an addendum to a Progress Note, follow the steps below:

1.	Click the Notes tab.

2.	From the index of Progress Notes on the left of the dialog, click the Note to which you want to add an addendum.

3.	Select Action | Make Addendum.

4.	Enter the text of the addendum.

5.	Select the Action menu and then one of the signing options that is available:

•	Add to Signature List

•	Save without Signature

•	Sign Note Now

Note:	Whether you have these options available depends on your level of authorization (key).

Related Topics

Opening and Reviewing Progress Notes

Write a New Progress Note

Signing a Note


Adding a Problem

To add a new problem to a patient’s problem list, use these steps:

1.	Select the Problems tab.

2.	Select New Problem

-or-

select Action | New Problem….

The Problem List Lexicon Search dialog displays.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Problem List Lexicon Search dialog. You must complete the encounter information dialog before proceeding.

3.	Enter a term that describes the problem in the Enter Term to Search field.

4.	Press <Enter>

-or-

select Search.

CPRS will search the lexicon for problems that contain the search term. The matching problems will appear in the bottom half of the Problem List Lexicon Search dialog.

5.	Select the appropriate problem.

Note:	If you try to select a problem that has an inactive diagnosis or procedure code, CPRS prompts you to select a problem with an active code.

6.	Select OK.

The New Problem form will appear.

7.	Complete the New Problem form by following the steps below:

a)	Select a status for the problem (Active or Inactive).

b)	Choose an immediacy for the problem (Active or Acute).

c)	Enter the date of onset.

d)	Select a responsible provider.

e)	Choose a service.

f)	Check any applicable treatment factors.

g)	Enter any comments (if necessary) by pressing the Add comment button.

8.	Select OK.

Related Topics

Problems List

Annotating a Problem

Changing a Problem

Customizing the Problems List

Making a Problem Inactive

Removing a Problem

Verifying a Problem


Additional Patient Information

You can obtain additional patient information by clicking the Patient ID box located on the upper left of the dialog. You can access this button from any chart tab.

The button shows the patient's name (in bold), status (inpatient or outpatient), social security number, date of birth, and age (as shown in the graphic below). If you click the button, CPRS brings up a window containing additional information such as the patient's address, the attending physician, and/or the date of admittance.

To obtain additional information about a patient, follow these steps:

1.	Select the Patient ID box.

The Patient Inquiry dialog displays. The Patient Inquiry dialog includes additional information such as the patient’s mailing address, telephone numbers (including the patient’s home, work, and cell phone numbers), admission information, and other relevant data, such as provider information and primary and secondary next of kin entries. While in the detailed display, you can select a new patient, print the detailed display, or close the detailed display.

2.	To print a copy of the Patient Inquiry dialog, select Print.

3.	To close the Patient Inquiry window and return to the Cover Sheet, select Close

-or-

select a new patient by selecting Select New Patient.


Adverse reactions popup
Adverse Reactions/Allergies

Posting that tells staff about medications, foods, and other conditions to which the patient is allergic or may have an adverse reaction. For example, a patient might be allergic to penicillin.


All Tests by (specified) Date
All Tests by Date

All Tests by Date shows you all tests performed during a certain period of time and uses the same date ranges as cumulative (today, one week, two weeks, etc). The difference is that this report groups entries together by test type. This report is an interim report.


Anatomic Pathology

Anatomic Pathology shows you the results in this section for the specified time period.


Annotating a Problem

To annotate a problem, use these steps:

1.	Select the Problems tab.

2.	Select the problem from the problem list.

3.	Select Action | Annotate...

-or-

right-click the problem and select Annotate... from the pop-up menu.

Note:	If you try to select a problem that has an inactive diagnosis or procedure code, CPRS prompts you to select a problem with an active code.

4.	Enter your annotation in the dialog that appears (up to 60 characters).

5.	Select OK.

Related Topics

Problems List

Adding a Problem

Changing a Problem

Customizing the Problems List

Making a Problem Inactive

Removing a Problem

Verifying a Problem


Blood Bank

Blood Bank shows any blood that was requested. It also shows the results of any screening and if the patient has any blood products in the blood bank.


CPRS Conventions

The CPRS Windows conventions are divided into three categories:

•	Standard Windows objects

•	Form buttons

•	Changing the size of Windows

Select one of these categories to see a list of all of the items in that category. Then, click on the item to go to the definition. To return to the top of this document, click the Back button once or twice as needed.

Standard Windows Objects

These types of data entry fields are located in standard Windows forms:

•	Check box

•	Command button

•	Date field

•	Drop down list

•	Faded Background

•	Keyboard commands

•	List box

•	Lookup box

•	Memo field

•	Non-white background

•	Radio button

•	Right mouse button or Shift F10

•	Tab key

•	Text box

Check Box

Toggles between a YES/NO, ON/OFF setting. Usually a square box containing a check mark or x. Clicking the box or pressing the spacebar toggles the check box setting.

Command Button

The Command button initiates an action. It is a rectangular box with a label that specifies what the button does. Command buttons that end with three dots indicate that a subsidiary screen may be evoked by selecting the command.

Date Field

Identified by "__/__/__" or a date "mm/dd/yy". Will usually have an associated pop-up calendar. Double clicking with the mouse inside the date edit box, or tabbing to the edit box and then pressing the F2 key, displays the calendar. Clicking on the desired date, or using the arrow keys to move to a date and then pressing the spacebar, selects the date. Each component of the date (month/day/year) must consist of two characters (i.e., 02/02/96). The selected entry will not be effective until you tab off or exit from the date field.

Drop Down List

A list box containing an arrow button on the right side which displays one entry at a time. Choose from a vertical list of choices. Select the entry you want by clicking the list entry. You cannot type in this box, only select an item from the list. Once an entry is selected, it cannot be deleted - only changed. If <None> is the last entry, selecting it will clear the list entry. If <More> is the last entry, selecting it will display additional entries. The selected entry will not be effective until you tab off or exit from the drop down list.

Faded Background

Fields that appear with a faded background are currently disabled.

Keyboard Commands

Most actions on the CPRS screens can be performed with keyboard commands.

List Box

Box which shows a list of items. If more items exist than can be seen in the box, a scroll bar appears on the side of the box. Selecting an entry from a list box requires either double clicking the entry or single clicking the entry and pressing the spacebar.

Lookup Box

Choose from a vertical list of choices. By typing in a few characters and pressing the ENTER or TAB key, a list of matching entries drops down. Select the entry you want by clicking the list entry. Entering a question mark and then pressing ENTER or TAB, or clicking the down arrow on an empty edit field, gives a complete listing of available entries. If <More> is the last entry, selecting it will display additional entries.

Memo Field

This field is equivalent to a word-processing field.

Non-White Background

Items in fields that appear with a non-white background can be selected but cannot be modified directly in that field.

Radio Button

Radio buttons appear in sets. Each button represents a single choice and only one button may be selected at any one time. For example, MALE or FEMALE may be offered as choices through two radio buttons. Click in the button to select it.

Right Mouse Button or Shift F10

You may click the right mouse button or press Shift F10 for a pop-up box of menu items.

Tab Key

Use the TAB key or the mouse to move between fields. Do not use the RETURN key. The RETURN key is usually reserved for the default command button or action (except in menu fields).

Text Box

Type the desired characters into the text box. The selected entry will not be effective until you tab off or exit from the text box.

Form Buttons

Buttons that appear on tab pages apply only to that tab and not the entire form. If there are action buttons on both the tab page and the form, the tab button should normally be clicked first. Note that every button has an associated menu bar command but not every menu bar command has an associated button.

•	Add

•	Cancel

•	Close

•	Help

•	OK

•	Save

•	Undo

Add

Anytime you reach a screen and the ADD button is enabled, you must first click the ADD button before entering any information.

Cancel

Cancels the latest entry (up until the OK or SAVE button is clicked).

Close

Closes the window. If there are any changes that have not been saved, you will get a confirmation message asking you if you want to continue without saving; save before exiting; or cancel the close action and return to the window.

Help

The Help Menu provides a table of contents, an index, or search to get to help for the area you are currently working in. *You can also click the right mouse button or press the F1 key for context-sensitive help (i.e., help that applies specifically to the area you are working in, such as a dialog box).

*not available yet

OK

Adds the new entry after the data has been entered.

Save

Saves all changes made since the last save action. If you attempt to save and all required fields have not yet been completed, you will receive notification that the required fields must be completed before saving.

Undo

Undoes all changes made since the last save action and redisplays the original data.

Changing the size of windows:

You can change the size of most CPRS windows using typical Windows conventions:

•	Position the mouse pointer over the side bar and drag out to make the window wider

•	Position the mouse pointer over the right-bottom corner and drag diagonally to increase the whole size of the window

•	Position the mouse pointer over the vertical panel divider and drag left or right to increase or decrease the size of either panel. For Example, in the window below, the left-hand panel which lists All Consults is too narrow to show all the information about each Consult. If you drag the dividing line to the right, you can see more data.


CPRS Features

Improved accessibility of online clinical information and results

•	Patient demographics, allergies and adverse reactions, postings (cautions, warnings, allergies, and advance directives), clinical reminders, current medications, problems, appointments, etc., can all be viewed or accessed from the Cover Sheet.

Improved efficiency of entering orders

•	You can quickly click on the specifications you want for each order you place.

•	Quick orders can be set up for frequently placed orders, so that a single click on a box will place the order.

•	Several orders can be placed and then you can sign for them all at once.

Time-delay capability for pre-admission, discharge, and transfer orders

Complete Order Sets that can be predefined and personalized

Order checking

•	The system does background checks on duplicate orders, drug-drug interactions, and many other criteria that you can choose.

Orders integrated with progress notes, results, procedures, diagnosis, and Problem List

Enhanced Patient/Provider linkage

Note:	Functionality is not available yet.

Related Topics

New Features and Components of CPRS


CPRS Guiding Principles

The Computerized Patient Record System suite of VISTA modules makes the computer an important aid in medical practice. CPRS places major emphasis on consistency and usability of the product.

CPRS uses these guiding principles:

•	Mimic traditional order entry processes where necessary to accommodate established clinical practices. Not only is the design of CPRS itself intended to follow hospital work flow patterns, but it also allows local site and individual customization to make it fit specific needs.

•	Provide real-time order checking, as well as extended expert system/decision support capabilities that enhance the order entry process. this not only helps ensure more accurate and valid patient information, but also helps prevents duplication and other inefficiencies.

•	Integrate all components of the patient record to provide comprehensive and intelligent clinical information access and reporting. CPRS allows multiple use and integration of information, including cutting and pasting among components, boilerplate capabilities, templates, etc., thus decreasing the amount of duplicate entry of data.

•	Create a system that is easy to use by improving the user interface to reflect industry standards and principles of usability and user-centered design. The designers and developers received extensive assistance from clerks, clinicians, clinical coordinators and others--throughout the whole development process--in creating CPRS.


CPRS Time Out

If a program has a time out and it is idle for a specific amount of time, it will be closed. A time out ensures that a record can be accessed by others who might need it if someone has opened the record, but is not using it.

IRM can set a different time out or idle value for CPRS (such as 10 minutes) through a CPRS GUI parameter. If CPRS is open but not used for the time specified in the parameter, CPRS will display the dialog informing you that it is going to close in the number of seconds IRM set, count down to zero, and then close.

To keep CPRS running, select Don't Close CPRS.

To close CPRS immediately, select Close CPRS.

If only one CPRS session is open, the dialog looks like this:

If multiple sessions are open, the dialog looks like this, including the identification of which session is about to close:

Because CPRS makes the session that is about to close active, users need to make sure they are in the correct chart after the user responds to this dialog.


Changing CPRS Windows Size

CPRS uses standard Windows method for resizing windows. In addition, CPRS allows you to change the size of some data fields within CPRS.

•	To change the width of the window, you position the mouse pointer over the right or left edge (when positioned correctly the pointer will become a two-headed arrow), and click and drag to make the window narrower or wider.

•	To change the height of the window, you position the mouse pointer over the top or bottom edge (when positioned correctly the pointer will become a two-headed arrow), and drag up or down to make the window taller or shorter

•	To change the width and height simultaneously, you position the mouse pointer over the bottom-right corner and click and drag diagonally to increase or decrease the overall size of the window

•	To change the size of adjustable field on a tab or window, you position the mouse pointer over the vertical panel divider and drag left or right to increase or decrease the size of either panel. For Example, in the window below, the left-hand panel which lists All Consults is too narrow to show all the information about each Consult. If you drag the dividing line to the right, you can see more data.


Changing Medication Orders

Users can only change Inpatient Medication orders for outpatients (IMO) if the patient is in an authorized IMO location.

To change a Medication order:

1.	Select either the Meds tab or the Orders tab.

2.	Select the medication order to select it.

3.	Select Action | Change... or right-click the order and click Change....

Note:	If the provider or location has not been defined, you will be prompted for that information.

4.	Complete the changes as appropriate in the dialog box that appears on the screen.

5.	Select Accept.

6.	You may sign the order now or later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)

Refilling a Medication


Changing a Problem

CPRS allows you to change existing problems.

To change a problem on a patient's problem list, use these steps:

1.	Select the Problems tab.

2.	Select the problem in the list box that you want to change.

3.	Select Action | Change….

4.	Enter the desired changes.

5.	Add or remove a comment if desired.

Note:	A comment can be as many as 60 characters (including spaces) in length.

6.	Select OK.

Note: 	When you view the details of a problem, you will see who changed the problem and when.

Related Topics

Problems List

Adding a Problem

Annotating a Problem

Customizing the Problems List

Making a Problem Inactive

Removing a Problem

Verifying a Problem


Changing an Order

To change an order:

1.	Select the Orders tab.

2.	Select the appropriate order.

3.	Select Action | Change ... or right-click the order and click Change....

Note:	If the provider or location has not been defined, you will be prompted for that information.

4.	Complete the changes as appropriate in the dialog box that appears on the screen.

Note:	The original order’s comments are not brought forward on a change to prevent inadvertently using a comment that was only for the original order.

5.	Select Accept.

Note:	You may sign the order now or later.


Encounter Information (overview)

CPRS has two kinds of encounter information: visit information and encounter form data.

For each visit (or telephone call) with a patient, you need to enter the provider, location, date, and time. CPRS requires this information before you can place orders, write notes, add to the problem list, and so on.

The parameter, ORWPCE ANYTIME ENCOUNTERS, can be set to allow encounters to be entered on the Notes tab when no note is being entered. This will allow encounter entry (at the time of the visit) for dictated notes. This parameter can be set at the User, Service, Division, and System levels. Note that this will edit the encounter associated with the current location and time, which is not necessarily the encounter associated with the currently displayed note.

To receive workload credit, you must enter the encounter form data, including the following information, for each encounter:

•	Service connection

•	Provider name

•	Location

•	Date

•	Diagnosis

•	Procedure

•	Visit Information

CPRS shows the encounter provider and location for the visit on the Visit Encounter box, identified in the graphic by the pointer. You can access this box from any chart tab.

If a provider or location has not been assigned, CPRS will prompt you for this information when you try to enter progress notes, create orders, and perform other tasks.

Encounter Form Data

To get workload credit and gather information, enter encounter form data whenever you create a progress note, complete a consult, or write a discharge summary. When you create one of these documents, an Encounter button appears. Select this button to bring up the Encounter Form. (Otherwise, you will be prompted for encounter information when you try to sign the note or exit the current patient’s chart.

The Encounter Form has the following eight tabs:

•	Visit Type

•	Diagnoses

•	Procedures

•	Vitals

•	Immunizations

•	Skin Tests

•	Patient Education

•	Health Factors

•	Exams

•	Global Assessment of Functioning (GAF) (The GAF tab is available only if specific Mental Health patches are installed and if the location is a mental health clinic.)

Your site defines forms from the Automated Information Collection System (AICS) application to be used with the Encounter Form. Once your site has defined the necessary forms and associated them with the Encounter Form, each tab has a number of general categories on the left. When you click a general category, the corresponding items appear in the list box on the right.

For example, the Visit Type tab might have New Patient, Established Patient, and so on listed in the left list box. The list box on the right would then have check boxes for the different types of patient appointments, such as Brief Exam, Limited Exam, Intermediate Exam, Extended Exam, and Comprehensive exam.

Even if you haven’t defined the form, you can click the Other button to get a list of choices that are active on your system.

When the forms are defined and associated with the Encounter Form, you can use the Encounter Form just as you would a paper form: just click the appropriate tab, category, and check boxes to mark items or click Other and select the appropriate choice. On the Visit Type tab, a provider can indicate if the encounter is related to the various exemption categories, such as Service Connected, Combat Veteran, Agent Orange exposure, Ionizing Radiation exposure, Southwest Asia Conditions, Shipboard Hazard and Defense, Military Sexual Trauma, and Head and/or Neck Cancer. If these forms have not yet been defined, ask your Clinical Coordinator for assistance.

Related Topics

Entering Encounter Form Data

Entering Current Activities Encounter


Closing a Patient Record

You can close a patient record in different ways. You can either close the record and exit CPRS completely or select a new patient record, which automatically closes the record you are in.

To close the patient record and exit CPRS, use one of the following:

•	Select File | Exit.

•	Click the close box ( · ) in the upper right corner of the CPRS window.

Note:	If you have just entered unsigned orders or notes, a screen will pop up asking you to sign the orders.

To simultaneously close the current patient record and select a new patient, see Opening a Patient Record. If you follow those steps, you will close the current patient record when you open a new patient.

Related Topics

Opening a Patient Record


Cover Sheet Detail
Clicking on a Cover Sheet entry will bring up a detail window such as the one seen below.


Example of Cover Sheet Detail

For example, you might see an item of interest in the Active Problems list box on Cover Sheet's upper left. You would click the item to bring up a window showing you the problem's details. You can also see details about Admissions, Clinical Reminders, Patient Postings, or Adverse Reactions/Allergies.


Crisis Notes

Cautionary information about critical behavior or health of a patient. Example: suicidal attempts or threats.


Cumulative

Cumulative lab results show you the results of all lab tests performed on the selected patient from the present to however the time you select (Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, or All Results). The report format is chronological and very brief. Choose a heading from the list to go to that section.


Customizing CPRS (general)
Customizing CPRS

You can customize CPRS in the following ways:

•	Change font size

To change the font size, select Edit | Preferences, then choose a different font size.

•	Change the date ranges for items that appear on the Cover Sheet

•	Change your patient list

•	Add Quick Orders or Order Sets

•	Change your notifications and the way they behave

•	Add or delete your order checks

•	Change printing formats and other parameters (Check with your Clinical Coordinator or IRM specialist.)

•	Make other programs (e.g., non-VA applications such as Excel) accessible through the Tools menu


Delete

You can choose Delete from the Action menu of any tab or by right-clicking on the item you want to delete in a tab's main window. By doing so, you can delete items in the current context (e.g., Meds).

Items that have been completed and become part of the permanent medical record, such as completed progress notes and orders that are no longer pending, cannot be deleted.


Directives

Also called Advanced Directives, Directives are recorded agreements that a patient and/or family have made with the clinical staff, such as DNR (Do Not Resuscitate).


Discharge Orders

Discharge Orders are sets of orders to be placed for a patient when checking out of the hospital.

•	Orders can be copied from existing inpatient orders. You can use cut-and-paste or drag-and-drop techniques.

•	If you don't have an order set for Discharge Orders, talk to your Clinical Coordinator or CPRS IRM Specialist.


Discharge Summaries

Authorized users can write, review, edit, save, and sign discharge summaries for individual patients through CPRS or through the Text Integration Utilities (TIU) package. With CPRS, you open one patient record at a time and can sign the discharge summary. If you want to review, write, edit, or sign for multiple patients at one time, you must use TIU.

To make entry of discharge summary easier, you can create and use document templates that contain text and TIU objects. Once you have created the templates, documenting visits, admissions, and consults should be much faster.

Related topics

Viewing Discharge Summaries

Writing Discharge Summaries

Changing Views on the Discharge Summaries tab


Discontinuing Orders

When an order is discontinued, the order’s Stop Date/Time is changed to the date/time the action is taken. Pending and Non-verified orders are deleted when discontinued and will no longer appear on the patient’s profile. An entry is placed in the order’s Activity Log recording who discontinued the order and when the action was taken.

For unsigned, unreleased orders, if the user discontinues the order in the same CPRS session when the order was placed, the order is deleted and will not display. The reason for this is that the order was never seen by anyone else, therefore, it can be deleted. If the order is unsigned and unreleased, but was placed in a different CPRS session, another user may have seen the order, therefore, the order is CANCELLED, but still displays so that others who might have seen it know that it was cancelled.

To discontinue an order, use these steps:

1.	Select the Orders tab.

2.	Select the order or orders you want to discontinue.

3.	Select Action | Discontinue/Cancel.

A dialog may appear asking for the clinician's name and the location (encounter information).

4.	Select the name of the clinician (you may need to scroll through the list), select the encounter location, and then select OK.

Another dialog will appear asking for the reason why the order is being discontinued.

5.	Select the appropriate reason from the box in the lower left of the dialog and select OK.

6.	If the order you are discontinuing is a pending renewal of another order, CPRS needs to know how to deal with the order you are discontinuing, and the original order. Choose the appropriate action from the dialog that displays:

o	DC Both

o	DC Pending

o	Cancel – No Action Taken

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)

Refilling a Medication


Review / Sign Changes Dialog

The Review / Sign Changes dialog allows you to simultaneously sign several orders and documents. This item is on the File menu and brings up a dialog with the items that need a signature from the current ordering session.

Sometimes during the ordering process, the status of a patient changes from outpatient to inpatient or vice versa. This might happen because an outpatient was admitted to the facility, or because an inpatient was sent to a clinic for treatment, or because of using Inpatient Medications for Outpatients (IMO) feature. When written unsigned orders exist and the patient’s status changes, the user must indicate which location the orders are associated with.

To designate which location written unsigned orders are associated with, the following dialog will appear:

This dialog asks to which location CPRS should associate the orders that have been placed but not signed.

The order location dialog shows the user the two locations the user can choose from, generally an outpatient clinic and an inpatient location. The user the has two basic options:

•	Associate all of the orders with a single location by selecting the appropriate button above the list of orders. The buttons will read All location where location is the name of the clinic or ward location. In the above screen capture the buttons read All MICU and All Mental Health Clinic.

•	Individually associate each order with one of the two locations. At the end of each order is a column to select the location for each order.

If the user is keeping the patient’s chart open, such as selecting File | Review / Sign changes… and this dialog appears, the “Where would you like to continue processing patient data?” prompt displays enabling the user to choose either the ward location or the clinic location. This prompt does not appear if the user is exiting the chart or switching patients.

To sign orders and documents with the Review / Sign Changes dialog, follow these steps:

1.	Do one of the following

o	Select File | Review / Sign Changes.... to sign orders or documents and stay in the current patient record.

o	Choose File | Select New Patient to sign orders or documents and select a new patient.

o	Choose File | Exit to sign orders and documents and exit CPRS.

After performing one of the above, one of the Review/Sign Changes dialogs displays. One dialog is simply a listing of items that require signature. Each item that requires a signature will have a check box in front of it. Users can select and deselect items as needed and then enter the electronic signature. The simpler dialogs is often used by non-providers.

The other dialog enables the provider to enter items related to the orders such as a diagnosis and copay factors, such as environmental factors that affect payment for prescriptions and so forth.

2.	(Conditional) If CPRS displays order checks, review the order checks and take the appropriate action below:

 In this screen capture, CPRS displays several possible conflicts between ordered medications. Users should review each item carefully before completing the order. If an order check is larger than the cell’s available space, the user can hover with the mouse to the get the full text or use the arrow keys to highlight the order check if using the keyboard or accessibility product for visually challenged users. Some order checks require an override reason. These order checks are designated by the “*Order Check requires Reason for Override” text in red and the order check text in blue.

a)	To redo the orders to avoid a possible interaction, select Return to Orders. This will cancel the signature process, but not the order.

b)	If the orders should not be placed, check the cancel check box in front of the orders that should not be placed and select Cancel Checked Order(s).

c)	If the possible interactions are not a problem, type a reason for override (required only for critical order checks) select Continue.

After performing step 1 and after addressing any order checks in step 2, one of the Review/Sign Changes dialogs shown below will appear. Each item that requires a signature will have a check box in front of it.

3.	Deselect any items that you do not want to sign by clicking the check box to the left of the order or document.

4.	If the Review / Sign Changes dialog is the simpler dialog, enter your electronic signature code and select Sign. The documents and orders will now be signed.

-or-

If the Review / Sign Changes dialog is the more complex dialog and contains blue question marks, continue to step 4.

5.	The blue question marks inside the dialog’s check boxes indicate that you need to specify how that order is related to the medical condition in that column. (SC = Service Connected Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense, MST=Military Sexual Trauma, and HNC=Head or Neck Cancer). If you place a check in a box, you are indicating that a medication order is related to the condition in that column. If you create an empty box, you are indicating that the medication order is not related to the condition in that column.  You must either check or uncheck every box that contains a blue question mark before you can sign the order.

Note:	Definitions for service connection and treatment factors are available to users by hovering the cursor over the term or using the appropriate keyboard shortcut as shown in the list below:

o	Service connection (SC)	Alt + c

o	Combat Veteran (CV)	Alt + v

o	Agent Orange (AO)	Alt + o

o	Ionizing Radiation (IR)	Alt + r

o	Southwest Asia Conditions (SWAC)	Alt + a

o	Shipboard Hazard and Defense (SHD)	Alt + h

o	Military Sexual Trauma (MST)	Alt + m

o	Head and/or Neck Cancer (HNC)	Alt + n

You can toggle the checkboxes by:

•	Selecting an individual checkbox or tabbing to the checkbox and pressing the spacebar.

This will toggle the box between checked and unchecked.

•	To check all checkboxes in a column, select the button above the appropriate column.

This will toggle all the check boxes in that column.

•	Selecting the All button.

This will toggle all the check boxes on the dialog.

6.	When you have dealt with the co-pay exemptions, begin the process of entering diagnoses by highlighting the orders using Shift + Click and Ctrl + Click to make a group of orders that will have the same diagnoses.

7.	Bring up the Assign Diagnoses to Order(s) dialog by selecting Diagnosis or by right-clicking on the highlighted orders and choosing Diagnosis on the pop-up menu.

8.	When the dialog displays, choose the source from which you would like to look for a diagnosis: under Diagnosis Section, you can choose from the Problem List, Personal Diagnosis list (if you have entered any items on your list), or the Encounter Form for the clinic location where you are (if one has been defined by your site) or you can select Other Diagnosis… to search the Lexicon.

9.	After choosing a source, select the appropriate diagnoses for the selected orders under Diagnosis Codes. You can select as many as four diagnoses although only one is required.

Note:	The first diagnosis you enter is automatically assigned as the primary diagnosis.

10.	If you want to change the primary diagnosis to another you have selected, highlight the diagnosis by clicking it and click Primary.

11.	(Optional) If you want to add one or more diagnoses to the problem list, highlight the diagnoses and click the Add to Problem List checkbox.

12.	(Optional) If you want to add one or more of the diagnoses to your Personal Diagnosis List, highlight the diagnoses and click the Add to Personal Dx List check box.

13.	When you have assigned the diagnoses correctly, choose OK.

14.	Repeat steps 5-10 for all orders or groups of orders that require a diagnosis.

15.	When you have removed all of the question marks from the dialog and entered a diagnosis for all appropriate orders, enter your electronic signature code and click Sign.

16.	If PKI is enabled and you have entered Outpatient Schedule 2 or 2n Medication orders, digitally sign the orders by inserting your smart card if you have not already done so and clicking OK, and then entering your PIN in dialog box and clicking OK for each order as necessary.

Criteria Used to Determine if the Copay Buttons are Displayed on the Review/Sign Changes Dialog

The Review/Sign Changes dialog may contain the Copay buttons (SC = Service Connected Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense, MST=Military Sexual Trauma, and HNC=Head or Neck Cancer) if the current patient has outpatient medication orders that need to be signed and certain additional conditions are met. The additional conditions are explained below.

Note:	The Copay buttons will not appear until after December 31, 2001 and PSO*7*71 has been installed.

Note:	Previously, CPRS did not display the buttons if a veteran was 50% or more service connected. If Clinical Indicators Data Capture (CIDC) is installed and the user is not enabled for CIDC, the buttons display for outpatient medications regardless of the patient’s level of service connection based on the criteria below. The 50% criterion below does not apply with CIDC installed.

•	To qualify for the Combat Veteran (CV) exemption, the veteran must have served in combat operations after the Gulf War or in combat against a hostile force after November 11, 1998. In addition, the condition for which the veteran is treated must be related to that combat, the veteran must have registered as a combat veteran, and be within two years of separation from active military service. Finally, the condition must not be already considered to be service related or that exemption should apply.

Note:	The Combat Veteran exemption is valid for two years from the date of separation from military service, not the registration date. For example, if a veteran registers for Combat Veteran status 18 months after the date of his or her separation, the veteran would be eligible for Combat Veteran exemption for six months only. For further details, see VHA Directive 2002-049, Combat Veterans Are Eligible for Medical Services for 2-Years after Separation from Military Service Notwithstanding Lack of Evidence for Service Connection.If a patient is a veteran and 50% service connected or greater then the Copay buttons will not be displayed on the Review / Sign Changes dialog.

•	If a patient is a veteran and 50% service connected or greater, then the Copay buttons will not be displayed on the Review / Sign Changes dialog.

•	If a patient is a veteran and less than 50% service connected and the patient is exempt from copay then the Copay buttons will not be displayed.

•	If a patient is a veteran and less than 50% service connected and the patient is not exempt from copay then the Pharmacy package checks to see if the drug specified in the medication order is marked as supply or investigational. If the drug is marked as supply or investigational, the copay buttons will not appear.

However, if the drug specified in the order is not marked as supply or investigational than CPRS checks if the patient has any other exemptions (Service Connected Condition, Agent Orange Exposure, Ionizing Radiation Exposure, Southwest Asia Conditions, Shipboard Hazard and Defense, Military Sexual Trauma, or Head and/or Neck Cancer). If a patient has any of these exemptions then CPRS displays the appropriate Copay button(s).

Related topics

Understanding Service Connection and Treatment Factors

Digital Signature (PKI) Overview

Electronic Signature (overview)

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Signing Orders before Selecting a New Patient or Exiting CPRS

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers

CIDC: Entering Diagnosis Codes for Specific Orders


Signing Orders before Selecting a New Patient or Exiting CPRS

Whenever a user leaves a patient chart whether to select a new patient or to exit CPRS completely, CPRS prompts the user to sign unsigned orders that the user has privileges to sign. The dialog that CPRS displays may be different than the Review/Sign Changes… or Sign Selected dialogs based on the parameter settings. By changing the parameters settings, the dialog may display one or more of the following categories of unsigned orders:

•	My Unsigned Orders - This Session

•	My Unsigned Orders - Previous Sessions

•	Others’ Unsigned Orders - All Sessions

Sometimes during the ordering process, the status of a patient changes from outpatient to inpatient or vice versa. This might happen because an outpatient was admitted to the facility, or because an inpatient was sent to a clinic for treatment, or because of using Inpatient Medications for Outpatients (IMO) feature. When written unsigned orders exist and the patient’s status changes, the user must indicate which location the orders are associated with.

To designate which location written unsigned orders are associated with, the following dialog will appear:

This dialog asks to which location CPRS should associate the orders that have been placed but not signed.

The order location dialog shows the user the two locations the user can choose from, generally an outpatient clinic and an inpatient location. The user has two basic options:

•	Associate All of the orders with a single location by selecting the appropriate button above the list of orders. The buttons will read All location where location is the name of the clinic or ward location. In the above screen capture the buttons read All MICU and All Mental Health Clinic.

•	Individually associate each order with one of the two locations. At the end of each order is a column to select the location for each order.

If the user selects File | Review / Sign changes… and this dialog appears, the “Where would you like to continue processing patient data?” prompt displays enabling the user to choose either the ward location or the clinic location. This prompt does not appear if the user is exiting the chart or switching patients.

To sign a number of orders, use these steps:

1.	Select the Orders tab.

2.	Highlight the orders you want to sign.

To select a range of items, click the order at the beginning of the range; then hold down the <Shift> key and click the order at the end of the range. To select multiple, individual orders, select the first order, hold down the CTRL key, and click the next order.

3.	Select Action | Sign Selected…

-or-

right-click and select Sign…

After performing one of the above, one of the Review/Sign Changes dialogs displays. One dialog is simply a listing of items that require signature. Each item that requires a signature will have a check box in front of it. Users can select and deselect items as needed and then enter the electronic signature. The simpler dialogs is often used by non-providers.

The other dialog enables the provider to enter items related to the orders such as a diagnosis and copay factors, such as environmental factors that affect payment for prescriptions and so forth.

Combat Veteran Status and Clinical Indicators Data Capture information is now gathered on the signature screens. Also, note that a Clinical Coordinator or similar person has set up this dialog to show the orders in three categories: My Unsigned Orders – This Session, My Unsigned Orders – Previous Sessions, and Others’ Unsigned Orders – All Sessions.

4.	If the Electronic Signature dialog resembles Figure A, enter your electronic signature code (if necessary) and click Sign.  The orders will now be signed.

If the Electronic Signature dialog resembles Figure B and contains checkboxes, continue to step 5.

5.	The question marks inside the check boxes in Figure B indicate that you need to specify how that order is related to the medical condition in that column. (SC = Service Connected Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense, MST=Military Sexual Trauma, and HNC=Head and/or Neck Cancer).  If you place a check in a box, you are indicating that a medication order is related to the condition in that column. If you create an empty box, you are indicating that the medication order is not related to the condition in that column.  You must either check or uncheck every box that contains a question mark before you can sign the order.

Note:	Definitions for service connection and treatment factors are available to users by hovering the cursor over the term or using the appropriate keyboard shortcut as shown in the list below:

o	Service connection (SC)	Alt + c

o	Combat Veteran (CV)	Alt + v

o	Agent Orange (AO)	Alt + o

o	Ionizing Radiation (IR)	Alt + r

o	Southwest Asia Conditions (SWAC)	Alt + a

o	Shipboard Hazard and Defense (SHD)	Alt + h

o	Military Sexual Trauma (MST)	Alt + m

o	Head and/or Neck Cancer (HNC)	Alt + n

You can toggle the check boxes by:

o	Selecting an individual checkbox or tabbing to the checkbox and pressing the spacebar.

This will toggle the box between checked and unchecked.

o	To check all checkboxes in a column, select the button above the appropriate column.

This will toggle all the check boxes in that column.

o	Selecting the All button.

This will toggle all the check boxes on the dialog.

6.	When you have dealt with the co-pay exemptions, begin the process of entering diagnoses by highlighting the orders using Shift + Click and Ctrl + Click to make a group of orders that will have the same diagnoses.

7.	Bring up the Assign Diagnoses to Order(s) dialog by clicking Diagnosis or by right-clicking on the highlighted orders and choosing Diagnosis on the pop-up menu.

8.	When the dialog displays, choose the source from which you would like to look for a diagnosis: under Diagnosis Section, you can choose from the Problem List, Personal Diagnosis list (if you have entered any items on your list), or the Encounter Form for the clinic location you are in (if one has been defined by your site) or you can click Other Diagnosis… to search the Lexicon.

9.	After choosing a source, select the appropriate diagnoses for the selected orders under Diagnosis Codes. You can select as many as four diagnoses although only one is required.

Note:	The first diagnosis you enter is automatically assigned as the primary diagnosis.

10.	If you want to change the primary diagnosis to another you have selected, highlight the diagnosis by clicking it and select Primary.

11.	(Optional) If you want to add one or more diagnoses to the problem list, highlight the diagnoses and select the Add to Problem List checkbox.

12.	(Optional) If you want to add one or more of the diagnoses to your Personal Diagnosis List, highlight the diagnoses and click the Add to Personal Dx List check box.

13.	When you have assigned the diagnoses correctly, choose OK.

14.	Repeat steps 5-10 for all orders or groups of orders that require a diagnosis.

15.	When you have removed all of the question marks from the dialog and entered a diagnosis for all appropriate orders, enter your electronic signature code and select Sign.

16.	If PKI is enabled and you have entered Outpatient Schedule 2 or 2n Medication orders, digitally sign the orders by inserting your smart card if you have not already done so and clicking OK, and then entering your PIN in dialog box and select OK for each order as required.

Related topics

Understanding Service Connection and Treatment Factors

Digital Signature (PKI) Overview

Electronic Signature (overview)

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers

CIDC: Entering Diagnosis Codes for Specific Orders


Encounter

An encounter is a visit (or telephone call) with a health care provider. All encounters require data, including service connection, a provider name, a location, a procedure, and a diagnosis, to receive workload credit. For information about changing encounter data, see Entering Encounter Information.


Entering Encounter Form Data

In order to receive workload credit, you must enter encounter form data when you create a new progress notes, complete a consult, or write a discharge summary.

Note:	Once a note, summary, or consult has been completed, you can only change encounter information directly through PCE.

To enter or change encounter form data, follow these steps:

1.	Select the appropriate tab: Notes, Consults, or D/C Summ.

2.	Select New Note, New Summary or select Action | Consult Results...or locate the appropriate unsigned document in the treeview. For the consult or discharge summary, skip to step 4.

3.	Type in a title for the note or summary or select one from the list and press <Enter>.

4.	On the Notes tab, select the Encounter button, Action | Encounter, or Edit Encounter Information from the right-click pop-up menu. On the Consults and D/c Summ tabs, only the Edit Encounter Information item is available on the pop-up menu.

The Encounter form will appear.  (Note about providers with similar first and last names.)

5.	Select the tab where you want to enter information (Type of Visit, where you can also enter the primary and secondary providers, Diagnoses, where you can have diagnoses automatically be added to the Problem List, Procedures, Vitals, Immunizations, Skin Tests, Patient Ed., Health Factors, or Exams).

6.	Select the appropriate category in the list box on the left and then click the check boxes by the appropriate items in the list box on the right.

-or-

if the section name you want is not shown or the list boxes are empty, use the search feature:

a)	Select Other tab name (each tab's button will be labeled differently).

Note:	The Type of Visit and Vitals tabs are different. Type of Visit has no button, and Vitals has an Enter Vitals button that brings up Vitals Lite. For help on entering vitals or measurements, use the Help file on the Vitals dialog that appears within CPRS.

b)	Locate and double-click the needed item.

Some tabs have a simple list to choose from. Diagnoses and Procedures have a search function. On these tabs, you need to enter the beginning of a term and click Search before double-clicking.

Note:	If a user tries to enter a diagnosis or procedure that has an inactive code associated with it, CPRS will not accept that selection and will request that the user change it.

7.	Enter any additional information as needed.

Several tabs have additional features, such as drop-down lists for results of exams, severity of problems, and so on.

8.	Fill in information for other tabs as needed by repeating steps 2-6.

9.	When finished, click OK.

Related Topics

Entering Current Activities Encounter

Encounter Information (overview)

Entering Encounter Form Data on the Procedures tab

Other Health Factors


Entering Vitals

CPRS users now have the Vitals Lite package to enter vitals signs and measurements. Users bring up the Vitals Lite package either from the CPRS Cover Sheet or the Encounter form’s Vitals tab.

To enter a patient's vitals information, follow these steps:

1.	Select on a value in the Cover Sheet's Vitals area.

The Vitals Lite dialog displays.

2.	Select Enter Vitals.

3.	In the Vitals Lite: Enter Vitals for {Patient Name} dialog appears, enter the appropriate viatls and meansurements.

Note:	If the visit has not been defined, the Visit Selection dialog appears. You must choose either a previous visit or define a new visit to enter the vitals.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Vitals entry for - [Patient Name} dialog. You must complete the encounter information dialog before proceeding.

4.	For additional help on entering vitals or measurements, on the Vitals Lite dialog, select Help | Quick Reference.

Note:	If vitals or measurements are entered in error, they will not be deleted, but they can be marked as entered in error.

Related Topics

Viewing Vitals


Entering Current Activities Encounter
Entering or Changing Encounter Information

Encounter information is required before you can enter orders, write notes, or perform other activities. It does not count for workload credit. For that, you must enter encounter form data.

To enter or change the Encounter provider, follow the steps below:

1.	If you are already in the Provider / Encounter dialog skip to step 2. Otherwise, from any chart tab, select the Provider / Encounter box located in the top center portion of the dialog.

Note:	These instructions are written as if the user must select a provider. If the user making the selection is a provider, the user will be selected by default and the cursor will go to the New Visit tab if no visit is defined, or to the Clinic Appointments tab if one is defined. If the user is not a provider, the cursor will go to the Encounter Provider field so that the user can select the provider for the encounter.

2.	In the Encounter Provider list box, locate and select the provider for this encounter.

(Note about providers with similar first and last names.)

3.	Select the tab of the correct encounter category for this visit:

o	Clinic Appointments

o	Hospital Admissions

o	New Visit

4.	Select a location for the visit from the choices in the list box.

5.	If you selected a Clinic Appointment or Hospital Admission, skip to step 7. If you are creating a New Visit, enter the date and time of the visit (the default is NOW).

6.	Select a visit category from the available options (such as, Historical) and select OK.

7.	When you have the correct provider and location, select OK.

Related Topics

Entering Encounter Form Data

Encounter Information (overview)


Example: Reviewing a Health Summary

To display a Health Summary, follow these steps:

1.	Select a patient after you enter the CPRS system.

2.	Select the Reports tab.

3.	Under the Available Reports box on the left-side of the screen, click the plus sign in order to expand the Health Summary heading.

4.	Select a Health Summary by clicking on the summary that you would like to see. After you have selected a summary, the appropriate data is displayed on the right-side of the screen.

5.	Use the scroll bar on the right to scroll through the different sections of the Health Summary.

Related Topics

Results


Examples and Demos
Examples

Opening a Patient Record

Patient Lists

Problem List

Progress Notes

Writing Orders

Viewing Medications

Consults

Viewing Laboratory Test Results

Reviewing Test Results

Reviewing a Health Summary


Exit

When you select File | Exit, if you have no unsigned orders or notes, the patient chart closes and you exit completely from CPRS.

If you have unsigned orders or notes, the Review/Sign Changes dialog box appears. Your ability to determine whether orders should be saved with a signature, do not require a signature, or can be saved without a signature (by checking the options at the bottom of the dialog) depends on the key you have been assigned and the kind of order.


File Menu

The following commands are available on the File menu:

•	Select New Patient

•	Refresh Patient Information

•	Update Provider /Location ...

•	Review /Sign Changes...

•	Print

•	Exit

Interface Notes

•	If you are accustomed to using the keyboard exclusively, you can continue to do so with Windows. You can use the keyboard to select menus and menu items.

To select a menu, you press the ALT key and then the letter in the menu title that is underlined. For example, to bring up the File menu, you press ALT + F because the F in File is underlined showing that it is the quick key.

To select a menu item when the menu is displayed, you type the underlined letter of the desired menu item (rather than clicking with your mouse). Continuing the above example, if you had brought up the File menu and wanted to choose Select New Patient, you would then type n.

•	The dots (ellipses) after a menu item or command button item indicate that further dialog boxes will open up when you choose these items or buttons.


Glossary

Consults

Consult/Request Tracking is a component or package of the CPRS (it can function as part of CPRS or independently as a standalone package or as part of TIU). A consult or consultation is a referral of a patient by the primary care physician to another hospital service/specialty, to obtain a medical opinion based on patient evaluation and completion of any procedures, modalities, or treatments the consulting specialist deems necessary to render a medical opinion.

CPRS

Computerized Patient Record System, the DHCP package (in both GUI and character-based formats) that provides access to most components of the patient chart.

CWAD

Crises, Warnings, Allergies, and (Advanced) Directives. Also called "postings", these notes provide important information about a patient, such as a "Do Not Resuscitate" order or known allergies. In the CPRS GUI, the CWAD button is on the upper right. If a patient has only Warnings, a "W" will appear on the button. Each letter will appear only if a note exists in that category.

D/C Summaries

See Discharge Summary.

Discharge Summary

A component or package of CPRS (it can function as part of CPRS or independently as a standalone package or as part of TIU). A Discharge Summary is a summary of a patient's record of care, required at time of discharge.

Encounter

A visit (or telephone call) with a health care provider. All outpatient visits require encounter data, including service connection, a provider name, a procedure, and a diagnosis, to receive workload credit. Health care workers will be prompted for encounter information when they enter clinically relevant information. Encounter information also helps track who gave what orders for patient care.

GUI

Graphical User Interface, the Windows-like screen with pull-down menus, icons, pointer device, etc.

Imaging

Imaging is the name of the umbrella package that includes Radiology and Nuclear Medicine. Tests and procedures for these packages can be ordered, results can be viewed, and reports can be generated through CPRS.

OE/RR

Order Entry/Results Reporting, a VISTA program that evolved into the more comprehensive CPRS.

Postings

Messages about a patient, similar to CWAD, but more extensive.

Progress Notes

A progress note is a health provider's recorded observations about a patient at the time of an encounter (inpatient or outpatient). Progress Notes can function as part of CPRS and also as part of TIU to let users enter, edit, sign, review, and print online progress notes through either program. At this time, if users want to enter, edit, review, or sign notes for multiple patients, they must go through the TIU interface.

TIU

Text Integration Utilities; a package for document handling, that includes Consults, Discharge Summary, and Progress Notes, and will later add other document types such as surgical pathology reports. TIU components can be accessed for individual patients through the CPRS, or for multiple patients through the TIU interface.

VISTA

Veterans Health Information Systems Technology and Architecture, the organization and program formerly called DHCP.


Graphing Lab Results

Selecting the Graph option brings up CPRS graphing in a separate window. For more information about graphing, please see Graphing Overview.

Related Topics

Viewing Laboratory Test Results

Graphing Overview


Health summaries
Health Summary

A Health Summary is a clinically-oriented, structured report that extracts many kinds of data from DHCP and displays it in a standard format. The individual patient is the focus of health summaries. Most health summaries can also be printed or displayed for groups of patients (ad hoc summaries cannot be printed). The data displayed covers a wide range of health-related information such as demographic data, allergies, current active medical problems, and laboratory results.


Help Menu

The Help menu includes:

•	Contents

•	Last Broker Call

•	Show List Box Data

•	Symbol Table

•	About

Note:	Last Broker Call, Show List Box Data, and Symbol Table are troubleshooting menu items for IRMs. If you are not IRM staff, you will not have these on your menu.

Contents

Whenever you need more information about anything in CPRS, click on Help on the menu bar at the top of the Window, and choose Contents. After the Contents window opens, you can pick one of the items listed, go to an index, or enter a subject to search for.


Historical Visit

A clinical visit that either occurred at a VAMC sometime in the past (exact date may be unknown) or at a non-VA clinic or hospital


Hold Medication Order

Only active orders may be placed on hold. Orders placed on hold will continue to show under the ACTIVE heading on the profiles until it is removed from hold. An entry is placed in the order’s Activity Log recording the person who placed/removed the order from hold and when the action was taken.

To place a medication on hold, use these steps:

1.	Select the Meds tab.

2.	Locate and highlight the medication.

3.	Select Action | Hold.

Related Topics

Release Hold Order

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Renew Medication Order

Other Medication Actions (popup menu)

Refilling a Medication


Release Hold Order

This action enables a user to release the hold that someone has placed on a medication order.

To release the hold on a medication, use these steps:

1.	Select the Meds tab.

2.	Locate and highlight the medication that you want to release from being held.

3.	Select Action | Release Hold….

Related Topics

Hold Order

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Renew Medication Order

Other Medication Actions (popup menu)

Refilling a Medication


How to Use Windows

See "Windows Introduction" under the Tools Menu. This takes you to the Help system that Microsoft Windows provides for use of Windows programs. CPRS follows Windows standards for almost all features.

Many Windows conventions, as well as specific CPRS conventions, are described under CPRS-Specific Windows Conventions.


How to Write Orders
Writing Orders (overview)

Orders are placed from the Write Orders pane on the Orders tab. You can place orders for a variety of items and procedures including medications, consults, and lab tests. You can also enter information about a patient’s allergies. Order checks are performed on all orders.

Users can specify that an order become active immediately, or specify that an order be event delayed and activated when the selected patient is admitted, transferred, or discharged. You can even save common or standard orders as quick orders or order sets so they can be placed more quickly.

Note:	The orders listed in the Write Orders field vary from site to site. Because of this, the orders discussed in this section may not be available from your Write Orders field.

Related Topics

Ordering a Diet

Entering Allergies from the Orders Tab

Event-Delayed Orders

Transfer Medication Orders from Inpatient to Outpatient

Transfer Outpatient Medication to Inpatient.

Viewing Orders

Signing Orders and Documents


IV Fluids

IV Fluids are part of Inpatient Medications. This module uses the types of information listed below for processing orders. Click on a term to go to its definition.

•	Type

•	Additive

•	Strength

•	Solution

•	Volume

•	Infusion rate

•	Med route

•	Schedule

•	Administration times

•	Remarks

•	Other print

•	Start date

•	Stop date

•	Provider

•	Nature of order

•	On call

Type

This describes the type of IV order to be placed. Orders identified as admixtures, chemotherapy admixtures, chemotherapy syringes (continuous) and hyperals are treated as continuous orders. Other types are assumed to be administered intermittently based on the order’s schedule.

Additive

There can be any number of additives for an order, including zero. You can enter an additive or additive synonym. If your IRM Chief/Site Manager or Application Coordinator has defined it in the IV Additives file, you may enter a quick code for an additive. The quick code allows you to predefine certain fields, thus speeding up the order entry process.

Strength

The strength of the additive specified to be included in the order. Strength must be entered for each additive.

Solution

There can be any number of solutions in an order, depending on the type. It is even possible to require zero solutions when an additive is premixed with a solution. If no solutions are chosen, the computer will give you a warning message, in case it is an oversight, and give you an opportunity to add one. You may enter an IV solution or IV solution synonym.

Volume

This is the amount of the solution to be included in the order. The total volume of the order is used along with Infusion Rate to determine projected administration times for the order.

Infusion Rate

The infusion rate is the rate at which the IV is to be administered. This value, in conjunction with the total volume of the hyperal or the admixture type, is used to determine the time covered by one bag; hence the system can predict the bags needed during a specified time of coverage. This field is free text for piggybacks. For admixtures you must enter a number that will represent the infusion rate. You can also specify the # of bags per day that will be needed. Example:  125 = 125 ml/hr (IV system will calculate bags needed per day), 125@2 = 125 ml/hr with 2 labels per day, Titrate@1 = Titrate with 1 label per day. The format of this field is either a number only or <free text > @ <Number of labels per day > (e.g., Titrate @ 1).

Med Route

This is the route of administration for this medication (e.g., IV, SQ). If a corresponding abbreviation is found for this route in the MEDICATION ROUTES file, this module will print that abbreviation on its reports.

Schedule

This defines the frequency the order is to be administered. Schedules may be selected from the ADMINISTRATION SCHEDULE file (#51.1) or day-of-week or admin/time schedules may be used. Inpatient Medications recognizes schedules in the following formats:

•	QxH - Hourly schedules where x is the number of hours between administrations

•	QxD - Daily schedules where x is the number of days between administrations

•	QxM - Monthly schedules where x is the number of months between administrations

If a schedule is defined for the Orderable Item selected when entering a new order, that schedule is displayed as the default for the order.

Administration Times

This defines the time(s) of day the order is to be given. If the schedule for the order contains "PRN" any administration times for the order will be ignored. In new order entry, the default administration times are determined as described below:

If administration times are defined for the Orderable Item selected, they will be shown as the default for the order.

If administration times are defined in the ADMINISTRATION SCHEDULE file (#51.1) for the patient’s ward and the order’s schedule, they will be shown as the default for the order.

If administration times are defined for the Schedule, they will be shown as the default for the order.

Remarks

This contains additional information about the order that is not to be included on the IV or MAR labels.

Other Print

This data is included on the IV and MAR labels.

Start Date

The default start date/time for the order is calculated based on the DEFAULT START DATE CALCULATION field (#.05) of the INPATIENT WARD PARAMETERS file (#59.6). This allows the site to use the next or closest administration or delivery time, or the order’s login date/time as the default start date/time. For continuous IV orders the default start date/time is based on the delivery times for the IV room specified. For intermittent IV orders this default is based on the order’s administration times.

Stop Date

The default stop date/time for the order is determined by the <IV TYPE> GOOD FOR HOW MANY DAYS fields in the IV ROOM file (#59.5), where <IV TYPE> is piggyback, admixture, syringe, chemotherapy, etc. If the NUMBER OF DAYS FOR IV ORDER field (#3) of the IV ADDITIVES file (#52.6) is less then it will be used instead.

Provider

This identifies the provider who authorized the order. Only users identified as providers who are authorized to write medication orders may be selected.

Nature Of Order

This specifies how the order originated. An order can be specified as written on the chart, telephoned, or verbal. This data is stored and displayed through OE/RR.

On Call

Only active orders may be placed on call. Orders placed on call will continue to show under the active heading of the profile until it is taken off call. An entry is placed in the order’s activity log recording the person who took the action and when it was taken.


Last Broker Call

This is a trouble-shooting tool for IRMS.


Locating an Item in a List

Type enough letters of the item's name to make the name appear in the list. Find the appropriate item by scrolling if necessary. Be careful to choose the correct item as some lists may have similarly named items.


Making a Problem Inactive

To inactivate a problem on a patient's problem list, use the following steps:

1.	Select the Problems tab.

2.	Select a problem in the list box.

3.	Select Action | Inactivate.

Related Topics

Problems List

Adding a Problem

Annotating a Problem

Changing a Problem

Customizing the Problems List

Removing a Problem

Verifying a Problem


Menus and Menu Commands

CPRS menus are listed in the Menu bar, the gray bar at the top of most Window applications.

The CPRS menus are File, Edit, View, Tools, and Help. See the help topics for each of these menus (by clicking on one of the hot spots on the line above) for a list of commands or options available under them.


Microbiology

Microbiology shows you the results from microbiology for the specified time period.


Most Recent

On the Labs tab, the Most Recent shows the latest lab test and allows the user to move back through the most recent results. In this dialog, the most recent lab results are listed in the pane. The provider uses four buttons to move to the Oldest, Previous Collected, Next, and Newest. Between the Previous Collected and Next buttons is the test’s collection date and time (if there is one). It also displays microbiology results and any comments on the collection.

Note:	Some lab tests can have a collection date but no collection time. In this case, CPRS displays on the date between the Previous Collected and Next buttons.

Each test then displays the following:

•	The Collection Date/Time

•	Test name

•	Result

•	Flag (L for abnormal low, H for abnormal High, and each may have an asterisk (*) if the result is critical)

•	Units

•	Reference range

Additional information includes the specimen type, accession number, and the provider who ordered the lab test, the report release date and time, and the name of the lab performing the test.

The most recent lab results are displayed for the selected patient.


Navigating a Patient Chart

The CPRS Windows interface mimics the paper chart of a patient's record, but CPRS makes locating information easier. With the Patient Selection screen, you can quickly bring up a record for any patient on the system. The Cover Sheet summarizes important information about the patient. Along the bottom of this dialog or page are a number of tabs that will quickly take you to the part of the chart you need to see. For example, you might want to see Progress Notes, Problems, Summaries, Medications, Lab Tests, or place new orders:

To go to a different part of the patient chart:

1.	Select the appropriate tab at the bottom of the chart

-or-

From the menus, choose View | Chart Tab, and then select the desired tab.


New Features and Components of CPRS

CPRS offers the following new features and components that OE/RR did not have:

•	Order checking

•	Adverse Reaction Tracking

•	Discharge summaries

•	Problem list

•	Lexicon

•	Order sets

•	Time-delay orders

•	Graphical user interface (GUI)

•	HL-7 communications protocol for transferring messages among packages

•	Text Integration Utilities (TIU) and Authorization/Subscription Utility (ASU), which will allow setting of business rules, document types, user classes, etc. to control access to documents, reports, verification, signing, and so on

•	Support of the Ambulatory Care Date Capture project for capturing encounter data for workload credit, as well as capturing clinically relevant data for reminders and reports


Notifications

Notifications are messages that provide information or prompt you to act on a clinical event. Clinical events, such as a critical lab value or a change in orders trigger a notification to be sent to all recipients identified by the triggering package (such as Lab, CPRS, or Radiology). The notifications are located at the bottom of the Patient Selection screen.

CPRS places an "I" before "information-only" notifications. Once you view (process) information-only notifications, CPRS deletes them. When you process notifications that require an action, such as signing an order, CPRS brings up the chart tab and the specific item (such as a note requiring a signature) that requires action.

From the main listing, users can also Remove, Renew, or Forward notifications.

•	Removing notifications is the same as deleting them. A new parameter (ORB REMOVE) enables your site to identify which notifications can be removed without processing.

•	Renewing notifications is useful when a user is processing a view alert, such as an abnormal lab result, and decides that the alert should not go away after the user views it. In this case, the user can renew the alert and it will still be there the next time the user logs in to CPRS.

•	Forwarding notifications enables users to send an alert to someone else at the site. The user can choose from the list of names that is in your site’s New Person file.

Note:	As a default, all Notifications are disabled. Information Resources Management (IRM) staff and Clinical Coordinators enable specific notifications by setting site parameters through the Notifications Management Menus in the List Manager version of CPRS. These specific Notifications are initially sent to all users. Users can then disable unwanted Notifications as desired, through List Manager’s Personal Preferences. Some notifications are mandatory and cannot be disabled.

Notifications are retained for a predetermined amount of time (up to 30 days), after which they may be sent to another destination, such as your MailMan surrogate or your supervisor. Confer with your clinical coordinator to establish and set up these options. You can also confer with your clinical coordinator to select what types of notifications you will receive. Some notifications are mandatory, however, and cannot be disabled.

Clinical Notifications are displayed on the bottom of the Patient Selection screen when you log in to CPRS. Only notifications for your patients or notifications that have been forwarded to you are shown.

Related Topics

Sorting Notifications and Viewing Comments of Forwarded Alerts

Removing Notifications

Processing Notifications

Forwarding Notifications


Selecting a Patient
Opening a Patient Record

To select a patient, you can narrow the patient list by selecting provider, team, specialty, clinic, or ward under the Patient List heading (located on the left-side of the window) to group the patient list or you may search the entire list. If you select a category, CPRS displays the associated patients in the Patients list box, followed by a line, and then the comprehensive patient list. Your Clinical Coordinator will usually create the lists for the teams, wards, and so on, but you can create personal lists using Tools | Options.

To locate a patient name, you can either type in part or all of their name, the social security number, or the first letter of the patient’s last name and last four digits of the social security number. When you stop typing, CPRS will use what you entered to search the patient list and bring up that part of the patient list, highlight a possible match, and display the patient's demographic information under the Cancel button.

To open a patient record, use these steps:

1.	If you are just opening CPRS, skip to step 2. Otherwise, select File | Select New Patient....

Note:	If you have just entered orders or documents that are unsigned, a screen will pop up asking you to review / sign the changes.

2.	In the Patient Selection screen, use one of the following methods to choose a patient:

o	Type the patient's social security number with or without dashes (000-44-4444 or 000444444); or the full social security number with "P" as the last character (000-44-4444p, or 000444444p).

o	Type all or part of the patient's last name or the patient's entire name.

o	Type the first letter of the patient’s last name and the last four digit of the patient’s Social Security number (c4444).

CPRS will try to match what you entered to a patient and highlight that patient. The patient's name and other information will appear below the Cancel button.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a patient name if the user types enough characters to uniquely identify a name in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user explicitly selects an item using the mouse or the keyboard.

3.	Verify that the correct patient is highlighted. If the correct patient is highlighted, select OK. If the correct patient is not highlighted, scroll through to find the correct patient, highlight the name, and then select OK.

When you click OK, CPRS opens to the Cover Sheet (unless you have set this to a different tab, which you can do using Tools | Options).

You can also use the radio buttons under the Patient List heading (located on the left-side of the window) to group the patient list according to provider, team, specialty, clinic, or ward. When you select a specific list for a provider, team, specialty, clinic, or ward, CPRS will display the associated patients in the Patients list box, followed by a line, and then the comprehensive patient list. You can then scroll to find the name. Your Clinical Coordinator will usually create the lists for the teams, wards, and so on.

How CPRS Sorts Names

VistA software uses a set of characters that include uppercase and lowercase Latin alphabetic characters (A-Z, a-z), numbers (0-9), and other special characters.

This is important because of how names are sorted if the user is searching for a partial name. If VistA has stored characters other than the Latin alphabetic and numeric, such as ñ, and the user does a partial search (types in only part of the name, for example), the names may not display in the order the user expects.

For example, if you had patients or clinicians with names like Pina, Piña, Piñon, Pine, Pinto, Pitcher, Pitt, Pixon, and Pizzelo, and the Piña and Piñon were entered with an ñ. If the user typed in “pi” as what CPRS should search for, CPRS would display the names as shown below:

Pina

Pine

Pinto

Pitcher

Pitt

Pixon

Pizzelo

Piña

Piñon

Note that Piña is after Pizzelo. This is because VistA sorts these characters based on their numeric values in the character set VistA uses. For example, in that table, the number for lowercase “a” might be 97, “z” might be 122, and “ñ” might be 241. Characters other than the uppercase and lowercase Latin alphabetic characters and numbers, such as ñ or the tilde (~) will display wherever their numeric equivalent falls, which is generally after z.

Related Topics

Closing a Patient Record

Setting a Default Patient List

Patient Lists

Cover Sheet


 Order Checking

Order Checking is based on a system of rules that reviews orders to see if they meet defined criteria. If they meet the criteria, an electronic message is sent to the ordering provider to alert the provider to a potential problem (such as creatinine clearance, polypharmacy, duplicate order, drug-lab interaction, etc.). The provider can then choose to cancel the order or override the order check and place the order.

The Order Checking system gives users and clinical application coordinators (CACs) some flexibility to determine which order checks and notifications are sent and whether the provider must enter a reason to override the order check. To accomplish this, CPRS includes several prepackaged order checks as well as three menus for setting Order Checking parameters such as enabling and disabling specific order checks. Order Checks can also be configured to be mandatory by the Clinical Coordinator or IRM. If this feature is enabled, users cannot indicate that they do not want to receive individual order checks. Non-mandatory order checks can be enabled or disabled through the Tools | Options menu.

CPRS calls for order checks on all orders. CPRS calls for order checks at the following times:

•	When the user opens the order dialog by selecting an item from the Write Orders pane or from an order menu

•	In the order dialog when the user selects Accept Order

•	When the user selects a signature action—before the user signs

CPRS uses three kinds of order checks: site-defined Clinical Reminder order checks, nationally released local orders checks, and remote orders checks between sites.

Related topics

Site-Defined Clinical Reminder Order Checks

Order Checking Local

Order Checking Remote

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Site-Defined Clinical Reminder Order Checks

CPRS enables sites to create their own order checks based on the Clinical Reminders features. Sites will define a group of orderable items for which certain rules apply. If the rules apply to the situation, the site can define text that will display in the order check window. Sites can also set the order check to require an override.

Setting Up Clinical Reminder Order Checks

Clinical Reminder order checks are defined at the site by those who normally work on the Clinical Reminders package. The set-up of a Clinical Reminders Order Check consists of two parts:

•	Creating a group of orderable items to which the rules should apply.

•	Creating the rules that will be applied to the orderable item when accepting an order in CPRS.  It will be possible to have the same orderable item in multiple groups. Each rule assigned to the different groups will be evaluated when placing the orderable item in CPRS. The order check groups and the rule will be stored in the Reminder Order Check file.

Rules can either be defined to run against a reminder term or a reminder definition. A reminder term is beneficial when the request is to evaluate the presence of specific data  (See Example #1). A reminder definition is beneficial if you need the full functionality of a reminder definition to determine if the rule should show in the order check form (See Example #2). The user setting up the Clinical Reminder order check can define only one or the other.

Note:	Sites should evaluate all requests to create a Clinical Reminder Order Check to determine the importance of adding it. The more reminders that are used in an order check, the more they could affect the performance of the order check system.

Example #1

Problem: An order check is needed for the interaction between timolol ophthalmic (used to treat glaucoma) and over-the-counter (OTC) antihistamines (which should not be used in the more rare narrow angle glaucoma).

Setup:

1.	Create a reminder term that looks for the presence of a diagnosis of narrow angle glaucoma. (May need to look at multiple files depending on your site practice)

2.	Create an Orderable Item Group that contains all orderable items for any OTC Antihistamines.

3.	Create a Rule that contains the term created in step 1.

4.	Set the rule to trigger the order check if the reminder term is evaluated at True.

5.	Create the text that should appear in the order check window.

Example of the Output in CPRS

This is an example of a Clinical Reminders order check.

Description of solution: A reminder term was used in the setup because the presence of Glaucoma was all that is needed to determine if the rule should trigger an order check. In the screen shot above, the text "Diagnosis of Glaucoma" was defined in the Display Name field. The rest of the text was defined in the Order Check Text field.

Example #2

Problem: Order Check is needed when ordering Glyburide for patients age 65 or greater and serum Cr 2.0 or greater.

Setup:

1.	Create a reminder definition that is applicable to the patient if the patient age is 65 or greater and the patient has a CR serum 2.0 or greater.

2.	Create an Orderable Item Group that contains all orderable items for the Glyburide.

3.	Create a Rule that contains the definition created in step 1.

4.	Set the rule to trigger the order check if the reminder definition is applicable to the patient.

5.	Create the text that should appear in the order check window. Set the order text to display the finding output in the order check text.

Example of the output in CPRS

This is an example of a Clinical Reminders order checks that uses a rule and contains part of the definition.

Description of solution: We needed a reminder definition to match patients older than 64 who had a lab test with the results greater than 2. In this example we set the rule up to display both the order check text and the definition evaluation text. The text “Glyburide Contraindicated” is the display name. The text “Avoid glyburide in patients with a calculated creatinine clearance < 50 ml/min or a creating 2 or greater. If an oral sulfonylurea is required, consider glipizide,” is defined by the site. The rest of the text is returned from the reminder definition evaluation.

Enabling Users to See the Reminders Order Checks

Clinical Reminder Order checks are defined with a testing field. If the order check is being tested, the Clinical Application Coordinator (CAC) or similar person sets this field in the Clinical Reminders order check definition to True. Then, only users who have the Clinical Reminder Test order check set to Yes will receive the order check—allowing a small number of users to test the order check before it is enabled for all users in the facility.

Related topics

Order Checking Overview

Order Checking Local

Order Checking Remote

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Local Order Checking

CPRS has several local order checks that occur during the ordering process.

Local Order Checks

These nationally released order checks are available on a local CPRS system:

•	Allergy-Contrast Media Interaction

•	Allergy-Drug Interaction

•	Aminoglycoside Ordered

•	Biochem Abnormality For Contrast Media

•	Clinical Reminder Live

•	Clinical Reminder Test

•	Clozapine Appropriateness

•	Critical Drug Interaction

•	CT & MRI Physical Limitations

•	Dangerous Meds For Pt > 64

•	Dispense Drug Not Selected

•	Drug Dosage

•	Duplicate Drug Class Order

•	Duplicate Drug Order

•	Duplicate Opioid Medications

•	Duplicate Order

•	Error Message

•	Estimated Creatinine Clearance

•	Glucophage-Contrast Media

•	Glucophage-Lab Results

•	Lab Order Freq Restrictions

•	Missing Lab Tests For Angiogram Procedure

•	No Allergy Assessment

•	Order Checking Not Available

•	Polypharmacy

•	Recent Barium Study

•	Recent Oral Cholecystogram

•	Renal Functions Over Age 65

•	Significant Drug Interaction

Note:	All of these order checks are exported disabled at the system level. IRMS can then turn them on for individuals or teams, as determined by the site. IRMs, Clinical Coordinators, individuals, or services can also disable individual order checks, if they choose to.

Several parameters that each site controls determine how these order checks behave.

Order Check On Acceptance Dialog

For medication orders, if a possible problem is found, CPRS displays the order check window, such as seen below when the user selects Accept:

When accepting a medication order, order checks are performed to identify potential problems.

The Order Checking dialog shows the order checks in a new format. The new format includes better separation of order check text and each order check is number using the format (1 of 2).

Order Checks Dialog on Signature Actions

If the clinician chooses to sign the order, CPRS displays the following dialog:

In this screen capture, CPRS displays several possible conflicts between ordered medications. Users should review each item carefully before completing the order. If an order check is larger than the cell’s available space, the user can hover with the mouse to the get the full text or use the arrow keys to highlight the order check if using the keyboard or accessibility product for visually challenged users. Some order checks require an override reason. These order checks are designated by the “*Order Check requires Reason for Override” text in red and the order check text in blue.

This dialog displays each medication or other item that had an order check in a separate section. Each item will have a check box allowing the user to check any orders that should be canceled at this point. Under the order text, the order checks are displayed, the most serious order checks are listed first. Those with High Clinical Danger Level items are displayed first, labeled as high danger, and colored blue. To accept these orders, the clinician must enter an override reason to justify accepting the order.

Whether the order check requires the clinician to enter a justification depends of how each site has set the Clinical Danger Level for each order check. For example, the Pharmacy package determines if an interaction is critical or significant. Each site then determines whether the provider must enter a reason for override by setting a Clinical Danger Level in CPRS for the Critical Drug Interaction and Significant Drug Interaction order checks.

Another example would be allergy assessments. If the site has the No Allergy Assessment order check set Clinical Danger Level to High and the patient does not have an allergy assessment, then the order will require a justification for override. If the site has the Clinical Danger Level to Moderate, no reason is required.

When a user enters a high clinical danger level override reason, the reason for override is sent with the orders to ancillary packages so that the information is available to their users.

The new dialog also has a See Monograph button. The button will not be active until after the release of the first portion of the Pharmacy Reengineering project. Selecting the See Monograph button will send the user to a monograph about the drug or drug class to help the provider with additional information. If there are more than one kind of drug, the Monographs for Order Checks dialog will displays a drop-down list with the choices for the various kinds of medications.

Related topics

Order Checking Overview

Site-Defined Clinical Reminder Order Checks

Order Checking Remote

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Remote Order Checking

Note:	Remote order checks will be available at sites when the RDI software, including patches OR*3.0*232, OR*3.0*238, OR*3.0*267, GMRA*4.0*26, and GMRA*4.0*37, is installed at each site. The RDI rollout is planned as a phased roll out that will last several months until all sites have the software installed.

In addition, with the Remote Data Interoperability (RDI) project, it is now possible to perform a limited number of order checks against remote outpatient pharmacy and allergy information from other Veterans Health Administration (VHA) facilities that is stored in the Health Data Repository (HDR). Another project, the Clinical Health Data Repository (CHDR) will enable remote order checks against allergies and outpatient medication data from Department of Defense (DoD) facility data that is stored in the HDR. The CHDR data only relates to active dual consumers (patients that are seen at both VHA and DoD facilities).

For the selected patient, RDI requests from the HDR all outpatient pharmacy data with an expiration or discontinued date starting 30 days in the past and going forward, including into the future.

What Remote Order Checks Are Available?

With RDI and CHDR, the following order checks occur:

•	Allergy Contrast Media Interaction

•	Allergy-Drug Interaction

•	Critical Drug Interaction

•	Duplicate Drug Class Order

•	Duplicate Drug Order

•	Significant Drug Interaction

Which Items Are NOT Used in Remote Order Checks?

Some items are not used in remote order checking because they are not stored in the HDR. Others have a high annoyance factor and therefore were not included at the request of field sites. The following items are not included in remote order checks:

•	Inpatient Medications

•	Non-VA Meds

•	Supply items

•	Local drugs that are not matched to the National Drug File

Note:	The HDR-Hx and HDR-IMS contain prescriptions with drugs that are not matched to the National Drug File (NDF). This prescription data should be used in remote order checking for duplicate drug classes. Because the National Drug File is updated regularly, these missing order checks could be resolved whenever the NDF is updated. Some drugs may never be matched, especially drugs used in research.

Will the Display Change?

With RDI, if an order check finds a problem, CPRS displays the information to the user. The dialog is the same one that CPRS users are accustomed to with the addition of some additional information:

•	Medication orders include the last refill date and the quantity.

•	Remote medication order checks also display the facility name where the medication was prescribed. The facility information is provided as a convenience should the user need to get further information from the facility. Local medication order checks do not have any text where the facility name would be.

•	For allergies, the term “remote”, “local”, and “local and remote” will display based on where the allergy is recorded.

Examples of the order check screen with remote facility names in the order checks are shown below.

In this screen capture, several order checks are displayed. For allergies or adverse reactions, indicates if the allergy or reaction is recorded locally, remotely, or both. Red boxes were added to show where location information for the order.

This screen capture shows a duplicate therapy warning, a general dosing check, and a message that the daily dose range check could not be performed because of missing data.

This screen capture shows sample order checks. Red boxes have been added to show where CPRS displays the remote medication order’s location, in this case a Department of Defense medical facility. The red boxes are for emphasis and do not display in CPRS. In this example, “4th Medical Group” denotes a DoD medical facility. Order checks also indicate if a monograph is available that contains additional information.

Allergy and local order checks do not display the facility name.

To ensure that providers have the information they need, CPRS also provides the message “Remote Order Checking not available – checks done on local data only” if CPRS cannot communicate with remote sources.

CPRS shows this message once during an ordering session when it cannot communicate with the HDR and then does not show it again until the user begins another ordering session. However, after displaying the message, CPRS continues to attempt communication with the HDR. If CPRS reaches the HDR, remote order checks will display when orders are placed.

How Is RDI Remote Order Checking Enabled?

To use remote order checking, your site must enable a parameter to access HDR data. This parameter is set for the entire facility.

When Does CPRS Get Remote Data?

Order checks from CPRS can happen several times during a CPRS ordering session:

•	Beginning to write/copy/change orders – When a user selects an order menu to begin writing orders, CPRS requests some order checks, such as polypharmacy, renal function, or creatinine clearance, for example.

•	On order acceptance – When the user selects Accept, CPRS requests the order checks.

•	Signature of orders – When a user signs the order, CPRS requests order checks.

How Long Is the Data Used?

A parameter that sites can set controls how long HDR data is stored locally and is considered “fresh” and can be used for order checks before the data will be retrieved again from the HDR. The default time for this parameter is 120 minutes or two hours, but each site can change the time in that parameter.

Related topics

Order Checking Overview

Site-Defined Clinical Reminder Order Checks

Order Checking Local

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Order Sets

An order set is a group of quick orders that require a minimum number of prompts. Your Clinical Coordinator can create order sets for your site.

Why Would I Use an Order Set?

The purpose of order sets is to streamline ordering. With order sets, you click order set once and then complete any necessary dialogs as CPRS steps each order sequentially. If the orders require no additional information, you can place multiple orders with a single click.

Common order sets might be the following:

•	Admission Orders

•	Pre-op

•	Discharge Orders

Who Creates an Order Set?

You can create (or ask your Clinical Coordinator to create) order sets, for commonly ordered groups of tests, medications, procedures, and so on. For example, your emergency room clinician might commonly order CBC, Chem 7, and other tests. These orders could be combined into an order set.

Can I Place a Menu on an Order Set?

You can also now place menus on order sets. Placing menus on order sets allows you to have an order set that will process through a number of orders, and as one of those steps, it will open another menu containing quick orders or other order sets. This will allow you to select the tests or orders that match the situation.

Order sets and menus on order sets are created using List Manager's Menu Management feature.

What Is the Small Window that Appears Doing?

When an order set is being processed, a small window appears showing the items in the order set. When each item is finished, a check appears in the box in front of the item. The set can be interrupted by pressing stop on this window.


Placing Additional Diet Orders

To place an additional diet order, follow these steps:

1.	Select the Orders tab.

2.	Select Diet in the Write Orders list box.

Note:	The Encounter Information dialog appears if no encounter information has been entered.

3.	Select the Additional Order tab.

4.	Type in (free text) the order that you want to place.

5.	Select Accept Order.

6.	When finished, click Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Ordering Consults

You can order a consult or procedure from either the Consults or the Orders tab. As you fill in the options, the consult request will be displayed in the text box at the bottom center of the dialog.

For an explanation of what consults are and the steps involved in requesting and completing a consult, see the Consults topics.

For specific help about ordering or requesting a consult, please see the appropriate link below.

Related Topics

Consults (overview)

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


Ordering Diet Isolation/Precautions

To place a diet isolation or precaution order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

Note:	The Encounter Information dialog appears if no encounter information has been entered.

3.	Select the Isolation/Precaution tab.

4.	Select the type of precaution (Protective, Respiratory, Strict, or Wound/Skin).

5.	Type the instructions in the Instructions text field.

6.	Select Accept Order.

7.	When finished, select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Additional Diet Order

How to Write Orders (overview)


Ordering Diets and Outpatient Meals (overview)

From the Orders tab, users can place diet orders for inpatients and outpatients. For inpatients, users can place regular diet orders, tubefeeding orders, early/late tray orders, isolations/precautions orders, and additional orders. For outpatients, users can place orders for recurring meals, special meals, tubefeeding, early/late tray, isolations/precautions, and additional orders.

Some set up is required to use Outpatient meals. If it is not working properly, contact your IRM or ADPAC staff. An overview of set up issues is covered in the OR*3.0*215 Setup Notes.

The Nutrition and Food Service documentation is available on the VistA Documentation Library (VDL) at http://www.va.gov/vdl/ under Nutrition and Food Service.

Note:	If a user begins to enter an inpatient diet and the patient already has a diet, CPRS will display a dialog to tell the user that the existing meal could be replaced. The dialog also shows the components of the existing diets.

CPRS displays this Confirm dialog if the user begins to enter an inpatient diet that will cancel and replace the current diet order.

Note:	If a user begins writing delayed diet orders that conflict because start and stop dates are not well defined, CPRS will display a dialog to inform the user that one of the diet orders may be replaced and gives users some guidance.

The Possible delayed order conflict dialog displays to ask the user if the user has checked a couple of items.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Isolation/Precaution

Additional Diet Order

How to Write Orders (overview)

Ordering Outpatient Recurring Meals

Ordering Outpatient Special Meals

Ordering Outpatient Meals Tubefeeding

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Isolations/Precautions

Ordering Outpatient Meal Additional Orders


Ordering Early/Late Trays

To order early or late trays, follow these steps:

1.	Select the Orders tab.

2.	Select Diet in the Write Orders list box.

Note:	The Encounter Information dialog appears if no encounter information has been entered.

3.	Select the Early/Late Tray tab.

4.	Select the meal (Breakfast, Lunch, or Dinner).

5.	Select the time you want the tray delivered.

6.	Enter the Start Date/Time using the following steps:

a.	Select the calendar button [image] in the Start Date/Time field.

b.	Choose the date. Arrows to the right and left of the month allow you to change the month. You then click on the desired day in the calendar shown.

c.	Choose a time. You can click on the hour and the minutes, choose Now, or choose midnight. Click OK.

7.	Enter the Stop Date/Time (use steps a-c above).

8.	Select the days of the week that you want the tray delivered at this time.

9.	Select Accept Order.

10.	When finished, select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Isolation/Precaution

Additional Diet Order

How to Write Orders (overview)


Ordering Infusions

There are several different kinds of infusion orders, including intravenous (IV), epidural, IV piggyback, etc.

In the Infusion Order dialog, the order type—Continuous or Intermittent— affects whether some fields are available or visible. The two types of IVs are defined as follows:

•	Continuous IV: an IV that runs at a specified rate (ml/hr, mcg/kg/min, etc.).

•	Intermittent IV: an IV administered at scheduled intervals (Q4H, QDAY) or One-Time only, “over a specified period of time” (e.g., “Infuse over 30 min.”).

For Intermittent orders, the Infusion Rate field changes to be Infuse over Time, the Schedule field becomes available (not greyed out), and checkboxes display for the PRN and Give additional Dose Now options. On both dialogs, required fields are identified by an asterisk following the field label (such as Route*, for example). Intermittent orders no longer required a solution to finish the order. Continuous orders still require a solution before the order can be finished. For CPRS to accept the order, the user must enter values in the required fields, including the units.

For the Route field, CPRS uses the following rules to define whether it displays a default route for the selected medication:

•	If all of the orderable items on the order have the same default medication route defined, CPRS designates the default medication route in the selection list.

•	If one or more orderable items on the order have different default medication routes, no medication route in the selection lest will be denoted as the default.

Related topics

How to Write Orders

Placing Continuous Infusion Orders

Placing Intermittent Infusion Orders


Ordering Imaging/Radiology

The Reason for Study and the Clinical History fields are now two separate entries. Developers made this change to support a new system. The Reason for Study field is now required and has a limit of 64 characters (numbers, letters, space, and punctuation). The Clinical History field is optional and has no character limit.

To order any type of imaging, such as an x-ray or a nuclear medicine exam or procedure, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Imaging in the Write Orders list box.

Note:	The imaging order may be labeled differently or may not be available from your Write Orders field.

The Order an Imaging Procedure dialog displays.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Order an Imaging Procedure dialog. You must complete the encounter information dialog before proceeding.

4.	Select the desired imaging type in the Imaging Type field.

5.	Select a procedure from the Imaging Procedure list box.

6.	Select an available modifier from the Available Modifiers field.

The modifier(s) you select will be displayed in the Selected Modifiers field.

Note:	You can remove a modifier by selecting the modifier and clicking Remove.

7.	Enter a reason for the exam in the Reason for Study field. (This is a required field that allows a maximum of 64 characters—which includes letters, numbers, punctuation, and spaces.)

8.	(Optional) If wanted, enter the history in the Clinical History field (If you enter anything, it must be at least two consecutive alphanumeric characters).

9.	If necessary, change the Requested Date, Urgency, Transport, and Category fields.

Note:	The Date Desired previously defaulted to TODAY, but this default has been removed from most orders. The user will need to enter the Date Desired.

10.	Complete the Submit To field (if necessary).

11.	Check the Isolation checkbox (if necessary).

12.	Select the appropriate answer (Yes, No, or Unknown) in the Pregnant field.

13.	Select the time that the PreOp is scheduled by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001)

o	entering a date formula (e.g. t-200)

o	pressing the [image] button to bring up a calendar

14.	Select Accept Order.

15.	Enter another order

-or-

select Quit.

Related Topics

Viewing Imaging/Radiology Orders

Viewing Imaging/Radiology Results


Ordering Inpatient Medications (Simple Dose)

Ordering medications now uses two dialogs in the ordering process and eliminates the dispense drug prompt. Inpatient medication orders now require a valid schedule. If users do not find the appropriate schedule in the list, they can choose to create a day-of-week/administration time schedule using the new Schedule builder. This feature also works for renewing, copying, and changing inpatient medication orders. The procedure for ordering medications is described below.

Note:	Because a valid schedule is required, if you attempt to modify an existing medication order that does not have a valid schedule, you will receive a message box stating that and will have to enter a valid schedule.

Note: 	Your site’s IRM staff may have specified rules governing the status of inpatient medication orders when patients are transferred from one ward or service to another. It may have also specified the number of days an inpatient medication order remains active. Please check with your site’s IRM staff for information about these rules.

CPRS now requires a unique match in the Medication, Dosage, Route, and Schedule fields for inpatient medications before CPRS will auto-select an item from the list. For inpatient medications, the Medication and Schedule fields must be an item from the list, but the Dosage and Route can be a free-text entry (the route must be in the MEDICATION ROUTES file #51.2). If the desired schedule is not on the list, the user can build a day-of-week/administration time schedule using the Schedule Builder.

CPRS displays unit dose routes based on the following rules:

1.	If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.

2.	If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.

3.	If there is only one possible medication route, it will be used as the default.

4.	If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

Also, medications that are not in the formulary display in the list with the letters “NF” after the name or synonym, which is also displayed. CPRS checks for non-formulary dosages (e.g., the VA formulary may not have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary orderable items (e.g., the VA may not carry a specific kind of allergy medication).

New Clozapine Requirements

With the Food and Drug Administration required changes for administering Clozapine, the following criteria must be met for a provider to order Clozapine:

•	The patient is part of the treatment program.

•	The patient has proper WBC (White Blood Count) and ANC (Absolute Neutrophil Count) lab tests within the past 7 days.

•	The ordering provider has the YSCL AUTHORIZED key.

•	The ordering provider has a valid Drug Enforcement Agency number or Veterans Administration number (DEA/VA#).

CPRS checks these criteria by calling an API provided by the Mental Health package that determines whether the patient should be permitted to receive the new prescription. CPRS gives order checks if the patient’s lab test values are in the mid or low range as shown below:

Lab Test Ranges

	Low Range	Mid Range	High Range
WBC	< 3	between 3 and 3.5	>3.5
ANC	<1.5	between 1.5 and 2	>2
The labs test results determine what level of override is needed for the patient to receive Clozapine:

•	High Range – No override needed.

•	Mid Range – Local override. This is like a normal medication order check and can be overridden at the local level.

•	Low Range – National Clozapine Coordinating Center (NCCC) override required. If the patient’s lab values are in the low range, the provider must contact the NCCC to receive an override that is valid for a single Clozapine order.

The other order checks related to Clozapine will continue to work as they have prior to these changes.

Additionally, the values of the Days Supply, Quantity, and Refills fields are restricted based on the type of patient that Mental Health designates in their files when the provider is ordering Clozapine. This can be a 7, 14, or 28-day recipient of the Clozapine drug. For refills, the following rules apply:

•	Patients on a 7-day monitoring frequency have no refills available.

•	Patients on a 14-day monitoring frequency can receive a full 14-day supply or a 7-day supply and ONE refill.

•	Patients on a 28-day monitoring frequency can receive EITHER a full 28-day supply, or a 14-day supply and ONE refill, or a 7-day supply and THREE refills.

CPRS now prevents the user from renewing outpatient and inpatient Clozapine orders.

To write a new Inpatient Medications order, follow these steps:

Note:	If the user attempts to order inpatient medications for an inpatient from an outpatient location, CPRS discontinues the order process and returns the user to original Orders or Meds tab display.

1.	Select the Meds tab and select Action | New Medication.

-or-

Select Orders tab and bring up the Inpatient dialog by selecting the appropriate item under the Write Orders box.

2.	Locate the desired medication or medication quick order.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3.	Select the quick order or medication name.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

Note:	CPRS now uses a look up from Pharmacy to check if the selected medication is a controlled substance that will require the signature of a provider with a DEA or VA number. A message will appear to the provider "Provider must have DEA# or VA# to order this medication". Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the dialog, change the provider, and then reenter the dialog.

Click here to see the inpatient medication selection dialog.

4.	In the Dosage field, select or type a dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. Also, the associated cost of the drug is displayed to the right of the dosage.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

5.	In the Route field, enter the appropriate route (a default route may have been set up) by either selecting one from the list or typing in a valid route.

6.	Select a schedule or if the schedule you want to use is not in the list, locate the Other (you can also click the Non-Standard? link and then click OK on the dialog that displays) entry and select it. If you selected Other, use these instructions to create a customized schedule.

Note:	See the second inpatient Medication Order dialog for a simple dose.

When the user selects a schedule, the administration times may display under the “Give additional dose now” text. The administration times will display if they have been defined for the ward or if there is a default as long as the order is not a PRN order.

7.	Select PRN if desired.

8.	Add comments (optional).

9.	CPRS displays when the first dose of the medication is expected to be given. (For example, CPRS cannot show an expected first dose for “on call” or schedules with PRN. On the complex tab, it will not try to determine an expected first dose after a THEN because the first item must be completed.) If you want to give an additional dose now, select to place a check in the "Give additional dose now" check box.

Note:	Make sure that you are careful about using give-additional-dose-now functionality. When you click the check box, CPRS creates two new orders and sends it to Inpatient Medications. Make sure the “Give additional dose now” and the regular order with the original schedule you entered do not overmedicate the patient. “Give additional dose now” is not available for ONCE, ONE-TIME, or NOW orders. It is also not available for delayed orders.

10.	Check the warning message to ensure that the orders you created are what you expected. If the orders are acceptable, click OK. If not, click Cancel to clear the Give additional dose now check box.

11.	Select the drop-down arrow and select a Priority.

12.	Select Accept Order.

Note:	If you do not complete the mandatory items or if the information is incorrect, CPRS sends a message that tells you that the information is incorrect and shows you the correct type of response.

13.	(Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o	To proceed, select Accept Order.

o	To stop the ordering process and return to the dialog, Cancel Order.

14.	Enter another medication order

-or-

select Quit.

Note:	The order must be signed before it is sent to pharmacy. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Ordering Lab Tests

To place an order for a lab test, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Lab Tests in the Write Orders list.

Note:	The lab tests order may be labeled differently or may not be available from your Write Orders field.

The Order a Lab Test dialog will appear.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Order a Lab Test dialog. You must complete the encounter information dialog before proceeding.

4.	Select the desired lab test in the Available Lab Tests list box.

5.	If desired, change the default values for the Collection Sample, Specimen, and/or Urgency fields. If you cannot change a field, the text label (to the left of the field) will be greyed out.

6.	Select the collection type.

7.	Choose a collection date and time.

8.	Complete the How Often? and How Long? fields (if necessary).

9.	Select Accept Order.

Note:	If you have selected an inpatient order with a collection type of “lab collect” or “immediate collect” and if a continuous schedule was selected (such as QD or QWEEKLY) and a child order falls on a day when the lab cannot perform the collection (for example, weekends or holidays), CPRS displays a message telling the user that the collection type will be changed to “ward collect” or of any such changes to child orders.

10.	Enter another lab test

-or-

select Quit.

Note:	The Lab Test order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Viewing Laboratory Test Results


Ordering Outpatient Medications (Simple Dose)

Outpatient medication orders can be written as simple doses or complex doses. Users must enter a medication name, dosage, route, and schedule. For outpatient medications, dosage, schedule, and route can be free-text entries, but the medication must be chosen from the list of options. The route can be typed in, but to be accepted, it must be a valid route that is in the MEDICATION ROUTES file #51.2.

CPRS displays unit dose routes based on the following rules:

1.	If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.

2.	If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.

3.	If there is only one possible medication route, it will be used as the default.

4.	If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

Also, medications that are not in the formulary display in the list with the letters “NF” after the name or synonym, which is also displayed. CPRS checks for non-formulary dosages (e.g., the VA formulary may not have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary orderable items (e.g., the VA may not carry a specific kind of allergy medication).

To write a new Outpatient Medications order, follow these steps:

1.	Select the Meds tab and select Action | New Medication…

-or-

select the Orders tab and click the appropriate item under the Write Orders list. CPRS will display the Medication Order dialog.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Medication Order dialog. You must complete the encounter information dialog before proceeding.

2.	Locate the medication name or quick order name in the list box by typing characters in the Medication field.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3.	Select the medication name or quick order name.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

Note:	If the selected medication is a controlled substance that requires the signature of a provider with a DEA or VA number, the DEA# Required dialog will appear. Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the Medication Order dialog, change the provider, and then reenter the Medication Order dialog.

4.	Select the dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage).

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

5.	Select a route from the Route field.

Note:	Outpatient orders for supply items do not require a route.

6.	Choose a schedule from the Schedule field. (Select PRN, if desired.)

7.	CPRS completes the default days supply field and calculates the quantity field based on the formula days supply x schedule = quantity. If necessary, highlight and change the numbers in these fields.

Note:	If you change a number, CPRS will attempt to recalculate the other field.  If you check PRN, be sure that the quantity field is correct before accepting the order.

8.	Enter the number of refills.

9.	Select the location where the patient should pick up the medication from the Pick Up field.

10.	Choose a priority.

11.	Add comments in the Comments field (if desired).

12.	Under certain circumstances, a check box may appear under the Days Supply field. If the medication is service-connected, make sure the box is checked

13.	Select Accept Order.

14.	(Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o	To proceed, select Accept Order.

o	To stop the ordering process and return to the dialog, Cancel Order.

15.	If you are finished ordering outpatient medications, select Quit.

Note:	The order must be signed before it is sent to the Pharmacy package. You can either sign the order now or wait until later.

Related Topics

Ordering Outpatient Medications (Complex Dose)

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Ordering Procedures

To order a procedure, follow these steps:

1.	Select the Orders tab.

2.	Select Procedure in the Write Orders list box.

Note:	The Encounter Information dialog appears if no encounter information has been entered.

3.	Locate and click the desired procedure in the Procedure list box.

4.	Enter the reason for the procedure.

5.	Select whether the patient is an inpatient or outpatient.

6.	Select the Urgency, Place of Consultation, to whose attention you are sending it, and the Provisional Diagnosis.

7.	Select Accept Order.

8.	When finished, select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals


Ordering Vitals

This section gives steps to place an order directing staff to collect vitals with a certain frequency over a certain time period. To record vitals and measurements, staff should use the new Vitals package or the Vitals Lite interface in CPRS.

To enter a vitals order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Vitals in the Write Orders list box.

The Vital Signs dialog appears.

Note:	The vitals order may be labeled differently or may not be available from your Write Orders list.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Vital Signs dialog.  You must complete the encounter information dialog before proceeding.

4.	Select a vital sign from the Vital Sign drop-down list.

5.	Select a date and time from the Start Date/Time field by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

6.	Enter a schedule in the Schedule field.

7.	Select a stop date and time from the Stop Date/Time field by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar

8.	Enter any special instructions in the Special Instructions field.

9.	Select Accept Order.

Related Topics

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Text Only Orders

Event-Delayed Orders


Ordering a Diet (Diet Tab)
Ordering a Diet

You can place several different types of diet orders from the Orders tab, including regular diet orders, tubefeeding orders, early/late tray orders, isolations/precautions orders, and additional orders.

Related Topics

Regular Diet Orders

Tubefeeding Diet Order

Early / Late Tray Orders

Isolations / Precautions Order

Additional Diet Order

Writing Orders (overview)


Patient Lists

You or your clinical coordinator can create patient or team lists that simplify tasks such as reviewing patient charts, ordering, and signing orders and notes. These lists can be based on wards, clinics, teams, or other groups. Users can create their own personal Patient Lists in the CPRS GUI. When the user creates the list, the user designates if the list can be viewed only by the owner (the person creating the list) or by all CPRS users. Clinical Application Coordinators (CACs) can create and manage general patient lists through the List Manager interface (the character-based version of CPRS).

With patient selection lists, you can:

•	Quickly locate your patients without going through all the patients in the list.

•	Create lists for teams of clinicians who can sign or cosign for each other.

•	Tie notifications to teams, ensuring that all team members receive necessary information about a patient.

Related Topics

Setting a Default Patient List


Placing a Quick Order

To place a quick order, do the following:

1.	Select the Orders tab.

2.	Select the item for Quick Orders.

3.	If necessary, select a category.

4.	Select the Quick Order.

5.	When finished, select Done.

Note:	When you have finished placing orders, you can sign the orders now or later.

Related Topics

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders


Postings
Postings (Overview)

Postings contain critical patient-related information about which hospital staffs need to be aware.  The Postings button is visible on all tabs of the CPRS GUI window and is always located in the upper right corner of the window

If a patient record contains postings, the Postings button displays one or more of the following letters: C, W, A, D. These letters correspond to the four types of postings described below.

C (Crisis Notes) – Cautionary information about critical behavior or patient health.

Example: Suicidal attempts or threats.

W (Warnings) – Notifications that inform medical center staff about possible risks associated with patients.

Example: Patient can be violent.

A (Adverse Reactions/Allergies) – Posting that displays information about medications, foods, and other items to which patients are allergic or to which they may have an adverse reaction. CPRS creates these postings automatically when users enter allergies.

D (Directives) – Also called advanced directives, directives are recorded agreements that a patient and/or family have made with the clinical staff.

Example: DNR (Do Not Resuscitate) directive on file.

 The Postings button

Related topics

Creating a New Posting

Viewing a Posting

Entering Allergies


Printing from CPRS

You can print most reports, notes, and detailed displays from within the CPRS GUI.

To print graphics and charts, you will need to print to a Windows printer. To print text documents, you can print to either a Windows printer or a VistA printer. The printer language used by Windows printers can accommodate graphics, while the language used by VistA printers cannot.

Printing Single Items

You can also print graphics on a Windows printer from the Labs tab and the Vitals screen. You can use File | Print Setup... to set the preferred attributes for the printer. CPRS remembers which printer you used last and will print to that printer again unless you changed it for the duration of the session. You can also configure and save a printer as the default for the user.

The print dialog enables the user to print a single item. A similar dialog, without the Chart copy / Work copy option appears for items on other tabs. Many report boxes now have Print button on them to make it easier for you to print the information you need.

Normally, you do not need to enter a right margin or page length value. These values are measured in characters and normally are already defined by the device.

You will also still have the options to print your regular tasked jobs.

Printing Multiple Notes, Consults, or Discharge Summaries

The ability to print multiple Progress Notes, Consults, and Discharge Summaries has been added to the CPRS GUI. This feature is available from those tabs only.

To print multiple Notes, Consults, or Discharge Summaries, use these steps:

1.	Go to the appropriate tab (Notes, Consults, or DC/Summ) by selecting on the tab or using the keyboard commands to locate the tab.

2.	Select File | Print Selected Items….

3.	Select the documents you want to print.

Note:	To select a number of items in a row, click the first item, hold down the Shift key, and click the last item. All items in the range will be selected. To select multiple items that are not in a row, click one, hold down the Control key, and click the other specific notifications.

4.	Select OK.

Related Topics

Printing a Report (Table View)


Problem List
Problems List

The problems list on the Problems tab displays a patient’s current and historical health care problems. The problems list allows each identified problem to be traced through the VISTA system.

Service Connected Conditions

If a problem is service connected, the problem’s service connected status is displayed in parentheses in the Description column.

Service Connected Condition Abbreviations

•	SC - Service Connected Condition

•	AO - Agent Orange Exposure

•	IR - Ionizing Radiation Exposure

•	SWAC - Southwest Asia Conditions

•	SHD – Shipboard Hazard and Defense

•	MST - Military Sexual Trauma,

•	HNC - Head or Neck Cancer

Related Topics

Adding a Problem

Annotating a Problem

Changing a Problem

Customizing the Problems List

Making a Problem Inactive

Removing a Problem

Verifying a Problem


Progress Notes

Health care providers can enter and sign online patient progress notes. Transcribers can prepare notes to be uploaded into VISTA and signed by care givers at a later date. Care givers may review progress notes online or print progress notes in chart format for filing in the patient's record.

Boilerplate capabilities, such as SOAP (subjective, objective, assessment, and plan), are available to help clinicians create progress notes more readily. You can also use embedded objects to bring in information from other VISTA programs. In addition, you can cut and paste from lab results, the Problem List, or other online information, to complete your Notes.

Outpatient notes must be associated with a Visit (Encounter). You can either link a note to an existing Visit or create a new Visit.

Go to the Which Part of this Topic? (When finished, click back to return to this mini-Table of Contents or scroll through the topic.)

•	Document Locking

•	Auto-Saving Documents

•	Changing the Document Title, Author, Date, etc.

•	Images Associated with a Document

•	New Document Template Information

•	Progress Notes Created during Reminder Processing

Document Locking

Progress notes, consult results, and Discharge Summaries are now locked while being edited--to two editing sessions and the problems that can create: missing text, inadvertent deletion by one author, and so on.

Auto-Saving of Documents

The CPRS GUI has changed the process for beginning progress notes. If you do not have a default title when you begin a new document, you will be prompted for specific information before entering note text.

When you start a new document, CPRS must have a document title, date, and author. Depending on the type of document you select, you may also have to enter an expected cosigner or an associated consult.

By getting this information when you begin the document, CPRS can then auto-save your document as you create it to minimize data lost if your system crashes or exits prematurely.

The auto-save interval is determined by a CPRS parameter.

Changing the Document Title, Author, Date

With this version of CPRS, you can change the title, author, date, expected cosigner, and other reference information for a document while you are editing the document. In addition, you have the choice to ignore, append, or replace boilerplate text when changing to a document title that has boilerplate text.

Images Associated with a Document

If your site uses the CPRS GUI and VistA Imaging, you can have images associated with documents. To view the image, you must have the VistA Imaging Display program on the workstation you are using.

To simultaneously view a document and the associated images, you will need to be running both VistA Imaging Display and the CPRS GUI. When you click on a document in CPRS that has an associated image, CPRS will bring up the note text and VistA Imaging Display will display the associated images.

To show you which documents have associated images, CPRS displays a small icon next to the document title in the document list. An example is shown in the graphic below.

Document Templates

In the Windows version of CPRS, Progress Notes can be created using templates--predefined text that both clinical coordinators and individual users can create and save, to later be entered into a note with a few clicks of the mouse.

You can create individual templates, group templates, and dialog templates. And you can organize them into a hierarchical structure using folders. You can also include Patient Data Objects (TIU objects) in your templates.

Progress Notes Created During Reminder Processing

The combination of the Windows version of CPRS and the new Clinical Reminders package will add another facet to Progress Note creation. As clinicians use the new reminder functionality to meet Clinical Guidelines, they will be able to quickly click on the appropriate check boxes in dialogs that sites will build to document an encounter, including entering PCE data, placing orders if wanted, and entering predefined text into their Progress Note.

Related Topics

Viewing Progress Notes

Writing a New Progress Note

Changing a Document's Author, Title, Reference, etc.

Document Templates (overview)


Quick Orders

A quick order is a predefined order that a user can select. It has a value for some or all of the fields for the specific type of order selected. For example, on an outpatient medication order, the user might define the type of medication, dosage, route, and schedule, quantity, and number of refills. If the user does not define a value for one or more mandatory fields, CPRS will display the dialog for the user to fill in the missing values. Quick orders can be created for many different types of orders. There are two types of quick orders: personal and shared.

Personal Quick Orders

Personal quick orders are created when a user fills out the order dialog, but before the user accepts the order, the user can select Options | Save as Quick Order… and give the quick order a name. CPRS saves the order, and it can then be used from that same dialog where it was created by the user that created it. Personal quick orders display at the top of the list of orders and are separated from the rest of the orders by a line.

For example, if a user creates a lab order and then saves it as a personal quick order, the user will give the personal quick order a name and that item will appear at the top of the lab order dialog with any other personal quick orders, followed by a line and then the full list of lab orders the next time that user opens the dialog.

To create a personal quick order, use these steps:

1.	Fill out an order dialog for a medication, lab, or other order that you frequently place, but DO NOT select Accept.

2.	With the order dialog still up, select Options | Save as Quick Order….

3.	In the Add Quick Orders (type) dialog, where type is the package or type of order, such as Labs, Outpatient meds, etc., enter a name for the quick order and select OK.

Note:	You cannot save personal quick orders with the same name, even if the capitalization is different.

To manage personal quick orders, use these steps:

1.	Open the appropriate ordering dialog (Outpatient Meds, Inpatient Meds, Infusions, Labs, etc.).

2.	Select Options | Edit Common List….

3.	To rename a personal quick order, do the following:

a)	Highlight the personal quick order name.

b)	Select the Rename button.

c)	In the Rename dialog, type the new name for the personal quick order and select OK.

d)	Repeat steps a-c if needed to rename additional orders.

4.	To change the position of a personal quick order in the list, do the following:

a)	Highlight the personal quick order name.

b)	Use the arrow buttons to the left of the name list to move the name up or down to the chosen position.

c)	Repeat steps a and b if needed to arrange the list to your preference.

5.	To delete a quick order, do the following:

a)	Highlight the personal quick order to be deleted.

b)	Select the Delete button.

c)	Repeat steps a and b if needed to delete additional personal quick orders.

6.	When finished managing the personal quick order list, select OK.

Site-Wide Quick Orders

Many sites have created an entire set of Quick Orders that they use. IRM staff at each site can customize the Write Orders list box with a selection that will bring up the Quick Order menus they have created. This item might be called Assign New Orders, Common Orders, or whatever the site deems appropriate. When a clinician clicks on this item, CPRS brings up the menu containing Quick Orders and other orders defined by the site. Sites can set up orderables to be Quick Orders. See your clinical coordinator if you have items you wish to have set up as sitewide Quick Orders.

Shared quick orders are created in VistA by someone like a Clinical Applications Coordinator (CAC). These quick orders can be made available to all CPRS users by placing them on order menus, and can be used in order sets.

Related topics

Placing a Quick Order


References

Below are two links. Once will launch a web browser and go to a web page with CPRS troubleshooting and frequently asked questions (FAQs). The second is to a very small CPRS glossary.

Troubleshooting and FAQ document

Glossary


Remove a Comment
Removing a Comment from a Problem

To remove a comment, follow these steps:

1.	Select on the text of the comment.

2.	Select Remove comment.


Removing a Problem

To remove a problem from a patient's problem list, use these steps:

1.	Select the Problems tab.

2.	Select the problem.

3.	Select Action | Remove

-or-

right-click the problem and select Remove.

Note: 	Deleted problems are not actually removed from the database. Rather, a deleted problem is flagged with a hidden tag. The hidden tag prevents the problem from appearing on any reports or lists.

Related Topics

Problems List

Adding a Problem

Annotating a Problem

Changing a Problem

Customizing the Problems List

Making a Problem Inactive

Verifying a Problem


Renew Medication
Renew Medication Order

Only active orders or those which have been expired less than 24 hours may be renewed. Users can only renew Inpatient Medication orders for outpatients (IMO) if the patient is in an authorized IMO location.

Note:	If the original order had comments, the comments do not carry over when the user renews an order. This is to prevent comments that should only apply to the original order from mistakenly being carried forward with the renewed order.

The default Start Date/Time for a renewal order is determined as follows:

•	Default Start Date Calculation = NOW

The default start date/time for the renewal order will be the order’s Login Date/time.

•	Default Start Date Calculation = USE NEXT ADMIN TIME

The original order’s Start Date/Time, the new order’s Login Date/Time, Schedule, and Administration Times are used to find the next date/time the order is to be administered after the new order’s Login Date/Time. If the schedule contains "PRN" any administration times for the order are ignored.

•	Default Start Date Calculation = USE CLOSEST ADMIN TIME

The original order’s Start Date/Time, the new order’s Login Date/Time, Schedule, and Administration Times are used to find the closest date/time the order is to be administered after the new order’s Login Date/Time. If the schedule contains "PRN" any administration times for the order are ignored.

After the new (renewal) order is accepted, the Start Date/Time for the new order becomes the Stop Date/Time for the original (renewed) order. The original order’s status is changed to RENEWED. The renewal and renewed orders are linked and may be viewed using the History Log function. Once an order has been renewed it may not be renewed or edited.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Other Medication Actions (popup menu)


Viewing a Report

CPRS reports include Clinical Reports, Health Summary, Imaging (Radiology and Nuclear Medicine), Lab Status, Blood Bank Report, Department of Defense remote data, Anatomic Pathology Report, Dietetics Profile, Nutritional Assessment, Vital Cumulatives, and others that your site wishes to list. You will see these reports in the Available Reports box.

Lab reports are generally text documents that can be printed. You can view lab results in a graph or worksheet format on the Labs tab.

To view a report, use these steps:

1.	Select the Reports tab.

2.	See if the text on the Remote Data button is blue. If the text is blue, the patient has remote data.

3.	To view remote data, which may include Department of Defense data, click the Remote Data button to display a list of sites that have remote data for the selected patient. If you do not want remote data, skip to step 5.

4.	Select All if you want data from all the sites listed, or click the check box in front of the site names you want to view remote data from and close the Remote Data button by selecting the button again.

Note:	If there is a problem getting the remote data, the following messages should give the user some feedback. For text reports only, CPRS adds a comment that describes the problem where the report would normally be. For ‘grid’ type reports, the error comment is put in the first column (after the facility name) of the report. Information is also included when the Remote Data button is used to display the list of sites that have data.

•	<No HDR Data Included> - Use “HDR Reports” menu for HDR Data.

•	<No HDR Data> - This site is not a source for HDR Data.

•	<No DOD Data> - Use “Dept. of Defense Reports” Menu to retrieve data from DOD.

•	<ERROR> - Unable to communicate with Remote site

5.	Select the report you want to view from the Available Reports box (click the "+" sign to expand a heading).

Note:	The "Available Reports on the Reports Tab," section lists the location of each report when they are exported. The list is configurable and your list may be different.

Choosing a Department of Defense (DoD) report does not limit you to DoD data. For example, if you choose Microbiology under Dept. of Defense, you will get DoD data and remote VA data. You do not have to run a separate report to get VA data.

6.	If necessary, select a date range from the Date Range box located in the lower left corner of the screen.

The report should be displayed either after step 5 or step 6. You can then scroll through and read the report. If the report is in tabular form, click on a row to reveal details about that row (to select more than one row press and hold the Control or Shift key).

Related Topics

Available Reports on the Reports Tab

Viewing a Health Summary

Printing from CPRS

Printing a Report (Table View)

Sorting a Report (Table View)


Results

Results of Lab tests, Imaging procedures, ECG procedures, and so on are available from different tabs of the patient record. Each tab has a slightly different emphasis.

•	The Cover Sheet shows lab tests completed in the last 30 days. If the test you want to see is listed there, you click on the entry to bring up the report.

•	The Reports tab contains text reports of tests completed organized by category (and some by date).

•	The Labs tab has the results of lab tests for specific categories that you can view in various formats and by specific periods of time (including all test results for a specific category).

To review lab results, use these steps:

1.	Open a patient chart.

2.	Select one of the following:

o	The specific lab test on the cover sheet

o	The Labs tab

o	The Reports tab


Selected Tests by Date

Selected Tests by Date allows you to select the specific tests you want to see rather than all tests performed. You can get the results you want if you know what you are looking for. The time periods you can select are the same as under Cumulative.


Patient List_Setting a Default Patient List
Setting a Default Patient List

To make it easier for you to locate your patients, CPRS enables you to set a default patient list. This is the list that will appear when you launch CPRS. For example, if you work in a specific ward, you can set the default patient list to be the list for that ward.

To set the default patient list, use these steps:

1.	If you are just opening CPRS, skip to step 2. Otherwise, select File | Select New Patient....

Note:	If you have just entered orders that are unsigned, a screen will pop up asking you to sign the orders.

2.	In the Patient Selection screen, select the category in which you want to search for a patient's record by clicking the radio button in front of the category (Default, Providers, Teams, Specialties, Clinics, Wards, or All).

3.	In the list box below the option button, click the item that narrows the search further (such as a specific ward).

4.	If you select something other than All, CPRS sorts the patient list and divides the list into two parts: The names above the line are the names for the category and item you selected; the names below the line make up a comprehensive patient list.

5.	To save the patient list you have chosen, click Save Patient List Settings.

If you selected "Clinics" in step 2, the Save Patient List Settings dialog displays.

6.	Select "Save For All Days of Week" If you wish to set the clinic as the default patient list for all days of the week.

-or-

select "Save for Current Day Only" if you wish to set the clinic as the default for only the current day of the week.

7.	Press OK.

Related Topics

Patient Lists


Show List Box Data

This is a trouble-shooting tool for IRMS.


Signing in to CPRS

Before you can login to CPRS, you will need to obtain an access code and a verify code. Typically, your Clinical Coordinator issues these codes.

To login to CPRS, follow these steps:

1.	Double-click the CPRS icon on your desktop.

The VISTA logo window and the VISTA Sign-on dialog will appear.

2.	If the Connect To dialog appears, click on the down-arrow, select the appropriate account (if more than one exists), and click OK.

3.	Type your access code into the Access Code field and press the Tab key.

4.	Type the verify code into the verify code field and press the <Enter> key or click OK.

Note:	You can also type the access code, followed by a semicolon, followed by the verify code. Once you have done this press the <Enter> key or click OK.


Symbol Table

This is a trouble-shooting tool for IRMS.


CPRS Tabs

The tabs at the bottom of the screen represent pages in a patient chart. CPRS has the following tabs: Cover, Problems, Meds, Orders, Notes, Consults, D/C Summ, Labs, and Reports. By clicking on a tab, you are opening that section of the chart--for example, the Progress Notes or Lab section.


TIU Definition
Text Integration Utilities (TIU)

A document-handling software package that currently includes Consults/Request Tracking, Discharge Summary, and Progress Notes. It has boilerplate and cut-and-paste capabilities. It is closely tied to Authorization/Subscription Utility (ASU) which includes User Class definitions and Business Rules. These tools allow sites to set up a system that defines who is qualified to do what to which kinds of documents. ASU is expected to be enhanced so that it can replace security keys. it will let a facility control most roles and responsibilities at a hospital as far as ordering, signing, editing, etc. through business rules and user class definition.


Text Orders
Text Only Orders

Text only orders such as Parameters, Activity, Patient Care, and Free Text orders are different kinds of orders that are placed for nursing and ward staff to take action on. They print only at the patient’s ward/location, and are not transmitted electronically to other services.

Examples of text only orders include:

Order Type	Order

Parameters	Vital signs

Activity	Bed rest, ambulate, up in chair

Patient Care	Skin and wound care, drains, hemodynamics

Free text	Immunizations

Predefined nursing orders (quick orders) may be available under various sub-menus.

To place a text only order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane.

3.	Select Text Only Order in the Write Orders list box.

The Word Processing Order dialog will appear.

Note:	The text only order may be labeled differently or may not be available from your Write Orders list.

4.	Enter the text for the order in the Order field.

5.	Enter a start date and time by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

6.	Enter a stop date and time by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

7.	Select Accept Order.

8.	Enter another order

-or-

select Quit.

Related Topics

Event-Delayed Orders

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals


Time Delay

This feature allows you to enter orders that will become effective upon admission, discharge, or transfer. Typically, an order set would be requested.


Tips
TIPS & TRICKS & Shortcuts

Here are a few tips that might help you use CPRS better.

•	In most windows or boxes, you can click on your right mouse button to get a pop-up window with a definition and/or a list of possible actions.

•	In the sign-on box, you must press the tab key (not Enter or Return) to move between the access and verify code fields.

Shortcut:  In the Access Code box, type your access code, then a semicolon, then your verify code, then hit the Enter or Return key, and you will go immediately to the Patient Selection window.

•	You can see detailed information about items on the Cover Sheet by double-clicking on them.

•	You can change the size of most CPRS windows using typical Windows conventions:

•	Other programs, including non-VA applications, can be attached to the Tools menu for easy access. Programs such as Excel, WordPerfect, Project, commercial Progress Notes packages, MedLine, are examples of commercial applications. Hospital policies and locally developed utilities or programs can also be "hooked" onto this menu. See your clinical coordinator or IRM specialist if you would like this done.


Tools Menu

The tools menu is a menu that you can customize. It can contain menu items to take you to other parts of VISTA, to local policies, to word-processing programs, to the Web, or to whatever your site chooses to put on this menu. An option for adding items to the Tools menu is on the CPRS Configuration Menu (Clin Coord). Talk to your Clinical Coordinator if you wish to have something added.


Unit Dose

For Unit Dose order entry, you must fill in the DRUG box. The items listed below are used in this type of order. To find out more about an item, click on it to go to its definition. To return to the top of the page, click the Back button.

•	Drug

•	Dosage ordered

•	Units per dose

•	Med route

•	Schedule type

•	Schedule

•	Administration times

•	Provider

•	Self med

•	Nature of order

Drug

Pharmacists select Unit Dose medications directly from the DRUG file (#50). The Orderable Item for the selected drug is automatically added to the order, and all dispense drugs entered for the order must be linked to that Orderable Item. If the Orderable Item is edited, data in the DOSAGE ORDERED and DISPENSE DRUG fields will be deleted. If multiple dispense drugs are needed in an order, they may be entered by selecting the DISPENSE DRUG field (#10) from the edit list before accepting the new order (see either the Inpatient Medications Nurses’ or Pharmacists Manual for more information on this process). After each dispense drug is selected, it will be checked against the patient’s current medications for duplicate drug or class orders, and drug-drug/drug-allergy interactions (see either the Inpatient Medications Nurses’ or Pharmacists Manual for more information on this process).

Note:	For IV order entry, you must bypass the "Select DRUG:" prompt in the Inpatient Order Entry option (by pressing the Return key) and then choose the IV type at the "Select IV TYPE:" prompt.

Dosage Ordered

To allow pharmacy greater control over the order display shown for Unit Dose orders on profiles, labels, MARs, etc., the DOSAGE ORDERED field is no longer required. If no DOSAGE ORDERED is defined for an order, the order will be displayed as follows:

DISPENSE DRUG NAME

Give: UNITS/DOSE  MEDICATION ROUTE  SCHEDULE

If DOSAGE ORDERED is defined for the order, it will be displayed as:

ORDERABLE ITEM NAME  DOSE FORM

Give: DOSAGE ORDERED  MEDICATION ROUTE  SCHEDULE

Note:	If an order contains multiple DISPENSE DRUGS, DOSAGE ORDERED will be required, and should contain the total dosage of the medication to be administered.

Units Per Dose

This is the number of units (tablets, capsules, etc.) of the dispense drug selected to be given when the order is administered. If no data is entered, the UNITS PER DOSE is assumed to be 1.

Med Route

This is the route of administration to be used for the order. If a default Medication Route is identified for the selected Orderable Item, it will be used as the default for the order.

Schedule Type

This defines the type of schedule to be used when administering the order. If the schedule type entered is one time, the order’s start and stop dates must be the same. When a new order is entered or an order entered through CPRS is finished by pharmacy the default Schedule Type is determined as described below:

•	If a schedule type is defined for the Orderable Item selected, that schedule type is used for the order.

•	If no schedule type has been found and if no schedule is defined, schedule type is CONTINUOUS.

•	If no schedule type has been found and the schedule contains PRN, the schedule type is PRN.

•	If no schedule type has been found and the schedule entered is found in the ADMINISTRATION SCHEDULE file (#51.1), and a schedule type is defined for it, that schedule type is used for the order.

•	If no schedule type has been found and the schedule is "NOW", "STAT", "ONCE", or "ONE-TIME" the schedule type is ONCE.

•	If the schedule type determined above is DAY OF WEEK the schedule type is set to CONTINUOUS.

•	If no schedule type was determined above, the schedule type is CONTINUOUS.

Schedule

This defines the frequency the order is to be administered. Schedules may be selected from the ADMINISTRATION SCHEDULE file (#51.1) or day-of-week or admin/time schedules may be used. Unit Dose recognizes schedules in the following formats:

•	QxH - Hourly schedules where x is the number of hours between administrations

•	QxD - Daily schedules where x is the number of days between administrations

•	QxM - Monthly schedules where x is the number of months between administrations

If a schedule is defined for the Orderable Item selected when entering a new order, that schedule is displayed as the default for the order.

Administration Times

This defines the time(s) of day the order is to be given. If the schedule for the order contains "PRN" any administration times for the order will be ignored. In new order entry the default administration times are determined as described below:

•	If administration times are defined for the Orderable Item selected, they will be shown as the default for the order.

•	If administration times are defined in the ADMINISTRATION SCHEDULE file (#51.1) for the patient’s ward and the order’s schedule, they will be shown as the default for the order.

•	If administration times are defined for the Schedule, they will be shown as the default for the order.

Provider

This identifies the provider who authorized the order. Only users identified as providers who are authorized to write medication orders may be selected.

Self Med

Identifies the order as to be given for administration by the patient. This prompt is only shown if the ‘SELF MED’ IN ORDER ENTRY field of the INPATIENT WARD PARAMETERS file (#59.6) is set to on.

Nature of Order

This specifies how the order originated. An order can be specified as written on the chart, telephoned, or verbal. This data is stored and displayed through OE/RR.


Unsigned Orders

Before orders can be processed, they must receive an electronic signature or be designated as Signed on Chart. If, for some reason, you haven't signed orders you entered into the Computerized Patient Record System, you will be notified that you have unsigned orders whenever you log into the CPRS.


Verifying a Problem

To verify a problem on a patient's problem list, use these steps:

1.	Select the Problems tab.

2.	Select the problem in the problem list.

Note:	If you try to select a problem that has an inactive diagnosis or procedure code, CPRS prompts you to select a problem with an active code.

3.	Select Action | Verify

-or-

right-click the problem and select Verify on the pop up menu.

Related Topics

Problems List

Adding a Problem

Annotating a Problem

Changing a Problem

Customizing the Problems List

Making a Problem Inactive

Removing a Problem


View Menu

The View menu changes depending on which tab you are on. It enables you to move between the different tabs and to change your view of the information on a tab or obtain more information. For example, when you are on the Problems tab, the View menu presents you with the options of viewing different categories of problems such as viewing only active problems or using filters to define locations, a provider, and whether you want inpatient, outpatient, or both.

Cover Sheet View Menu

•	Chart Tab

•	Demographics

•	Postings

Problems View Menu

•	Chart Tab

•	Active Problems

•	Both Active/Inactive Problems

•	Filters...

Medications View Menu

•	Chart Tab

•	Active Medications

•	Expiring Medications

•	Sort by VA Drug Class

•	Sort by Drug Name

•	Details...

Orders View Menu

•	Chart Tab

•	Active Orders

•	Expiring Orders

•	Unsigned Orders

•	Custom Order View Format

•	Details...

•	Results...

Notes View Menu

•	Chart Tab

•	Signed Notes (All)

•	Signed Notes by Author

•	Signed Notes by Date Range

•	Uncosigned Notes

•	Unsigned Notes

•	Details

Consults View Menu

•	Chart Tab

•	All Consults

•	Consults by Status

•	Consults by Service

•	Consults by Date Range

•	Custom List

D/C Summaries View Menu

•	Chart Tab

•	Details

Lab View Menu

•	Chart Tab

•	Demographics

•	Postings

Reports View Menu

•	Chart Tab

•	Demographics

•	Postings


Viewing Consults

To view the consults or procedures for the selected patient, use the steps below. When you select a specific consult, you will see an area that lists any notes associated with the consult. You can also click on a note entry to view the full text of the note.

The All Consults list box shows the date, status (p=pending, c=complete, dc=discontinued, and x=canceled), and title of each consult. An asterisk preceding the title tells you that there are significant findings for that consult.

To view consults, follow these steps:

1.	Select the Consults tab.

2.	Select the consult you would like to view from the All Consults list.

The text of the consult will appear in the details pane. Any notes associated with that consult or procedure will appear in the Related Documents pane. To view the text of a related note, click on the note.

Note:	The All Consults list shows the date, status (p=pending, c=complete, dc=discontinued, and x=cancelled), and title of each consult. An asterisk preceding the title tells you that there are significant findings for that consult.  If a note listed in the related documents pane is a CP-class document, the Date/Time Performed and Procedure Summary Code fields will appear in the full text of the document.

Related Topics

Consults (overview)

Complete a Consult or Clinical Procedure from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Tracking Consults Requests


Tracking Consults Requests

When CPRS displays a request for a new consult, the user can take several actions from the Consult Tracking menu item:

•	Receive – When the request arrives at the specified service, the designated person, such as a clerk, can use Receive to change the consult status to active.

•	Schedule – The service can schedule a consult, which makes the consult available to be resulted.

•	Cancel (Deny) – A consult service may cancel or deny a consult request because of incomplete information or for some other reason. The consult requester is then notified that the consult was canceled so that the requester can take appropriate action.

•	Discontinue – The user can discontinue a consult if it is no longer needed.

•	Forward – The user can forward a consult if the user is not the appropriate person for the consult.

•	Add Comment – The user can add comments and designate to whom the comment should go in an alert.

•	Significant Findings – The user can add significant findings and designate them as such.

Many of the above actions send an alert to the recipients for the service and/or back to the requester to let them know that the status of the request has changed or that some has taken some action on the request.

CPRS alert recipients follow these rules:

•	When a user takes an action on a consult that generates an alert, that individual should not receive the alert.

•	If an ordering provider, that is a member of a consult team, takes an action on a consult, the alert should be sent to the consult team and not to the ordering provider.

•	If an unrestricted access user, that is not the ordering provider or a member of the consult team, acts on a consult, the alert should be sent to both the consult team and the ordering provider.

Related topics

Consults (overview)

Complete a Consult or Clinical Procedure from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


Viewing Imaging/Radiology Orders

To see a list of pending or completed Imaging exams, follow these steps:

1.	Select the Orders tab.

The orders for the selected patient are displayed. The orders are in order by service. The service is shown in the first column of the list of orders.

2.	Locate the imaging orders, scrolling down the list of orders if necessary.

3.	If necessary, change the category of the orders displayed:

a.	Select the View menu.

b.	Select the desired category

o	Active Orders

o	Expiring Orders

o	Unsigned Orders

o	Custom Order View...

Related Topics

Ordering Imaging/Radiology


Viewing Laboratory Test Results

Through CPRS, you can review lab test results in many formats, such as the following:

•	Most Recent

•	Cumulative

•	All Tests by (specified) Date

•	Selected Tests by Date

•	Worksheet

•	Graph

•	Microbiology

•	Anatomic Pathology

•	Blood Bank

•	Lab Status

To view lab test results, use these steps:

1.	Select the Labs tab.

2.	In the Lab Results box, select the type of results you want to see.

Note:	A plus sign (+) by a lab test means it has a schedule.

Some of the results will need you to determine which test results you want to see. If the Select Lab Test dialog appears, you need to choose the tests you want to see.

3.	If necessary, select the tests for which you want to see the results.

4.	Also, you may need to choose a date range (Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, or All Results.)

Related Topics

Ordering Lab Tests


Viewing Medications

The Meds tab contains a list of medications for the selected patient. Inpatient, outpatient, and Non-VA (including non-prescription and herbal) medications are listed in separate sections of the window.

When you select the Meds tab, you see a list of medications that have been ordered for this patient. If you would like to view additional information about a specific medication, double click the medication entry or select a medication and choose View | Details.

Note:	You can also review or add medication orders from the Orders tab. Also, if a medication is preceded by an asterisk (*), the asterisk indicates that the order was changed as a service correction.

The Meds tab shows three different areas: Inpatient Meds, Non-VA Meds, and Outpatient Meds as shown below. Directly below the Patient Inquiry button, CPRS displays the sort method for the Meds tab (in this case “Sort by Status/Exp. Date (IMO first on Inpt”)), followed by the date range for the medications viewed if a date range has been defined. If no date range has been defined, no dates display after the sort order, and CPRS will use the default dates from the pharmacy package.

Users should always check this line to see what they are viewing.

When ordering medications, you can order Outpatient Pharmacy or Inpatient Meds, which includes IV Fluids and Unit Dose.

Related Topics

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Entering Non-VA Medication Information

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Viewing Postings
Viewing a Posting

CPRS offers two ways to view a posting. You can view a posting by clicking the Postings button from any chart tab, or you can select a specific posting from the Cover Sheet tab.

To view a posting by using the Postings button, follow these steps:

1.	Select the Postings button.

The Patient Postings dialog appears. The Patient Postings dialog contains all postings for the selected patient. The postings are divided into two categories. Allergies are listed in the top half of the dialog and crisis notes, warning notes, and directives are listed in the bottom half.

2.	Select a posting to see a detailed explanation.

CPRS displays a new window that contains the full text of the posting.

3.	When you are finished reading the posting, select Close.

To view a specific posting from the Cover Sheet tab, follow these steps:

1.	Select a posting from the Postings pane one the Cover Sheet tab.

CPRS displays a new window that contains the full text of the posting.

2.	When finished, select Close.

Related topics

Postings (Overview)

Creating a New Posting


Viewing Progress Notes

To view the text of a progress note, follow these steps:

1.	Select the Notes tab.

2.	Select a document title from the left side of the screen. (Click the "+" sign to expand a heading.)

Note:	If a note has an addendum, the [image] icon will appear in front of the note title. You may view the addendum by clicking the "+" sign to expand the note title and then selecting the appropriate addendum.

The text of the progress note will be displayed on the right side of the screen.

3.	 (Optional) To view additional details of the progress note, such as editing history, patient record flag links, associated problems, select View | Details.

4.	To find specific text, use these steps.

Related Topics

Viewing All of the Progress Notes Under a Particular Heading

Viewing all Signed Notes, All Unsigned Notes, or All Uncosigned Notes

Viewing all Signed Notes by a Specific Author

Viewing all Signed Notes for a Date Range

Finding Specific Text in a Document


Viewing Vitals

CPRS displays the patient’s most recent vitals in the vitals area of the Cover Sheet (the vitals area is in the lower center). CPRS now uses the Vitals Lite Dynamic Link Library (.dll) to view and enter a patient’s vitals. Vitals Lite has its own online help. To access the Vitals Lite help, select Help | Quick Reference.

CPRS displays the following vitals and measurements:

•	Blood pressure

•	Central venous pressure

•	Circumference/girth

•	Height

•	Pain

•	Pulse

•	Pulse oximetry

•	Respiration

•	Temperature

•	Weight

Users bring up detailed vitals information by clicking anywhere in the vitals area on the CPRS cover sheet. By using the new Vitals Lite component, CPRS users can enter vitals with qualifiers, such as sitting, standing, actual, estimated, left arm, right leg, etc., and then on the Cover Sheet, CPRS displays the all vitals that have a value entered, any qualifiers, and the date the vital was entered. For example, a user might see blood pressure, temperature, and pulse from two months ago, while a value for pulse oximetry might be from six months ago.

CPRS users can enter vitals with qualifiers from the Cover Sheet or from the Vitals tab of the Encounter form.

The following items are also displayed in the Vitals view:

•	Body Mass Index (BMI): This value is calculated using the following formula:

BMI =	                 Weight in Kilograms

(Height in Meters) x (Height in Meters)

•	L/Min/%: Liters per minute of oxygen or percentage is entered when the user enters oxygen saturation based on Pulse oximetry.

•	In 24hr (c.c.): Intake for the past 24 hours measured in cubic centimeters is taken from the Intake and Output package.

•	Out 24hr (c.c.): Output for the past 24 hours measured in cubic centimeters is taken from the Intake and Output package.

To view the selected patient's vitals history, use these steps:

1.	Select a value in the Cover Sheet's Vitals area.

The Vitals Lite dialog appears.

2.	Additional help, bring up the Vitals Lite help by selecting Help | Quick Reference.

Related Topics

Entering Vitals


Processing Notifications

CPRS provides you with flexibility in processing, removing, and forwarding Notifications. First you select the alerts that you want to act on and then click the appropriate button. For processing notifications, you have three choices: Process Info, Process All, and Process, which will process those notifications that you have highlighted. When you are processing notifications, you can also renew a notification, which ensures that you will see the notification again the next time you log in, or forward the notification to one or more users.

Note:	Sometimes CPRS will display an alert that belongs to a sensitive record—one that the user cannot view. CPRS blocks access to sensitive records when the user is processing notifications and alerts. If the alert that cannot be viewed is the first one to be processed, CPRS will give an error message and return to the Patient Selection screen. If the sensitive record is for an alert other than the first, CPRS will process the alerts until it gets to the sensitive record and will then return the user to the Patient Selection screen. Then the user can reselect alerts, excluding the one to the sensitive record, and continue processing.

To process notifications, use these steps:

1.	Bring up the Patient Selection screen, either by launching CPRS or if you are already running CPRS, selecting File | Select New Patient.

2.	Decide which notifications to process.

o	To process all information notifications (items preceded by an I.), click Process Info.

o	To process all notifications, click Process All.

o	To process specific notifications, highlight one or more notifications, and then click Process. You can also process a notification by double-clicking on it.

Note:	To select a number of notifications in a row, click the first item, hold down the Shift key, and click the last item. All items in the range will be selected. To select multiple items that are not in a row, click one, hold down the Control key, and click the other specific notifications.

3.	Process the notification by completing the necessary task, such as signing an overdue order or viewing information notifications.

4.	If you want to renew or forward this notification to someone else, right-click the Next button and select either Renew or Forward as shown in the graphic below. If you selected Forward, proceed to step 5. If you selected Renew, go to step 6.

 This above graphic shows the pop-up menu items available by right-clicking the Next button.

5.	Select the individuals that you want to receive the Notification.

A.)	In the field labeled Select or enter name, type the first few letters of the person’s last name.

B.)	Find the person’s name in the list and click it to add it to the list of recipients.

C.)	Repeat steps A and B until all those you want to forward this notification to are listed under Currently selected recipients.

D.)	Type a comment if needed (comments are limited to 180 characters including spaces).

E.)	Select OK.

6.	Select the Next button on the status bar.

7.	Process the remaining notifications using steps 3-5.

8.	When finished, you may select a new patient (File | Select New Patient) or exit CPRS (File | Exit).

Related topics

Notifications and Alerts

Sorting Notifications and Viewing Comments of Forwarded Alerts

Removing Notifications

Forwarding Notifications


Viewing Orders

You can control which orders appear on the Orders tab by defining specific criteria. For example, you can specify that only unsigned orders associated with a specific service or section appear on the Orders tab.

Unsigned orders are underlined on the Orders tab. Unsigned orders for the current provider are bold and underlined.

Predefined views or sorting on the Orders tab include the following options:

•	Active Orders (including pending, recent activity) – This view includes orders that have a status of

o	Hold

o	Flagged

o	Pending

o	Active

o	Scheduled

o	Partial Results

o	Unreleased

o	Renewed

Recent activity also includes the following if their status changed in the number of hours you site defines in a system parameter:

o	Discontinued

o	Complete

o	Expired

o	Cancelled

•	Current Orders (active/pending status only) – This name of this view explains it, active and pending orders only.

•	Auto DC/Release Event Orders – This view includes only those orders that will be automatically discontinued or automatically released when an event occurs.

•	Expiring Orders – This view shows all orders that will expire between now and midnight or now and midnight of the following day if the following day is a holiday.

•	Unsigned Orders – This view shows orders that have not been signed.

•	Recently Expired Orders – This view shows orders that have expired within the number of hours specified by a system parameter.

Locating IV Orders on the Orders Tab

In which display group CPRS places the IV medication orders depends on how the pharmacist finishes it. After CPRS v. 27, IV orders entered through the Infusion dialog should display under the Infusion display group, while those entered through the Unit Dose dialog should display under the Inpatient display group (Inpt. Meds). However, the key is how the pharmacist finishes the order. If the pharmacist finishes the order as a Unit Dose medication, it will display under the Inpatient display group. If finished as an IV order, then CPRS displays the order under the Infusion display group.

Changing the View on the Orders Tab

To create a specific view of the orders, users have the Custom Order View menu option. When the user selects Custom Order View, the dialog should display with the settings of the current view.

To view orders on the Orders tab, follow these steps:

1.	Select the Orders tab.

2.	Select View | Active Orders (includes pending, recent activity), View | Current Orders (active, pending status only), View | Patient Event Orders, View | Expiring Orders, or View | Unsigned Orders | Recently Expired Orders.

-or-

Select the type of orders you would like to view from the View Orders pane on the left side of the dialog.

Note:	If you select View | Event Released Orders the Event Released Orders dialog box appears Select the release event associated with the orders you would like to view and click OK.

If you select View | Recently Expired Orders, the parameter ORWOR EXPIRED ORDERS stores the number of hours in the past that CPRS will look for expired orders. A coordinator can set that value for your site.

The appropriate orders will appear on the Orders tab.

If you would like to filter the orders further, continue with step 3.

3.	Select View | Custom Order View….

The Custom Order View dialog displays. The settings in the dialog should match what is currently displayed on the Orders tab.

Note:	To view Inpatient Medication for Outpatient orders, users can expand the All Services service/section and then select Clinic Orders or they can expand All Services, expand Pharmacy, and then select Clinic Orders.

4.	Select the criteria for the orders that you want to display on the Orders tab by doing some or all of the following:

o	Select an order status from the left side of the window. (Select the + to expand a heading.)

o	Select a service or section from the right side of the window.

o	If you would like to limit the orders to a specific date range, check the Only List Orders Placed During Time Period check box and enter a from and through date. Select [image] to choose a date from a calendar.

o	Select Reverse Chronological Sequence if you want the oldest orders to appear at the top of the Orders tab.

o	Select Group Orders by Service if you want the orders to be sorted according to the service they are associated with.

5.	Select OK.

6.	The orders that meet the criteria you specified on the Custom Order View dialog will appear on the Orders tab. The criteria for the displayed orders will appear above the Service column.

Note:	If all of the active orders are not displayed on the Orders tab, the [image] icon will appear below the Postings button (on the right side of the screen).

Using the right-click menu on the Orders tab, if the user selects several items and the right-clicks either on the items or elsewhere in the list, CPRS displays a popup menu. When the user selects an action from the popup menu, the action applies to all selected items. For example, if the user selects three orders and selects Discontinue, the dialog appears with those three orders listed for discontinuation.

However, if no items are selected (highlighted in blue) and the user right-clicks on an item, it is selected and the popup menu appears.

The Orders tab popup menu includes the following items:

•	Details…

•	Results

•	Results History…

•	Change…

•	Change Release Event

•	Copy to New Order…

•	Discontinue…

•	Refill…

•	Renew…

•	Sign…

Related Topics

Writing Orders (overview)

Ordering a Diet

Event-Delayed Orders

Transfer Medication Orders From Inpatient to Outpatient

Transfer Outpatient Medication to Inpatient

Signing Orders and Documents


Visits

A list of clinic visits and hospital admissions appears on the Cover Sheet.

To see the Progress Note from a clinic visit or a discharge summary from an admission, use these steps:

1.	Highlight a visit to select it.

2.	Select View | Details.

Note:	All Outpatient Encounters now have to be associated with a Visit, and include Provider, Diagnosis, and Procedure. If this information hasn't already been added (through Encounter Forms or manual entry into Scheduling, PCE, TIU, or other), you can enter it into CPRS.


Warnings

Information about a patient that medical center personnel need to be aware of, such as that a patient is violent.


What is CPRS?

The Computerized Patient Record System (CPRS) is a Veterans Health Information Systems and Technology Architecture (VISTA) product that integrates Adverse Reaction Tracking, Bed Control, Consults, Dietetics, Encounter Forms, Order Check Expert System, Inpatient Pharmacy, Laboratory, Order Entry, Outpatient Pharmacy, Problem List, Radiology/Nuclear Medicine, Registration, Scheduling, Text Integration Utilities, and Vitals.

CPRS 1.0 is a Windows program that presents all relevant patient data--including medical history and conditions, problems and diagnoses, diagnostic and therapeutic procedures, and interventions--in a way that directly supports clinical decision making. The goal of CPRS is to deliver an environment where providers can easily and efficiently obtain all clinically relevant information and enter all clinical orders.

Related Topics

What's the Difference between OE/RR and CPRS?

CPRS Guiding Principles

CPRS Features

How to Use Windows

CPRS Conventions

Getting Started--The Cover Sheet


Cover Sheet

The Cover Sheet is the first screen you see after opening a patient record (unless the site or user defines another tab as the initial screen). The Cover Sheet displays an overview of a patient’s condition and history. It shows active problems, allergies and postings, active medications, clinical reminders, lab results, vitals, and a list of appointments or visits.

You can quickly review the active problems (asterisks identify acute problems, and dollar signs identify unverified problems. Service Connected conditions are indicated by abbreviations in parentheses if Problem List patch GMPL*2.0*26 is installed. The pound symbol "#" shows problems that have inactive codes, which users can update using the Change action on the problems tab). Scroll bars beside a box mean that more information is available if you scroll up or down. Single-click on one of the five menus: File, Edit, View, Tools, or Help, to see choices of things you can do or other options available to you.

The File menu contains three menu items that you will use often:

•	Select New Patient

This menu item opens the Patient Selection dialog.

•	Update/Provider/Location

This menu item opens the Provider & Location for Current Activities dialog. This dialog enables you to change the clinician or location associated with an encounter.

•	Review/Sign Changes

This menu item enables you to view the orders you have placed that require an electronic signature, select the orders you want to sign at this time, and enter your electronic signature code (if you are an authorized signer).

Select any item to get more detailed information. For example, you can select the Patient Identification box (or button) to get more information about the patient. You can select on a Visit to see details. For example, a patient could have Zantac listed in the Allergies/Adverse Reactions dialog. By selecting it, you bring up a details screen that contains information, such as the causative agent, signs and symptoms, originator, dates, etc.

Select a tab at the bottom of the screen to go to that section of the patient chart.

Related Topics

Menu bar

Patient Information Box

CPRS Tabs

Provider Box

Patient Postings


What's the Difference between OE/RR and CPRS?

Order Entry/Results Reporting (OE/RR) Version 2.5 has evolved into the Computerized Patient Record System (CPRS). Although OE/RR encompassed more than just order entry and results reporting (including Progress Notes, Consults/Request Tracking, notifications, and so on), CPRS is more comprehensive in its components, capabilities, open architecture, and general design.

CPRS is the umbrella package for clinical software. You can access CPRS through either this graphical user interface (GUI)--Windows--or through the terminal-based user interface (List Manager). CPRS includes ordering, Consults, Progress Notes, Problem List, Imaging (X-rays and other procedures), Lab results, Discharge Summary, Reports, and other clinically relevant information and processes.

In short, CPRS supports the new directions of VISTA:

•	An increased focus on ambulatory care

•	Improved patient service through readier and more complete access to patient records

•	The ability to share and transfer data among disciplines and between facilities

•	The ability to track a patient's history and treatment over time

•	The ability to track costs

Related Topics

New Features and Components of CPRS


popup lab worksheet results
If you pick Worksheet while on the Labs tab, CPRS displays the results in a screen such as the one below:


Write a New Progress Note

To write a new note, use these steps:

1.	On the Notes tab, select New Note or select Action | New Progress Note....

Note:	If this visit is undefined, you will be prompted for encounter type and location, clinician, date, and type of visit, such as Ambulatory, Telephone, or Historical.

2.	In the Progress Note Properties dialog, select the following so that the note may be auto-saved:

Note:	The Progress Note Properties Dialog is where the user selects the progress note title, date, author, and in the case of a consult or patient record flag note, the consult number or patient record flag action for the note.

a)	Progress Note Title (e.g., General, SOAP, Warning, etc.). Additional items will appear on the dialog for titles that require entry of a cosigner or an associated consult.

b)	If necessary, change the note date by clicking the button next to the date and entering a new date.

c)	If necessary, change the note author by selecting the author from the Author drop-down list.

(Note about providers with similar first and last names.)

Note:	Occasionally a problem occurs if a cosigner’s access lapses and they have become "disusered". If this occurs, you can select OK and proceed with that selection or select Cancel and choose another cosigner.

d)	If the note is to resolve a consult or to document a patient record flag, select the consult number or the patient record flag action to which the note should be linked. To help users select the correct consult when a title that will resolve a consult is selected and a consult is available to resolve, a Show Details button that brings up the details of the consult is available.

Note:	If the user attempts to change the characteristics of a PRF note and has highlighted an action that reads Yes under note, CPRS assumes that the user is trying to link to an already linked action and will not allow the change to continue. However, if the user removes the highlight from the Yes action, the changes can occur.

e)	Select OK.

3.	In the main text box, enter the content of the note using one of more of the methods below:

o	Copy and paste from other documents

o	Type in text

o	Insert predefined text from templates.

a.	Select the Templates drawer.

b.	Locate the template you need.

c.	Double-click the template, drag-and-drop the template into the document, or right-click and select Insert Template. (It will be placed where the cursor is.)

d.	Repeat steps b and c as needed.

Note:	If you need to view the consult details while writing a note, bring up the popup menu by right-clicking in the note editing pane and choosing View Consult Details or using the shortcut Shift+Ctrl+U.

Note:	Spell checking and grammar checking are now available in the CPRS GUI.

4.	After you enter the note, if you select Encounter, you can enter encounter information for the visit.

Diagnosis, procedure, and Visit Type are required. The check boxes are based on the Encounter Form defined for the Progress Note Title you select. When you click on Other Diagnoses or Other Procedures, a Lexicon look up (terms with their corresponding ICD or CPT codes) is displayed for you to choose from.

Note:	When finished, you can continue working or select an item from the Action menu, such as Sign Note Now..., Save Without Signature, or Add to Signature List.

Related Topics

Progress Notes

Sign Document Now

Opening and Reviewing Progress Notes

Editing a Progress Note

Adding to Existing Progress Notes (addendum)

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates


Discharge Summary

The discharge summary is a formal recapitulation of the patient's course of care, which includes pertinent diagnostic and therapeutic steps and the conclusions reached as a result. It is prepared for all discharges from a VA medical center, domiciliary, and nursing home, following guidelines in Chapter 5 of the VA Operations Manual M-1.


Procedures

Radiology/Nuclear Medicine procedures, ECGs, etc.


Tubefeeding Quantity

The following may be entered for quantity:

•	Units: K for Kcals; M for ml; O for oz.; or U for units (such as cans); PKG

•	Frequency: Daily, Hour, QH, BID, TID, QID, Q2H, Q3H, Q4H, or Q6H

Or 100 ml/HR X 16 for 16 hours

•	If powder form product, then (# GRAMS or # Unit or PKG)/FREQUENCY

Examples:

20 GRAMS/DAY

1 PKG/TID

6 U/D

1 U/Q3H

50ml/TID, 100 ML/HR


Troubleshooting

You will find some troubleshooting tips for CPRS at the following World Wide Web address:

CPRS Troubleshooting and FAQ

The above address takes you to a Web page containing frequently asked questions (FAQs) and a few common error messages with their explanations.


Using CPRS

Opening a Patient Record

Cover Sheet

Notifications and Alerts

Problem List

Viewing Medications

Results

Progress Notes

Viewing Orders

Writing Orders

Consults

Discharge Summaries

Viewing Laboratory Test Results

Reports

Visits (Encounter Information)

Postings


Consults

Consults are requests from one clinician to a hospital, service or specialty for a procedure or other service.

The Consults process involves the following steps.

1.	The clinician orders a consult. From within the patient’s CPRS medical record, the clinician enters an order for a consultation or procedure. The ordering clinician may first have to enter Encounter Information.

2.	The consult service receives an alert and a printed SF 513. The receiving service can then accept the consult, forward it to another service, or send it back to the originating clinician for more information.

3.	The consult service accepts or rejects the consult request. To accept the consult, the service uses the receive action. The service can also discontinue or cancel the consult. Cancelled consults can be edited and resubmitted by the ordering clinician. A consult service clinician sees the patient.

The consult service enters results and comments. Resulting is primarily handled through TIU.

4.	The originating clinician receives a CONSULT/REQUEST UPDATED alert that the consult is complete. The results can now be examined and further action can be taken on behalf of the patient.

5.	The SF 513 report becomes part of the patient’s medical record. A hard copy can be filed and the electronic copy is on line for paperless access.

6.	Results from the Medicine package can be attached to complete consults involving procedures. This function is available through the GUI for the Consults package, but will only be seen when the supporting Consults patch GMRC*3.0*15 is installed. The absence of these patches will result only in the function not being present.

7.	If Consults patch GMRC*3.0*18 has been installed, the Edit/Resubmit action is available for cancelled consults. The consult must be "resubmittable" and the user must be authorized to resubmit consults.

8.	The Consults tab has a list of consults in a tree view similar to the ones found on the Notes tab and the Discharge Summary tab. However, the list view feature is not available due to differences in the tabs functions. Consults are differentiated from procedures in the tree by the type of icon displayed. Consults are represented by a notepad icon while procedures are represented by a caduceus-like icon.

9.	Right-click in the Consults text and you may select the "Find in Selected Consult" option from the popup menu. This option allows you to search the displayed text. A "Replace Text" option is also available, but it is only active when a consult is being edited.

10.	The field below the list of consults displays a list of documents related to the highlighted consult or procedure. These related documents are also in a tree view.

Related topics

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults

Changing Views on the Consults tab


Complete a Consult from the Consults Tab
Complete a Consult or Clinical Procedure from the Consults Tab

Note:	Until Clinical Procedures 1.0 is released, completion of all consults and procedures will continue to function as it does currently.  After the installation and implementation of Clinical Procedures 1.0, any procedure defined as a Clinical Procedure will be completed using a document from the "Clinical Procedures" TIU class, which has some unique properties.  In addition, to complete a Clinical Procedure, a person must be defined as an interpreter (update user) for the consult service to which the Clinical Procedure was directed.

To complete a consult from the Consults tab, complete the following steps:

1.	Select the Consults tab.

2.	Select on Action | Consult Results | Complete/Update Results.

Note:	If this visit is undefined, you will be prompted for encounter type and location, clinician, date, and type of visit, such as Ambulatory, Telephone, or Historical.

3.	In the Consult Note Properties dialog, select Progress Note Title (e.g., General, SOAP, Warning, etc.). For titles that require entry of a cosigner, another field will display where the user can enter the information.

In the Consult Note Properties dialog, the user selects the items for the note that will complete the consult, including the Note title, the date and time (if not when the user began the note), and the author, which should default to the user if the user is a provider.

4.	If necessary, change the note date by selecting the button next to the date and entering a new date or by typing in a new date and time directly in the field.

5.	If necessary, change the note author by selecting the author from the Author drop-down list.

(Note about providers with similar first and last names.)

6.	Enter any additional information, such as an associated consult or expected cosigner. Completing these steps will allow the note to be automatically saved.

Note:	Occasionally a problem occurs if a cosigner’s access lapses and they have become "disusered". If this occurs, you can click OK and proceed with that selection or click Cancel and choose another cosigner.

7.	Select OK.

8.	Create your note by typing text, using templates, and including any test results.

Note:	If you need to view the consult details while writing a note, bring up the popup menu by right-clicking in the note editing pane and choosing View Consult Details or using the shortcut Shift+Ctrl+U.

9.	From the Action menu, select either Sign Note Now or Save without Signature.

Note:	The Date/Time Performed and Procedure Summary Code fields must also be completed on the first CP document that completes the procedure request. Completing the Date/Time Performed and Procedure Summary Code fields is optional on subsequent CP documents.

Related Topics

Consults (overview)

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


Complete a Consult from the Notes Tab

1.	Select the Notes tab.

2.	Select the New Note button (or select New Progress Note from the Action menu).

Note:	If this visit is undefined, you will prompted for encounter type and location, clinician, date, and type of visit, such as Ambulatory, Telephone, or Historical.

3.	In the Progress Note Properties dialog, select the following so that the note may be auto-saved:

a)	Progress Note Title (e.g., General, SOAP, Warning, etc.). Additional items will appear on the dialog for titles that require entry of a cosigner or an associated consult.

b)	At the bottom of the Progress Note Properties dialog, select the consult that the note is resolving. If you need help choosing the consult, highlight the consult and select the Show Details button as shown below:

The Show Details button helps the user select the correct consult to resolve.

c)	If necessary, change the note author by selecting the author from the Author drop-down list.

(Note about providers with similar first and last names.)

d)	Enter any additional information, such as an associated consult or expected cosigner.

Note:	Occasionally a problem occurs if a cosigner’s access lapses and they have become "disusered". If this occurs, you can click OK and proceed with that selection or click Cancel and choose another cosigner.

e)	Click OK.

4.	From the Consult Request Selection dialog, select the consult you are closing.

5.	Type your note, including any test results.

6.	From the Action menu, select either Sign Note Now or Save without Signature.

Related topics

Consults (overview)

Complete a Consult from the Consults Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


New Consult from the Orders Tab
Ordering a Consult from the Orders Tab

To order a consult from the Orders tab follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Consult in the Write Orders list.

Note:	The consults order may be labeled differently or may not be available from your Write Orders field.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Order a Consult dialog. You must complete the encounter information dialog before proceeding.

The Order a Consult dialog displays.

4.	Select a type of consult from the Consult to Service/Specialty field.

When you select the Consult Service or Specialty, several things may happen:

o	If the service has some prerequisites, a dialog will display stating what those are and will allow you to print the information, continue to place the consult order, or cancel the order.

o	In addition, any predefined text or template will display to help the user fill out the Reason for Request field.

o	The Provisional Diagnosis field becomes active as well.

5.	Select an urgency from the Urgency field.

6.	Select an individual from the Attention field.

(Note about providers with similar first and last names.)

7.	If needed, designate a different Earliest Appropriate Date (the default is Today).

Note:	The Earliest Appropriate Date field does not apply to Prosthetics consults services, and the field is not available when the user selects a Prosthetic service.

8.	Choose inpatient or outpatient from the "Patient will be seen as an:" option group.

9.	Choose a location from the Place of Consultation drop-down box.

10.	Enter a provisional diagnosis.

Note:	If a user tries to enter a diagnosis with an inactive code, CPRS will bring up a message indicating that the code must be changed and giving the user the chance to choose a diagnosis with and active code.

For each consult, this field is either set up to require that

o	The user type in an answer (the box will be white and the Lexicon button unavailable), or

o	The user must select a response must be from the Lexicon (the field will be yellow and the Lexicon button is available).

11.	Enter a reason for the request in the Reason for Request field.

Sites can help users by putting in predetermined boilerplate text, text with TIU objects, and/or it could be linked to a template that users can fill out. Users can then add to the text already present. Or the field may be left blank for the user to fill in the reason. However, a reason for request is required and the consult cannot be saved without a reason for request.

12.	Select Accept Order.

13.	Enter another consult

-or-

select Quit.

Note:	You may sign the consult now or wait to later.

Relate topics

Consults (overview)

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


New Consult from the Consults Tab

1.	Go to the Consults tab.

2.	Select the New Consult button.

3.	If the Provider & Location for Current Activities dialog opens, fill in the Visit Location and other information and select OK.

4.	Select a service from in the Consult to Service/Specialty window.

When you select the Consult Service or Specialty, several things may happen:

o	If the service has some prerequisites, a dialog will display stating what those are and will allow you to print the information, continue to place the consult order, or cancel the order.

o	In addition, any predefined text or template will display to help the user fill out the Reason for Request field.

o	The Provisional Diagnosis field becomes active as well.

5.	Select the urgency from the Urgency field.

6.	Select the person to whom you are sending the consult from the Attention field.

(Note about providers with similar first and last names.)

7.	If necessary, enter a different Earliest Appropriate Date (Today is the default).

Note:	The Earliest Appropriate Date field does not apply to Prosthetics consults services, and the field is not available when the user selects a Prosthetic service.

8.	Select whether the consult is for an inpatient or an outpatient.

9.	Select the Place of Consultation from the list.

10.	Enter a Provisional Diagnosis

For each consult, this field is either set up to require that

o	The user type in an answer (the box will be white and the Lexicon button unavailable), or

o	The user must select a response must be from the Lexicon (the field will be yellow and the Lexicon button is available).

Note:	If a user tries to enter a diagnosis with an inactive code, CPRS will bring up a message indicating that the code must be changed and giving the user the chance to choose a diagnosis with and active code.

11.	Fill in a Reason for Request.

Sites can help users by putting in predetermined boilerplate text, text with TIU objects, and/or it could be linked to a template that users can fill out. Users can then add to the text already present. Or the field may be left blank for the user to fill in the reason. However, a reason for request is required and the consult cannot be saved without a reason for request.

12.	Select Accept Order.

13.	If finished ordering consults for this patient, select Quit.

14.	You may sign the consult now or later.

Related topics

Consults (overview)

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

New Procedure from the Orders Tab

Viewing Consults


New Procedure from the Consults Tab

1.	Select the Consults Tab.

2.	Select the New Procedure button.

3.	If the Provider & Location for Current Activities dialog opens, fill in contact information, and select OK.

4.	Locate and select the procedure in the Procedure list.

When you select the Consult Service or Specialty, several things may happen:

o	If the service has some prerequisites, a dialog will display stating what those are and will allow you to print the information, continue to place the consult order, or cancel the order.

o	In addition, any predefined text or template will display to help the user fill out the Reason for Request field.

o	The Provisional Diagnosis field becomes active as well.

5.	Select the urgency from the Urgency field.

6.	Select an individual from the Attention field. (Note about providers with similar first and last names.)

7.	If needed, designate a different Earliest Appropriate Date (the default is Today).

Note:	The Earliest Appropriate Date field does not apply to Prosthetics consults services, and the field is not available when the user selects a Prosthetic service.

8.	If necessary, select a service that will perform the procedure by using the down arrow to open the list and then selecting the service.

Often, the service is already defined. However, sometimes, the user has the chance to choose.

9.	Select whether the patient is an inpatient or outpatient.

10.	Select a place of consultation from the Place of Consultation drop-down list.

11.	Enter a provisional diagnosis in the Provisional Diagnosis field.

For each procedure, this field is either set up to require that

o	the user type in an answer (the box will be white and the Lexicon button unavailable), or

o	the user must select a response must be from the Lexicon (the field will be yellow and the Lexicon button is available).

Note:	If a user tries to enter a diagnosis with an inactive code, CPRS will bring up a message indicating that the code must be changed and giving the user the chance to choose a diagnosis with and active code.

12.	Enter a reason for this request in the Reason for request field.

Sites can help users by putting in predetermined boilerplate text, text with TIU objects, and/or it could be linked to a template that users can fill out. Users can then add to the text already present. Or the field may be left blank for the user to fill in the reason. However, a reason for request is required and the consult cannot be saved without a reason for request.

13.	Select Accept Order.

14.	If there are no other procedure orders for this patient, select Quit.

15.	You may sign the consult now or later.

Related topics

Consults (overview)

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Orders Tab

Viewing Consults


New Procedure from the Orders Tab
Order a Procedure from the Orders Tab

To order a procedure, follow these steps:

1.	Select the Orders tab.

2.	Select Procedure in the Write Orders list box.

Note:	The procedure order may be labeled differently or may not be available from your Write Orders list box.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Order a Procedure dialog. You must complete the encounter information dialog before proceeding.

The Order a Procedure dialog displays.

3.	Locate and select the desired procedure in the Procedure list.

When you select the Consult Service or Specialty, several things may happen:

o	If the service has some prerequisites, a dialog will display stating what those are and will allow you to print the information, continue to place the consult order, or cancel the order.

o	In addition, any predefined text or template will display to help the user fill out the Reason for Request field.

o	The Provisional Diagnosis field becomes active as well.

4.	Select the urgency from the Urgency field.

5.	Select an individual from the Attention field.

(Note about providers with similar first and last names.)

6.	If needed, designate a different Earliest Appropriate Date (the default is Today).

Note:	The Earliest Appropriate Date field does not apply to Prosthetics consults services, and the field is not available when the user selects a Prosthetic service.

7.	If necessary, select a service that will perform the procedure by using the down arrow to open the list and then selecting the service.

Often, the service is already defined. However, sometimes, the user has the chance to choose.

8.	Select whether the patient is an inpatient or outpatient.

9.	Select a place of consultation from the Place of Consultation drop-down list.

10.	Enter a provisional diagnosis in the Provisional Diagnosis field. (Click the Lexicon button to access the lexicon.)

For each procedure, this field is either set up to require that

o	the user type in an answer (the box will be white and the Lexicon button unavailable), or

o	the user must select a response must be from the Lexicon (the field will be yellow and the Lexicon button is available).

Note:	If a user tries to enter a diagnosis with an inactive code, CPRS will bring up a message indicating that the code must be changed and giving the user the chance to choose a diagnosis with an active code.

11.	Enter a reason for this request in the Reason for Request field.

Sites can help users by putting in predetermined boilerplate text, text with TIU objects, and/or it could be linked to a template that users can fill out. Users can then add to the text already present. Or the field may be left blank for the user to fill in the reason. However, a reason for request is required and the consult cannot be saved without a reason for request.

12.	Select Accept Order.

13.	Enter another procedure order

-or-

select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related topics

Consults (overview)

Complete a Consult from the Consults Tab

Complete a Consult from the Notes Tab

New Consult from the Consults Tab

New Consult from the Orders Tab

New Procedure from the Consults Tab

Viewing Consults


Entering Allergies

You can enter allergies or adverse reactions from the Orders tab and the Cover Sheet tab.

Related topics

Entering Allergies from the Orders Tab

Entering Allergies from the Cover Sheet Tab

Entering No Known Allergies Assessments

Viewing Allergies/Adverse Reactions

Marking Allergies as Entered in Error


Entering Allergies from the Orders Tab

Although allergies and adverse reactions are not orders and CPRS does not display them on the Orders tab, you can enter allergies and adverse reactions from the Orders tab.  You can also enter allergies from the Cover Sheet tab. (See Entering Allergies from the Cover Sheet.)

To enter allergies or adverse reactions from the Orders tab, take the following steps:

1.	Select the Orders tab.

2.	Select Allergies from the Write Orders pane.

The Allergy Reactant Lookup dialog appears.

Note:	Your site may have defined and configured other order menus to include allergy-entry dialogs. Regardless of the allergy-entry menu you select, if you haven’t entered encounter information, CPRS displays the Location for Current Activities dialog before displaying the Allergy Reactant Lookup dialog. You must complete the Location for Current Activities dialog before proceeding.

3.	Type the causative agent in the search field. (You must enter the first three letters (minimum) of the agent’s name.)

4.	Select Search.

Matching agents appear in the Select from one of the following items pane. If the causative agent you typed does not match any of the agents currently available for your site, CPRS displays the Causative Agent Not On File dialog, from which you can select one of the following options:

Note:	The patient’s chart will not be updated unless you choose a causative agent that is on file.

a)	Yes: Use this option to request that the causative agent be added for your site. When you click Yes, CPRS displays the Enter Optional Comments dialog, which enables you to type additional comments (optional), such as the signs or symptoms that occurred as a result of contact with this causative agent, or whether you observed these symptoms firsthand. After you type your comments, click Continue. CPRS then sends to members of your site’s GMRA Request New Reactant mail group a message that includes the following items:

•	The causative agent you attempted to enter

•	The name of the patient for whom you attempted to make this entry

•	Your name, title, and contact information

•	Your comments

Note:	When the bulletin is sent, a message such as the following will display. This message also informs the user that the allergy was NOT entered into the patient’s record.

“Members of your site’s GMRA Request New Reactant mail group will review this message and, if appropriate, add the causative agent to your site’s ALLERGIES file.”

Note:	If your site’s IRM staff has not yet added members to your site’s GMRA Request New Reactant mail group, CPRS displays the following message: Mail group GMRA Request New Reactant has no members – Contact IRM.

b)	No: Use this option if you want to try an alternate spelling or trade name for your causative agent, or if you want to type another causative agent.

c)	Cancel: Use this option if you want to cancel your allergy order.

5.	If the causative agent you typed matches an agent that is currently available for your site, select the agent. (Click + to expand a heading.)

Note:	With CPRS GUI 24 or later, you may not add free-text causative agents. If you select an item under the "Add new free-text allergy" heading, CPRS displays the Causative Agent Not On File dialog.

6.	Select OK.

The Enter Allergy or Adverse Reaction dialog appears.

Note:	You can view a patient’s current allergies or adverse reactions by clicking the Active Allergies button. Also, CPRS no longer allows the user to change the allergy Originator.

7.	Use the Observed or Historical option button to indicate whether the entry is for an observed or historical allergy, respectively. (When you point your mouse at either of these buttons, CPRS displays a hover hint explaining the observed and historical options.)

Note:	Observed or Historical used to have a default, but the user must now select the appropriate choice. CPRS does not allow you to select future dates for observed allergy/adverse reaction entries.

Note:	When you select Observed for a drug reaction, CPRS generates a Progress Note. Once this note is signed by the user entering the allergy or by an administrative update user, the note will be viewable by all users.

8.	Select the Nature of Reaction (Allergy, Pharmacological, or Unknown).

The Nature of Reaction (also known as mechanism) can be Allergy, Pharmacologic, or Unknown. An allergic reaction occurs because the patient is sensitive to a causative agent, regardless of the amount the patient is exposed to. A pharmacologic (non-allergic) reaction occurs when the patient is sensitive to an agent under certain conditions, such as exposure to a large amount. Unknown is provided if you are not sure what mechanism to enter.

Note: 	Allergies are a subset of the world of adverse reactions. All allergies are adverse reactions, but not all adverse reactions are allergies.

9.	If you are entering an observed allergy, use the Reaction Date/Time and Severity boxes to select a reaction date, time, and severity. (The Severity box is not visible for historical allergies. When the Severity box is visible, CPRS displays a ? button next to it. If you click this button, CPRS displays text that provides information about available severity selections.)

Note:	CPRS does not allow you to enter future dates for observed reactions.

10.	Using the Signs/Symptoms box, select one or more signs or symptoms.  The signs and symptoms you select appear in the Selected Symptoms pane.

11.	To associate a date and time with a symptom (optional), click to select the symptom in the Selected Symptoms pane.

12.	Select the Date/Time button located below the Selected Symptoms pane.

CPRS displays the Select Date/Time dialog, from which you can select the date and time that the symptom first appeared.

Note:	If you mistakenly enter a sign or symptom but have not yet accepted it by selecting OK, select the symptom in the Selected Symptoms pane and click the Remove button located beneath the pane.

13.	Type comments for the allergy in the Comments box.

14.	If you have marked the allergy or adverse reaction on the patient’s identification (ID) band (or if you know someone else has), select the ID Band Marked check box.

Note:	CPRS activates the ID Band Marked check box only for inpatients and then only if your site’s IRM staff has set a parameter indicating that your site wants to track this information.  Depending on whether your IRM staff has set related parameters, if you do not select activated ID Band Marked check box, the system may send a bulletin notifying a mail group that the patient’s allergy or adverse reaction is not marked on his or her ID band.

15.	Select OK.

 Related topics

Entering Allergies from the Cover Sheet Tab

Causative Agent Not on File

Marking Allergies as Entered in Error

Viewing Allergies/Adverse Reactions


Entering Allergies from the Cover Sheet Tab

You can enter a new allergy or adverse reaction from the Cover Sheet tab in either of two ways:

•	Right-click anywhere within the Allergies/Adverse Reactions pane.

•	Click to display more information about a causative agent listed in the Allergies/Adverse Reactions pane.

Method One

Take the following steps to enter new allergies using the first of the two methods mentioned above:

1.	Move your mouse arrow to a location anywhere within the Allergies/Adverse Reactions pane.

2.	Right-click to display a pop-up menu.

3.	From this menu, select Enter new allergy. CPRS displays the Allergy Reactant Lookup dialog.

4.	In the Enter causative agent for Allergy or Adverse Drug Reaction field, type the first three characters (minimum) of the causative agent’s name.

5.	Select Search. CPRS displays a list of possible matches.

6.	If the causative agent you typed does not match any of the agents currently available for your site, CPRS displays the Causative Agent Not On File dialog, from which you can select one of the following three options:

Note:	The patient’s chart will not be updated unless you choose a causative agent that is on file.

a)	Yes: Use this option to request that the causative agent be added for your site’s ALLERGIES file. When you click Yes, CPRS displays the Enter Optional Comments dialog, which enables you to type additional comments (optional), such as the signs or symptoms that occurred as a result of contact with this causative agent, or whether you observed these symptoms firsthand. After you type your comments, click Continue. CPRS then sends to members of your site’s GMRA Request New Reactant mail group a message that includes the following items:

•	The causative agent you attempted to enter

•	The name of the patient for whom you attempted to make this entry

•	Your name, title, and contact information

•	Your comments

Note:	When the bulletin is sent, a message such as the following will display. This message also informs the user that the allergy was NOT entered into the patient’s record.

Members of your site’s GMRA Request New Reactant mail group will review this message and, if appropriate, add the causative agent to your site’s ALLERGIES file.

Note:	If your site’s IRM staff has not yet added members to your site’s GMRA Request New Reactant mail group, CPRS displays the following message: Mail group GMRA Request New Reactant has no members – Contact IRM

b)	No: Clicking No enables you to try an alternate spelling or trade name for your causative agent, or to type another causative agent.

c)	Cancel: Use this option if you want to cancel your allergy order.

7.	If the causative agent you typed matches an agent that is currently available for your site, select the agent. (Click + to expand a heading.)

Note:	With CPRS GUI 24 or later, you may not add free-text causative agents. If you select an item under the "Add new free-text allergy" heading, CPRS displays the Causative Agent Not On File dialog.

8.	Select OK.

The Enter Allergy or Adverse Reaction dialog appears.

Note:	You can view a patient’s current allergies or adverse reactions by selecting the Active Allergies button. Also, the user previously could change the Originator, but this is no longer allowed. The originator is the user logged in.

9.	Use the Observed or Historical option button to indicate whether the entry is for an observed or historical allergy, respectively. (If you point your mouse at either of these option buttons, CPRS displays a hover hint that explains the observed and historical options.)

Note: 	Observed or Historical used to have a default, but the user must now select the appropriate choice. CPRS does not allow you to select future dates for observed allergy/adverse reaction entries.

Note:	When you select Observed for a drug reaction, CPRS generates a Progress Note. Once this note is signed by the user entering the allergy or by an administrative update user, the note will be viewable by all users.

10.	Select the Nature of Reaction (Allergy, Pharmacological, or Unknown).

The Nature of Reaction can be Allergy, Pharmacologic, or Unknown. An allergic reaction occurs because the patient is sensitive to a causative agent, regardless of the amount the patient is exposed to. A pharmacologic (non-allergic) reaction occurs when the patient is sensitive to an agent under certain conditions, such as exposure to a large amount. Unknown is provided if you are not sure what Nature of Reaction (mechanism) to enter.

Note: 	Allergies are a subset of adverse reactions. All allergies are adverse reactions, but not all adverse reactions are allergies.

11.	If you are entering an observed allergy, use the Reaction Date/Time and Severity boxes to select a reaction date, time, and severity. (The Severity box is not visible for historical allergies. If the Severity box is visible, CPRS displays a ? button at its side. If you select this button, CPRS displays text explaining severity selections.)

12.	Using the Signs/Symptoms box, select one or more signs or symptoms. The signs and symptoms you select appear in the Selected Symptoms pane.

Note:	Signs and symptoms must be selected from the list. Users cannot enter free-text entries.

13.	To associate a date and time with a symptom (optional), click to select the symptom in the Selected Symptoms pane.

14.	Select the Date/Time button located below the Selected Symptoms pane. CPRS displays the Select Date/Time dialog, from which you can select the date and time that the symptom first appeared.

Note:	If you mistakenly enter a sign or symptom but have not yet accepted it by selecting OK, select the symptom in the Selected Symptoms pane and select the Remove button located beneath the pane.

15.	Type comments for the allergy in the Comments text box.

16.	If you have marked the allergy or adverse reaction on the patient’s identification (ID) band (or if you know that someone else has), select the ID Band Marked check box.

Note:	CPRS activates the ID Band Marked check box only for inpatients and then only if your site’s IRM staff has set a parameter indicating that your site wants to track this information. Depending on whether your IRM staff has set related parameters, if you do not select activated ID Band Marked check box, the system may send a bulletin notifying a mail group that the patient’s allergy or adverse reaction is not marked on his or her ID band.

17.	Select OK.

CPRS displays the newly entered causative agent in the Allergies/Adverse Reactions pane. If you click on the causative agent, CPRS displays all of the information you just entered about the associated allergy or adverse reaction. CPRS also displays the letter A (for allergies) on the Postings button and the word Allergies in the Postings pane. If you click the word Allergies in the Postings pane, CPRS displays selected information about all of the patient’s active allergies and adverse reactions, including the allergy or adverse reaction you just entered.

Method Two

Take the following steps to enter a new allergy using the second of the two methods mentioned above:

1.	Select a causative agent listed in the Allergies/Adverse Reactions pane. CPRS displays a dialog that includes details about the allergy or adverse reaction associated with the selected causative agent. The dialog also includes four buttons.

2.	Select the Add New button.

CPRS displays the Allergy Reactant Lookup dialog.

3.	Follow steps 4 through 17 of the instructions for entering allergies using the first method. CPRS displays the newly entered causative agent in the Allergies/Adverse Reactions pane. If you click on the causative agent, CPRS displays all of the information you just entered about the associated allergy or adverse reaction. CPRS also displays the letter A (for allergies) on the Postings button and the word Allergies in the Postings pane. If you click the word Allergies in the Postings pane, CPRS displays selected information about all of the patient’s allergies or adverse reactions, including the allergy or adverse reaction you just entered.

Related topics

Causative Agent Not On File

Entering Allergies from the Orders Tab

Marking Allergies as Entered in Error

Viewing Allergies/Adverse Reactions

Viewing Postings


Causative Agent Not On File

If you can’t enter an allergy because the causative agent does not match any of the causative agents currently available for your site, CPRS displays the Causative Agent Not On File dialog, from which you can select one of the following three options:

1.	Yes: Use this option to request that the causative agent be added for your site. When you click Yes, CPRS displays the Enter Optional Comments dialog, which enables you to type additional comments (optional), such as the signs or symptoms that occurred as a result of contact with this causative agent, or whether you observed these symptoms firsthand. After you type your comments, click Continue. CPRS then sends to members of your site’s GMRA Request New Reactant mail group a message that includes the following items:

o	The causative agent you attempted to enter

o	The name of the patient for whom you attempted to make this entry

o	Your name, title, and contact information

o	Your comments

Note:	When the bulletin is sent, a message such as the following will display. This message also informs the user that the allergy was NOT entered into the patient’s record.

Members of your site’s GMRA Request New Reactant mail group will review this message and, if appropriate, add the causative agent to your site’s ALLERGIES file.

Note:	If your site’s IRM staff has not yet added members to your site’s GMRA Request New Reactant mail group, CPRS displays the following message: Mail group GMRA Request New Reactant has no members – Contact IRM

2.	No: Clicking No enables you to try an alternate spelling or trade name for your causative agent, or if you want to type another causative agent.

3.	Cancel: Use this option if you want to cancel your allergy entry.

Related topics

Entering Allergies from the Cover Sheet Tab

Entering Allergies from the Orders Tab


Marking Allergies as Entered in Error

CPRS offers two methods for marking allergies as entered in error from the Cover Sheet tab. To mark an allergy as entered in error, the user must have the parameter OR ALLERGY ENTERED IN ERROR appropriately set.

Method One

Take the following steps to use the first method:

1.	In the Allergies/Adverse Reactions pane, place your mouse pointer over an erroneously entered causative agent and right-click to display a menu.

2.	From this menu, select Mark selected allergy as entered in error.

CPRS displays the Mark Allergy/Adverse Reaction Entered In Error dialog.

3.	If your site has enabled the Comments feature, you may (optionally) type comments in the Comments (optional) dialog.

Note:	If your site has not enabled the Comments feature, CPRS disables the dialog, which in this case is named Comments (disabled).

4.	Select OK.

CPRS displays an Are you sure? dialog.

5.	If you are sure the causative agent was entered in error, select Yes. CPRS removes the causative agent from the Allergies/Adverse Reactions pane and from the list of allergies it displays when you click Allergies in the Postings pane.

Note:	CPRS also generates a Progress Note when an allergy is marked "Entered in Error". When this note is signed by the user who marked the allergy as entered in error or by an administrative update user, the note will be viewable by all CPRS users.

Method Two

Take the following steps to use the second method:

1.	Select a causative agent (or highlight and press <Enter>) that appears in the Allergies/Adverse Reactions pane.

CPRS displays a dialog that contains detailed information about the allergy or adverse reaction. This dialog includes four buttons.

2.	Select the Entered in Error button.

CPRS displays the Mark Allergy/Adverse Reaction Entered In Error dialog.

3.	If your site has enabled the Comments feature, you may (optionally) type comments in the Comments (optional) dialog.

4.	Select OK.

CPRS displays an Are you sure? dialog.

5.	If you are sure the causative agent was entered in error, Select Yes.

CPRS removes the causative agent from the Allergies/Adverse Reactions pane and from the list of allergies it displays when you click Allergies in the Postings pane.

Note:	CPRS also generates a Progress Note when an allergy is marked "Entered in Error". When this note is signed by the user who marked the allergy as entered in error or by an administrative update user, the note will be viewable by all CPRS users.

Related topics

Entering Allergies from the Cover Sheet Tab

Entering Allergies from the Orders Tab

Viewing Allergies/Adverse Reactions

Viewing Postings


Lab Status

As the name implies, you can use this option to check on the status of labs that have been ordered for the selected patient. The orders are grouped by date and show the order number, the type of lab ordered, the provider, the urgency, and the status.


About this Help File

This help file is for patch OR*3.0*280 (CPRS GUI v.28). There was a major change in this help file a few versions back. Due to technical changes, it was necessary to remove many of the graphics in this help file. With the graphics in, the file size became unmanageably large. However, many of the graphics that were in the help file are included in the CPRS User Guide: GUI Version. Your site should have this document. If you do not have it, please contact your Information Resource Management (IRM) staff or your Clinical Application Coordinator (CAC).

To perform as designed, you should have three files for the help system: CPRS.HLP, CPRS.CNT, and CPRSWT.HLP. These three files should be installed in the same directory as the CPRS executable.


Spell checking
Spell Checking for Notes, Consults, and Discharge Summaries

You can use spell checking on notes, consults, and discharge summaries if you have Microsoft Word 97, Word 2000, or Word 2003 on your workstation.

To spell check a document or a selection, use these steps:

1.	To spell check the entire document, skip to step 2. Click-and-drag to select text if you want to only check a selection.

2.	Right-click on the selection or document and select Spell Check....

To add another dictionary, such as an online medical dictionary to Word's spell checker, see the Microsoft Word Help file entries about dictionaries.


Document Templates (overview)

With the CPRS GUI, you can create document templates to quickly add commonly used text and Template Fields when writing or editing progress notes, completing consults, or writing discharge summaries. Template import and export utilities are available through the Template Editor Tools menu. A print button has been added to the Preview Templates dialog so that you may either view the template on the screen or send it to a printer.

You can go to the following areas of this overview:

•	Personal and Shared Templates talks about the difference between shared and personal templates.

•	Types of Templates discusses templates, group templates, and folders.

•	Arranging Topics for Ease of Use talks very briefly about grouping templates.

•	Creating and Modifying Shared and Personal Templates explains uses and features of Template Editor.

•	Using Templates to Create Documents gives a brief look at how to add template text and objects to documents.

•	Template Fields explains how to add text fields to templates.

Personal and Shared Templates

You can create and use your own templates or you can use shared templates created by your Clinical Coordinator. The icon legend shows you the various icons and what they represent.

•	Personal templates. Authorized users can create personal templates. You can copy and paste text into a template, type in new content, add Template Fields, or copy a shared template into your personal templates folder. A shared template that you simply copy into your personal templates folder without changing continues to be updated whenever the original template is changed or modified in the Shared Templates folder. Once you personalize or change the copy of the shared template in your personal templates folder, the icon used to represent it changes and it become a personal template. From that moment on, the personal template is not related to the shared template and is not updated with the original. Personal template and folder icons have a folded upper right corner. In the tree view, personal template and folder icons have a folded corner.

•	Shared# templates. Only members of the Clinical Coordinator ASU class can create shared templates. Shared templates are available to all users. Coordinators can copy and paste text into a template, type in new content, add Template FieldsTemplate_Fields>overvw, or copy a personal template and modify it as needed. In the tree view, shared template and folder icons do not have a folded corner.

Types of Templates

When you create templates, you can go directly into the template editor, type in text, and add TIU objects and Template Fields, or if you are in a document and type in something you will use repeatedly, you simply select that text, right-click, select Create New Template, and the editor comes up with the selected text in the editing area.

You can create individual templates, group templates, dialog templates, folders, or link templates to Reminder dialogs.

•	Templates contain text, TIU objects,and Template Fields that you can place in a document.

•	Group templates contain text and TIU objects and can also contain other templates. If you place a group template in a document, all text and objects in the group template and all the templates it contains (unless they are excluded from the group template) will be placed in the document. You can also expand the view of the group template and place the individual templates it contains in a document one at a time.

•	Dialog templates are like group templates in that they contain other templates. You can place a number of other templates under a dialog template. Then, when you drag the dialog template in your document, a dialog appears that has a check box for each template under the Dialog template. The person writing the document can check the items they want and click OK to place them in the note.

•	Folders are like folders or directories in a file system. They are used to group and organize templates. It is there to hold templates and help in navigating the template tree view. For example, you might create a folder called "radiology" for templates, group templates, and other folders relating to radiology.

•	Reminder Dialogs can have templates linked to them. This allows templates to place orders, enter PCE information, and enter vitals and mental health data. Refer to Creating Reminder Dialogs for the procedure.

Arranging Templates for Ease of Use

You can use file cabinets and folders to group similar templates together to make them easier to find and use.  For example, you may want to place all of the pulmonary templates together rather than listing the templates in alphabetical order.

Using Templates to Create Documents

Once you or your clinical coordinator has created templates, adding them to a document is easy. When you create a new note, a Templates drawer appears. When you click the drawer, it opens to show you the templates that are available.

Group templates, dialogs, and folders may have a plus next to them. Click the plus to expand the tree view and see the templates they contain. Click a minus sign to collapse the tree view, hiding the templates under that item.

When you find the template you want to place in a document, you can drag-and-drop it into the document, double-click it, or right-click and choose Insert Template. The text and objects will appear where the cursor was a few seconds later.

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Related topics

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Editing Document Templates

Previewing a Template

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Creating Personal Document Templates

You can create personal templates from text, Template Fields, and Patient Data Objects to speed document creation. You can use the templates to create progress notes, complete consults, and write discharge summaries.

Note:	If you have not done so, you may want to read Document Templates (overview) before proceeding.

Select which kind of template you want to create:

•	Template

•	Group Template

•	Dialog Template

•	Folder

•	Reminder Dialog

Personal Template

To create a personal document template, follow these steps:

1.	Select the Notes, Consults, or D/C Summ tab.

2.	Start the Template Editor by selecting Options | Create New Template

-or-

Select the text that you would like to save as a template, right-click the text, and select Copy into New Template.

3.	Type in a name for the new template in the Name field under Personal Template Properties.

Note: Template names must begin with a letter or a number, be between 3 and 30 characters in length (including spaces), and cannot be named "New Template."

4.	Select the drop-down button in the Template Type field and select Template.

5.	Enter the content for the template by copying and pasting from documents outside CPRS, typing in text, and/or inserting Template Fields.

Note: After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or check for errors (which looks for invalid Template Fields).

6.	Place the template in the tree view in the desired location. (To do this, click the plus sign next to an item to view its subordinate objects and then drag-and-drop the template to its desired location. You can also move the template by using the arrows below the personal templates tree view.)

7.	Select Apply to save the template.

8.	Select OK to save and exit the editor.

Note: You are not required to click Apply after each template, but it is recommended. If you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

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Group Template

You can create group templates that contain other templates under them. You can then place the entire group template in the note, which will bring in the text and TIU objects from all templates in that group, or expand the tree view in the templates drawer and place the individual templates under the group template in the note.

To create a personal Group Template, use these steps:

1.	Select the Notes, Consults, or D/C Summ tab.

2.	Select Options | Create New Template

-or-

Select the text that you would like to save as a template, right-click the text, and select Copy into New Template.

3.	Enter a name for the new template in the Name field under Personal Template Properties.

Note: Template names must begin with a letter or a number, be between 3 and 30 characters in length (including spaces), and cannot be named "New Template."

4.	Select the drop-down button in the Template Type field and select Group Template.

5.	Enter the text and Template Fields to create content in the main text area of the group template, if desired. (You can enter content by copying and pasting from documents outside CPRS, typing in text, and/or inserting Template Fields.)

Note: After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or Check Boilerplate for Errors, which looks for invalid Template Fields.

Note: You can also create additional templates under the Group Template that you just created. To do this, simply highlight the appropriate group template and click New Template. Then complete the steps for creating a new template outlined above.

6.	Place the template in the tree view in the desired location. (To do this, click the plus sign next to an item to view its subordinate objects and then drag-and-drop the template to its desired location. You can also move the template by using the arrows below the personal templates tree view.)

7.	Select Apply to save the template.

8.	Select OK to exit the template editor.

Note: You are not required to click Apply after each template, but it is recommended. If you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

Back to the top

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

Dialog Templates

Dialog templates contain other templates just as group templates do. Unless there is only one template, each template under a dialog template will have a check box in a dialog when the dialog template is placed in a document. A single template under a dialog template will not have a check box in the dialog. Pressing the OK button will insert the dialog element into the note.

If you double-click a dialog template or drag it onto the note, a dialog appears. The dialog shows the text for each template preceded by a check box.

Click the box to check which items are to be included in the note. You can click All to select all of the elements or None to start over. Click OK when you have completed your selection.

To create a personal Dialog Template, use these steps:

1.	Select Options | Create New Template on the Notes, Consults, or D/C Summ tab to bring up the Template Editor

-or-

select the text that you would like to save as a template, right-click the text, and select Copy into New Template.

2.	Enter a name for the new template in the Name field under Personal Template Properties.

Note: Template names must begin with a letter or a number, be between 3 and 30 characters in length (including spaces), and cannot be named "New Template."

3.	Select the drop-down button in the Template Type field and select Dialog.

4.	Enter the text and Template Fields to create content in the main text area of the template, if desired. You can enter content by copying and pasting from documents outside CPRS, typing in text, and/or inserting Template Fields.

Note: After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or Check Boilerplate for Errors, which looks for invalid Template Fields.

Note: You can also create additional templates under the Group Template that you just created. To do this, simply highlight the appropriate group template and click New Template. Then complete the steps for creating a new template outlined above.

5.	Place the template in the tree view in the desired location. (To do this, click the plus sign next to an item to view its subordinate objects and then drag-and-drop the template to its desired location. You can also move the template by using the arrows below the personal templates tree view.)

6.	Select Apply to save the template.

7.	Select OK to exit the template editor.

Note:	You are not required to click Apply after each template, but it is recommended. If you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

Back to the top

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

Folder

Folders are simply containers that allow you to organize and categorize your templates. For example, you might want to create a folder for templates about diabetes or one for templates about mental health issues.

To create a personal template folder, complete the following steps:

1.	Select Options | Create New Template on the Notes, Consults, or D/C Summ tab to bring up the Template Editor

-or-

Select the text that you would like to save as a template, right-click the text, and select Copy into New Template.

2.	In the Name field under Personal Template Properties, enter a name for the new folder. For ease of use, you should create a name that describes the content of the template.

3.	Click the template type: Folder.

4.	Drag-and-drop relevant templates into the template folder that you have created.

Note:	It is recommended that you click Apply after adding a template to save your changes. If you accidentally click Cancel, you will lose all the changes you have made since the last time you clicked Apply or OK.

Back to the top

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Template Name Requirements

By default, the template you are creating is called "New Template." Template names must

•	Begin with a letter or a number

•	Be between 3 and 30 characters in length (including spaces)

•	Cannot be named "New Template."

Also, give the template a meaningful name to help you remember its contents or to search for the first word in a template name.


Inserting TIU Objects

To insert a TIU object, use these steps:

1.	Right-click in the Template Boilerplate area.

2.	Select Insert TIU Object.

3.	Locate the object you want (you can either scroll or type in the first few letters) and select it.

You can only select one object at a time. The object will be placed in the template where the cursor is.


Inactive Templates and Folders

This feature is simply a convenience to keep your templates tree view clean while you or your users are creating documents or looking through templates.

Inactive templates, group templates, folders, and the templates they contain are hidden in the templates drawer and in the Template Editor unless the Hide Inactive check box under the Shared or Personal tree views is not checked.

If you are creating or editing templates or if something is wrong with the template, such as an invalid TIU object, you can make the template inactive so that it doesn't clutter your display.

When the template is ready, you can select the template and click the Active check box to make it appear.


Creating Shared Document Templates

To create shared document templates, you must be a belong to the Clinical Coordinator ASU class.

Note:	If you have not done so, you may want to read Document Templates (overview) before proceeding.

You can then create templates containing text and Template Fields objects that will be available to all users.

Pick which template type you want instructions for:

•	Template (shared) including Patient Data Objects

•	Group Template (shared)

•	Dialog (shared)

•	Folder (shared)

•	Reminder Dialog

Shared Template

To create shared templates, use these steps:

1.	On the Notes, Consults, or D/C Summ tab, bring up the Template Editor by selecting Options | Create New Shared Template.

2.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

3.	Select the template type: Template.

4.	Enter the content for the template using any or all of these methods:

o	Copy and paste from documents outside CPRS

o	Type in text

o	Insert Template Fields

Note:	After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or Check Boilerplate for Errors, which looks for invalid Template Fields.

5.	Place the template where you want it in the tree view.

a.	Click the plus sign next to an item to see the objects under it.

b.	Drag-and-drop the template where you want it in the tree. (Or use arrows below the personal templates tree view.)

6.	To save the template, click Apply. To save and exit the editor, click OK.

Note:	You do not have to click Apply after each template, but it is recommended because if you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

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Patient Data Objects

Another area of shared templates is creating Patient Data Object templates for newly created TIU objects that will enable users to place these objects into their other templates.

To create a new Patient Data Object template, use the following steps:

1.	Open the Template Editor from the Notes, Consults, or DC/Summ tab by selecting Options | Edit Shared Templates….

2.	Verify that Edit Shared Templates is checked.

3.	Expand the treeview of Shared Templates and then Patient Data Objects by clicking on the plus sign beside each.

4.	Click on the existing object above which you want your new object to be.

5.	Click New Template and edit the name of the template.

6.	Place the cursor in the Template Boilerplate box and select Edit | Insert Patient Data Object or right-click and select Insert Patient Data Object to bring up a dialog containing a list of TIU objects.

7.	Click the appropriate TIU object (that was probably just created).

8.	Click Apply or OK to make the new object available in GUI templates.

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Related topics

Document Templates (overview)

Generating a Template from a Template Field or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

Group Template

You can create group templates that contain other templates under them. You can then place the entire group template in the note, which will bring in the text and Template Fields from all templates in that group, or expand the tree view in the templates drawer and place the individual templates under the group template in the note.

To create a personal Group Template, use these steps:

1.	On the Notes, Consults, or D/C Summ tab, bring up the Template Editor by selecting Options | Create New Shared Template.

2.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

3.	Select the template type: Group Template.

4.	If desired, enter the text and Template Fields (if desired) to create content in the main text area of the group template. You can enter content in these ways:

o	Copy and paste from documents outside CPRS

o	Type in text

o	Insert Template Fields

Note:	After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or Check Boilerplate for Errors, which looks for invalid Template Fields.

5.	You can also create additional templates under the Group Template that you just created and add content there:

a.	Highlight the appropriate group template and click New Template.

b.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

c.	Select the template type.

d.	Enter the content:

o	Copy and paste from documents outside CPRS

o	Type in text

o	Insert Template Fields

e.	Repeat steps a-d as many times as desired to create the templates under the group template.

6.	Place the template where you want it in the tree view.

a.	Click the plus sign next to an item to see the objects under it.

b.	Drag-and-drop the template where you want it in the tree. (Or use arrows below the personal templates tree view.)

7.	To save the template, select Apply. To save and exit the editor, select OK.

Note:	You do not have to click Apply after each template, but it is recommended because if you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

Back to the top

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

Dialog Templates

Dialog templates contain other templates just as group templates do. Each template under a dialog template will have a check box in a dialog when the dialog template is placed in a document.

When a user double-clicks a dialog template or drags it onto the note, a dialog appears. The dialog shows the text for each template preceded by a check box. (Example)

The user clicks the box to check which items they want included in the note. The user can choose All or choose None if they need to begin again, and clicks OK when done.

To create a personal Dialog Template, use these steps:

1.	On the Notes, Consults, or D/C Summ tab, bring up the Template Editor by selecting Options | Create New Shared Template.

2.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

3.	Select the template type: Dialog.

4.	If desired, enter the text and Template Fields (if desired) to create content in the main text area of the group template. You can enter content in these ways:

o	Copy and paste from documents outside CPRS

o	Type in text

o	Insert Template Fields

Note:	After you enter the content, you can right-click in the Template Boilerplate area to select spell check, grammar check, or Check Boilerplate for Errors, which looks for invalid Template Fields.

5.	You can also create additional templates under the dialog template that you just created and add content there as shown below.

a.	Highlight the appropriate dialog template and click New Template.

b.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

c.	Click the template type.

d.	Enter the content:

o	Copy and paste from documents outside CPRS

o	Type in text

o	Insert Template Fields

e.	Repeat steps a-d as many times as desired to create the templates under the group template.

6.	Place the template where you want it in the tree view.

a.	Click the plus sign next to an item to see the objects under it.

b.	Drag-and-drop the template where you want it in the tree. (Or use arrows below the personal templates tree view.)

7.	To save the template, select Apply. To save and exit the editor, click OK.

Note:	You do not have to click Apply after each template, but it is recommended because if you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

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Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates

Folder

Folders are simply containers that allow you to organize and categorize your templates. For example, you might want to create a folder for templates about diabetes or one about mental health issues.

To create a personal template folder, user these steps:

1.	On the Notes, Consults, or D/C Summ tab, bring up the Template Editor by selecting Options | Create New Shared Template.

2.	In the Name field under Personal Template Properties, enter a name for the new template. Remember the template name requirements. You should also make the name descriptive of the content for ease of use.

3.	Select the template type: Folder.

4.	Select and drag the templates that related to the folder you created.

Note:	You do not have to click Apply after each template, but it is recommended because if you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

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Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Editing Document Templates

You can change your personal templates and members of the Clinical Coordinator ASU class can change shared templates at any time.

To edit a document template, use these steps:

1.	Select the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates (Option | Edit Shard Templates to edit shared)

-or-

If the Templates drawer (Notes tab) is open, right-click in the drawer, and select Edit Templates.

3.	Find the template you want to edit.

a.	Click the plus sign next to an item to see the objects under it.

b.	Select the template you want to edit.

4.	Make any desired changes, such as the following, for example:

o	Type in more text.

o	Add Template Fields

o	Change the template name

o	Move the template to a different location.

o	Make the template inactive if you don't want it seen in the template drawer.

o	If part of a group template, exclude it to make it not copy into a document when the group icon is dragged-and-dropped or double-clicked. Or, if excluded, you can click the check box to include it again.

o	Change the template type (template, group template, dialog)

Note:	If you change from a template or group template to a folder, you will lose the text in the template.

5.	To spell check or Check Boilerplate for Errors, right-click in the Boilerplate Template area and select the appropriate option.

6.	When finished, select Apply to save or select OK to save and exit the editor.

Note:	The Line and Column indicator (under the Personal Templates area) indicate the cursors position in the Boilerplate Template area.

Related topics

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Copying Document Templates

Users can copy a shared template into their personal templates. Clinical Coordinators can copy personal templates into the shared templates also. In addition, you can also copy a template and paste it elsewhere in the same personal or shared tree (hierarchy).

Instructions for copying templates within a tree

To copy a shared template into personal, use these steps:

1.	Select the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates

-or-

If the Templates drawer (Notes tab) is open, right-click in the drawer, and select Edit Templates.

3.	Expand the personal template tree to show find where you will paste the shared template.

a.	Click the plus sign next to an item to see the objects under it.

b.	Continue until you find the right location.

c.	Select the template under which you want the shared template.

4.	Find the shared template you want to copy.

a.	In the shared templates, click the plus sign next to items to see the objects under them.

b.	Select the template you want to copy.

5.	Select the arrow button between the trees, double-click the shared template, or drag-and-drop the shared template to the chosen location.

Note:	At this point, the template is still a shared template. Changes to the original shared template will appear in your version also, which may be desirable. But if you change your version in any way, it becomes a personal template, the icon will have a folded corner and changes to the original will not affect your version.

6.	To save the template, select Apply. To save and exit the editor, select OK.

Related topics

Instructions for Copying Within a Tree

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Editing Document Templates

Searching for Document Templates

Deleting Document Templates

To copy a template within the same tree, use these steps:

1.	Click the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates

-or-

If the Templates drawer is open, right-click in the drawer, and select Edit Templates.

3.	Find the template you want to copy.

4.	Right-click on the template and select Copy.

5.	Find the template under which you will place the copied template.

6.	Right-click the template and select Paste.

7.	To save the template, click Apply. To save and exit the editor, click OK.

Related topics

Instructions for Copying a Shared Template to Personal Templates

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Editing Document Templates

Searching for Document Templates

Deleting Document Templates


Searching for Document Templates
Searching for Templates

Searches for templates used to take some time, but changes included with CPRS v.27 should improve the template search speed.

To search for a template, use the following steps:

1.	Right-click in the tree view (in either the Template Editor or the Templates drawer).

2.	Select the appropriate option: Find Templates, Find Personal Templates, or Find Shared Templates (depending on which tree view you are in).

A search screen will appear.

Note:	You may want to narrow your search by using the Find Options feature.

3.	Enter the word or words you want to find and check the appropriate boxes.

4.	Select Find.

Note:	If the search lasts longer a few seconds, a dialog displays letting the user know that CPRS is still looking for the template. This dialog has an animation of a flashlight and there is a Cancel button is the user wishes to cancel the search.

5.	If you do not find the template you want, scan the list or click Find Next.

6.	Repeat step 5 until you find the desired template.

Related topics

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


find or search options for notes
Find Options

To help more narrowly define a search, you can set two find options:

•	Match Case

•	Whole Words Only.

If you check Match Case, you can limit your search to find only words that have the same capitalization that you enter. For example, you could find "Patient" without having to look at all the titles with the word "patient."

If you check Whole Words Only, you can locate titles that contain specific words. For example, this search would allow you to find "patient" without wading through all of the titles with the word "patients."


Entering Enough Information to Find What You Need

Choosing the right words or numbers to search for will find the right template more quickly.

For example, if you wanted to find a template called "patient's arthritis," and you have several templates with both "arthritis" and "patient's" in the title, you will need to enter both words in the right order.

But, if you only have one template with the word "glaucoma," you might have to enter only "gla" to find it.

Choose your search words carefully and you will get what you want faster.


Deleting Document Templates

To delete a document template, follow these steps:

1.	Select the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates

-or-

If the Templates drawer is open, right-click in the drawer, and select Edit Templates.

3.	Find the template you want to delete. (Click the + sign to expand a heading.)

4.	Right-click the template you want to delete and select Delete.

-or-

select the template you want to delete and then click the Delete button under the tree view.

5.	Select Yes to confirm the deletion.

Related topics

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates


Exclude from Group Template

The Exclude from Group Template feature is available only for templates within group templates.

Exclude from Group Template lets you designate a template within a group template that should not automatically be placed in a document when you insert the group template into a document.

The excluded templates is still visible in the tree view, and you can place them in the document individually.

Exclude from Group Template might be useful if you have exams that are sometimes, but not always done with a visits. For example, you could insert the group template and then insert any excluded templates if those exams or activities were also conducted.


Do you want to see one of these topics?

Creating Personal Document Templates

Copying Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

If yes, select where you want to go.

If not, select Back in the main topic.


Viewing Discharge Summaries

To view a discharge summary, use these steps:

1.	Select the D/C Summ tab.

2.	In the list box, select the summary.

3.	To sort the list, select View and the appropriate choice below:

o	Signed Summaries (All)

o	Signed Summaries by Author

o	Signed Summaries by Date Range

o	Uncosigned Summaries

o	Unsigned Summaries

o	Custom View

Note:	To set one of these views as the default, select View | Save as Default.

4.	Locate the summary and select it.

Related topics

Discharge Summaries (overview)

Writing Discharge Summaries


Discharge Summary: Custom View

You can set up the list of discharge summary the way you like it. You get the same sorting choices as on the View menu, but you can further refine the search.

For Unsigned Documents, Uncosigned Documents, and Signed Documents/Author, you can select

•	author

•	date range

•	maximum number of summaries CPRS should display

•	the sort order (ascending or descending)

For Signed Documents (All) and Signed Documents/Date Range, you can select

•	date range

•	maximum number of summaries CPRS should display

•	the sort order (ascending or descending)


Writing Discharge Summaries

You can enter discharge summaries through CPRS. The document templates and TIU titles that your site can create should make creating these documents much faster and easier.

To write a discharge summary, use these steps:

1.	Select the D/C Summ tab.

2.	Select New Summary or select Action | New Discharge Summary.

Note:	If this visit is undefined, you will be prompted for encounter type and location, clinician, date, and type of visit, such as Ambulatory, Telephone, or Historical.

3.	In the Discharge Summary Properties dialog, select the following so that the note may be auto-saved:

a.	Discharge Summary Title (e.g., General, SOAP, Warning, etc.). Additional items will appear on the dialog for titles that require entry of a cosigner or an associated consult.

b.	If necessary, change the note date by clicking the button next to the date and entering a new date.

c.	If necessary, change the note author by selecting the author from the Author drop-down list.

(Note about providers with similar first and last names.)

d.	Enter the attending physician.

(Note about providers with similar first and last names.)

e.	Click the admission related to this Discharge Summary.

f.	Enter any additional information, such as an expected cosigner.

Note:	For a Discharge Summary, if a user requires a cosigner (such as a student or other type of clinician), that user’s name should not appear in the list of potential cosigners. Also, occasionally a problem occurs if a cosigner’s access lapses and they have become "disusered". If this occurs, you can click OK and proceed with that selection or click Cancel and choose another cosigner.

g.	Select OK.

4.	Create the summary content by doing some or all of the following:

o	Type text

o	Copy and paste

o	Insert templates into the document

a.	Click the template drawer if it is not open.

b.	Locate the appropriate templates.

c.	Double-click the template (You can also drag-and-drop or right-click the template and select Insert Template) and modify as needed.

5.	(Optional) When finished entering text, you can right-click in the text area and select Check Spelling and Check Grammar.

6.	When complete, decide when you will sign the summary and choose the appropriate option:

o	Add to Signature List (To place it with other orders or documents you need to sign for this patient)

o	Save Without Signature

o	Sign Discharge Summary Now (To sign the summary immediately)

Related topics

Discharge Summaries (overview)

Viewing Discharge Summaries

Document Templates (overview)


Entering Primary and Secondary providers popup
Entering Primary and Secondary Providers

You can enter a primary provider and secondary providers in the Encounter Frame. The primary provider is designated by the word "primary" in parenthesis.

Also, you cannot remove a primary provider until you have designated a new primary provider.

1.	In the Encounter Frame, select the Visit Type tab.

2.	To assign a new provider, select the provider's name under Available Providers and then select Add. You may do this several times to move more than one provider onto the Current Providers list.

3.	To designate the primary provider, select the provider under Current Providers and select Primary.

4.	To remove providers from the Current list, select the provider name and click Remove.

5.	When finished, select OK.


Transfer Inpatient Medications to Outpatient

You can transfer inpatient medications to outpatient medications with CPRS. CPRS will tell you if the medication cannot be changed to an outpatient medication.

Because of the differences, you will go through each order and make the necessary changes.

To transfer an inpatient medication order to an outpatient medication order, use these steps:

1.	Select the Meds tab.

2.	Select the inpatient medications you want to transfer. Hold down the CTRL key to select more than one medication. Hold down the SHIFT key and click on the first and last medications to select a range.

3.	Select Action | Transfer to Outpatient.

CPRS displays the Copy Medication Orders dialog.

4.	If you would like to release the copied order(s) immediately, check the "Released copied orders immediately" option. If you would like to delay the release of the copied order(s), select one of the options in the "Delay release of copied orders until" group.

5.	Select OK.

The Medication Order dialog displays.

6.	Enter the necessary information in the Medication Order dialog for the first order and click Accept.

7.	Repeat Step 6 as needed for the selected medications.

Note:	When finished, you can sign the orders now or wait until later.

Related topics

Transfer Outpatient Medications to Inpatient


Transfer Outpatient Medications to Inpatient

You can transfer outpatient medications to inpatient medications with CPRS. CPRS will tell you if the medication cannot be changed to an inpatient medication.

Because of the differences, you will go through each order and make the necessary changes.

To transfer the medication to inpatient, use these steps:

1.	Select the Meds tab.

2.	Select the outpatient medications you want to transfer. Use SHIFT and CTRL click in combination to select the desired medications.

o	CTRL click to select individual medications.

o	Click on a medication and SHIFT click another to select those two medications and the entire range of medications between them.

3.	Select Action | Transfer to Inpatient.

4.	Enter the necessary information for the first order and select Accept.

Note:	Provider comments are brought forward for editing if necessary. Sometimes, provider comments give needed instructions to the patient.

5.	Repeat step 4 as needed for the selected medications.

Note:	When finished, you can sign the orders now or wait until later.

Related topics

Transfer Inpatient Medications to Outpatient


Copy Existing Orders

Users can only copy Inpatient Medication orders for outpatients (IMO) if the patient is in an authorized IMO location.

To copy an existing order to a new order, follow these steps:

1.	Select the Orders tab.

2.	Select the type of order you would like to copy from the View Orders pane.

3.	Select the order or orders you want to copy from the detail pane on the right- side of the screen. Hold down the CTRL key and click on the desired orders to select more than one order. Hold down the SHIFT key and click on the first and last desired orders to select a range of orders.

4.	Select Action | Copy to New Order…

-or-

right-click on a selected order and select Copy to New Order…

The Copy Orders dialog appears.

5.	From the Copy Orders dialog, select either Release copied orders immediately or Delay release of copied orders.

6.	If you chose Release copied orders immediately, skip to step 8. If you chose Delay release of copied orders, select the event that should occur before the order(s) are released.

7.	Select OK.

8.	If necessary, choose the specialty or admission location.

9.	An order verification dialog box will appear. If the order does not require changes, click Accept (or Accept Order). If the order requires changes, click Edit (or make the appropriate changes) and click Accept Order.

Note:	The original order’s comments are not brought forward on a copy to prevent inadvertently using a comment that was only for the original order.

10.	When finished, you can sign the orders or wait until later.

Related Topics

Writing Orders (Overview)

Event-Delayed Orders


Sign Document Now
Sign Note Now and Sign Discharge Summary Now Commands

The Sign Note Now and Sign Discharge Summary Now menu items let you sign the currently selected note or discharge summary.

Note:	Notes and discharge summaries cannot be altered once they are signed.

To sign a note or discharge summary, use these steps:

1.	Select the Notes or DC/Summ tab.

2.	Select the note or discharge summary that you would like to sign.

3.	Select Action | Sign Note Now (or Sign Discharge Summary Now).

-or-

right-click in the document area and select Sign Note Now (or Sign Discharge Summary Now).

4.	Type in your electronic signature code.

5.	Select OK.

Related topics

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Selected Orders Command

Signing Orders before Selecting a New Patient or Exiting CPRS

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers


Identify Additional Signers

With the Identify Additional Signers feature, you can select other individuals that you want to sign a note or discharge summary. Once you have selected the additional signers, CPRS will send them an alert that indicates a note is ready for them to sign.

The Identify Additional Signers feature helps you ensure that team members see a note. For example, one psychiatrist might identify another psychiatrist to sign the note to ensure that he or she agrees with an assessment.

To identify additional signers, use these steps:

1.	Select the Notes or DC/Summ tab.

2.	Select a signed note or discharge summary.

3.	Select Action | Identify Additional Signers

-or-

right-click in the main text area and select Identify Additional Signers.

4.	To identify a signer, locate the person’s name (scroll or type in the first few letters of the last name) and select it.

Note: 	For a Discharge Summary, if a user requires a cosigner (such as a student or other type of clinician), that user’s name should not appear in the list of potential cosigners. Additionally, for all types of documents, to help users distinguish between providers, CPRS displays their titles (if available). When two or more providers have identical names, CPRS also displays the following information.

5.	Repeat step 4 as needed.

6.	(Optional) To remove a name select the name under Current Additional Signers and select Remove.

7.	When finished, select OK.

Related topics

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Signing Orders before Selecting a New Patient or Exiting CPRS

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries


Add to Signature List

With the Add to Signature List command, you can place notes or discharge summaries for the same patient on a list where you can simultaneously sign them.

To add a note or discharge summary to your signature list, follow these steps:

1.	Select the Notes or DC/Summ tab.

2.	Select the note or discharge summary that you would like to add to your signature list.

3.	Choose Action | Add to Signature List.

The note or discharge summary will be added to your signature list. To sign all of the notes or discharge summaries on your signature list select File | Review / Sign Changes.

Related topics

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers


Sign Selected Orders
Sign Selected Orders Command

The Sign Selected Orders command allows you to select a number of orders and sign them all simultaneously. However, you cannot sign documents with this command.

Sometimes during the ordering process, the status of a patient changes from outpatient to inpatient or vice versa. This might happen because an outpatient was admitted to the facility, or because an inpatient was sent to a clinic for treatment, or because of using Inpatient Medications for Outpatients (IMO) feature. When written unsigned orders exist and the patient’s status changes, the user must indicate which location the orders are associated with.

Users designate which location the written unsigned orders are associated with in the Order Location dialog.

The order location dialog shows the user the two locations the user can choose from, generally an outpatient clinic and an inpatient location. The user has two basic options:

•	Associate All of the orders with a single location by selecting the appropriate button above the list of orders. The buttons will read All location where location is the name of the clinic or ward location. In the above screen capture the buttons read All MICU and All Mental Health Clinic.

•	Individually associate each order with one of the two locations. At the end of each order is a column to select the location for each order.

If the user is keeping the patient’s chart open, such as selecting File | Review / Sign changes… and this dialog appears, the “Where would you like to continue processing patient data?” prompt displays enabling the user to choose either the ward location or the clinic location. This prompt does not appear if the user is exiting the chart or switching patients.

To sign a number of orders, use these steps:

1.	Select the Orders tab.

2.	Highlight the orders you want to sign.

To select a range of items, click the order at the beginning of the range; then hold down the SHIFT key and click the order at the end of the range. To select multiple, individual orders, select the first order, hold down the CTRL key, and click the next order.

3.	Select Action | Sign Selected…

-or-

right-click and select Sign…

An Electronic Signature dialog box will display. One dialog is simply a listing of items that require signature. Each item that requires a signature will have a check box in front of it. Users can select and deselect items as needed and then enter the electronic signature. The simpler dialogs is often used by non-providers.

The other dialog enables the provider to enter items related to the orders such as a diagnosis and copay factors, such as environmental factors that affect payment for prescriptions and so forth.

4.	If the simpler Electronic Signature dialog displays, select or deselect orders as needed and then enter your electronic signature code (if necessary) and select Sign.  The orders will now be signed.

If the more complex Electronic Signature dialog displays and contains blue question marks, continue to step 5.

5.	The blue question marks inside the boxes in Figure B indicate that you need to specify how that order is related to the medical condition in that column. (SC = Service Connected Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense, MST=Military Sexual Trauma, and HNC=Head or Neck Cancer).  If you place a check in a box, you are indicating that a medication order is related to the condition in that column. If you create an empty box, you are indicating that the medication order is not related to the condition in that column.  You must either check or uncheck every box that contains a blue question mark before you can sign the order.

Note:	Definitions for service connection and treatment factors are available to users by hovering the cursor over the term or using the appropriate keyboard shortcut as shown in the list below:

o	Service connection (SC)	Alt + c

o	Combat Veteran (CV)	Alt + v

o	Agent Orange (AO)	Alt + o

o	Ionizing Radiation (IR)	Alt + r

o	Southwest Asia Conditions (SWAC)	Alt + a

o	Shipboard Hazard and Defense (SHD)	Alt + h

o	Head and/or Neck Cancer (HNC)	Alt + n

You can toggle the checkboxes by:

o	Selecting an individual checkbox.

This will toggle the box between checked and unchecked.

o	To select all the checkboxes in one column, press the button above the appropriate column (SC = Service Connected Condition, CV=Combat Veteran, AO=Agent Orange Exposure, IR=Ionizing Radiation Exposure, SWAC=Southwest Asia Conditions, SHD=Shipboard Hazard and Defense, MST=Military Sexual Trauma, and HNC=Head or Neck Cancer).

This will toggle all the check boxes in that column.

o	To check all checkboxes on the dialog, press the All button.

This will toggle all the check boxes on the screen.

6.	When you have dealt with the co-pay exemptions, begin the process of entering diagnoses by highlighting the orders using Shift + Click and Ctrl + Click to make a group of orders that will have the same diagnoses.

7.	Bring up the Assign Diagnoses to Order(s) dialog by clicking Diagnosis or by right-clicking on the highlighted orders and choosing Diagnosis on the pop-up menu.

8.	When the dialog displays, choose the source from which you would like to look for a diagnosis: under Diagnosis Section, you can choose from the Problem List, Personal Diagnosis list (if you have entered any items on your list), or the Encounter Form for the clinic location you are in (if one has been defined by your site) or you can click Other Diagnosis… to search the Lexicon.

Note:	The Assign Diagnosis to Order(s) dialog enables providers to select as many as four diagnoses for each order. Also shown is the ability to right-click on a diagnosis to add it to the user’s Personal Diagnosis List.

9.	After choosing a source, select the appropriate diagnoses for the selected orders under Diagnosis Codes. You can select as many as four diagnoses although only one is required.

Note:	The first diagnosis you enter is automatically assigned as the primary diagnosis.

10.	If you want to change the primary diagnosis to another you have selected, highlight the diagnosis and select Primary.

11.	(Optional) If you want to add one or more diagnoses to the problem list, highlight the diagnoses and select the Add to Problem List checkbox.

12.	(Optional) If you want to add one or more of the diagnoses to your Personal Diagnosis List, highlight the diagnoses and select the Add to Personal Dx List check box.

13.	When you have assigned the diagnoses correctly, select OK.

14.	Repeat steps 5-10 for all orders or groups of orders that require a diagnosis.

15.	When you have removed all of the question marks from the dialog and entered a diagnosis for all appropriate orders, enter your electronic signature code and select Sign.

16.	If PKI is enabled and you have entered Outpatient Schedule 2 or 2n Medication orders, digitally sign the orders by inserting your smart card if you have not already done so and clicking OK, and then entering your PIN in dialog box and clicking OK for each order as necessary.

Related topics

Digital Signature (PKI) Overview

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Note Now and Sign Discharge Summary Now Commands

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers

CIDC: Entering Diagnosis Codes for Specific Orders


Electronic Signature (overview)

Most orders or documents, such as progress notes, reports, or health summaries, require an electronic signature. Generally, orders that require a signature are not released to services or activated until they are signed.

Note:	There are two exceptions to this rule: 1) orders that can be designated as "signed on chart" and 2) generic orders that do not require a signature.

To electronically sign an order or a document, you must have an electronic signature code. If you do not have a signature code, your Clinical Coordinator can create one for you. You must keep your signature code secret and use it properly to help keep an accurate medical record.

A pilot program for digitally signing Schedule II and Schedule IIn drugs is also underway. To find out more about digital signatures, also known as PKI, please use the link below.

Related topics

Electronic and Digital Signatures (Overview)

Digital Signature: PKI Overview

Review / Sign Changes Dialog

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers


Electronic and Digital Signatures (Overview)

CPRS now has two types of signatures: electronic and digital. Electronic signatures, which have been available for some time, require an electronic signature code that can be created at your site. Digital signatures are new to CPRS and are only in use in a pilot program.

There are three different levels of keys that influence what can be done with orders, including what dialog CPRS brings up when signing orders. Although actual practice at each site may vary, the three levels are usually referred to in these ways:

•	OREMAS is the clerk key

•	ORELSE is the nurse key

•	ORES is the provider key

In CPRS, users who hold the provider key sometimes have additional privileges and are sometimes asked for more information than those who hold one of the other two keys. This is true on the signature screen with regard to entering information about what conditions orders are related to. If the copay items are on or Clinical Indicators Data Capture (CIDC) is enabled, users with the provider key may be prompted for the following:

•	If orders are related to service connection and/or specific treatment factors—ionizing radiation, agent orange, etc.

•	For sites using CIDC, a diagnosis will also be required.

This section will describe the differences between electronic and digital signatures, give an overview of service connection and treatment factors, and then give steps for the various ways users will sign orders. For example, users can sign orders several different ways:

•	Review / Sign Changes…enables users to sign all orders from the current ordering session. Using this method, the user could write a number of orders and create documents and then sign all items at the same time.

•	Sign selected…enables users to highlight one or more orders and then sign them. When the dialog displays, only the selected orders or documents will display for signature.

•	Select New Patient brings up the signature dialog that includes all unsigned orders for the current patient before opening another patient record. The orders are broken into three groups, the user’s orders from this ordering session, the user’s unsigned orders for the patient from previous ordering sessions, and unsigned orders for the patient written by other users. The user can then select and deselect the orders to be signed.

•	Exiting the chart (closing CPRS) brings up the same dialog as selecting a new patient (see above).

Related topics

Digital Signature: PKI Overview

Review / Sign Changes Dialog

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Add to Signature List

Viewing Unsigned Notes or Discharge Summaries

Identify Additional Signers

Electronic Signature (overview)


Grammar Checking for Notes, Consults, and Discharge Summaries

You can use grammar checking on notes, consults, and discharge summaries if you have Microsoft Word 97 or Word 2000 on your workstation.

To check a document or a selection, use these steps:

1.	To check the grammar of an entire document, skip to step 2. Click-and-drag to select text if you want to only check a selection.

2.	Right-click on the selection or document and select Grammar Check....


Flagging an Order

With CPRS, you can flag an order to draw attention to it. When an order is flagged, the word “Flagged” will appear in the Orders column and a red box will appear in the Service or Event column. The order will remain flagged until someone “unflags” the order. CPRS records the name of the person who flagged the order and the date and time that it was flagged.

If the applicable CPRS parameter is set to automatically unflag orders, processing the alert from the order unflags the order for the user. When the user processes the order, CPRS displays the reason for the flag in the order text on the Orders tab.

To flag an order, use these steps:

1.	Select the Orders tab.

2.	Select the Order that you would like to flag.

3.	Select Action | Flag....

The Flag Order dialog will appear.

4.	Enter a reason for the flag in the Reason for Flag field. Users can choose a reason from the drop-down list, choose a reason and add additional text, or enter their own text. The Reason for flag field has an 80-character limit.

5.	Choose an alert recipient from the Alert Recipient drop-down field.

Note:	A recipient must have the FLAG ORDER FOR CLARIFICATION notification/alert enabled in order to receive the alert.

6.	Select OK.

Related topics

Unflagging an Order


Unflagging an Order

You can remove the flag from an order very simply. You can enter a reason for removing the flag, but CPRS does not require you to enter a reason.

In the order's detailed display, CPRS will record the name of the person who removed the flag and the date and time that person removed it.

To unflag an order, use these steps:

1.	Select the Orders tab.

2.	Select the order you want to unflag.

3.	Select Action | Unflag.

4.	(Optional) Enter a reason, if desired.

5.	Select OK.

Related topics

Flagging an Order


Entering No Known Allergies
Entering a No Known Allergies Assessment

You can enter no-known-allergies (NKA) assessments for patients who have no active allergies by taking the following steps:

1.	On the Cover Sheet, right-click within the Allergies/Adverse Reactions pane.

2.	From this menu, select Mark patient as having No Known Allergies (NKA).

CPRS displays the No Known Allergies dialog.

Note:	CPRS activates The Mark patient as having No Known Allergies (NKA) menu selection only for patients who have no active allergies. When patients have active allergies, CPRS deactivates this selection.

3.	Select OK.

Although CPRS does not display allergy-related assessments on the Orders tab, you can also enter an assessment of no known allergies (NKA) from the Orders tab.

To enter a no-known-allergies assessment from the Orders tab, follow these steps:

1.	Select the Orders tab.

2.	Select Allergies from the Write Orders pane.

The Allergy Reactant Lookup dialog appears.

Note:     Your site may have defined and configured other order menus to include allergy-entry dialogs. Regardless of the allergy-entry menu you select, if you have not entered encounter information, CPRS displays the Location for Current Activities dialog before it displays the Allergy Reactant Lookup dialog. You must complete the Location for Current Activities dialog before proceeding.

3.	Select the No Known Allergies check box in the lower portion of the dialog box.

4.	Select OK.

Related topics

Entering Allergies

Viewing Allergies


Verifying Orders

Verification shows that the nurse has seen the order.

When a nurse verifies an order, the nurse's initials are then placed in the appropriate column on the Orders tab.

Note:	If you do not have the correct key, you will not see the Verify option on the Action menu.

To verify an order, use these steps:

1.	Select the Orders tab.

2.	Hold down the CTRL key and click the orders you want to verify.

3.	Select Action | Verify.

4.	In the dialog that appears, enter your electronic signature code.

Related topics

Doing a Chart Review for Orders


Doing a Chart Review for Orders

You can do both a nurse verification of orders and a chart review through CPRS.

When a nurse does the chart review, the nurse's initials are then placed in the appropriate column on the Orders tab.

Note:	If you do not have the correct key, you will not see the Chart review option on the Action menu.

To do a chart review for orders, use these steps:

1.	Select the Orders tab.

2.	Hold down the CTRL key and click the orders you want to sign as reviewed.

3.	Select Action | Chart review.

4.	In the dialog that appears, enter your electronic signature code and press Enter.

Related topics

Verifying Orders


Automatically Add Diagnoses to the Problem List

If you want to automatically add diagnoses to the Problem List while entering encounter information, check Add to Problem List under the Section Name. The diagnoses will then be added to the Problem List when the note is signed.


How Do I Know a Patient Has Reminders
Clinical Reminders

When a user opens a patient record, CPRS starts a job to evaluate whether the patient has reminders that are due, available, etc. While the evaluation is in process, a magnifying glass goes in a circle on the Reminder button. When the magnifying glass stops, and a clock icon appears, the reminders evaluation is complete.

You can find out if a patient has reminders by doing one of the following:

•	Selecting the Reminders button near the top right of the CPRS form. When you select this button, a dialog with a reminders tree view will be displayed. The reminders button may display one of five icons. When it displays a red clock, as shown in the following graphic, the patient has reminders due.

•	Looking on the Cover Sheet area specifically for reminders. The Cover Sheet shows the reminder due for the patient and the Due Date.

Note:	If under Due Date, the user sees Error or CNBD (which stands for “could not be determined”), a problem occurred while the reminders were being evaluated. You should contact your reminders coordinator.

•	Opening a reminders drawer to check on the reminders for a patient after you have begun a new progress note. When you click the Reminders drawer, you will see a dialog with a tree view of due, applicable, and other reminders.

Related topics

Reminders Overview

How did this reminder get selected for this patient and how do I satisfy the reminder?

What happens when I process a reminder?

What do the Reminders icons mean?


Reminders Icons

The reminders icons tell you if a patient has reminders and whether reminders have been evaluated or are due. A quick reminder of the meanings of the icons can be found on the Available Reminders dialog by clicking View. Click an icon below for an explanation:

•	 Due : This icon appears either on the Reminders button or in the tree view. The patient meets all the conditions for the reminder and the appropriate amount of time has elapsed. For example, the patient might be a 50-year-old male who has not had a prostate exam in 2 years.

•	 Applicable: This icon appears either on the Reminders button or in the tree view. The patient meets all the conditions for the reminder, but the appropriate time has not elapsed. For example, a flu shot is given once a year, but it not been a year yet. Perhaps although a full year has not elapsed, the patient can still receive a flu shot at this visit.

•	 Other: Reminders are placed in the parameter that were not evaluated for the selected patient, but that may be useful to the provider or may be especially important. For example, although not part of the normal routine, a particular education topic might be very useful and be placed in Other.

•	 Question Mark: A question mark on the Reminders button indicated that the reminders have not yet been evaluated. This is because the CPRS GUI can now be set to open to a tab other than the cover sheet. Click the Reminders button or the Reminders drawer on the Notes tab to evaluate the reminders.

•	 Grayed-out Alarm Clock: This icon appears on the reminders button only. This icon indicates that there are no due nor applicable reminders, nor are there any reminder categories available.

•	 Dialogs over Icons: These icons appear in the Reminders tree view. The small dialog icon over the clock or question mark shows that this reminder has a dialog associated with it.

•	 Checked Dialogs over Icons: These icons appear in the Reminders tree view. The red check mark over the dialog indicates that the reminder has been processed. When the reminders are reevaluated, the check mark will be removed.


What Happens When I Process a Reminder?

To process a reminder, you must start a new progress note. When you begin a new progress note, the reminders drawer will appear. You can click that to get a tree view of the reminders for this visit.

1.	In the tree view, you open all the folders that contain reminders (with dialogs) that you want to process. Then, click a reminder to bring up a dialog and begin processing reminders. The content of this dialog has been created at your site. The CAC or other person can create a CPRS GUI dialog that will allow you to click check boxes by the activities accomplished during your visit.

2.	Marking a check box may bring up additional choices: an area for comments, a way to choose a diagnosis, or other ways to enter the information that will satisfy the reminder.

3.	As you select the appropriate check boxes, the dialog can be set up to insert predefined text into the progress note you have started and select encounter codes to be sent to the Patient Care Encounter (PCE) package for workload credit and billing purposes.

4.	As you make your selections, you can see the text of the progress note below the Clear, Back, and Next buttons. Below that is the encounter information. The bold text in those areas applies to the specific reminder you are processing. You can process multiple reminders, document the visit, and enter the PCE data all through this dialog.

5.	You can select another reminders or select Next to go the next reminder that has a dialog defined.

6.	When you have processed all of the reminders you wish to at this time, you click Finish to place the text in the note, send the PCE data, and place orders, or whatever else is defined in the dialog.

7.	After you finish processing the reminder, you can make other comments in the note and have a completed progress note for the encounter.

Related topics

How do I know a patient has reminders?

How did this reminder get selected for this patient and how do I satisfy the reminder?


Reminder Evaluation for a Patient

When you open a patient record, if your default tab is the Cover Sheet, an evaluation is performed to determine which reminders defined in a CPRS parameter apply to the selected patient. If you have set CPRS to open to a different tab, you will have to begin the evaluation process manually (see Manually Evaluating Reminders).

While the evaluation is proceeding, you will see an animated magnifying glass over the Reminders button. When the evaluation is complete, the magnifying glass is no longer visible.

When this evaluation is complete, you can get additional information about the reminder and how it can be resolved.

Right-click on a reminder either in the tree view or on the coversheet to bring up a popup menu with these options:

•	Clinical Maintenance - shows the possible resolutions and the findings associated with the reminder

•	Education topic definition - may list the education topics that have been defined for a reminder. You can select a topic to view the desired education outcome and any standards.

•	Reminder Inquiry - will show the reminder definition describing which patients are selected for this reminder

•	Reference Information - which can list web sites with additional information.

Each of these options will bring up a window. When you are finished with the window, click Close.

Related topics

How do I know a patient has reminders?

What happens when I process a reminder?


The Main Reminders Processing Dialog

If you process reminders (also on the Notes tab), you will process your reminders using this dialog. It shows the possible activities that can occur during a visit and that can satisfy the reminder. You may need to enter additional information.

When you check an item, it may expand to enable entry of more detailed information, such as dates, locations, test results, or orders that you might often place based on a response. The information depends on how the dialog was created at your site.

When you click a check box or item, the associated text that will be placed in the progress note is shown in the area below the buttons. PCE data for the item is shown in the area below that.

Text and PCE data for the reminder you are currently processing are in bold.


Processing a Reminder

To process a reminder for a patient, use the following steps:

1.	If you have not already, begin a new progress note by clicking the Notes tab, then New Note, and then select a note title. (If prompted, enter the encounter location and provider.)

2.	Select the Reminders drawer to open its tree view or select the Reminders button to open a tree view of the reminders for this patient.

3.	Click the plus sign to expand the hierarchy where needed and click the reminder you will process.

Note:	If you click the reminders button, you can also choose Action | Process Reminders Due to begin with the first reminder due.

CPRS displays the dialog for processing reminders.

4.	Read the choices, click the check boxes in front of the items that apply to this patient, and enter any additional information requested such as comments, diagnoses, and so forth.

5.	When you are finished with this reminder, select another reminder or select Next to move to the next reminder.

6.	Repeat steps 4 and 5 as necessary to process the desired reminders.

7.	When you have processed all the reminders you want to do at this time, select Finish. If service-connected information is required for the encounter and note title, the Visit Info dialog will automatically appear. If needed, adjust the Vital Entry Date and Time field and click the appropriate Visit Related To check boxes.

8.	Review and finish your progress note and enter any information necessary in order dialogs.

Related topics

Moving to Another Reminder

Finishing Reminder Processing

Clearing a Single Reminder

Canceling Out of the Processing Dialog

Interface Tour: The Reminders Processing Dialog

Reminders Overview


Manually Evaluating Reminders

If you open CPRS to a tab other than the Cover Sheet, you will have to start the reminder evaluation process manually.

To manually begin the evaluation of reminders, use these steps:

1.	Select the Reminders button [image] , which is available from any tab. If the reminders button has a clock on it, the reminders have already been evaluated.

-or-

select the Reminders Drawer on the Notes tab.

When the evaluation begins, the reminders button will show an animated magnifying glass.

2.	Once Reminders have been evaluated, the Available Reminders dialog opens.

Note:	To assist users in remembering the meaning of each Reminder icon, click on View and note that a graphic of each icon appears next to the name of the icon. The icons with check marks indicate which types of reminders will be displayed on the Available Reminders dialog.

Related topics

How Did this Reminder Get Selected for this Patient and How Do I Satisfy It?


Moving to Another Reminder

In the tree view from either the Reminders button or the Reminders drawer, you move between reminders by clicking on the reminder you want to view.

You can also click on specific reminders when you are processing reminders. But, you can also use the Next and Back buttons to move up and down the tree view between reminders that have dialogs available. The Next and Back buttons will move up and down through any folders that are open.

Related topics

Processing a Reminder

Finishing Reminder Processing

Clearing a Single Reminder

Canceling Out of the Processing Dialog


Finishing Reminder Processing
Completing Reminder Processing

After you have entered all the information, you can finish processing the reminders.

When you finish, the following things will happen:

•	The predefined text is placed in the note you started to write.

•	The encounter information to is sent to PCE.

•	If there are orders defined in the dialog, the orders will also be created. If the orders require input, the order dialogs will appear so that you can complete the orders. You must sign any orders that are created. After you have signed the orders, click Finish to finish processing remainders.

Related topics

Processing a Reminder

Moving to Another Reminder

Clearing a Single Reminder

Canceling Out of the Processing Dialog


Canceling Out of the Processing Dialog

If you reach the Reminders processing dialog by mistake or if you have entered information for reminders, but you need to get rid of that information and start over, simply click Cancel.

Note:	If you click Cancel, you will lose all of the information for reminders that you have entered. Use this option only if losing this information is not important.

Related topics

Processing a Reminder

Moving to Another Reminder

Finishing Reminder Processing

Clearing a Single Reminder


Clearing a Single Reminder

You will probably process several reminders for a single visit. If you have entered information on a reminder, but you need to start over on that reminder only, you can simply click Clear. This removes the entries you have and lets you start again on this one reminder.

Note:	Selecting Clear will remove the information from only one reminder. Be careful that you are on the correct reminder before you select Clear.

Related topics

Processing a Reminder

Moving to Another Reminder

Finishing Reminder Processing

Canceling Out of the Processing Dialog


The Reminders Drawer

When you begin a new progress note, you will see the reminders drawer. If you click the drawer, a tree view of due, applicable, and other reminders will be displayed. The Due category automatically expands when you open the Reminders drawer, while the Applicable and Other categories do not.

Note: Before you can process a reminder, a CAC or someone else must create a dialog in a similar position at your site. A dialog image over the clock or question mark icon shows that a reminder has an associated dialog.

After you process a reminder but before you reevaluate it, a check is placed over the reminder to show it has been processed. Once you reevaluate the reminder, it will be moved to the category for reminders that are applicable but not due.

Click a reminder to bring up the Reminders Processing dialog and process the reminder.

Right-click on a reminder to get the following options:

•	Clinical Maintenance - shows the possible resolutions and the findings associated with the reminder.

•	Education topic definition - may list the education topics that have been defined for a reminder. You can select a topic to view the desired education outcome and any standards.

•	Reminder Inquiry - will show the reminder definition describing which patients are selected for this reminder.

•	Reference Information - can list web sites with additional information.

•	Evaluate Reminder - tells you if a reminder is due, applicable or other.

•	Reminder Icon Legend - displays icon legend screen with icons and meanings.

Each of these options will bring up a window. When you are finished with the window, click Close.

Related topics

Reminders Overview

The Reminders Button Tree View

The Main Reminders Processing Dialog

Processing a Reminder


The Reminders Button Tree View

You get the view shown below when you click the Reminders button. The Reminders drawer has a similar tree view.

You cannot begin processing reminders from this dialog until you begin a new progress note. You can, however, review the reminders that are due and applicable to this patient. Coordinators can also use this dialog to quickly refresh dialogs as they build them.

The View menu contains four options:

•	Clinical Maintenance

•	Education Topic Definition

•	Reminder Inquiry

•	Reference information

The Action menu contains these options:

•	Evaluate Reminders

•	Evaluate Processed Reminders

•	Refresh Reminder Dialogs

CACs use the Refresh Reminder Dialogs option when they are creating the reminder dialogs. Then, they do not have to constantly exit the CPRS GUI and launch it again to see their changes.

To process reminders, you must have an unsaved progress note for the selected patient open. You cannot process reminders directly from the Available Reminders tree view that you get by clicking the Reminders button.

Select View on the Available Reminders dialog to determine or change the types of reminders that are displayed in the Reminders Drawer. A check mark next to the icon indicates that that type of reminder will be included in the tree view. Click on any of the menu items to change it.

Related topics

Reminders Overview

Reminders Icons

The Reminders Drawer

The Main Reminders Processing Dialog

Processing a Reminder


Should I Evaluate Reminders
Should I Evaluate Reminders?

You evaluate reminders for two reasons:

•	Before you process a reminder, to see if specific reminders in the Other category should be Applicable or should be Due for the selected patient (Evaluate Reminder)

•	After you have processed a reminder, to ascertain if your actions during the encounter satisfied the reminder (Evaluate Processed Reminders)

You would use the Evaluate Reminder option to see if some reminders in the Other category should be applicable or due. For example, in a diabetic clinic, you might see a patient around flu season and evaluate the flu shot reminder in the other category to see if they need a flu shot.

For Evaluate Processed Reminders, remember that the satisfying a reminder may require more than you originally think. You may want to evaluate the reminders after you have processed them to make sure you have satisfied the reminder.

Note:	PCE data may take a few minutes to be correctly recorded. Please wait a few minutes after processing a reminder before evaluating it again to ensure that it was satisfied.

To evaluate reminders, right-click in a tree view and select Evaluate Reminder or in the Available Reminders dialog choose Action | Evaluate Reminder or Action | Evaluate Processed Reminders.


Reminders Overview

The following topics explain the Reminders functionality.

Interface tour

Explain to me the:

•	Reminders drawer

•	The Reminders button tree view

•	The main Reminders processing dialog

Some overview questions you might have:

•	How do I know a patient has reminders?

•	What's are due, applicable, and other reminders? What does the question mark icon mean?

•	How did this reminder get selected for this patient and how do I satisfy the reminder?

•	What happens when I process a reminder?

Processing Reminders

How do I?

•	Manually start the Reminder evaluation if I see the Question Mark icon?

•	Process a reminder?

•	Move from one reminder to the next?

•	Clear what I have done for a single reminder?

•	Get rid of what I have done and start over?

•	Save everything I have done and finish the reminder processing?

Should I evaluate reminders?


Remote Data

You can view remote patient data with CPRS if Master Patient Index/Patient Demographics (MPI/PD) and several other patches have been installed at your site. If these patches have been installed and the proper parameters have been set, you can access remote data generated at other VA and Department of Defense (DOD) facilities.

 Text on the Remote Data and VistaWeb buttons

The CPRS user now has two choices for viewing remote data. One is the traditional Remote Data View (which has been streamlined), the other is VistAWeb. Each system has its advantages.

The rest of this section follows Remote Data Views. If you want to use VistAWeb, documentation is available on the VistAWeb VA intranet page at: http://vista.med.va.gov/vistaweb/

If the patient has remote data, the VistaWeb button text changes color to blue. If the user selects the VistaWeb button, the button changes appearance to look as if it is depressed. It will keep that appearance until the user selects a new patient.

When VistaWeb is launched by CPRS Context Management is maintained. This means that VistAWeb will change patients whenever the user selects a new patient in CPRS.

How Do I Know a Patient Has Remote Medical Data?

As part of opening a patient record, CPRS checks in the Treating Specialty file to see if the selected patient visited other facilities. If the patient has remote data, the words on the Remote Data button turn blue. If there is no remote data for the selected patient, the letters are gray and the button unavailable.

If the user selects the Remote Data button with the blue text indicating that there is remote data, CPRS displays a list of sites that tells the user where and when the patient has been seen.

What Does the List of Sites Represent?

If you select on the Remote Data button, a drop-down list appears with the name(s) of sites where the patient has been seen. This list is based on either:

•	Sites that have been specifically designated for your facility to access. These sites are assigned in a parameter that your Clinical Applications Coordinator (CAC) can set up.

•	All VA sites where the patient has been seen and any Department of Defense remote data if it is available.

What Kind of Data Can I View?

Currently with CPRS, you can view some lab and health summary components. There are limitations to what you can view.

•	You can view any lab results that do not require input other than a date range.

•	All reports listed on the Reports tab unless they are labeled "local only"

•	You can view health summary components that have the same name on both the local and the remote site. You can therefore exchange national Health Summaries, but locally defined components may not be available unless the other site also has a component with the same name.

•	If it is available, CPRS can also show some Department of Defense remote data.

How Will the Remote Data Be Viewed?

Viewing remote data is a two-step process. First, you select which remote sites you want to see data from, and then you select the specific information you want to view, such as lab tests or Health Summary components.

On the Reports tab, each site you select will have a separate tab for its data. As an example, you would might see five tabs on the Reports tab: Local, Department of Defense, Devcur, Loma Linda, Ca., and Office of Information.

You would then select the reports you want to view and a date range (if necessary). After this, CPRS will attempt to retrieve those reports if they are available on the remote sites. You would then click on each Treatment Facility’s tab to see the report from that site. While CPRS is attempting to retrieve the data, the message "Transmission in Progress:" is displayed until the data is retrieved.

Related topics

Viewing Remote Data

Choosing RDV or VistaWeb to View Remote Data


Viewing Remote Data

The CPRS user now has two choices for viewing remote data. One is the traditional Remote Data View which has been streamlined, the other is VistAWeb. Each system has its advantages.

The rest of this section follows Remote Data Views. If you want to use VistAWeb, documentation is available on the VistAWeb page at: http://vista.med.va.gov/vistaweb/

To view a patient's remote data, use these steps:

1.	After opening the patient's record, see if the text on the Remote Data button is blue. If the text is blue, the patient has remote data.

2.	Select the tab you want remote data from (e.g., Labs or Reports).

3.	Select the Remote Data button to display a list of sites that have remote data for the selected patient.

4.	Select the sites you want to view remote data from by selecting the check box in front of the site name and then select the Remote Data button again to close the list.

5.	Select the report or lab you would like to view from the Available Reports or Lab Results section on the left-side of the screen (click the plus sign in order to expand a report heading).

Note:	With the exception of the DoD Consults report, choosing a Department of Defense (DoD) report does not limit you to DoD data. For example, if you choose Microbiology under Dept. of Defense, you will get DoD data and remote VA data. You do not have to run a separate report to get VA data.

It may take a few minutes to retrieve the data. While CPRS retrieves the data, the message "Transmission in Progress" will be displayed on the tab.

Note:	For remote data, the local and remote sites must use the same names for the data they want. Nationally released health summaries will work.

Depending on how the report or lab is configured, CPRS will return the remote data in one of two ways.

Text Format with Site Tabs

If the remote data is in text format, the data from each remote site will be displayed under a separate site tab. To view data from a particular site, click on the appropriate tab.

Table format

If the report or lab is available in table view, CPRS will return data from all of the sites in a single table. The "facility" column indicates where the data in a particular row was collected. The table can be sorted by facility or by any other column heading (alphabetically, numerically, or by date) by selecting the appropriate heading. Selecting on the heading again will sort the table in inverse order.

6.	To see detailed information about a particular item in the table, select that item. If detailed information is available, it will be displayed in the bottom-half of the screen. To select multiple rows, press and hold the Shift or Control key.

Related topics

Remote Patient Data Overview

Choosing RDV or VistaWeb to View Remote Data


Active Orders (includes pending and recent activity)
Active Orders (including pending and recent activity)

If you choose Active Orders, you will see the following:

•	active orders

•	pending orders

•	all orders that have seen activity in the past number or hours your site specifies in a CPRS parameter

Some sites use this to see all activity in the past 24, 48, or 72 hours. IRM staff can set the number of hours.


Saving a Default Order View

After you customize your view of the orders list, you can save the view as your default view. You will then see that default view when you go to the Orders tab. You can still change the view or make a Custom Order View, but you will have the default view. You can save any view of the orders list as a default view.

To save a default order view, use these steps:

1.	Select the Orders tab.

2.	Select the view you want:

o	Active

o	Current

o	Expiring

o	Unsigned

o	Custom Order View... (this option requires additional steps)

3.	Select View | Save as Default View.

Related topics

      Return to the Default Order View


Return to Default Order View
Return to the Default Order View

You can use the items on the View menu or the orders tab to sort the order list. If you create a default view of the order list, you simply use this command to bring up the default sorting of the order list.

To bring up the default order list view, use these steps:

1.	On the Orders tab, select View | Return to Default View.

Related topics

Saving a Default Order View


Entering a Complex Dose

Note:	If the user attempts to order inpatient medications for an inpatient from an outpatient location, CPRS discontinues the order process and returns the user to original Orders or Meds tab display.

To enter a complex dose, use these steps:

1.	Select the Complex Dose tab.

Note:	Once you begin a complex order, you must remain on the Complex tab until you finish that order. Do not attempt to start from or switch back to the Dosage tab. If you do, all complex dosages will be erased and you will be forced to start again.

2.	In the dosage field, select the appropriate dosage.

3.	In the Route cell, enter the route.

4.	In the Schedule cell, enter how often the medication should be taken (click PRN if desired).

5.	In the Duration cell, enter a number and select units (days is the default) a patient should use the specified dose.

6.	Add the appropriate conjunction: And, Then, Except (Except is only for Outpatient Meds) or no conjunction for the final line.

7.	Move to the dosage field in the next row and select a dosage.

8.	CPRS will fill in the Route and Schedule fields. If necessary, click in and change the Route and Schedule cells.

9.	Move to each cell as needed and enter a duration and a conjunction.

10.	Repeat steps 7-9 until you have completed the complex dose.

Note:	You can also add or remove a row in the complex dosage. If you add a row, the new row will be placed above the selected row. To add a row, click the gray area in front of the row and click Add Row. To delete a row, click the gray area in front of the row to be deleted and click Delete Row.

11.	Return to the normal instructions for medications ordering (click on the popup window to make it disappear).


Changing a Document's Author, Title, Reference, etc.
Changing a Document's Author, Title, Reference Date, etc.

CPRS now collects document information, such as title, author, date, related consult, and related admission, when you create a document, which allows the document to be auto-saved.

If you do not have a default title, you will be prompted for this information

When you are working on a Progress Note, consult results, or a Discharge Summary, you will see a Change button to the right of the title, author, and other information. You use this button to change the reference information.

With the latest version, you can also change the document title without losing the text you have entered. CPRS will ask if you want to keep the text or not.

Note:	You may only edit this information on unsigned notes. Once a note is signed, you may not edit it.

To change a document's reference information, use these steps:

1.	While in the unsigned note, click Change... to the right of the title, author, and other information.

2.	In the document properties dialog, make the necessary changes.

3.	Select OK.

Note:	If you select a new title that does not have boilerplate text, CPRS will ask if you want to clear the previously loaded boilerplate text. This option will clear all the text you have entered and the new note will be blank.

If the previous title and the new title you choose have boilerplate text, CPRS will ask what it should do with the text:

The Clear Previous Boilerplate Text dialog displays as shown below.

4.	To keep the text in the note, select No. To remove the text, select Yes.

Related topics

Progress Notes

Write a new Progress Note


GAF Score (overview)

You can enter a Global Assessment of Functioning (GAF) score through CPRS. To enter a GAF score, two things are required:

•	You must have the Mental Health package and two specific Mental Health patches installed.

•	Your location must be a mental health clinic.

The GAF tab is on the Encounter frame so you must be creating or editing a progress note to enter a GAF score.

The GAF tab has

•	A display of as many as 5 previous scores, if available, including the score, date determined, the name of the person that determined the score, and a comment, which is used only if a score was entered in error.

•	Places to enter a new score, date, and person who determined the score

•	A Reference Information button that launches your web browser to bring up a web page that describes the GAF score.

Related topics

Entering a GAF Score


Entering a GAF Score

To enter a GAF score, your location must be a mental health clinic. In addition, you must be creating or editing an unsigned progress note and be in the encounter form.

To enter a GAF score, use these steps:

1.	If you are in the encounter frame, skip to step 3. Otherwise, select the Notes tab.

2.	Select New Note and enter the note title, date, author, and other information.

3.	Select Encounter.

4.	Select the GAF tab.

5.	Enter the score, who determined the score, and the date.

6.	Select OK.

Related topics

GAF Score (overview)

Encounter Information (overview)


Sample Dialog from Dialog Template

The graphic below shows a simple dialog from the dialog template. Each template in the dialog template has its text and check box. A user can quickly click the text they want, Select OK, and the text is placed in the document.


Generating a Template from a TIU Object or Note Title
Generating a Template

You can also generate a template from an existing Template Field or from a boilerplated note title.

To generate a template, use these steps:

1.	Select the appropriate tab: Notes, Consults, or D/C Summ.

2.	Select Options | Edit Templates for personal templates or Options | Edit Shared Templates for Coordinators working on shared templates.

3.	Select the template under which you want the new template.

4.	In the template editor, select Action | Generate Template.

5.	Select the source from which to generate the template: Patient Data (object) or Boilerplated Note Title.

6.	Locate the Patient Data or Note Title by either typing a few letters of the name or scrolling through the list. Then click the appropriate item and click OK.

Note:	When you click OK, the boilerplate text or patient data is brought into the template and a new template is created with either the object name or the note title.

7.	Add any necessary content to the document and click Apply to save the template or click OK to save the template and exit the editor.


Problems_Customizing the Problems List
Customizing the Problems List

You can control which problems appear on the problems list by defining specific criteria.  For example, you can specify that only inactive problems associated with a specific clinic appear on the problems list.

To control which problems appear on the problems list, follow these steps:

1.	From the Problems tab, select any of the options listed in the View options field (Active, Inactive, Both active and inactive, or Removed).

-or-

select  View | Active Problems, View | Inactive Problems, View | Both Active/Inactive Problems, or View | Removed Problems.

The appropriate problems will appear on the problems list.

If you would like to filter the problems list further, continue with step 2.

2.	Select View | Filters….

The Problem List View Filters dialog appears.

3.	Select the criteria for the problems that you want to display on the problems list by doing some or all of the following:

a)	Select either Outpatient or Inpatient from the Primary View option group.

b)	Select a status from the Status drop-down list.

c)	Move the appropriate source services or source clinics to the Selected Service(s) or Selected Clinic(s) field by clicking on the > button.

d)	Choose a provider from the Selected Provider drop-down list.

4.	Select OK.

The problems that meet the criteria you specified on the Problem List View Filters dialog will appear on the Problems tab.

Related Topics

Problems List

Adding a Problem

Annotating a Problem

Changing a Problem

Making a Problem Inactive

Removing a Problem

Verifying a Problem


Changing Views on the Meds tab

Changing view on the Meds tab simply reformats the information for a particular medication so that it can be printed or viewed. You may double-click on any medication either the Outpatient of Inpatient lists or you may highlight any medication and select on View | Details.


Changing Views on the Orders tab

Changing the view of the Orders tab allows you to focus the list of orders on one of several criteria. Focusing the list will speed up the selection process.

You may change the Orders List view to only include the following problems:

•	Active Orders (includes pending and recent activity)

•	Current Orders (includes only active and pending orders)

•	Expiring Orders

•	Unsigned Orders

To change the view, click on View on the menu and select the desired list items. You may also double-click on Active Orders in the Orders Sheet field to access that list.

You may select the Custom Order View... option on the menu to further focus the list of orders you wish to have displayed. From the Custom Order View dialog, you may choose to display orders by any combination of Order Status, Service/Section, and date range.


Changing Views on the Notes tab

Changing the view of the Notes tab allows you to focus the list of notes on one of several criteria. Focusing the list will speed up the selection process.

You may change the Orders List view to only include the following problems:

•	Signed Notes (All)

•	Signed Notes by Author

•	Signed Notes by Date Range

•	Uncosigned Notes

•	Unsigned Notes

To change the view, click on View on the menu and select the desired list items.

You may select the Custom View option on the menu to further focus the list of notes you wish to have displayed. From the List Selected Documents dialog, you may choose to display notes by a combination of Status, Author, and date range.

Note:	Choosing some criteria will make other unavailable. If you choose "all notes" in one criteria, for example, you cannot set a maximum number to return or a date range because that conflicts with the "all" choice.

1.	From the Notes tab, select View | Custom View.

The List Selected Documents dialog will appear.

2.	Select the criteria for the documents that you want to display on the Notes tab by doing some or all of the following:

a)	Select a status from the left side of the window.

b)	Enter the maximum number of notes that you would like to display in the Max Number to Return field.

c)	Select an author or expected cosigner from the Author or Expected Cosigner field.

d)	Select a beginning and ending date by doing one of the following:

•	entering a date (e.g. 6/21/01 or June 21, 2001)

•	entering a date formula (e.g. t-200)

•	pressing the [image] button to bring up a calendar

e)	Select a sort order from the Note Tree View option group.

f)	If you would like to group the notes, make a selection from the Group By drop-down list.

g)	If you would like to further sort the notes that have been grouped in step f, select the criteria to sort by in the Sort By drop-down list.

h)	If you would like the subject of the notes to be displayed in the tree view, check the “Show subject in list” check box.

i)	If you would like to limit the notes that are displayed to notes that contain specific text in the title or in the subject line, click the appropriate check box and enter the text in the Contains field.

Note:	You can erase the contents of the List Selected Documents dialog by clicking the Clear Sort/Group/Search button.

3.	Click OK.

The notes that meet the criteria you specified will appear on the Notes tab.

Related topics

Viewing All Signed Notes for a Date Range

Viewing All Signed Notes by a Specific Author

Viewing All Signed Notes, All Unsigned Notes, or All Uncosigned Notes


Changing Views on the Consults tab

Changing the view of the Consults tab allows you to focus the list of consults on one of several criteria. Focusing the list will speed up the selection process.

You may change the Consults view to only include the following problems:

•	All Consults

•	Consults by Status

•	Consults by Service

•	Consults by Date Range

To change the view, select View on the menu and select the desired list items.

You may select the Custom list option on the menu to further focus the list of notes you wish to have displayed. From the List Selected Consults dialog, you may choose to display consults by any combination of Service, Status, and date range.


Changing Views on the Discharge Summaries Tab

Changing the view of the Discharge Summary tab allows you to focus the list of summaries on one of several criteria. Focusing the list will speed up the selection process.

You may change the Discharge Summaries List view to only include the following summaries:

•	Signed Summaries (All)

•	Signed Summaries by Author

•	Signed Summaries by Date Range

•	Uncosigned Summaries

•	Unsigned Summaries

To change the view, select View on the menu and select the desired list items.

You may select the Custom View option on the menu to further narrow the list of summaries you wish to have displayed. From the List Selected Documents dialog, you may choose to display summaries by a combination of Status, Author, and date range.

Related topics

Discharge Summaries (overview)

Viewing Discharge Summaries

Document Templates (overview)


Changing Views on the Labs Tab

The View menu on the Labs tab is different from most of the other tabs in that the menu options do not sort or focus the listed items. The menu items are a way to open different windows and displays with information the clinician may need to see in conjunction with the lab results.

Demographics

From the Labs tab, select View | Demographics to display the Patient Inquiry screen of the currently selected patient.

Postings

From the Labs tab, select View | Postings to display the Patient Postings screen of the currently selected patient. The Patient Postings window displays information about the patient’s allergies, and any Crisis Notes, Warning Notes, and Directives that may apply to the patient.

Reminders

From the Labs tab, select View | Reminders to display the Available Reminders dialog for the currently selected patient. The Available Reminders dialog allows you to review all reminders including the ones that apply to the currently selected patient.


Entering Encounter Form Data - Procedures

To receive workload credit, you enter encounter form data when you create a new Progress Note, completing a consult, or writing a discharge summary for the selected patient. All of the tabs are similar, but the Procedures tab has a small, but important difference.

Note:	Once a note, summary, or consult has been completed, you can only change encounter information directly through PCE.

When you select an item from the Procedure Section list box on the left side of the tab, specific items are displayed in the Section Name list box in the middle. Highlight any item in the Section Name list box and the Modifiers for that Section are displayed (as read-only) in the list box on the right side of the tab. Click on any check box in the Section Name and the Modifiers can be selected. Once the Modifiers list box is enabled, you may click on any combination of check boxes. The results of your selections are displayed in the list box at the bottom of the tab.

To enter encounter form data on the Procedures tab, follow these steps:

1.	Select the appropriate tab: Notes, Consults, or D/C Summ.

2.	Select New Note, New Summary or select Action | Consult Results....

3.	Select Encounter.

4.	Select the Procedures tab.

5.	Select the appropriate category in the Procedure Section list box on the left.

6.	Select on one or more check boxes by the appropriate items in the Section Name list box in the middle.

-or-

If the Section Name you want is not shown or the list boxes are empty, use the search feature by clicking on Other Procedure. Type in the beginning of a term and click Search, then locate and double-click the needed item.

7.	Select on one or more check boxes by the appropriate items in the Modifiers list box in the right. You may accept the default list of modifiers or change them to whatever you need.

8.	Enter any additional information as necessary.

9.	When finished, select OK.

Related Topics

Entering Current Activities Encounter

Encounter Information (overview)

Entering Encounter Form Data on the Procedures tab

Other Health Factors


Other Health Factors
Entering Encounter Form Data - Health Factors

To receive workload credit, you enter encounter form data when you create a new Progress Note, completing a consult, or writing a discharge summary for the selected patient.

Note:	Once a note, summary, or consult has been completed, you can only change encounter information directly through PCE.

When you select an item from the Health Factors Section list box on the left side of the tab, specific items are displayed in the Section Name list box on the right. The results of your selections are displayed in the list box at the bottom of the tab.

To enter encounter form data on the Health Factors tab, follow these steps:

1.	Select the appropriate tab: Notes, Consults, or D/C Summ.

2.	Select New Note, New Summary or select Action | Consult Results....

3.	Select Encounter.

4.	Select the Health Factors tab.

5.	Select the appropriate category in the Health Factors Section list box on the left. If no Health Factors are listed, select on the Other Health Factors button to search a comprehensive three-way search for of health factors.

Note:	To select other health factors, you may (a) type in the first few letters of the health factor in the search field at the top of the dialog and the program will search for the closest match, (b) scroll through the alphabetic list of health factors in the second field until you find the desired health factor, or (c) select on the expand buttons to reveal health factors grouped by category in the second field. Any time you highlight a health factor in either the second or third field, the program finds and highlights the duplicate entry in the other field.

6.	Select on one or more check boxes by the appropriate items in the Section Name list box on the right. The information is automatically added to the Level/Severity-Selected Health Factors field at the bottom of the dialog.

7.	Enter any additional information as necessary, such as Level/Severity.

8.	When finished, select OK.

Related Topics

Entering Current Activities Encounter

Encounter Information (overview)

Entering Encounter Form Data on the Procedures tab


Notes tab

On the Notes tab, the list of documents is presented in a tree structure. Highlight any note listed in the left pane to view the text of the note in the right or details pane. Addenda are separately selectable and are displayed as a page with a plus sign behind a note page. Interdisciplinary notes are grouped under the original note and are marked with a yellow folder icon with a plus sign on it. Interdisciplinary notes are notes produced by several different departments or disciplines (physicians, addenda, consults, emergency room, pharmacy, dietitians, etc.) Double click the plus sign to expand the list. Once expanded, any note may be selected and viewed. The Templates drawer is available without opening or editing a Note. This allows templates to be copied and used in other word processing fields throughout CPRS.

Select a grouping node (for example "All signed notes") in the tree to display a second list of all the documents falling under that grouping node. This second list can be sorted by clicking on the column headings (Date, Title, Author, Location).

The Custom View dialog (View | Custom View) has been greatly expanded, allowing the items in the tree to be grouped and sorted in a variety of ways. All custom view selections can be saved as the user's default view (View | Save as Default View).


Creating and Modifying Shared and Personal Templates

Shared and personal templates can simplify and speed-up creation of notes, consult requests, and discharge summaries by creating easy-to-use dialogs of frequently or commonly used text elements that can be selected and dropped into CPRS GUI text fields.

When opening the Template Editor, the currently selected template in the templates drawer will now be selected in the Template Editor, provided the user is authorized to edit the template.

Related topics

Opening a Template

Creating a Personal Template

Copying Template Text

Mark a Template as Default

Go to the Default Template

View Template Notes

Hide Items in Dialogs

Display Only

Only Show First Line

Indent Dialog Items

One Item Only

Hide Dialog Items


Opening a Template

To open a shared template or personal template (if you have created any):

1.	 Select the Notes tab.

2.	Select the Templates drawer.

Note:	You may open the Templates drawer without creating a new note, which gives you the ability to use templates in any CPRS text field if you use Copy Template Text.

3.	Expand either the Shared Template or Personal Templates trees.

4.	Right-click the desired template.

5.	From the resulting menu, select Preview/Print Template to see the template.


Go to the Default Template

Once you have selected a default template, you may right-click from any template and select Go to Default Template from the menu. The highlight will jump to your default template so that you may access it.


Display Only

Click this check box to make individual parts of a dialog as display only. When a template is display only, the check box is removed and the item is used for information or instructions.


Only Show First Line

Click on this check box and the template will display only the first line of text followed by an ellipsis (...). The ellipsis indicates that more text exists. Hold the cursor over the line of text and a Hint box displays the complete text. This feature gives you the ability to have long paragraphs of text that do not take up a lot of room on the template. If selected, the entire paragraph is be inserted into the note.


Indent Dialog Items

Clicking on this check box affects the way that children items are displayed on the template. When selected, this feature gives the ability to show hierarchical structure in the dialog. All of the subordinate items for the selected item are indented.


One Item Only

Clicking on this check box affects the way that children items are displayed on the template. click on this check box if you want to allow only one of the subordinate items be be selectable. Clicking on this check box changes the check boxes into radio buttons so that only one item can be selected at a time. To deselect all items, click on the one that is selected and the radio button is cleared.


Hide Dialog Items

Clicking on this check box affects the way that children items are displayed on the template. Click on this option to have subordinate items appear only if the parent item is selected. This feature allows for custom user input. those. the user only sees the options related to the items selected. This feature requires boilerplated text at the parent level.


Hide Items in Dialogs

Click on this check box and children templates are no longer available from the template drawer. Only the parent group template, dialog or folder is available.


Reminder Dialog
Creating a Reminder Dialog

Templates can be linked to Reminder dialogs that are listed in the TIU Reminder Dialogs parameter. This enables you to use templates to place orders, enter PCE information, and enter vital signs and mental health data. If there are no Reminder Dialogs in the TIU Reminders Dialog parameter, the Reminder Dialog template type will not be available.

To create a Reminder Dialog, follow these steps:

1.	Select Options | Create New Template… on the Notes, Consults, or D/C Summ tab

The Template Editor will appear.

2.	Type in a name for the new template in the Name field under Personal Template Properties.

Note:	Template names must begin with a letter or a number, be between 3 and 30 characters in length (including spaces), and cannot be named "New Template."

3.	Select the drop-down button in the Template Type field and select Reminder Dialog.

4.	Select the drop-down button in the Dialog field and select the Reminder Dialog desired.

5.	Place the template in the tree view in the desired location. (To do this, click the plus sign next to an item to view its subordinate objects and then drag-and-drop the template to its desired location. You can also move the template by using the arrows below the personal templates tree view.)

6.	Select Apply to save the template.

7.	Select OK to exit the editor.

Note:	You do not have to click Apply after each template, but it is recommended because if you click Cancel, you will lose all changes you have made since the last time you clicked Apply or OK.

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Insert Patient Data Object
Inserting Patient Data Objects

When creating a note, consult or discharge summary, current data from the selected patients file may need to be included. A quick and easy way to include such data objects it to create a template that automatically includes the needed data.

1.	While editing a template, select Edit | Insert Patient Data (Object).

2.	From the Insert Patient Data (Object) dialog, scroll through the list of available patient data objects or type the first few letters of the object name in the field to highlight the desired data object.

3.	Select Insert Object.

4.	Repeat steps 2 and 3 for each data object you want to insert into the template.

5.	After inserting all desired data objects select Done.

6.	You may review the template appearance by selecting Edit | Preview/Print Template.

Note:	The Insert Patient Data (Object) dialog is non-modal and can be boilerplated at will.


Tools
Tools Menu

The Tools menu allows you to quickly access other applications and utilities from within CPRS. Depending on the configuration of your site, the Tools menu may allow you to access other VistA applications such as VistA Imaging or connect you to third-party applications such as word-processing programs or Internet browsers. Talk to your clinical coordinator if you wish to add an application or utility to the Tools menu.

At the request of sites, CPRS added the ability to create nested or submenus (menus within menus) to help them organize the items that sites place on their Tools menus. The number of items was increased to 99 total items (including items and separator lines). Again, these items are placed on the menu and organized by a Clinical Application Coordinator (CAC) or someone with a similar role at your site.

The Tools menu also contains two standard menu items: Lab Test Information and Options…

Related Topics

Lab Test Information

Options


General Tab (Tools | Options)

The General tab includes the Date Range Defaults…button, which allows you to limit the date range for lab results as well as appointments and visits that appear on the cover sheet. The Clinical Reminders… button enables you to configure and arrange which clinical reminders are displayed on the cover sheet. The Other Parameters…button enables you to set which tab is active when CPRS starts and limit the number of imaging reports that are available from the Reports tab. The buttons on the General tab are explained in more detail below.

Date Range Defaults...

Select Date Range Defaults... to set how long lab results, appointments, and visits will be displayed on the Cover Sheet.

Clinical Reminders...

Click on Clinical Reminders... to configure and arrange which clinical reminders are displayed on the Cover Sheet.

Based on the setting of the parameter ORQQPX NEW REMINDER PARAMS, you will see one of two dialogs for configuring and arranging clinical reminders on your coversheet. If this parameter is set to "Off," you will see the "Clinical Reminders on Cover Sheet" dialog. If the parameter is set to "On," you will see the Clinical Reminders and Reminder Categories Displayed on Cover Sheet dialog. Your Clinical Coordinator sets the ORQQPX NEW REMINDERS PARAMS parameter.

Clinical Reminders on Cover Sheet

To select the clinical reminders you want displayed on the Cover Sheet, follow these steps:

1.	From the Clinical Reminders on Cover Sheet dialog, highlight an item in the “Reminders not being displayed:” field.

2.	Select the arrow button (>)  to add the clinical reminder to the “Reminders being displayed:” field. (Hold down the control key to select more than one reminder at a time.) The reminders in this field will be displayed on the Cover Sheet. Select the arrow button (>) to remove an item.

3.	To control how the reminders are displayed on the Cover Sheet, do one of the following:

o	select the “Display Order” option (at the bottom of the dialog) to display the reminders in their current order. To move a reminder up or down the list, select the reminder and click either the up or down arrow.

o	select the “Alphabetical” option (at the bottom of the dialog) to display the reminders in alphabetical order.

Clinical Reminders and Reminder Categories Displayed on Cover Sheet

This advanced dialog displays reminders in a way that allows the user to better manage the reminders that are displayed on the Cover Sheet. The dialog consists mainly of three large list fields. The "Cover Sheet Reminders (Cumulative List)" field displays selected information on the reminders that will be displayed on the Cover Sheet. The "Available Reminders & Categories" field lists all available reminders and serves as a selection list. The "User Level Reminders" field displays the reminders that you have added to or removed from the cumulative list.

You may sort the Reminders in the "Cover Sheet Reminders (Cumulative List)" field by clicking on any of the column headers. Click on the Seq (Sequence) column header to view the Reminders in the order in which they will be displayed on your Cover Sheet.

An icon legend is displayed to the right of the "Cover Sheet Reminders (Cumulative List)" field. A folder icon represents a group of Reminders while a red alarm clock represents an individual Reminder. A Reminder with a plus sign in the first column has been added to the list while a Reminder with a minus sign in the first column has been removed from the list. The user cannot remove reminders with a padlock icon in the first column.

Cover Sheet Reminders (Cumulative List)

The Level column of the "Cover Sheet Reminders (Cumulative List)" field displays the originating authority of the Reminder, which can include System, Division, Location, User Class, and User. Reminders on this list that display a small gray padlock icon at the beginning of the line cannot be removed. These Reminders are mandatory. The Seq (Sequence) column defines the order in which the Reminders will be displayed on the Cover Sheet. If there are two or more Reminders with the same sequence number, the Reminders will be listed by level (System, Division, Service, Location, User class, User).

Location shown in Cumulative List

Select this drop-down box and select a location. The Reminders assigned to that location appear on the Cumulative List.

Available Reminders & Categories

This field displays all of the Reminders and Categories available to the user. Notice that the reminder name is in parentheses after the print name. Categories are groups of related Reminders that can be added as a group. Individual reminders within a category can be removed from the User Level Reminders field. Highlight a Reminder or Category from the field and click the right arrow to add them to the User Level Reminders field.

User-Level Reminders

This field displays all of the Reminders selected by the user. To add a Reminder to your User Level Reminders, highlight the desired Reminder in the Available Reminders & Categories field and click the right arrow button. To delete a Reminder from your User Level Reminders field, highlight the Reminder in the User Level Reminders field and click the left arrow.

You may determine the order in which the Reminders will be displayed on the Cover Sheet by changing the Reminder’s sequence number. For example, to place a Reminder at the top of the Reminders list, assign it a number less than 10. To change the order of User Level Reminders, highlight Reminders and click the up arrow or down arrow until the desired order is achieved.

You may remove any or all non-mandatory Reminders assigned at any level by adding the Reminder to your User Level and then clicking the Remove button.

Cover Sheet Reminders

Once you have the cumulative List, as you want it, select View Cover Sheet Reminders to view how the reminders will be displayed on your Cover Sheet for the specified locations.

Once you have made all of the desired changes to the Reminders that will be displayed on the Cover Sheet, select OK.

Other Parameters...

To set the initial chart tab, Meds tab date range, or Encounter date range select Other Parameters.

Chart Tabs

Select the drop-down field and select the chart tab with which CPRS should open. select the check box if you want CPRS to remain on the last selected tab when you change patients.

Note:	For this change to take effect, you must exit CPRS and log back in.

Meds Tab Date Ranges

1.	Enter a start date by doing one of the following:

o	Typing a date (e.g. 6/21/01 or June 21, 2001).

o	Typing a date formula (e.g. t-200).

o	Pressing the [image] button to bring up a calendar and select a date.

2.	Enter a stop date by doing one of the following:

o	Typing a date (e.g. 6/21/01 or June 21, 2001).

o	Typing a date formula (e.g. t-200).

o	Pressing the [image] button to bring up a calendar and select a date.

3.	When you have entered the dates, go to another option on this dialog or select OK.

Encounter Appointments Date Range

This option enables users to set the date range for Encounter appointments that CPRS displays on the Cover Sheet and the Encounter form. The two values are based on today’s date and represent how many days in the past and how many days in the future the user may set for CPRS to display appointments.

To set these values, use the following steps:

1.	In the Start Date field, type or use the arrows to select a number of days in the past CPRS should display appointments.

2.	In the Stop Date field, type or use the arrows to select a number of days in the future CPRS should display appointments.

Note:	Your site can set a parameter to give you a warning if you select an appointment too far in the future. CPRS will display a warning to let you know that you may be going against local policy. This message is just a warning and you may proceed.

3.	When you have entered the dates, go to another option on this dialog or select OK.

Related Topics

Personal Preferences (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


Notifications Tab (Tools | Options)

This tab allows you to change your notification options. Click the check box if you wish to have MailMan send you a bulletin for flagged orders.

Surrogate Settings...

To set a surrogate, click on Surrogate Settings… From the Surrogate for Notifications dialog, select a surrogate from the drop-down list. When saved, the surrogate information is displayed on the Notifications tab. To set a surrogate date range, click on Surrogate Date Range… From the Date Range dialog, click on the [image] button and select a start date and a stop date. You may also select a start time and a stop time for the surrogate. When saved, the surrogate date range information is displayed on the Surrogate for Notifications dialog.

Remove Pending Notifications...

WARNING:  When a provider is identified as a surrogate for another user for a designated period of time, notifications from the original user are sent to the surrogate. If a surrogate user chooses to use this button to remove pending notifications, all alerts are deleted, even if they are for actions such as requiring signature.  The alerts are deleted not only for the surrogate but also the user they are a surrogate for. The alerts are permanently deleted for the surrogate, never to be regenerated, even if they have not been processed.  However, if the alerts have not been processed by the surrogate, some may be returned to the original user based on a certain set of rules implemented in the Kernel.

The following are the set of rules. When the surrogacy period expires and unprocessed surrogate alerts have not been returned yet, the alerts sent to the surrogate(s) for the user are checked.

•	If the surrogate has processed an alert, it is ignored.

•	If the surrogate has not processed an alert originally intended for the user, it is returned to the originally intended recipient.

•	If the unprocessed alert was also sent to the surrogate as an initial recipient, then the alert is also retained by the surrogate.

•	If the alert was forwarded to the surrogate, but meant only to be sent to the original user, then the alert is electronically removed from the surrogate’s notification list.

•	Any unprocessed alerts that are retained by the surrogate will require manual intervention to remove them.

There is no difference in how informational vs. action notifications are managed with respect to surrogacy. The above rules are applicable regardless of the type of notification.

Please use care when using this button to remove pending notifications, especially if you are designated as a surrogate for another user, as patient care may be delayed until the original provider returns.

To remove pending notifications, if necessary, use the following steps:

1.	Select the Remove Pending Notifications button and then on Yes on the Warning dialog to clear all of your current pending notifications. (This button is enabled only if you are authorized to use it.)

2.	If you are sure you want to remove the pending notifications, select Yes.

Display Sort

Select on the Display Sort drop-down field to select the sort method for your notifications. Choices include Patient, Type, and Urgency.

Notifications list

Select the check box next to any notification to enable or disable it. Notifications with "Mandatory" in the Comment column cannot be turned off or disabled. Click the heading to sort notifications so that you can see which are turned on and which are turned off.

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


Order Checks Tab (Tools | Options)

Select the check box next to any order check to enable or disable it. Order checks with "Mandatory" in the Comment column cannot be turned off or disabled. Select the heading to sort order checks so that you can see which are turned on and which are turned off.

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


Lists/Teams Tab (Tools | Options)

The Lists/Teams tab allows you to set defaults for selecting patients. It also contains your personal lists and the teams of which you are a member.

Patient Selection Defaults...

Select on Patient Selection Defaults... to change your defaults for selecting patients. Click a radio button in the List Source group. If you select Combination, you will be able to select from more than one source. After selecting a list source, click the appropriate drop-down button (or buttons if Combination is selected) and select the criteria for that source. If you select Clinic or if Clinic is one of the sources in your combination of sources, you will need to select a clinic for each applicable day of the week. If you do not work in any clinic on a particular day, leave the field for that day empty.

Select a radio button in the Sort Order group to determine the sort order for the patients. If an item is dimmed, it is not available with the list source(s) you have selected.

To display patients who have clinic appointments within a specific date range, click the selection buttons. The Start and Stop fields denote the number of days before or after today that appointments should be displayed.

The defaults that are set here are used when you select patients from the Patient Selection dialog in the CPRS chart. Therefore, if you choose Ward, it will display the patients for the ward you have set as your default and if you choose Clinic, it will display the clinic patients for that day.

Source Combinations...

Select Source Combinations... to edit or create a list of sources from which your patients can be selected. You can change you combinations by adding or removing specific wards, clinics, providers, specialties or lists.

To create a source combination:

1.	Select on a radio button in the "Select source by" group.

2.	Select an entry in the selection field below the "Select source by" group.

3.	Select Add.

4.	Repeat steps 1 through 3 for each desired source.

5.	When all desired entries are in the Combinations field, click OK.

You can create only one combination list. The combination list can be set as your default using the Patient Selection dialog.

Personal Lists...

This option allows you to edit your personal lists of patients or combinations of wards, clinics, providers, specialties or lists.

To create a personal list, use these steps:

1.	Select Personal Lists... to edit or create list of patients.

2.	To create a list, select New List...

3.	In the New Personal List dialog, type in a name for your list. Then, indicate whether the list will by visible only to you by selecting the Myself only radio button or allow all users to see the list by selecting the All CPRS users radio button.

4.	Locate the appropriate patients by selecting the appropriate category under the “Select patients by” group: Patient, Ward, Clinic, Provider, Specialty, Other.

When a category is selected, CPRS displays the items for the category. For example, if you choose Clinic, CPRS displays the list of clinics.

5.	Select the item within the category that you want to use. For example, if you have a patient and you know the patient is in a specific clinic, select that clinic.

6.	The Patients to add field lists all of the patients that can be added from the particular selection method. Highlight the patient names in this field and click Add (which moves the highlighted patient or patients into the Patients on Personal List pane. To add all patients, select Add All to copy all the patients under the Patient to add pane.

7.	Repeat steps 4-6 until you have added all the patients you want to your new personal list.

8.	Review the list. If changes need to be made, use the steps 4-6 to add new names. To remove names, highlight them under the Patients on Personal List pane and select Remove. To remove all the names under Patients on Personal List pane, select Remove All.

9.	If needed, select whether the list should be for Myself only or for All CPRS users.

10.	When you have all the patients that you want on the list, select Save Changes if you plan to make other changes on the Personal List dialog such as creating one or more additional Personal Lists. If you are finished creating personal lists for now, select OK.

To edit a personal list, use these steps:

1.	On the Lists/Team tab, select Personal Lists….

2.	In the Personal Lists dialog, select the list under the Personal Lists pane that you want to edit.

3.	To add patients to the list, locate the appropriate patients by selecting the appropriate category under the “Select patients by” group: Patient, Ward, Clinic, Provider, Specialty, Other.

When a category is selected, CPRS displays the items for the category. For example, if you choose Clinic, CPRS displays the list of clinics.

4.	Select the item within the category that you want to use. For example, if you have a patient and you know the patient is in a specific clinic, select that clinic.

5.	The Patients to add field lists all of the patients that can be added from the particular selection method. Highlight the patient names in this field and click Add (which moves the highlighted patient or patients into the Patients on Personal List pane. To add all patients, select Add All to copy all the patients under the Patient to add pane.

6.	Repeat steps 3-5 until you have added all the patients you want to your new personal list.

7.	Review the list. If changes need to be made, use the steps 3-5 to add new names. To remove names, highlight them under the Patients on Personal List pane and select Remove. To remove all the names under Patients on Personal List pane, select Remove All.

8.	If needed, select whether the list should be for Myself only or for All CPRS users.

9.	When you have all the patients that you want on the list, select Save Changes if you plan to make other changes on the Personal List dialog such as creating one or more additional Personal Lists. If you are finished creating personal lists for now, select OK.

You maintain these lists by using this dialog. Patients are not updated automatically on personal lists. You can select from these lists by selecting the Teams choice on the Patient Selection dialog.

Personal Diagnosis List…

This option enables users to create and maintain a Personal Diagnosis List that displays as one option in the Assign Diagnosis to Order(s) dialog used with Clinical Indicators Data Capture (CIDC) features to assign a diagnosis to specific kinds of orders.

The Personal Diagnosis List dialog enables users to choose diagnoses from the patient’s Problem List entries, nationally defined encounter forms, and the Lexicon and add them to a personal diagnosis list for quicker entry of CIDC information.

To create or edit a Personal Diagnoses List, use the following steps:

1.	Bring up the Options dialog by choosing Tools | Options….

2.	Select the Lists/Teams tab by either clicking on it or pressing Ctrl + Tab until that tab is selected.

3.	Bring up the Personal Diagnoses List dialog by either clicking Personal Diagnoses List… or tabbing to that selection and pressing Space.

4.	To add diagnoses to your personal list using available sources other than the Lexicon, select a category (Problem List, national encounter form or today’s Orders) from the Diagnoses Section pane, highlight one or more diagnoses, and click Add or tab to that button and press Space. Repeat until you have the entries you want in your personal list.

-or-

To add diagnoses to your personal list using the Lexicon, select Other diagnoses… or tab to that button and press Space, type some letters that will help you find the appropriate diagnosis, and select Search or tab to Search and press Space. When you find the diagnosis, select it and press OK. Repeat until you have the entries you want in your personal list.

5.	To remove an unwanted item from your personal list, highlight the item (which will make the Remove button display) and select Remove or tab to that button and press Space.

6.	When you have the items you want on your personal list, select OK or tab to that button and press Space.

Teams Information...

This option allows you to view the teams you are on and the patients associated with those teams. Click a team to view the patients associated with it and other team members. Click the check box to include your personal lists. Click Remove yourself from this team to remove yourself from the highlighted team. Click the drop-down button on the "Subscribe to a team" field and select a team to which you wish to be added. You can only subscribe yourself to or remove yourself from teams that have been defined as "subscribable."

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


Notes Tab (Tools | Options)

Notes...

This option on the Notes tab allows you to configure defaults for editing and saving notes. Use the selection arrows to change the number of seconds between auto save intervals for notes. You may also assign a default cosigner for notes by selecting the drop-down button and selecting a provider. You may also click on the either of the two check boxes, if you wish to be prompted for a subject for progress notes and if you wish to verify note titles.

Document Titles...

You may select a personal list of document titles to be displayed for several different types of documents. Select on the drop-down button on the Document class field and select the class of document for which you would like to create a list. When you have selected a document class, the Document titles field is automatically populated with all available choices. Highlight one and select on Add. Hold down the Control key to select more than one title at a time. To select a title from your list as your default, highlight it and select on Set as Default. Select on Save Changes if you will be making more changes on this dialog before you select OK.

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


popup: Inpatient Medications Selection dialog


popup: inpatient meds dialog with NSS link


Template Fields

Template fields allow you to create text edit boxes and to create lists of text that can be selected via combo boxes, buttons, check boxes, or radio buttons. Through a new type of markup syntax {FLD:TemplateFieldName}, these controls can be added to templates, boilerplate titles, boiler plate reasons for request, and reminder dialogs. A Template field editor has also been added that can be used by members of the ASU user classes listed in the new TIU FIELD EDITOR CLASSES parameter. You can access the template field editor through the options menu on the Notes, Consults and D/C Summaries tabs, as well as through the new Template Editor Tools menu. There is also a new Insert Template Field menu option in the Template Editor, following the Insert Patient Data Object menu option.

Template Dialogs will now show an asterisk ( * ) before required template fields, and will not allow you to press the OK button if you have not completed the required fields. A message has also been added at the bottom of the template dialogs that states "* Indicates a Required Field".

Using the Template Field Editor

Inserting Template Fields into a Template

Template fields can also be used in boilerplated text that can be associated to a new Note, Consult or Discharge Summary.

When you select the Preview button, you can view how the template dialog will appear. Note that since the Separate Lines check box is enable on the Template field Editor dialog, the check box items on the preview are each listed on a separate line. These fields can optionally be marked as Required.


Using the Template Field Editor

You can reduce the time required to complete a note, consult, or discharge summary by adding template fields to your templates and dialogs. Information that you would normally have to look up can be pulled directly into your note, consult, or discharge summary from the template fields in your templates.

To view the predefined characteristics of the template fields:

1.	Select on either the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates.

3.	Select the desired template field in the Template Fields list on the left side of the dialog. The field is copied to the Name field on the right side of the dialog and all of the existing elements of the field are displayed.

4.	Select Preview to see how the Template Field will appear on a template or click OK to complete the procedure.

To create a new template field:

1.	Select either the Notes, Consults, or D/C Summ tab.

2.	Select Options | Edit Templates Fields.

3.	Select New Template in the upper right corner of the Template Field Editor dialog.

4.	Type a unique name for the new template field.

5.	Select a Type.

o	Edit Box

o	Combo Box

o	Button

o	Check boxes

o	Radio buttons

o	Date

o	Number

o	Hyperlink

o	Text

o	Word Processing

6.	If Edit Box is selected, type or select a number between 1 and 70 into the Maximum Number of Characters field. If Combo Box, Button, Check Boxes or Radio Buttons are selected as the Type, the Default field and Maximum Number of Characters fields are unavailable. The Items field and the Default field below Items are active.

7.	The Default field below the Type field is available only when Edit Box is the Type selected. Type the text that you wish to have appears in the Edit Box by default. On the template, the user can accept the default text or change it, as long as the new text is within the Maximum Number of Characters limit.

8.	If the Type is Combo Box, Button, Check Boxes, or Radio Buttons, the Items field will be active. Type the different choices from which you wish to let the user choose. Each item must be on a separate line in the Items field. however, if you wish to have the Items listed on separate lines in the template, you must enable the Separate Lines check box.

9.	If the Type is Combo Box, Button, Check Boxes, or Radio Buttons, the second Default field will be active. If you wish, you may click the drop-down button and select one of the Items as the default Default

10.	If you wish, you may type text in the LM Text field and it will appear in the List Manager version. Template Fields have been developed strictly for GUI functionality. If you are still using LM, the text {FLD:TEMPLATE FIELD NAME} will appear in LM body of the note. To avoid this, type text in this field.

11.	If the field being created on the template is required, enable the Required check box, which will prevent the template from being closed without the field being selected or completed.

12.	You may include text in the Notes field that will explain or describe the Template Field. You may also use it to record changes that have been made to the Template field. The text typed into this field will not appear on the template. These notes will not appear to a user when entering a note. They are for development use only as notes to the creator.

13.	Select Preview to see how the Template Field will appear on a template or click OK to complete the procedure.

Related topics

Template Fields

Inserting Template Fields into a Template


Inserting Template Fields into a Template

Once you have decided which Template fields to use or you have defined the Template Field that you need, you can add them into a template. With the Template field in the Template, you can quickly and easily select the items you wish to add to a note, consult or discharge summary.

Developers added two new template fields to CPRS v.27 to enable sites to better serve their visually impaired users:

•	Screen Reader Stop Code

•	Screen Reader Continue Code

Screen readers work by speaking text and labels on dialogs and forms presented to the user. The screen reader will stop when it gets to a control, such a drop-down box or some other item. These codes will allow the users who create templates at the sites to control when the screen reader needs to stop and when it would be better for it to continue. For example, if in the template, the user needs to enter a number, but some explanatory text after the number is needed, the Screen reader Continue Code will enable the template creator to make the screen reader continue reading to give the visually impaired user all the information he or she needs. Another example would be some text that normally would not be read until a button received focus.

These codes enable template creators to more tightly control what is read when the screen reader is running. When it is not, they will not have the effect. Template creators will need to work with visually impaired users to ensure the templates are reading correctly.

To add a Template Field into a Template complete the following steps:

1.	From the Notes, Consults or D/C Summ tab, select Options | Edit Templates..., Create Templates, Edit Shared Templates, or Create New Shared Template...

2.	From the Template Editor, select the template to which you will add a Template Field.

3.	Insert the cursor at the place in the Template Boilerplate field where you wish to insert the Template Field.

4.	From the toolbar, select Edit | Insert Template Field or right-click in the template and select Insert Template Field.

5.	On the Insert Template Field dialog, type the first few letters of the desired field or scroll through the list until the desired field is located and select it.

6.	Select the field you want to insert.

7.	Select Insert Field.

8.	Repeat steps 5 through 7 for each additional Template field you wish to insert.

9.	Select Done when you have added all of the desired template fields.

10.	From the tool bar, select Edit | Preview/Print Template or right-click in the template and select Preview/Print Template. This will preview the template. If the template does not display with the desired appearance, you may continue to edit it.

11.	On the Template Editor dialog, select OK to save the changes to the template.

Note:	The Insert Template Field dialog is non-modal and can be used as a boilerplate if desired.

Related Topics

Document Templates (overview)


Refresh Patient Information

You can refresh a patient’s information so that recent changes will be reflected. To refresh a patient’s records, select File | Refresh Patient Information. This option will refresh the information of the currently selected patient in the same manner that changing patients looks for the latest information. Refreshing a patient’s information will result in notes in progress being saved, and the review/sign changes screen will appear if changes are pending.

If the user has opened the chart and changed the patient’s location (from an inpatient location to an outpatient location or vice versa), but has not written any orders, the following dialog will appear when the user selects File | Refresh Patient Information to enable the user to select where orders should be processed that are written later:

This dialog appears after a refresh when the patient’s location has been changed, but no orders have been written yet. The reason for this is that sometimes it can be difficult to make sure the patient’s location is correct when the location has changed.


Icon Legend

This non-modal, stay-on-top window has five tabs that define various icons for items in CPRS: templates, reminders, notes, consults, and surgery. The window can be opened using the following methods:

•	From the Notes, Consults or D/C Summ tab, select View | Icon Legend.

•	Right-click in the Templates Drawer.

•	From the Templates Editor, select Tools | Icon Legend.

•	Right-click anywhere a Reminder is displayed including the Coversheet, Reminders Drawer, and the Reminders Tree available from the Reminder Button.


Patient Data Objects

Patient Data Objects are items of information from a patient's record that can be called and inserted into notes, consults and discharge summaries through templates. A Patient Data Object could, for example, cause the name, birth date, latest blood pressure reading, or any number of informational items to be inserted into a text document.


Reports Tab (Tools | Options)

This tab allows you to set the date ranges and the maximum number of occurrences for CPRS reports. You can change the settings for all reports or for individual reports.

To change the date range and maximum number of occurrences for all CPRS reports:

1.	Select Tools | Options....

2.	Select the Reports tab.

3.	Press the Set All Reports… button.

The "Change default parameters for all CPRS reports" dialog displays.

4.	Change the value in the Start Date and Stop Date fields by selecting the appropriate field and by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

5.	After you have entered a start and stop date, you can change the maximum number of occurrences (if necessary) by using the Max Occurrences field.

6.	Select OK.

A confirmation dialog box will appear.

7.	Select Yes to confirm and save your changes.

8.	Select OK to close the Options dialog box.

To change the date range and maximum number of occurrences for individual CPRS reports:

1.	Select Tools | Options...

2.	In the Options dialog, select the Reports tab.

3.	Select the Set Individual Report button.

The "Customize individual CPRS report parameters" dialog will appear.

4.	Place the cursor in the "Type the first few letters of the report you are looking for:"field (located at the top of the dialog box) and type the name of the report that you would like to change

-or-

use the scroll bars to find the report.

5.	Change the value in the Start Date and/or Stop Date field by clicking in the appropriate column and doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

6.	After you have entered a start and stop date, you can change the maximum number of occurrences (if necessary) by using in the Max field.

7.	Select Apply to save your changes

-or-

select OK to save your changes and close the dialog box.

8.	Select OK to close the "Options" dialog box.

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Graphs Tab (Tools | Options)


Graphs Tab (Tools | Options)

From the Graphs tab, users can configure collections of data as Graphing view definitions and configure the default graphing settings. Both buttons on this tab bring up dialogs that are discussed elsewhere in this manual.

For instructions on these two dialogs, please see the following sections:

•	Creating Predefined Views

•	Setting Display Options Using the Graph Settings Dialog Box

Related Topics

Personal Preferences (Tools | Options)

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)


Sorting a Report (Table View)

If a report is available in a table view, the table can be sorted alphabetically, numerically, or by date.

To sort data in a report table:

1.	Select the column heading you wish to sort by.

The table will be sorted alphabetically (A-Z), numerically (0-9), or by date (most recent-least recent).

2.	If you click the column heading again, the table will be sorted in inverse order (Z-A, 9-0, or least recent-most recent).

3.	To perform a secondary sort, click on another column heading.

Note:	If you hold the pointer over the table, a hover hint will appear indicating the criteria used to sort the table.

Related Topics

Viewing a Report


Printing a Report

To print a report, follow these steps:

1.	From the Reports tab, select the report you would like to print.

2.	If the report is in text format, right click on the text of the report

-or-

if the report is in table format, click on the row that contains the data you would like to print (to select more than one row, press and hold either the Shift or Control key). After you have selected the appropriate row(s), right click on the area or row you have selected.

3.	Select Print.

Related Topics

Printing from CPRS


Associating a Template

To associate a template with a document title, type of consult, or a procedure, follow these steps:

1.	Create a new template (by following the instructions for creating personal document templates or creating shared document templates)

-or-

edit an existing template by selecting Options | Edit Templates….

2.	Select the Edit Shared Templates checkbox located in the lower-left corner of the Template Editor window.

3.	Select the template you would like to associate from the Personal Templates section of the Template Editor window.

4.	Drag and drop the template into either the Document Titles, Consult Reasons for Request or Procedure Reasons for Request folder in the Shared Templates area of the window.

5.	In the Shared Templates area of the window, select the template that you just moved (click "+"to expand a heading).

6.	Select a procedure from the Associated Procedure drop-down list

-or-

select a consult service from the Associated Consult Service drop-down list.

7.	Select OK.

The template is now associated. When you order a consult or a procedure, the associated template text will appear in the Reason for Request field. When you enter a new progress note, the associated template text will appear in the text of the note.

Related topics

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Viewing a Health Summary

Health Summaries provide important information to users about a patient’s condition. With Remote Data Views (RDV), users may be able to access remote Health Summary information from other facilities or the Department of Defense (DoD). If the patient has DoD data, but it is not available, CPRS will provide feedback for the text or grid type reports.

CPRS adds a comment that describes the problem where the data from the remote report would normally be. For ‘grid’ type reports, the error comment is put in the first column (after the facility name) of the report.  Here are some examples of the comments that could show up, depending on the type of query and what the user has selected:

•	<No HDR Data Included> - Use “HDR Reports” menu for HDR Data.

•	<No HDR Data> This site is not a source for HDR Data.

•	<No DoD Data> - Use “Dept. of Defense Reports” Menu to retrieve data from DoD.

•	<ERROR> - Unable to communicate with Remote site

In addition to this text, error messages will also be shown after each remote site listed under the (blue) Remote Data button, when appropriate.

To view a Health Summary, follow these steps:

1.	Select a patient after you enter the CPRS system.

2.	Select the Reports tab.

3.	Under the Available Reports box on the left-side of the screen, click the plus sign in order to expand the Health Summary heading.

4.	Select a Health Summary that you would like to see. After you have selected a summary, the appropriate data is displayed on the right-side of the screen.

5.	Use the scroll bar on the right to scroll through the different sections of the Health Summary.

Related Topics

Viewing a Report


Copying Data from a Report

To copy data from a report, follow these steps:

1.	From the Reports tab, select the report you would like to copy data from.

2.	If the report is in text format, select the text you would like to copy and then right-click

-or-

if the report is in table format, click on the row that contains the data you would like to copy (to select more than one row, press and hold either the Shift or Control key). After you have selected the appropriate row(s), right-click on the area or row(s) you have selected.

3.	Select Copy (text format) or Copy Data From Table (table format).

You can now paste the data into another area in CPRS or into another program.

Related Topics

Printing from CPRS


Medication Administration History

You can view the administration history for a medication in three ways.

•	Double-click on a medication. The administration history will be listed at the bottom of the details screen.

•	Select a medication and then select View | Administration History.

•	Select a medication and then right-click. Choose Administration History from the pop-up menu.

Related Topics

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Importing Document Templates

You can import existing document template files (.txml), Microsoft Word files (Word 97 or higher), or XML files into the CPRS Template Editor.

To import a template, follow these steps:

1.	Start the Template Editor.

2.	Browse to the file cabinet or folder where you would like to store the imported template (click "+" to expand a heading).

Note:	In order to import a template to the Shared Templates area of the screen, you must, 1) be authorized to edit shared temples and 2) place a checkmark in the Edit Shared Templates checkbox (located in the lower left side of the Template Editor).

3.	Select Tools | Import Template.

4.	Select the file you would like to import and click Open.

The template will appear in the Template Editor.

Note:	If you do not have authorization to edit template fields, you may see a dialog with a message that the imported template has one or more new fields and you do not have authority to create new fields.

5.	If you press OK, the template will be imported without the new fields. If you press Cancel, the import process will be cancelled.

Related Topics

Document Templates (overview)

Exporting Document Templates


Exporting Document Templates

You can also export a template or a group of templates with the Template Editor. Exported templates are saved with the .txml file extension.

Note:	Patient data objects are not exported with a template.

To export a template or a group of templates, follow these steps:

1.	Start the Template Editor.

2.	Select the template or group of templates (file cabinet) that you would like to export.

3.	Select Tools | Export Template.

4.	Choose a destination and file name for the template file.

5.	Select Save.

Related Topics

Document Templates (overview)

Importing Document Templates


Postings_Creating New Postings
Creating New Postings

You create the following types of postings by creating progress notes using note titles that your site’s IRM staff has configured for this purpose. (Check with your site’s IRM staff if you don’t know which note titles create which types of postings.)

•	Clinical Warning (which is the same as Warning)

•	Crisis Note

•	Directive

•	Warning

For example, to create a posting for a crisis note, take the following steps:

1.	Select the Notes tab.

2.	Select New Note.

CPRS displays the Progress Note Properties dialog.

3.	In the Progress Note Title pane, select a note title that generates a crisis note.

4.	In the Date/Time of Note field, select a date.

5.	In the Author field, select an author.

6.	Select OK.

7.	From the main menu, select File | Refresh Patient Information. CPRS displays the letter C (for crisis note) on the Postings button and, in the Postings pane on the Cover Sheet tab, displays the title Crisis Note and the date you selected for the note.

To create a posting for an allergy or adverse reaction, enter the allergy from either the Cover Sheet tab or the Orders tab. (See Entering Allergies from the Cover Sheet Tab and Entering Allergies from the Orders Tab, respectively.)

Note:	Although you may be able to enter progress notes for allergies/adverse reactions, doing so does not create Allergies postings. As mentioned above, you can create Allergies postings only by entering allergies via the Cover Sheet or Orders tab. CPRS cannot perform order checks on allergies you document via progress notes.

Related Links

Entering Allergies from the Cover Sheet Tab

Entering Allergies from the Orders Tab

Postings

Viewing Postings


Viewing Unsigned Notes or Discharge Summaries

With the View Unsigned Notes or View Unsigned Discharge Summaries command, you can view all the notes and discharge summaries that you have not yet signed.

To view unsigned notes or discharge summaries, follow these steps:

1.	Select the Notes or DC/Summ tab.

2.	Select the appropriate option:

o	View | Unsigned Notes

o	View | Uncosigned Notes

o	View | Unsigned Summaries

o	View | Uncosigned Summaries

The unsigned notes or discharge summaries will appear in the detail portion of the window.

Related topics

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Selected Orders Command

Sign Note Now and Sign Discharge Summary Now Commands

Add to Signature List

Identify Additional Signers


Lab Test Information

The Lab Test Information menu option displays information about various lab tests.

To display lab test information:

1.	Select Tools | Lab Test Information.

The Lab Test Description dialog will appear

2.	Select a lab test from the panel on the left side of the dialog.

A description of the lab test you selected will be displayed in the right side of the dialog.

Related Topics

Tools Menu


Personal Preferences (Tools | Options)

You can change many of the settings that control the way CPRS works. The Options choice on the Tools menu contains dialogs that allow you to change which notifications and order checking messages you get, manage team and personal lists, assign your default patient selection settings, and modify your default tab preferences. To access the personal preferences settings, select Tools | Options from any CPRS tab.

The Options dialog consists of a number of tabs, each of which allows access to a category or type of preference settings.

Related Topics

General Tab (Tools | Options)

Notifications Tab (Tools | Options)

Order Checks Tab (Tools | Options)

Lists/Teams Tab (Tools | Options)

Notes Tab (Tools | Options)

Reports Tab (Tools | Options)

Graphs Tab (Tools | Options)


Ordering_Regular Diet Orders
Regular Diet Orders

To place a regular diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Diet in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note: 	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and select OK.

4.	Choose a diet from the Available Diet Components list box on the Diet tab. (Quick orders are at the top of the list).

The component that you select will be displayed in the Selected Diet Components field. You can remove a component by selecting it and clicking Remove.

5.	Enter the effective date and time and the expiration date and time by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001)

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

6.	Select a delivery method from the Delivery field.

7.	Type in any special instructions.

8.	Select Accept Order.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Tubefeeding Diet Order

Early / Late Tray Orders

Isolations / Precautions Order

Additional Diet Order

Writing Orders (overview)


Tubefeeding Diet Order

To place a tubefeeding diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Diet in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and click OK.

4.	Select the Tubefeeding tab.

5.	Select a tubefeeding product from the list.

6.	Select a strength and a quantity from the grid on the right side of the dialog.

CPRS will automatically complete the Amount field if it needs to multiplied as a result of the schedule. If there is a problem with the Quantity, CPRS displays a dialog with text to help the user know how to enter an acceptable value.

Note: You can remove a product by selecting the product and pressing Remove.

7.	If you would like to cancel future tray orders, select the "Cancel Future TRAY Orders" checkbox.

8.	Enter any special instructions.

9.	Select Accept Order.

Related Topics

Regular Diet Orders

Early / Late Tray Orders

Isolations / Precautions Order

Additional Diet Order

Writing Orders (overview)


Ordering_Early / Late Tray Diet Order
Early / Late Tray Diet Order

Early/Late Tray orders must be associated with an existing diet order. Once these orders have been placed, they are separate from the order with which they are associated. These orders do not discontinue automatically if the existing order is discontinued.

To place an early / late tray diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane.

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Diet in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and click OK.

4.	Select the Early / Late Tray tab.

5.	Select Breakfast, Lunch, or Evening from the Meal option group.

The appropriate meal times will appear in the Meal Times option group.

6.	Select a meal time.

7.	Select a start and end date by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

8.	Select which days the order will be effective from the Days of Week option group.

9.	Select Accept Order.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Isolation/Precaution

Additional Diet Order

How to Write Orders (overview)


Isolations / Precautions Order

To place an isolations / precautions order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Diet in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and click OK.

4.	Select the Isolations / Precautions tab.

5.	Select a type of precaution.

6.	Enter any necessary instructions in the Instructions field.

7.	Select Accept Order.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Isolation/Precaution

Additional Diet Order

How to Write Orders (overview)


Additional Diet Order

To place an additional diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Diet in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and click OK.

4.	Select the Additional Order tab.

5.	Enter the text for the order in the Additional Diet Order field.

6.	Select Accept Order.

Related Topics

Regular Diet Orders

Tubefeeding Orders

Early/Late Tray Order

Isolation/Precaution

Additional Diet Order

How to Write Orders (overview)


Available Reports on the Reports Tab

The table below lists the reports available from the Reports tab. A "+" sign indicates that the topic is a heading that can be expanded. Some of these reports may have remote data.

In the list below, those reports that may have remote data from the Department of Defense are noted. Also, there is a part of the tree that lists the Department of Defense reports.

Note:	With the exception of Consults, choosing a Department of Defense (DoD) report does not limit you to DoD data. (Consults is limited to only DoD data). For example, if you choose Microbiology under Dept. of Defense, you will get DoD data and remote VA data. You do not have to run a separate report to get VA data.

Another new addition to the Reports tab treeview is the HDR (Health Data Repository) section that contains four items: Allergies, Chem & Hematology, Vital Signs, and Pharmacy All Outpatient.

Other changes are the inclusion of modifiers and qualifiers (flow rate, oxygen concentration, and methods) for Pulse Oximetry, and in the HDR All Outpatient Pharmacy report, any set of results that has a SIG with a length greater than 60 characters will show “[+]” in the corresponding column.

Note:	These items are currently inactive until HDR data is ready and sites receive instruction to begin using HDR data. If the user selects on of these items, CPRS will display a dialog telling them to use VistaWeb to get this data.

Please note that the order of the reports may be different depending on the configuration of your site. This list is what is exported from CPRS.

+	Clinical Reports

Allergies (can contain remote data from Department of Defense)

+	Patient information

Demographics

Insurance

Disabilities

+	Visits / Admissions

Adm./Discharge

Expanded ADT (can contain remote data from Department of Defense)

Discharge Diagnosis

Discharges

Future Clinic Visits

Past Clinic Visits

ICD Procedures

ICD Surgeries

Transfers

Treating Specialty

Comp & Pen Exams

+	Dietetics

Generic

Diet

Nutritional Status

Supp. Feedings

Tube Feeding

Dietetics Profile

Nutritional Assessment

Discharge Summary (can contain remote data from Department of Defense)

+	Laboratory

Blood Availability

Blood Transfusion

Blood Bank Report

Anatomic Pathology (can contain remote data from Department of Defense)

Lab Orders   (can contain remote data from Department of Defense)

Chem & Hematology (can contain remote data from Department of Defense)

Microbiology (can contain remote data from Department of Defense)

+	Medicine

Abnormal

Brief Report

Full Captioned

Full Report

Procedures (local only)

Procedures

+	Orders

Orders Current

Daily Order Summary

Order Summary for a Date Range

Chart Copy Summary

+	Outpatient Encounters / GAF Scores

Education

Education Latest

Exam Latest

GAF Scores

Health Factors

Immunizations

Outpatient Diagnosis

Outpatient Encounter

Skin Tests

Treatment Provided

+	Pharmacy

Active Outpatient

All Outpatient (can contain remote data from Department of Defense)

Outpatient RX Profile

Active IV

All IV

Unit Dose

Med Admin History (BCMA)

Med Admin Log (BCMA)

+	Problem List

Active Problems

All Problems

Inactive Problems

+	Progress Notes

Progress Notes

Advance Directive

Clinical Warnings

Crisis Notes

+	Radiology

Report (can contain remote data from Department of Defense)

Status

Imaging (local only)

Imaging

Surgery Reports

Vital Signs

+	Health Summary

Adhoc Report

Ac Clinical Summary

Discharge Summary

Radiology

Pain Management

Remote Demo/Visits/Pce (1y)

Remote Demo/Vists/Pce (3m)

Remote Clinical Data (1y)

Remote Clinical Data (3m)

Remote Clinical Data (4y)

Remote Oncology View

Remote Oncology View

Global Assessment Functioning

+	HDR

Allergies

Chem & Hematology

Pharmacy All Outpatient

Vital Signs

+	Dept. of Defense Reports (All of these reports, except Consults, will contain VA and DoD data, if there is DoD data available)

Allergies

Expanded ADT

Consults (contains DoD remote data only)

Discharge Summary

+	Laboratory

Lab Orders

Chem & Hematology

Surgical Pathology

Cytology

Microbiology

Outpatient Encounter

Pharmacy All Outpatient

Progress Notes

All Problem List

Radiology Report

Vital Signs

Imaging (local only)

Lab Status

Blood Bank Report

+	Anatomic Path Reports

Electron Microscopy

Surgical Pathology

Cytopathology

Autopsy

Anatomic Pathology

Dietetics Profile

Nutritional Assessment

Vitals Cumulative

Procedures (local only)

Daily Order Summary

Order Summary for a Date Range

Chart Copy Summary

Outpatient RX Profile

Med Admin Log (BCMA)

Med Admin History (BCMA)

Surgery (local only)

+	Event Capture

PCE Data Summary Report

Patient Summary Report

Related topics

Viewing a Health Summary

Viewing a Report


Marking a Template as the Default Template

A default template will automatically be selected the first time you open the Templates Drawer. The default template can also be accessed at any time with the Go to Default Template option. Each tab (Notes, Consults, and D/C Summ) can have its own default templates.

To set a template as your default template, follow these steps:

1.	Open the Template Drawer on the Notes tab by clicking on it.

The available templates will be displayed in a tree view.

2.	Right-click on any template and select Mark as Default from the right-click menu.

Related topics

Document Templates (overview)

Generating a Template from a TIU Object or Note Title

Creating Personal Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Hiding Child Templates

To make child templates unavailable from the template drawer, follow these steps:

1.	Start the Template Editor by selecting Options | Edit Templates from the Notes tab.

2.	Select Hide Dialog Items from the Dialog Properties option group.

3.	Select OK.

Related topics

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Adding a Template to a Document

To add a template to a Note, use the following steps:

1.	From the Notes tab, create a new note by clicking on New Note.

2.	Complete the Progress Note Properties dialog.

3.	Select OK.

The Progress Note Properties dialog will close and the Templates Drawer will appear above the Reminder Drawer.

4.	Select the Templates drawer.

The available templates will appear.

5.	Select the template that you would like to use (click the + to expand a heading).

6.	Drag the template into the detail area of the note

-or-

double click on the template

-or-

right-click on the template and select Insert Template.

Related topics

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Previewing a Template

To preview a template before inserting it into your document, follow these steps:

1.	Right-click the template in the Templates drawer on the Notes tab.

2.	Select Preview/Print Template.

The preview dialog will appear.

Note:	You can print a copy of the template by pressing the Print button.

Related topics

Document Templates Overview

Creating Personal Document Templates

Creating Shared Document Templates

Generating a Template from a TIU Object or Note Title

Editing Document Templates

Copying Document Templates

Searching for Document Templates

Deleting Document Templates


Alerting a user when order results are avaialble
Notifying a User when Order Results are Available

To notify a user when the results of an order are available, follow these steps:

1.	Select the Orders tab.

2.	Select an order.

3.	Select Action | Alert when Results...

The Alert when Results dialog will appear.

4.	Choose an alert recipient from the Alert Recipient drop-down field.

Note:	A recipient must have the ORDERER-FLAGGED RESULTS  notification/alert enabled in order to receive the alert.

5.	Select OK.

Related Topics

Writing Orders (overview)

Ordering a Diet

Event-Delayed Orders

Transfer Medication Orders From Inpatient to Outpatient

Transfer Outpatient Medication to Inpatient.

Signing Orders and Documents

Electronic Signature (overview)


Viewing all the Progress Notes Under a Particular Heading
Viewing All the Progress Notes under a Heading

To view all the progress notes under a particular heading, follow these steps:

1.	Select the Notes tab.

2.	Double-click the heading that you would like to view.

The notes that are related to that heading will appear in a table on the right side of the screen.

3.	To view the details of a specific note, select the note from the table. You can also sort the table by clicking on the column you wish to sort by (click the column again to sort the table in inverse order).

Related Topics

Viewing Progress Notes

Viewing all Signed Notes, All Unsigned Notes, or All Uncosigned Notes

Viewing all Signed Notes by a Specific Author

Viewing all Signed Notes for a Date Range

Searching for Text (Within Current View)

Finding Specific Text in a Document


Viewing All Signed Notes, All Unsigned Notes, or All Uncosigned Notes

To view all signed notes, all unsigned notes, or all uncosigned notes, follow these steps:

1.	Select the Notes tab.

2.	Select View | Signed Notes (All), View | Uncosigned Notes, or View | Unsigned Notes.

The appropriate progress notes will appear on the Notes tab.

Related Topics

Viewing Progress Notes

Viewing all the Progress Notes Under a Particular Heading

Viewing all Signed Notes by a Specific Author

Viewing all Signed Notes for a Date Range

Searching for Text (Within Current View)

Finding Specific Text in a Document


Viewing All Signed Notes by a Specific Author

To view all signed notes by a specific author, follow these steps:

1.	Select the Notes tab.

2.	Select View | Signed Notes by Author.

The List Signed Notes by Author dialog displays.

3.	Select the author of the note(s) that you would like to view.

4.	In the Sort Order option group, select Ascending (oldest first) to view the oldest notes first, or Descending (newest first) to view the newest notes first.

5.	Select OK.

The appropriate notes will appear on the Notes tab.

Related Topics

Viewing Progress Notes

Viewing all the Progress Notes Under a Particular Heading

Viewing all Signed Notes, All Unsigned Notes, or All Uncosigned Notes

Viewing all Signed Notes for a Date Range

Searching for Text (Within Current View)

Finding Specific Text in a Document


Viewing All Signed Notes for a Date Range

To view all signed notes by a specific author, follow these steps:

1.	Select the Notes tab.

2.	Select View | Signed Notes by Date Range.

The List Signed Notes by Date Range dialog displays.

3.	Enter a beginning date by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

4.	Enter an ending date by doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

5.	Select OK.

The appropriate notes will be displayed on the Notes tab.

Related Topics

Viewing Progress Notes

Viewing all the Progress Notes Under a Particular Heading

Viewing all Signed Notes, All Unsigned Notes, or All Uncosigned Notes

Viewing all Signed Notes by a Specific Author

Searching for Text (Within Current View)

Finding Specific Text in a Document


View Template Notes

Template Notes can be used to describe what is in the template or to track changes to the template.

To add or display Template Notes, follow these steps:

1.	Select the Notes tab.

2.	Select Options | Edit Templates.

3.	Select the shared or personal template for which you wish to add or change the Template Notes.

4.	Select the Show Template Notes check box at the bottom of the dialog.

The Template Notes field appears below the Template Boilerplate field.

5.	Add or change the note as much as you wish.

Note:	If the template you wish to edit is a shared template and you have the authority to edit it, you will need to click the Edit Shared Templates check box on the lower left corner of the Template Editor dialog.

Related topics

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates

Editing Document Templates

Copying Document Templates

Searching for Document Templates


Copying Template Text

To copy text from a template to any text field, complete the following steps:

1.	Open a new note, consult or discharge summary.

2.	Select a note, consult or discharge summary title.

3.	Select the Notes tab

4.	Select on the Templates drawer.

5.	Expand either the Shared Template or Personal Templates tree.

6.	Right-click on the desired template.

7.	Click Copy Template Text (or press Control+C) to simply copy the text to the Clipboard.

Note:	You can paste the copied text into any text field by right clicking in the desired field and selecting Paste.

Related topics

Opening a Template

Creating a Personal Template

Mark a Template as Default

Go to the Default Template

View Template Notes

Hide Items in Dialogs

Display Only

Only Show First Line

Indent Dialog Items

One Item Only

Hide Dialog Items


What's New in CPRS GUI v.20 (OR*3.0*141)

Event-Delayed Orders

•	Changing the Release Event / Assigning a Release Event to an Unreleased Order

•	Event-Delayed Orders

•	Manually Releasing an Event-Delayed Order

o	Viewing an Event-Delayed Order After it is Released

o	Viewing Orders on the Orders tab

Orders Tab

•	Copying Existing Orders


Surgery Tab

The Surgery tab allows you to view signed operative reports generated in the VistA Surgery package. These reports include the Operation Report, Nurse Intraoperative Report, Anesthesia Report, and Procedure Report (Non-O.R.).  You can also view the Surgery (local only) report from the Reports tab.

The Surgery tab will only be visible if your site is configured to use the tab, if you have the correct access permissions, and Surgery patch SR*3.0*100 is installed.

To view a surgery report, follow these steps:

1.	Select the Surgery tab.

2.	Select a report title from the All Surgery Cases pane. Click the "+" sign to expand a heading (if necessary).

3.	The text of the report will be displayed in the details pane on the right side of the window.

Related topics

Customizing the Surgery Tab

Creating an Addendum to a Surgery Report

Finding Specific Text in a Document

Signing a Surgery Report

Viewing all Surgery Cases for a Patient


Finding Specific Text in a Document

To find specific text in a document, follow these steps:

1.	Select the appropriate tab: Notes, D/C Summ, Consults, or Surgery.

2.	Select a document title.

3.	Right-click in the details pane where the text of the report is displayed.

4.	Select Find in Selected kind of document (such as note, summary, or report).

5.	Type in the text you wish to find in the Find what field of the Find dialog box.

6.	To narrow your selection, use these steps.

7.	Select Find Next.

The appropriate text will be highlighted if it is found in the document.

8.	To find another instance, click or select Find Next again.

9.	When finished, close the dialog.

Related Topics

Surgery Tab

Customizing the Surgery Tab

Creating an Addendum to a Surgery Report

Signing a Surgery Report

Viewing all Surgery Cases for a Patient

Viewing Progress Notes

Searching for All Notes that Contain Specific Text


Customizing the Surgery Tab

Note:	The Surgery tab will only be visible if your site is configured to use the tab, if you have the correct access permissions, and Surgery patch SR*3.0*100 is installed.

You can limit the surgery cases that appear on the Surgery tab. You can specify that only surgery cases from a specific date or date range appear on the tab, or you can specify that all available surgery cases appear.

To limit the surgery cases displayed to a specific date range, follow these steps:

1.	Select the Surgery tab.

2.	Select View | Custom View.

The List Selected Cases dialog box appears.

3.	Select a start date by selecting in the appropriate field and doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

4.	Select stop date by selecting in the appropriate field and doing one of the following:

o	entering a date (e.g. 6/21/01 or June 21, 2001).

o	entering a date formula (e.g. t-200).

o	pressing the [image] button to bring up a calendar.

5.	Enter the maximum number of occurrences you would like to display in the Max Number to Return field.

6.	Select a surgery case sort order (ascending or descending).

7.	Select a category to group the surgery cases by (from the Group By drop-down list).

8.	Select a case report sort order (ascending or descending).

9.	Select a category to sort case reports by (from the Sort By drop-down list).

10.	Select OK.

The appropriate surgery cases will appear in the details pane.

11.	Select the "+" sign to expand a heading (if necessary).

Related Topics

Surgery Tab

Creating an Addendum to a Surgery Report

Finding Specific Text in a Document

Signing a Surgery Report

Viewing all Surgery Cases for a Patient


View all Surgery Cases
Viewing All the Surgery Cases for a Patient

To view all the surgery cases for a patient, follow these steps:

1.	Select the Surgery tab.

2.	Select View | All Cases.

Related Topics

Surgery Tab

Customizing the Surgery Tab

Creating an Addendum to a Surgery Report

Finding Specific Text in a Document

Signing a Surgery Report


Signing a Surgery Report

Depending on the configuration of your site and your access permissions, you may be able to sign certain surgery reports.

To sign a surgery report, follow these steps:

1.	Select the Surgery tab.

2.	Select a surgery report from the All Surgery Cases pane.

3.	Select Action | Sign Report Now…

-or-

right-click in the details pane and select Sign Report Now.

4.	Enter your electronic signature code.

5.	Select Sign.

Related Topics

Surgery Tab

Customizing the Surgery Tab

Creating an Addendum to a Surgery Report

Finding Specific Text in a Document

Viewing all Surgery Cases for a Patient


Creating an Addendum to a Surgery Report

Note:	The Surgery tab will only be visible if your site is configured to use the tab, if you have the correct access permissions, and Surgery patch SR*3.0*100 is installed.

Depending on the configuration of your site and your access permissions, you may be able to make addenda to certain surgery reports.

To make an addendum to a surgery report, follow these steps:

1.	Select the Surgery tab.

2.	Select a surgery report from the All Surgery Cases pane.

3.	Select Action | Make Addendum….

4.	Type the text for the addendum.

Note:	You may either sign the addendum now or do so when you close this patient’s record, open another patient’s record, or refresh the patient’s chart.

Related Topics

Surgery Tab

Customizing the Surgery tab

Finding Specific Text in a Document

Signing a Surgery Report

Viewing all Surgery Cases for a Patient


About CPRS Read_Only
About CPRS Read-Only

CPRS Read-Only enables you to select a patient and view reports from the patient’s medical record. As the name implies, you cannot enter, or update the information connected with any patient. The purpose of CPRS Read-Only is to give controlled access to specific users that will enable them to review the medical records but not change any information.

Users will be able to open the patient charts made available to them, including accessing remote data from other VA Medical Centers  (VAMCs) facilities and from the Department of Defense if available. Read-Only users can view, copy, and print reports that are available from the Reports tab of CPRS.

Each site controls who has CPRS Read-Only access. To grant a user CPRS Read-Only access, someone at the site (probably whoever creates new users) will make entries into the NEW PERSON file to give the user access only to the Reports tab and usually assign a restricted patient list that contains the appropriate records. If the list is not assigned when you try to run the application, CPRS Read-Only will show an error message that states "Patient selection list not found." When the user click OK to close the message box, CPRS Read-Only aborts.

Related Topics

Available Reports on the Reports Tab

Viewing a Health Summary

Viewing a Report

Printing a Report (Table View)

Sorting a Report (Table View)


Event Delayed Orders
Event-Delayed Orders

An event-delayed order is an order that is executed only after a predefined event (known as a release event) occurs. A release event can be an event such as an admission, discharge, or transfer. For example, you could write an event-delayed diet order that would not execute until a patient is transferred to a specific ward.

A CAC defines the release events at your site. (For more information on defining release events, see Appendix G of the CPRS List Manager Technical Manual or the Event-Delayed Orders topic in the CPRS GUI Technical Manual). Once a CAC has defined a release event, you can write an order that will not execute until that release event occurs.

Related Topics

Assigning/Changing the Release Event

Manually Releasing an Event-Delayed Order

Viewing an Event-Delayed Order After it is Released

Writing an Event-Delayed Order


Writing Event-Delayed Orders
Writing an Event-Delayed Order

To write an event-delayed order, follow these steps:

1.	Select the Orders tab.

2.	Select the Write Delayed Orders button located below the View Orders box.

The Release Orders dialog box appears.  The available release events will appear in a list.  Your list may contain a highlighted default release event and a common release event list.  Your CAC defines the default release event and the common release event list. (For more information about defining a default release event and a common release event list, please see the Event-Delayed Orders topic in the CPRS GUI Technical Manual or Appendix F in the CPRS List Manager Technical Manual).

3.	Select the "Delay release of new order(s) until" option.

The available release events will appear.

4.	Select the appropriate release event.

Note:	If the patient’s location has a treating specialty of “observation” and the user tried to write delayed orders, the “transfer” event should not appear in the selection list. The reason is that orders are discontinued on transfer. The result would be if a patient were in an observation location, and delayed orders were written when the patient was moved out of observation, the orders would be cancelled.

5.	Select OK

If the Copy active orders for selected event dialog appears, skip to step 6. Otherwise, the Release Orders dialog will close and the name of the release event will now appear below the Write Delayed Orders button. Enter the order as you normally would.

6.	Check the active orders that you would like to delay in the Copy active orders for selected release event dialog. These orders will be delayed until the release event specified at the top of the dialog occurs.

7.	Select OK.

The Ordering Information dialog will appear. This dialog will contain the release event that you have selected. Check to be sure that you selected the correct release event.

8.	Select OK.

9.	Enter the order as you normally would.

Related Topics

Assigning/Changing the Release Event

Event-Delayed Orders

Manually Releasing an Event-Delayed Order

Viewing an Event-Delayed Order After it is Released


Changing the Release Event / Assigning a Release Event to an Unreleased Order
Assigning/Changing the Release Event

If an order is not signed, you can change the order’s release event or assign a release event to the order. However, once an order has been signed, you cannot make any changes.

To assign or change a release event, follow these steps:

1.	Select the Orders tab.

2.	Select the type of order you would like to change from the View Orders list.

The orders for the type you select will be displayed in the details pane on the right side of the screen.

3.	Highlight the order you would like to change from the details pane.

4.	Select Action | Change Release Event

-or-

right-click on the order and select Change Release Event from the right-click menu.

The Change Release Event dialog will appear with the current release event highlighted.

Note:	If the release event for the order you selected cannot be changed, the Unable to be Released to Service dialog will appear. The reason that the release event cannot be changed is listed at the bottom of the dialog. Press OK to close the dialog.

5.	To change the release event, select another event and click Change. To simply remove the existing event, select Remove.

A confirmation dialog will appear.

6.	Select OK to confirm your changes.

Related Topics

Event-Delayed Orders

Manually Releasing an Event-Delayed Order

Viewing an Event-Delayed Order After it is Released

Writing an Event-Delayed Order


Manually Releasing an Event-Delayed Order

Note:	Each site can set a parameter that determines if the user must hold a key or if a parameter setting will determine which users can release delayed orders.

To release an event-delayed order manually (before the release event occurs), follow these steps:

1.	Select the Orders tab.

2.	Select the type of order you would like to release from the View Orders pane.

The corresponding orders will appear on the right side of the screen.

3.	Highlight the order you would like to release from the details pane on the right side of the screen.

4.	Select Action | Release Delayed Orders.

-or-

right click on the order and select Release Delayed Orders.

Note:	You must sign an order before it can be released.

The Release to Service dialog displays.

5.	Review the orders you wish to release, and press OK.

6.	If the Print Orders dialog appears, select the appropriate prints and devices and press Print All Checked Items or Print Highlighted Items Only.

Related Topics

Assigning/Changing the Release Event

Event-Delayed Orders

Viewing an Event-Delayed Order After it is Released

Writing an Event-Delayed Order


Viewing an Event-Delayed Order After it is Released

To view an event-delayed order after it has been released, follow these steps:

1.	Select the Orders tab.

2.	Select View | Auto-DC/Release Event Orders.

The Auto-DC/Release Event Orders dialog will appear.

3.	Select the event the order is associated with.

4.	Select OK.

The appropriate orders will appear on the Orders tab.

Related Topics

Assigning/Changing the Release Event

Event-Delayed Orders

Manually Releasing an Event-Delayed Order

Writing an Event-Delayed Order


Ordering Outpatient Medications (Complex Dose)

In a complex dose order, the user must define specific characteristics for the order. Because the dose can affect the quantity, for example, changing certain fields may cause the quantity field to either recalculate or reset to zero to force the user to enter the quantity.

To write a new Outpatient Medication order with a complex dose, follow these steps:

1.	Select the Meds tab and select Action | New Medication…

-or-

select the Orders tab and select the appropriate item under the Write Orders list box. CPRS will display the Medication Order dialog.

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Medication Order dialog. You must complete the encounter information dialog before proceeding.

2.	Locate the medication name or quick order name in the list box by typing characters in the Medication field.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3.	Select a medication or quick order from the list box.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

Note: 	If the selected medication is a controlled substance that requires the signature of a provider with a DEA or VA number, the DEA# Required dialog displays. Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the Medication Order dialog, change the provider, and then reenter the Medication Order dialog.

4.	Select the Complex dose tab.

Note:	Once you begin a complex medication order, you must remain on the Complex tab until you finish the order. If you switch tabs, all complex dosages will be erased, and you will be forced to start the order again.

5.	Select the Dosage field and select the appropriate dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

6.	Select the Route field and enter a route.

Note:	Outpatient orders for supply items do not require a route.

CPRS displays unit dose routes based on the following rules:

a)	If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.

b)	If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.

c)	If there is only one possible medication route, it will be used as the default.

d)	If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

7.	Enter a schedule in the Schedule field. (Select PRN if desired).

8.	Select the Duration cell and enter a number and select units (days is the default) a patient should use the specified dose.

9.	Add the appropriate conjunction: And, Then, Except (Except is only for Outpatient Meds) or no conjunction for the final line.

10.	Note:	The conjunction “Then” requires a duration to be added.

11.	Select the dosage field in the next row and select a dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

12.	CPRS will fill in the Route and Schedule fields. If necessary, select and change the Route and Schedule cells.

13.	Select a duration and a conjunction (no conjunction on the final line).

14.	Repeat steps 5-9 until you have completed the complex dose.

Note:	You can add or remove a row in the complex dosage. To add a row, click the gray area in front of the row and click Add Row. (The new row will be placed above the selected row.) To delete a row, click the gray area in front of the row to be deleted and click Delete Row.

15.	CPRS will display a default value in the Days Supply and Quantity fields. The quantity is calculated based on the formula Days Supply x Schedule = Quantity. If necessary, you can change the value in these fields.

Note:	If you change a number, CPRS will attempt to recalculate the other field.

16.	Enter the number of refills.

17.	Select the location where the patient should pick up the medication from the Pick Up field.

18.	Add comments if necessary.

19.	Under certain circumstances, a check box may appear under the Days Supply field. If the medication is service-connected, make sure the box is checked.

20.	Select Accept Order.

21.	(Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o	To proceed, select Accept Order.

o	To stop the ordering process and return to the dialog, Cancel Order.

22.	If you are finished ordering outpatient medications, select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Outpatient Medications (Simple Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Viewing the Results of an Order

To view the results of an order, follow these steps:

1.	Select the Orders tab.

2.	Highlight the appropriate order.

3.	Select View | Results.

The results of the order will be displayed.

To view a history of results, follow these steps:

1.	Select the Orders tab.

2.	Highlight the appropriate order.

3.	Select View | Results History….

The results history will be displayed.

Related Topics

Writing Orders (overview)

Ordering a Diet

Event-Delayed Orders

Transfer Medication Orders From Inpatient to Outpatient

Transfer Outpatient Medication to Inpatient

Signing Orders and Documents


Keyboard Shortcuts for Common CPRS Commands
Keyboard Shortcuts for CPRS Commands

•	Navigation

•	Common Commands

•	Cover Sheet

•	Problems Tab

•	Meds Tab

•	Orders Tab

•	Complex Tab of the Medication Order Dialog

•	Template Editor

•	Consults Tab

•	DC/Summ Tab

•	Labs Tab

•	Reports Tab

Navigation

Navigation	Keystroke
Select the Cover Sheet tab	Ctrl + S
Select the Problems tab	Ctrl + P
Select the Meds tab	Ctrl + M
Select the Orders tab	Ctrl + O
Select the Notes tab	Ctrl + N
Select the Consults tab	Ctrl + T
Select the D/C Summ tab	Ctrl + D
Select the Labs tab	Ctrl + L
Select the Reports tab	Ctrl + R
To advance to the next field, button, or control (left-right).	Tab
To exit a field that accepts tabs (e.g. the details pane of the Notes tab) and move to the next control (left-right)	Control + Tab
To exit a field that accepts tabs and move to the previous control (right-left)	Shift + Control + Tab
Pull down a list box	Down Arrow
Navigate a list box	Up Arrow or Down Arrow
Select an item in a list box	Return or Enter
Expand a tree view	Right Arrow
Collapse a tree view	Left Arrow
To advance (left-right) to the next tabbed page of a dialog box. To exit a field that accepts tabs  (e.g. the Note pane of the Notes tab, the  Reason for Request field on a consult, the Fields on the complex medication form)  and move to the next control (left to right)	Control + Tab
To move backwards (right-left) between tabbed pages of a dialog box	Shift + Control + Tab
To toggle a check box on or off	Spacebar
Back to Top

Common Commands

Menu	Command	Keystroke
File
	Select New Patient	Alt-F-N
	Display demographic information in the patient selection dialog box so it can be read by a screen reader	Ctrl + D
	Refresh Patient Information	Alt-F-I
	Update Provider / Location	Alt-F-U
	Review/Sign Changes	Alt-F-R
	Next Notification	Alt-F-F
	Remove Current Notification	Alt-F-V
	Print Setup	Alt-F-S
	Print	Alt-F-P
	Exit	Alt-F-X
Edit
	Undo	Ctrl + Z
	Cut	Ctrl + X
	Copy	Ctrl + C
	Paste	Ctrl + V
	Preferences | Fonts | 8 pt	Alt-E-R-F-8
	Preferences | Fonts | 10 pt	Alt-E-R-F-1
	Preferences | Fonts | 12 pt	Alt-E-R-F-2
	Preferences | Fonts | 14 pt	Alt-E-R-F-4
	Preferences | Fonts | 18 pt	Alt-E-R-F-P
	Preferences | Fonts | 24 pt	Alt-E-R-F-T
Help
	Contents	Alt-H-C
	About CPRS	Alt-H-A
Back to Top

Cover Sheet

Menu	Command	Keystroke
View
	Demographics	Alt-V-M
	Postings	Alt-V-P
	Reminders	Alt-V-R
Back to Top

Problems Tab

Menu	Command	Keystroke
View
	Active Problems	Alt-V-A
	Inactive Problems	Alt-V-I
	Both Active/Inactive Problems	Alt-V-B
	Removed Problems	Alt-V-R
	Filters	Alt-V-L
	Show Comments	Alt-V-C
	Save as Default View	Alt-V-V
	Return to Default View	Alt-V-F
Action
	New Problems	Alt-A-N
	Change	Alt-A-C
	Inactive	Alt-A-I
	Verify	Alt-A-V
	Annotate	Alt-A-A
	Remove	Alt-A-R
	Restore	Alt-A-S
	View Details	Alt-A-D
Back to Top

Meds Tab

Menu	Command	Keystroke
View
	Details	Alt-V-D
	Administration History	Alt-V-H
Action
	New Medication	Alt-A-N
	Change	Alt-A-C
	Discontinue/Cancel	Alt-A-D
	Release Hold	Alt-A-L
	Hold	Alt-A-H
	Renew	Alt-A-W
	Copy to New Order	Alt-A-P
	Transfer to	Alt-A-T
	Refill	Alt-A-E
Back to Top

Orders Tab

Menu	Command	Keystroke
View
	Active Orders (includes pending, recent activity)	Alt-V-A
	Current Orders (active/pending status only)	Alt-V-O
	Auto DC/Release Event Orders	Alt-V-V
	Expiring Orders	Alt-V-E
	Unsigned Orders	Alt-V-U
	Custom Order View…	Alt-V-C
	Save as Default View…	Alt-V-S
	Return to Default View	Alt-V-R
	Details	Alt-V-D
	Results	Alt-V-L
	Results History	Alt-V-H
Action
	Change	Alt-A-C
	Copy to New Order	Alt-A-N
	Discontinue / Cancel	Alt-A-D
	Change Release Event	Alt-A-G
	Hold	Alt-A-H
	Release Hold	Alt-A-L
	Renew	Alt-A-W
	Alert when Results	Alt-A-A
	Complete	Alt-A-M
	Flag	Alt-A-F
	Unflag	Alt-A-U
	Order Comments	Alt-A-R
	Sign Selected	Alt-A-S
Options
	Save as Quick Order	Alt-O-S
	Edit Common List	Alt-O-E
Back to Top

Complex Tab of the Medication Order Dialog

	Command	Keystroke
	Enter a field in a grid	Spacebar
	Insert a row in a grid	Select the row and then press Insert.
	Delete a row in a grid	Select the row and then press Delete.
	Drop down the then/and list	Spacebar
Back to Top

Notes Tab

Menu	Command	Keystroke
View
	Signed Notes (All)	Alt-V-S
	Signed Notes by Author	Alt-V-A
	Signed Notes by Date Range	Alt-V-R
	Uncosigned Notes	Alt-V-C
	Unsigned Notes	Alt-V-U
	Custom View	Alt-V-M
	Save as Default View	Alt-V-V
	Return to Default View	Alt-V-F
	Details	Alt-V-D
	Icon Legend	Alt-V-I
Action
	New Progress Note	Alt-A-N or Shift + Ctrl + N
	Make Addendum	Alt-A-M or Shift + Ctrl + M
	Add New Entry to Interdisciplinary Note	Alt-A-W
	Attach to Interdisciplinary Note	Alt-A-T
	Detach from Interdisciplinary Note	Alt-A-H
	Change Title	Alt-A-C
	Reload Boilerplate Text	Alt-A-B
	Add to Signature List	Alt-A-L
	Delete Progress Note	Alt-A-D or Shift + Ctrl + D
	Edit Progress Note	Alt-A-E or Shift + Ctrl + E
	Save Without Signature	Alt-A-A or Shift + Ctrl + A
	Sign Note Now…	Alt-A-G or Shift + Ctrl + G
	Identify Additional Signers	Alt-A-I
Options
	Edit Templates	Alt-O-T
	Create New Template…	Alt-O-N
	Edit Shared Templates…	Alt-O-S
	Create New Shared Template	Alt-O-C
	Edit Template Fields	Alt-O-F
Details Pane Right-Click Menu
	Reformat Paragraph	Shift + Ctrl + R
	Preview/Print Current Template	Ctrl + W
	Insert Current Template	Ctrl + Insert
Templates Pane
	Open the templates drawer	Spacebar
	To expand a template file cabinet or tree view	Left Arrow
	To collapse a template file cabinet or tree view	Right Arrow
	Find Templates	Select a template or template file cabinet and press Ctrl + F
	Copy Template Text	Select the template and then press Ctrl + C
	Insert Template	Select a template and then press Ctrl + Insert
	Preview/Print Template	Select a template and then press Ctrl + W
	Goto Default	Select a template or template file cabinet and press Ctrl + G
	Mark as Default	Select a template and then press Ctrl + Space
	View Template Notes	Ctrl + V
Back to Top

Template Editor

Edit
	Undo	Ctrl + Z
	Cut	Ctrl + X
	Copy	Ctrl + C
	Paste	Ctrl + V
	Select All	Ctrl + A
	Insert Patient Data (Object)	Ctrl + I
	Insert Template Field	Ctrl + F
	Check for Errors	Ctrl + E
	Preview/Print Template	Ctrl + T
	Check Grammar	Ctrl + G
	Check Spelling	Ctrl + S
Action
	New Template	Alt-A-N
	Generate Template	Alt-A-G
	Copy Template	Alt-A-C
	Paste Template	Alt-A-P
	Delete Template	Alt-A-D
	Sort	Alt-A-O
	Find Shared Templates	Alt-A-S
	Find Personal Templates	Alt-A-F
	Collapse Shared Tree	Alt-A-L
	Collapse Personal Tree	Alt-A-A
Tools
	Edit Template Fields	Alt-T-F
	Import Template	Alt-T-I
	Export Template	Alt-T-E
	Refresh Templates	Alt-T-R
	Template Icon Legend	Alt-T-T
Back to Top

Consults Tab

Menu	Command	Keystroke
View
	All Consults	Alt-V-A
	Consults by Status	Alt-V-U
	Consults by Service	Alt-V-S
	Consults by Date Range	Alt-V-R
	Custom View	Alt-V-M
	Save as Default View	Alt-V-V
	Return to Default View	Alt-V-F
	Icon Legend	Alt-V-I
Action
	New | Consult…	Alt-A-N-C
	New | Procedure…	Alt-A-N-P
	Consult Tracking | Receive	Alt-A-C-R
	Consult Tracking | Schedule	Alt-A-C-L
	Consult Tracking | Cancel (Deny)	Alt-A-C-C
	Consult Tracking | Edit/Resubmit	Alt-A-C-E
	Consult Tracking | Discontinue	Alt-A-C-D
	Consult Tracking | Forward	Alt-A-C-F
	Consult Tracking | Add Comment	Alt-A-C-A
	Consult Tracking | Significant Findings	Alt-A-C-S
	Consult Tracking | Administrative Complete	Alt-A-C-M
	Consult Tracking | Display Details	Alt-A-C-T
	Consult Tracking | Display Results	Alt-A-C-U
	Consult Tracking | Display SF 513	Alt-A-C-5
	Consult Tracking | Print SF 513	Alt-A-C-P
	Consult Results…
Options
	Edit Templates…	Alt-O-T
	Create New Template…	Alt-O-N
	Edit Shared Templates	Alt-O-S
	Create New Shared Template	Alt-O-C
	Edit Template Fields	Alt-O-F
Back to Top

DC/Summ Tab

Menu	Command	Keystroke
View
	Signed Summaries (All)	Alt-V-S
	Signed Summaries by Author	Alt-V-A
	Signed Summaries by Date Range	Alt-V-R
	Uncosigned Summaries	Alt-V-C
	Unsigned Summaries	Alt-V-U
	Custom View	Alt-V-M
	Save as Default View	Alt-V-V
	Return to Default View	Alt-V-F
	Details	Alt-V-D
	Icon Legend	Alt-V-I
Action
	New Discharge Summary	Alt-A-N or Shift + Ctrl + N
	Make Addendum	Alt-A-M or Shift + Ctrl + M
	Change Title	Alt-A-C or Shift + Ctrl + C
	Reload Boilerplate Text	Alt-A-B
	Add to Signature List	Alt-A-L
	Delete Discharge Summary	Alt-A-D or Shift + Ctrl + D
	Edit Discharge Summary	Alt-A-E or Shift + Ctrl + E
	Save without Signature	Alt-A-A or Shift + Ctrl + A
	Sign Discharge Summary Now	Alt-A-G or Shift + Ctrl + G
	Identify Additional Signers	Alt-A-I
Options
	Edit Templates…	Alt-O-T
	Create New Template…	Alt-O-N
	Edit Shared Templates	Alt-O-S
	Create New Shared Template	Alt-O-C
	Edit Template Fields	Alt-O-F
Back to Top

Labs Tab

Menu	Command	Keystroke
View
	Demographics	Alt-V-M
	Postings	Alt-V-P
	Reminder	Alt-V-R
Back to Top

Reports Tab

Menu	Command	Keystroke
View
	Demographics	Alt-V-M
	Postings	Alt-V-P
	Reminder	Alt-V-R
	View a selected report	Spacebar
Back to Top

Related topics

Changing the Font Size

Changing the Window Background Color


What's New in CPRS GUI v.21 (OR*3.0*149)

Accessibility for Individuals with Disabilities

•	Keyboard Shortcuts for CPRS CommandKeyboard_Shortcuts_for_Common_CPRS_CommandssKeyboard_Shortcuts_for_Common_CPRS_Commands

•	Changing the Font Size Accessibility_Changing_the_Font_Sizes

•	Changing the Window Background ColorAccesibility_Changing_the_Window_Color


Accessibility: Changing the Font Sizes
Changing the Font Size

CPRS supports 8, 10, 12, 14, and 18 point font sizes. Font sizes larger than 18 point, make CPRS difficult for the user to navigate. If the user requires font sizes larger than 18 point, then the use of font magnification software, such as Windows Magnifier or other similar tools is recommended.

Changing the size of the fonts used in CPRS is a two-step process. The instructions in CPRS Windows and Dialog Boxes will change the size of most of the fonts displayed in CPRS windows and dialog boxes. However, to change the font size used for CPRS menus and Windows alert boxes, you will also need to follow the steps in CPRS Menus and Windows Alert boxes.

CPRS Windows and Dialog Boxes

You can adjust the font size for most windows and dialog boxes that appear in CPRS. If you change the font size, some screen components will be resized to fit the new font size.  If this occurs, you will need to manually resize some dialog boxes and screen components.  CPRS will save the dimensions for the resized components so you will only have to resize them once.

To change the font size for CPRS windows and dialog boxes, follow these steps:

1.	Select Edit | Preferences | Fonts and choose the appropriate font size.

The font size will be changed.

Note: 	The menu fonts and alert box fonts will not be changed until you follow the steps in CPRS Menus and Windows Alert boxes (below).

CPRS Menus and Windows Alert Boxes

To change the font size used for CPRS menus and Windows alert boxes, follow these steps:

Note: 	The steps below will change the font used in menus and Windows boxes for ALL of the applications on your computer.

1.	Select Start | Settings | Control Panel.

2.	Double-click on the Display icon.

3.	Select the Appearance tab.

4.	From the Item drop-down list box, select either Menu or Message Box.

5.	Select a font from the Font drop-down list.

6.	Select a size from the Size drop-down list.

7.	Select a color from the Color drop-down list.

8.	Select Apply.

9.	If necessary, repeat steps 4-8 to change the display settings for another item.

10.	Press OK.

Related topics

Keyboard Shortcuts for CPRS Commands

Changing the Window Background Color


Accessibility: Changing the Window Color
Changing the Window Background Color

To change the background color of CPRS windows and dialog boxes, follow these steps:

Note: 	The steps below will change the background color of windows and dialog boxes for ALL applications on your computer.

1.	Select Start | Settings | Control Panel.

2.	Double-click on the Display icon.

The Display Properties dialog box will appear.

3.	Select the Appearance tab.

4.	From the Item drop-down list box, select Window.

5.	Select a color from the Color drop-down list box.

6.	Select Apply.

7.	If necessary, repeat steps 4-6 to change the display settings for another item.

8.	Press OK.

Related topics

Keyboard Shortcuts for CPRS Commands

Changing the Font Size


Digital Signature (PKI) Overview

Digital signatures are part of a Veterans Administration (VA)/Drug Enforcement Agency (DEA) Public Key Infrastructure (PKI) Pilot project to introduce electronic signature for outpatient medication orders of Schedule 2 and Schedule 2n controlled substances. DEA policy is that these controlled substances cannot be signed for electronically and require a "wet" signature or hand-written prescription that goes to the pharmacy. This pilot project uses smart cards, card readers attached to workstations, and digital certificates, and other technologies to electronically (digitally) sign outpatient orders for Schedule 2 and Schedule 2n controlled substances.

Note:	Internet Explorer 5.5 or later with 128-bit encryption is required for PKI functionality.

What’s on the Smart Card?

In the VA/DEA PKI Pilot, the clinician uses a smart card to digitally sign outpatient medication orders for Schedule 2 and Schedule 2n controlled substances after using the current electronic signature process within CPRS. The technologies used in PKI add security for these substances. Smart cards have the clinician’s photo and an integrated circuit (a computer chip) that stores other information such as demographics, access and verify codes, a personal identification number (PIN), and a digital certificate.

The VA Issuing Station is responsible for creating the smart cards and sending each approved clinician a smart card with the appropriate information. Then, the VA Issuing Station separately sends each card user a personal identification number (PIN) that will enable access to the smart card’s information during the signature process and for PIN verification or change. A digital certificate will also be placed on the card to verify that the user is currently authorized to write orders for these controlled substances.

To be authorized to order and sign for Schedule 2 and Schedule 2n controlled substances, clinicians must have either a DEA assigned to them or use a VA/DEA number assigned to their facility.

Once the user has a DEA or VA number, the user can apply for a smart card when your site rolls out this feature. The user will have to supply the needed information to the VA Issuing Station so that they can create and send a card.

Note:	Currently the project is only a pilot program. If the pilot is a success, the VA will then decide whether to roll out the hardware and software to all sites and what that project would entail.

How Does CPRS Show a Digital Signature?

CPRS displays order information in several places where users will be able to see that an outpatient Schedule 2 or Schedule 2n order was digitally signed.

Cover Sheet: If the order has been digitally signed, the detailed order display from right-clicking the order on the Cover Sheet where it now shows "Elec Signature:" will show "Dig Signature:".

Orders Tab and Meds Tab: If the order has been digitally signed, the detailed order display from right-clicking the order on the Orders tab or from selecting it and choosing Details from the View menu where it now shows "Elec Signature:" will show "Dig Signature:" .

Reports Tab: On the Daily Order Summary and Order Summary by a Date Range reports, the signature type will be Digital. On the Chart Copy Summary report, the indicator shows that the order was digitally signed.

Digitally Signing Orders

A Personal Identification Number (PIN) controls access to the smart card. When a user needs to change the verify and access codes on the card, digitally sign an order, or change the card’s PIN, the user must be at a workstation with a card reader and must enter the card’s current PIN.

If you are using PKI and have entered an order for a Schedule 2 and Schedule 2n controlled substance, digitally sign the order by

•	Proceeding with the normal electronic signature process.

•	Inserting the smart card into the card reader.

•	When prompted, enter your PIN and select OK or press <Enter>.

Note:	The provider will have to enter their PIN for each order that requires a digital signature.

Several things can cause you to have problems signing the orders digitally. If a problem occurs, a dialog displays showing the reason why the signature failed.

Contact IRM or a CAC to have the problem corrected. The following is a list of error messages that users might encounter:

•	Order Text is blank

•	DEA # missing

•	Drug Schedule missing

•	DEA # not valid

•	Valid Certificate not found

•	Couldn’t load CSP

•	Smart card Reader not found

•	Certificate with DEA # not found

•	Certificate not valid for schedule

•	Crypto Error (contact IRM)

•	Corrupted (Decode failure)

•	Corrupted (Hash mismatch)

•	Certificate revoked

•	Verification failure

•	Before Cert effective date

•	Certificate expired

Changing Your PKI Personal Identification Number (PIN)

Keeping your smart card PIN confidential is extremely important because if your site implements the sign on function, you will be able to log on to a workstation by inserting your smart card and entering your PIN. Protecting the PIN will also ensure that Schedule 2 and Schedule 2n orders will be signed only by authorized providers.

Note: 	When a clinician writes a Schedule 2 or Schedule 2n outpatient medication order, the clinician will be prompted for his or her electronic signature and then for the digital signature.

To change your PIN, use the following steps:

1.	Bring up the Passage Control Center by selecting Start | Programs | RSA SecurID Passage | Control Center.

2.	On the General Tab under Card PIN Management, choose Change.

3.	Enter your current PIN in the Old PIN and tab to New PIN. Enter your New PIN, remember to use strong passwords that include upper and lower case letters, numbers, and special characters. Tab to Confirm New PIN and enter the same new PIN.

4.	Select Change.

5.	Insert your smart card into the card reader if you have not already done so and select OK.

Related Topics

Electronic Signature (overview)

Review / Sign Changes Dialog

Sign Selected Orders


What's New in CPRS GUI v.22 (OR*3.0*173)

PKI

Digital Signature (PKI) Overview

Review / Sign Changes Dialog

Sign Selected Orders

Federal Health Information Exchange (FHIE), tells which reports may contain Department of Defense Data

Available Reports on the Reports Tab

Context Management (CCOW)

Context Management (CCOW) in CPRS

Joining Context

Breaking Context

Notification Enhancements

Notifications and Alerts

Sorting Notifications

Removing Notifications

Forwarding Notifications

Processing Notifications

Additional Dose Now Changes

Ordering Inpatient Medications

Printing Multiple Notes, Consults, or Discharge Summaries

Printing in CPRS


Context Management (CCOW) in CPRS

Clinical Context Management (sometimes referred to as "CCOW") is a way for graphical user interface (GUI) applications to synchronize their clinical context based on the Health Level 7 CCOW standard. In simple terms, this means that if CCOW-compliant applications are sharing context and one of the applications changes to a different patient, the other applications will change to that patient as well.

The VA purchased Sentillion’s Vergence context management software to work with VistA.

To use the CCOW standard, VistA set up must include these two components:

•	a context vault, which is a server on the VA LAN that tracks context for each clinical workstation

•	desktop components installed on each workstation that will use CCOW

To allow VistA GUI applications to use context management, the developers must make the necessary changes to HL7 messages for each application to allow synchronization. Current plans call for the following applications to be CCOW-compliant:

•	CPRS *

•	HealtheVet Desktop (Care Management) *

•	Imaging *

•	Clinical Procedures

•	BCMA (Bar Code Medication Administration)

•	Vitals

•	FIM (Functional Independence Measure)

•	Scheduling

* These applications will be made CCOW compliant first.

CPRS has been made CCOW-compliant and can now synchronize with other VistA CCOW-compliant applications. The first three applications that will be CCOW-compliant are CPRS, Care Management, and Imaging. Care Management provides one example of applications synchronization. If you were in Care Management, which is also CCOW-compliant, and clicked the CPRS Chart link, the CPRS GUI chart would be launched and would bring up the same patient that had focus in Care Management. You can also have two CPRS sessions synchronized. And, of course, you can bring up two different CPRS sessions and not synchronize them, thus allowing you to view two patients’ charts at the same time.

The CCOW icon shows whether the current application is linked with others on the desktop.

 The above graphic shows the CCOW icon in outlined in red at the far left of the chart.

CPRS enables users to join or break context with other applications. The icon displays whether CPRS is joined in context or not. The following three icons will display based on the CCOW state:

  Linked

  Broken

  Changing

Note:	There are a few cases when you cannot change context, such as when a print dialog is open or when you are trying to open an application from the Tools menu. If you try to change context with unsigned orders or notes, the Problem Changing Clinical Data dialog display and tell the user if there are items that will not be signed. Another dialog display if there is a contextor problem.

Related Topics

Joining Context

Breaking Context


Joining Context

Note:	If a context error occurs, the Rejoin patient link menu item will not be available for the rest of the current CPRS session. It will be available again when the user closes CPRS and then launches CPRS again.

1.	Give focus to the application that you want to join context by either clicking on that application window or by holding down the Alt key and pressing tab until you highlight the appropriate application and then release the keys.

2.	Choose File | Rejoin patient link.

3.	If you want the other open applications to synchronize with the current patient in the application that has focus, choose Set new context. Or, if you want the current application to synchronize with the patient the other applications have open, choose Use Existing Context.

Related topics

Context Management (CCOW) in CPRS

Breaking Context


Breaking Context

Note:	If a context error occurs, the Rejoin patient link menu item will not be available for the rest of the current CPRS session. It will be available again when the user closes CPRS and then launches CPRS again.

1.	Give focus to the application that you want to remove from context by either clicking on that application window or by holding down the Alt key and pressing tab until you highlight the appropriate application and then release the keys.

2.	Choose File | Remove from link.

Related Topics

Context Management (CCOW) in CPRS

Joining Context


Sorting Notifications and Viewing Comments of Forwarded Alerts

To enable users to decide which of their Notifications or Alerts they would like to process first, the format for displaying Notifications in the CPRS GUI has been changed to columns that enable users to sort their Notifications based on column heading:

•	Info (information alerts are preceded with an "I")

•	Patient name (alphabetical or reverse alphabetical)

•	Location (patient location, if known, alphabetical or reverse alphabetical)

•	Urgency (valued HIGH, Moderate, or low as indicated by the CPRS parameter ORB URGENCY. TIU alerts are given a Moderate urgency value. Other alerts without a parameter value are given an urgency of low.)

•	Alert Date/Time (date/time the alert was triggered, newest to oldest or oldest to newest)

•	Message (alert message or text, alphabetical or reverse alphabetical)

•	Forwarded By/When (sorts alerts alphabetically and then by time for the same forwarding person)

Clicking a heading will sort the alerts by that heading.

Sorting Notification Columns Using the Mouse

To sort Notifications using the mouse, click the column heading you want to sort by. To reverse the sort order, click the same heading again. For example, a user could decide to sort by date and time. Normally, the most recent alerts are listed first. The user could click the column heading to reverse the order and have the oldest alerts displayed first. Clicking the column heading again would list the most recent alerts first.

Sorting Notifications Using the Keyboard

Users who do not use the mouse can sort Notifications in ascending order (alphabetical order or most recent Date/Time) using the keyboard only. When users sort using the Ctrl + <key> combination, CPRS will recognize either upper or lower case letters (this feature is not case-sensitive). Users can sort Notifications using the following Ctrl + <key> combinations:

Key Combination	Column Sorted

Ctrl + I	Info

Ctrl + P	Patient

Ctrl + L	Location

Ctrl + U	Urgency

Ctrl + D	Alert Date/Time

Ctrl + M	Message

Ctrl + F	Forwarded By/When

Note:	A limitation exists in the programming environment that does not allow the user to user the same key combination to then reverse the sort. Making this change would not be trivial and will not be addressed the CPRS GUI at this time.

Viewing Comments of Forwarded Alerts

Users may also want to view comments associated with forwarded alerts. To view a comment, simply place the cursor over the alert, leave it still for a few seconds, and the comment will display. Move the mouse and the comment will no longer be displayed.

This graphic shows that when you place the cursor over a forwarded alert the associated comment will display.

To bring up the forwarded comment in a separate dialog, highlight the notification with the comment and select the Show Comment button.

Related topics

Notifications and Alerts

Removing Notifications

Forwarding Notifications

Processing Notifications


Removing Notifications

1.	Bring up the Patient Selection screen, either by launching CPRS or if you are already running CPRS, selecting File | Select New Patient.

2.	Highlight the notifications that you want to remove.

Note:	To select a number of notifications in a row, click the first item, hold down the Shift key, and click the last item. All items in the range will be selected. To select multiple items that are not in a row, click one, hold down the Control key, and click the other specific notifications.

Warning:	Once you remove these notifications you cannot get them back. Be careful that you really want to remove or delete these notifications before you proceed.

3.	Select Remove.

Note:	A new parameter ORB REMOVE enables sites to specify which notifications can be removed in this way. If the notification is not removed, you will have to process the notification.

Related topics

Notifications and Alerts

Sorting Notifications and Viewing Comments of Forwarded Alerts

Forwarding Notifications

Processing Notifications


Forwarding a Notification to Another User

1.	Bring up the Patient Selection screen, either by launching CPRS or if you are already running CPRS, selecting File | Select New Patient.

2.	Highlight the notifications that you want to forward and click Forward.

Note: To select a number of notifications in a row, click the first item, hold down the Shift key, and click the last item. All items in the range will be selected. To select multiple items that are not in a row, click one, hold down the Control key, and click the other specific notifications.

3.	When the dialog shown below displays for each notification, select the recipients’ names for this notification.

a.	In the field labeled Select or enter name, type the first few letters of the person’s last name.

b.	Find the person’s name in the list and click it to add it to the list of recipients.

c.	Repeat steps A and B until all those you want to forward this notification to are listed under Currently selected recipients.

d.	Type a comment if needed (comments are limited to 180 characters including spaces).

e.	Click OK.

4.	Repeat the above steps as necessary for additional notifications you want to forward.

Related topics

Notifications and Alerts

Sorting Notifications and Viewing Comments of Forwarded Alerts

Removing Notifications

Processing Notifications


Keeping Diagnostic and Procedure Codes Current

Code set versioning (CSV) modifies VistA to comply with the Health Insurance Portability and Accessibility Act (HIPAA) stipulations that diagnostic and procedure codes used for billing purposes must be the codes that were applicable at the time the service was provided. Because the codes change, CPRS currently checks ICD and CPT code validity as of a specified date when codes are entered, when a new code set is implemented, and whenever Clinical Application Coordinators (CACs) or IRM personnel choose to run the option.

CPRS GUI users will see indicators for inactive codes on the Cover Sheet, Problems tab, Encounter form, and in Clinical Reminders (although the Clinical Reminders changes may be less apparent).

In these GUI locations, any diagnosis or procedure codes that are inactive or will become inactive by a specified date because a new code set has been installed display with the "#" symbol in front of them as shown in the following examples.

Cover Sheet Displays

On the Cover Sheet, the active problems display. Users can quickly see if the patient has any inactive codes for the active problems. The ‘#’ symbol shows the user that this active problem has an inactive code.

If the user tries to get a detailed display of the problem, the user first gets a warning about the inactive code.

The warning message instructs the user to correct the inactive code from the Problems tab. When the user closes the warning dialog, the detailed display then comes up. The “#” symbol in the detailed display also shows that the code is inactive.

Problems Tab Display

On the Problems tab, users are alerted to inactive codes in two ways. The first time the user goes to the Problems tab if there are problems with inactive codes, a dialog displays that tells how many problems with inactive codes have been found.

Note:	This dialog appears only the first time the user goes to the problems tab for that patient in a session. When the user closes the dialog, the Problems tab display. Problems with inactive codes have the "#" symbol in the status column.

The detailed display of a problem also indicates that the current code is inactive. Users should use the Change feature to associate the problem with an active code.

Encounter Form Display

The Diagnoses tab of the Encounter dialog displays a "#" next to the code if the code is inactive.

If the user tries to select that diagnosis the following warning displays that tells users about [image]  codes that need to be updated through the Problems tab.

Consults Tab Display

For Consults and Procedures, only active codes will be allowed for the following functions:

•	Lexicon look up for provisional diagnosis as of the ordering date

•	Copying or changing existing orders (the consult or procedure will not be accepted until a valid code is selected)

•	Edit/Resubmit, the original code will be checked to see if it is active, if it is inactive an active code will need to be entered before CPRS will accept it

Clinical Reminders

CPRS GUI will only display codes that were active in the reminder date range.


Patient Record Flags: Overview

Patient Record Flags (PRF) are advisories that authorized users place on a patient’s chart to improve employee safety and the efficient delivery of health care. Each advisory or flag includes a narrative that describes the reason for the flag and may include some suggested actions for users to take when they encounter the patient. Other information displayed to the user includes the Flag Type, Flag Category, Assignment Status, Initial Assignment Date, Approved by, Next Review Date, Owner Site, and Originating Site. When assigning a flag, authorized users must write a progress note that clinically justifies each flag action.

Flags are defined in the PRF List Manager software either through a patch or by an authorized user. Once the flag definition exists, authorized users can use the following actions in the PRF software to assign and maintain the flag on a specific patient’s record: new assignment, continue, inactivate, mark as entered in error, and reactivate.

To make flags widely available to VHA employees who interact with patients, Patient Record Flags are tied to the patient look-up. Whenever a user looks up a patient, the software checks to see if the patient’s record has been flagged, and if a flag exists, the software displays the list of flag names.

To ensure that users notice them, CPRS uses a Patient Record Flags pop-up box. After a user selects a patient with an active flag assignment, CPRS pops up a dialog containing all flags for the patient. Users can review the flags or close the box. The rest of the patient record does not load until the user closes the PRF pop-up box. Once the rest of the record is loaded, users can view flags at any time using the Flag button or the Cover Sheet list of PRF displayed on the upper right of the Cover Sheet under Patient Record Flags.

Sites can help users notice the flags by using Patient Record Flags judiciously. Overusing these flags could make them cumbersome to users who might therefore choose to ignore them. Ignoring flags could put employees, other patients, and the health care environment at risk.

To avoid this situation, before placing a flag on a patient’s record, sites must have in place a system for deciding when a flag is appropriate and when it will be reviewed. Sites should also have policies about how to handle questions about flags. To give sites some direction about implementing Patient Record Flags, VHA Directive 2003-048, dated August 28, 2003, titled: National Patient Record Flags has been issued.

Category I and Category II Flags

Patient Record Flags are divided into types: Category I (national) and Category II (local). Category I Patient Record Flags are the most critical and are transmitted to all facilities, ensuring that these flags are universally available. Category II Patient Record Flags are local only, belonging only to the site that created them; they are not shared between sites.

Category I or National Flags

Currently, the only Category I Patient Record Flag is a Behavioral flag for violent or potentially violent patients. The Office of Information created this flag to help VHA properly protect its employees and maintain a safe environment for health care. The Office of Information defines and distributes Category I flags through national patches and the definition of the flag cannot be edited by local sites.

Each Category I flag assignment to a specific patient’s record is owned by a single facility. The facility that placed the Category I flag on the patient’s record would normally own and maintain the flag. The site that owns the Category I flag is the only site that can:

•	review whether to remove or continue the flag

•	edit the flag

•	inactivate the flag

•	reactivate the flag

•	mark the flag as entered in error

•	change ownership of the flag

•	enter a Patient Record Flag Category I progress note for the flag

However, ownership of a Category I flag assignment can be transferred. If a patient received the majority of care at a different VA facility than the one that assigned the flag, the site giving the majority of care could request that ownership of the flag be transferred to the that site. The owning site could then change the ownership to the second site through the PRF software in List Manager.

Category II or Local Flags

Category II flags are local. Each site can create and maintain its own set of local flags that are not transmitted to other sites. However, the purpose of Category II flags is similar to Category I—to provide important patient information to health care providers. For example, a site could create a Patient Record Flags Cat II – Diabetes flag or a Category II Infectious Disease flag.

In VHA Directive 2003-048, dated August 28, 2003, titled: National Patient Record Flags, VHA advised sites to create and use Patient Record Flags sparingly so that users will notice flags and pay careful attention to them. Creating a large number of flags for many different reasons might lessen the impact of flags and cause staff to miss important information. Both Category I flags and Category II flags require a progress note to document the reason for placing a flag on the patient’s record.

Creating, Assigning, and Maintaining PRF

Some sites may have two different groups of users who work with Patient Record Flags: administrative users who create, maintain, and assign flags and the clinical users that document why the flag was placed on the patient’s record. Authorized users can define Category II flags and edit their definitions. They assign and maintain the flag on a patient’s record using the assignment actions in the PRF software through the List Manager interface:  new assignment, continue, inactivate, mark as entered in error, and reactivate. (Additional documentation for PRF creation, assignment, and maintenance is available in the Patient Record Flags User Guide.)

Documenting PRF

With CPRS GUI v.26, each Patient Record Flag action (new assignment, continue, inactivate, reactivate, or mark as entered in error) must have a linked progress note that clinically justifies any action taken. Previously, each flag needed to have a progress note, but there was no link between the note and the flag action. Now when the user writes a PRF progress note, the user must link the note to a flag action. The note might also contain references to supporting documentation.

In each flag definition, the user must select the previously created PRF progress note title that will document the reasons for any flag action. This is referred to as associating a progress note title with a PRF. Before a title can be associated with a PRF, the title must be created either by a patch for a national flag or by someone at the site for a local flag.

For example, if a user were defining a Wandering flag in the PRF List Manager software, someone at the site must have already used TIU to create the appropriate note title in the correct document class. Then, the user defining the flag would associate a title such as, Patient Record Flag Category II – Risk, Wandering, by selecting that title from the list of available PRF progress note titles.

Once the flag and the progress note title are associated, when the user writing a new progress note selects a PRF progress note title, CPRS displays the flag actions on the selected patient and whether each action has been linked to PRF progress note (Yes or No). For the new PRF note, the user then selects the available flag action to create the link between the note and the flag action.

Note:	There is a one-to-one correspondence between flag actions and progress notes. Each PRF action for a patient can only be linked to one progress note; each progress note can only be linked to one flag action.

Prerequisites to Writing PRF Progress Notes

Before users can write progress notes that document PRF, PRF progress note titles must be set up correctly. Each PRF progress note title must be associated with a specific flag definition, and users must be assigned to the appropriate user classes to write specific kinds of notes. Also, someone must have assigned the flag to the patient.

For users to write a progress note and correctly link the note to a flag action, sites must complete the following set up:

•	To write a PRF note for a category I flag, the user must belong to the DGPF PATIENT RECORD FLAG MGR user class. Each site will be responsible for populating this user class.

•	Because Category II Patient Record Flags are local, each site must determine if the site will create a user class and business rules to govern which users can write Category II PRF progress notes.

•	The PRF note titles should follow the naming conventions described in the directive and be descriptive enough that users can tell which note title corresponds to which flag.

•	The flag definition must contain the progress note title that documents actions for that flag—each PRF note title can only be associated with one flag.

•	Category II PRF progress note titles must be in the Patient Record Flag Cat II document class under the Progress Notes document class to allow users to associate them with a PRF Category II definition. If the titles are not in this document class, they will not display when the user attempts to associate the title with a PRF Category II flag nor will CPRS get the information about which flags actions are linked. Progress note titles for Category I patient record flags are defined and associated by national patch.

PRF Note Titles

Currently, there is only one Category I flag: Behavioral. The Progress Note title for documenting this flag is “Patient Record Flag Category I”.

To help sites that will be creating local Category II flags, four partially customizable Progress Note titles have been distributed:

•	Patient Record Flag Category II – Risk, Fall

•	Patient Record Flag Category II – Risk, Wandering

•	Patient Record Flag Category II – Research Study

•	Patient Record Flag Category II – Infectious Disease

Clinical Application Coordinators (CACs) can customize these titles by changing the text after the dash using TIU utilities. For example, the first title could be changed from “Patient Record Flag Category II – Risk, Fall” to “Patient Record Flag Category II – Behavioral, Drug Seeking” or other titles sites create.

CACs can also create their own titles, but the title must follow the naming convention “Patient Record Flag Category II – other text” where other text is the text specific to the local note title.

Linking PRF Notes to Flag Actions

In the CPRS GUI, users must link a PRF progress note to a flag action when the user writes a PRF note. This linking can also be done through the List Manager interface using TIU options. In the CPRS GUI’s Progress Note Properties dialog, when a user selects a Patient Record Flag progress note title, CPRS displays a list of flag actions to which the note can be linked at the bottom of the dialog. This list shows all the actions for the flag and whether each action has been linked.

For progress note titles that document the justification for a patient record flag, users will be able to link the progress note to the specific flag action they are documenting. The example shown here is of a Category I PRF progress note and the Continue action to which the user would choose to link.

Note:	For PRF notes, users must select a flag action to link the note to before they can write the note—the same way users link a note with a consult. CPRS will not allow the user to write the note unless an unused flag action is selected. If the user does not select a flag action, CPRS displays a dialog that states, “Notes of this title require the selection of a patient record flag action”.

When the user select a PRF progress note title, CPRS displays this list of note actions only if sites have done the correct set up as described earlier. The user must then pick the action (new assignment, inactivate, reactivate, continue, or entered in error) that the note is documenting.

If a user is viewing a note and wants to see to which PRF action the note is linked, the user can select View | Details on the Notes tab. The details include the flag name, the date, and the action that was linked.

If a user writing a new progress note chooses a PRF progress note but CPRS does not display any flag actions for linking, one of the following has probably occurred:

•	The flag has not been assigned to this patient yet.

•	The user has selected the wrong progress note title for the flag.

•	If it is a Category I flag, the site may not own the flag.

Marking PRF as Entered in Error

Marking PRF as entered in error terminates the flag’s display in the patient’s record. However, if there was a progress note linked to the flag, the progress note is still in the patient’s record. If the flag was entered in error, an authorized TIU user should retract or retract and reassign the linked progress note.

Note:	Users should be aware that although the flag does not display, a history of this flag is kept in the Patient Record Flag software and users can reactivate the flag. To prevent users from entering notes on previous, inaccurate PRF actions, all previous PRF actions are hidden when a flag is marked as entered in error.

Related topics

Viewing Patient Record Flags


Viewing Patient Record Flags

Patient Record Flags are displayed in the applications that use the patient look up, including the CPRS GUI. In the CPRS GUI, there are three places where users can see if a patient has PRF:

•	The Patient Record Flag Pop-up Box

•	The CPRS Cover Sheet

•	The Flag button (available from any tab)

When the user selects a patient name from the Patient Selection Screen, CPRS begins to load the record, displays any relevant messages ("means test require",  deceased patient, sensitive record, etc.), and then, if the record is flagged, displays a pop-up box with the flag titles for the selected patient to ensure that the user sees the flags. The pop-up box is shown below.

The Patient Record Flags pop-up box displays a list of all flags for the patient, with the first flag in the list highlighted and the narrative for that flag displayed below the flag list and a list of links to notes that have been linked to flag actions. Category I flags are displayed first, followed by any Category II (or local) flags.

The flag narrative is the text the person assigning the flag enters that they want the user to see. It should give the purpose of the flag and may also contain examples of past behavior and instructions for users to follow when encountering the patient. For example, the narrative for a particular Behavioral flag might state that a patient has been known to carry weapons and has verbally threatened VHA staff in the past. It may also recommend that users call the VA police if this patient comes in for care. However, the purpose of Patient Record Flags is not to stigmatize nor discriminate, rather it is protect VHA staff and patients and to ensure the efficient delivery of health care.

On the bottom of the Patient Record Flags popup box, CPRS displays a list of notes that are linked to specific flag actions. Links will only display for those notes that have been signed and linked to a flag action. When the user selects a link, CPRS displays the linked progress note for the action in a detailed display window.

Users can review the flags or close the box.

When the user is already in a patient record and wants to view Patient Record Flags, the user can use either the listing on the Cover Sheet or the Flag button. On the CPRS Cover Sheet, a new box called Patient Record Flags has been added above the Postings area. Flags for the selected patient are listed in the box.

The Flag button is visible from all CPRS tabs. If a patient’s record has been flagged, the Flag button with its red text displays next to the Remote Data button. If the patient’s record does not have any flags, the text on the button is grayed out instead of red. The Cover Sheet and Flag button are shown in the graphic below.

 This screen capture shows the red text on the Flag button indicating this patient record has PRF and shows the flag list on the CPRS Cover Sheet.

To view a Patient Record Flag when entering a record, use the following steps:

1.	Select a patient from the Patient Selection screen by either double-clicking on a patient name or highlighting the name and pressing the <Enter> key.

Note: 	When the record loads, CPRS checks to see if the record is sensitive and displays a warning to the user that the user must acknowledge to proceed. Then, if the record has one or more flags, CPRS displays a pop-up box with the patient’s record flags title. The first flag is highlighted and the narrative details displayed below. If CPRS displays the pop-up box, the user must close this box before CPRS will load the patient chart.

2.	Then, bring up the flag narrative you want to view by selecting the flag name or highlighting the flag name with the tab and arrow keys and pressing <Tab> (note that the number of flags in each category is listed after the category label).

This graphic shows the Patient Record Flag pop-up box listing the patient’s flags, the narrative for the highlighted flag, and the links to any signed, linked progress notes documenting the reasons for the flag. Using the Flag button or clicking on a flag title on the Cover Sheet also displays this pop-up box. Category I flags are in the orange field, they blink, and the text changes color from white to black and back. Category II flags are in the field below.

3.	To view the linked progress note, select the appropriate link in the lower part of the dialog. When finished, select Close.

4.	When finished viewing the narrative, close the narrative box by choosing Close.

To view a Patient Record Flag when already viewing a record, use the following steps:

1.	Go the Cover Sheet by clicking the Cover Sheet tab or pressing Ctrl + S or use the Flag button by clicking Flag or pressing tab until you highlight the Flag button and press <Enter>.

2.	Select the flag title to see the narrative details by clicking the title or using the Up and Down arrows to highlight the name and pressing <Enter>.

3.	When finished, close the box by clicking Close or tabbing to Close and pressing <Enter>.

Related topics

Patient Record Flag: Overview


What's New in CPRS GUI v.23 (OR*3.0*187)

Patient Record Flags

Patient Record Flags: Overview

Viewing Patient Record Flags

Code Set Versioning

Keeping Diagnostic and Procedure Codes Current

Provider Selection Pop-up (this will occur several places in the help)

Distinguishing Between Providers with similar First and Last Names

Inpatient Medications for Outpatients

Ordering Inpatient Medications for Outpatients (Overview)

Ordering Inpatient Medications for Outpatients (Meds tab)

Ordering Inpatient Medications for Outpatients (Orders tab)


Provider Selection Critieria for Similar Names
To help you distinguish between providers, CPRS displays their titles (if available). When two or more providers have identical names, CPRS also displays:

•	The service/section and site division (if any) associated with these providers; site divisions are displayed based on the following rules:

o	When no division is listed for a provider, no division is displayed.

o	If only one division is listed, this division is displayed.

o	If the site has multiple divisions or more than one division is listed and one of these listed divisions is marked as Default, CPRS displays the division marked as Default.

o	If more than one division is listed for a provider and none is marked as Default, CPRS does not display division information for this provider.

•	Providers who are listed in the New Person file as Visitors are screened out from the provider list. (These screened-out providers are listed as Visitors because their entries were created as a result of a Remote Data View.)


Ordering Inpatient Medications for Outpatients (Overview)
Inpatient Medication Orders for Outpatients (Overview)

Note:	IMO features will not be available in the CPRS until patch SD*5.3*285 is installed in your account. This patch is currently under development.

The Inpatient Medications for Outpatients (IMO) project is designed to enable a CPRS user in an authorized location to order unit-dose medications or intravenous (IV) medications that are dispensed by inpatient pharmacy and administered to an outpatient in a clinic setting. IMO allows VistA order checks to function for such medication orders. Each site must decide which clinics should be defined as IMO locations and then IRM or CAC staff will need to set up those locations.

On the Orders tab, CPRS displays IMO unit-dose orders, IV Fluid (Infusion) orders, and Nursing text orders written in an IMO location under a new display group named Clinic Orders. To show under the Clinic Orders display group, Nursing text orders must have the display group of Nursing and must be ordered from an authorized IMO location. If they are note ordered from an IMO location, the Nursing text orders will display under the Nursing display group. This includes text orders that are part of an order set.

Note:	If IMO Nursing orders do not display where expected, they may not be set up properly. IRM or CAC personnel should check the CPRS Technical Manual: GUI Version for more information.

This example shows the Order tab with all three types of orders--unit-dose, intravenous (IV), and nursing text only orders--that can appear under the IMO display group of Clinic Orders.

On the Meds tab, IMO medication orders of all statuses except unreleased orders display at the top of the Inpatient Medications pane before other inpatient medications orders. Nursing text orders do not display on the Meds tab. User can distinguish IMO orders because they have an entry in the Location column of the Meds tab display.

Note: 	IMO orders are affected by both CPRS auto-DC rules and Inpatient Medications rules for auto-discontinuing orders on admission and discharge. If sites do not want IMO orders to auto-discontinue on admission and discharge, sites will have to ensure that neither CPRS nor Inpatient Medications discontinues IMO orders. Inpatient Medications uses the AUTO-DC IMO ORDERS parameter to exclude IMO orders from being discontinued.

Criteria for Ordering Inpatient Medications for Outpatients

To successfully write an IMO order, the outpatient must meet at least one of the following criteria:

•	He or she must have a scheduled appointment at an authorized hospital/clinic location for the current day or a day in the future

•	He or she must be currently checked in at an authorized hospital/clinic location

Note:	If the patient does not meet either of these criteria, you can create a new visit for the patient at an authorized hospital location. To create a new visit, select the Provider/Encounter button (shown below), select the Visit tab, select New, and then select OK.

In addition, before you can use the Meds tab to place IMO orders, your site’s CAC (or the person who manages information resources at your site) must set up the new-medication order dialog to include inpatient medications.

Related Topics

Ordering Inpatient Medications for Outpatients (Meds tab)

Ordering Inpatient Medications for Outpatients (Orders tab)

Sorting the Medications View

Changing or Copying IMO Orders


Ordering Inpatient Medications for Outpatients (Meds tab)

Take the following steps to write an IMO (inpatient-medications for outpatients) order:

1.	Select the Meds tab.

2.	Select Action | New Medication

-or-

click to select the area within the Inpatient Medications window, then right click and select New Medication from the shortcut menu.

3.	CPRS prompts you to select a location for current activities. Select a current or future scheduled appointment in an authorized hospital/clinic location or create a new visit in an authorized hospital/clinic location using the default time for new visits (NOW).

Note:	CPRS allows you to change your clinic selection after you have started an order. However, if you are in the process of placing an order and change clinic locations midstream, CPRS does not reflect this change in the finished order. For example, suppose you are in the process of placing an inpatient medication order for an outpatient using an authorized clinic. Now suppose you change your mind and select instead a clinic that is not authorized for placing these orders. CPRS finishes your order as an IMO order using the authorized clinic. If you are in the process of placing an IMO order from an unauthorized clinic, then change the location to an authorized clinic, CPRS does not display a complete list of inpatient (unit-dose and IV) medications. Instead, it continues to display the list of injectable inpatient medications available for the unauthorized clinic. Furthermore, CPRS does not reflect this clinic change in the finished order.

4.	CPRS displays one or more new medication dialogs. These dialogs are site—and sometimes user—specific. For example, the person who manages information resources at your site may have set the ORWDX NEW MEDS parameter (which controls the new-medication order dialog) to display a list of your inpatient and outpatient quick orders.

However, the person who manages information resources at your site could also define a generic dialog for all applicable users.

5.	Select an inpatient medication.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

6.	To place a simple-dose or complex-dose order for this medication, follow the appropriate steps outlined in Ordering Inpatient Medications.

On the Meds tab, CPRS displays IMO orders sorted at the top of the Inpatient Medications pane with corresponding authorized hospital/clinic locations in the Location column.

CPRS displays IMO orders at the top of the Inpatient Medications pane on the Meds tab.

Related topics

Ordering Inpatient Medications for Outpatient (Overview)

Ordering Inpatient Medications for Outpatient (Orders tab)

Sorting the Medications View

Changing or Copying IMO Orders


Ordering Inpatient Medications for Outpatient (Orders tab)

Take the following steps to write IMO (inpatient medications for outpatients) orders:

1.	Select the Orders tab.

2.	From the Write Orders pane, select Meds, Inpatient. CPRS prompts you to select a location for current activities.

Note:	Depending on how menus are set up at your particular site, you may need to select a different option from the Write Orders pane. Check with your site’s Clinical Application Coordinator (CAC) (or the person who manages information resources at your site) to find out which Write Orders selection provides a complete list of inpatient medications.

3.	Select a scheduled current or future appointment in an authorized hospital/clinic location, or create a new visit by selecting an authorized hospital/clinic location and accepting the default time (NOW). CPRS displays a comprehensive list of available inpatient medications.

Note:	If you select a hospital location that is not authorized for IMO orders, or if the patient does not meet the criteria delineated above, CPRS displays a list comprised only of IV (injectable) inpatient medications.

CPRS allows you to change your clinic selection after you have started an order. However, if you are in the process of placing an order and change clinic locations midstream, CPRS does not reflect this change in the finished order. For example, suppose you are in the process of placing an inpatient medication order for an outpatient using an authorized clinic. Now suppose you change your mind and select instead a clinic that is not authorized for placing these orders. CPRS finishes your order as an inpatient medication order for an outpatient using the authorized clinic. If you are in the process of placing an inpatient medication order for an outpatient from an unauthorized clinic, then change the location to an authorized clinic, CPRS does not display a complete list of inpatient (unit-dose and IV) medications. Instead, it continues to display the list of injectable inpatient medications available for the unauthorized clinic. Furthermore, CPRS does not reflect this clinic change in the finished order.

4.	Select a medication.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

5.	Follow the appropriate instructions for completing simple- or complex-dose medication orders that appear in the topic Ordering Inpatient Medications.

On the Orders tab, CPRS displays IMO orders under the Clinic Orders display group, with the ordering location in the Location column.

Related topics

Ordering Inpatient Medications for Outpatients (Overview)

Ordering Inpatient Medications for Outpatients (Meds tab)

Sorting the Medications View

Changing or Copying IMO Orders


Non-VA Medications (Overview)

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has indicated that all medications, including herbal supplements, over-the-counter (OTC) non-prescription medications, and medications prescribed by providers outside the VA (collectively known as "Non-VA medications") should be entered in the medical record. CPRS, Outpatient Pharmacy, and Inpatient Medications developers have made changes that enable users to enter this information into the medical record so that providers have a better picture of the medications the patient is taking and that order checks against these medications can occur.

Making Non-VA Meds Available for Entry

For users to be able to enter these medications through CPRS, they must be in the CPRS Orderable Items file so that they appear when the user chooses the new order sheet. The Pharmacy patch (PSS*1.0*68) enables sites to mark items as Non-VA Medications. Initially, all Pharmacy orderable items that are marked as "outpatient" and are not supply items will be automatically made Non-VA medications. Subsequently, Pharmacy coordinators can use the Pharmacy option Drug Enter/Edit [PSS DRUG ENTER/EDIT] to identify items as Non-VA Meds or remove the designation.

Note:	For more information about how to get Non-VA Medications added to the appropriate file, please see “Section 5.1: Communicating New Non-VA Meds Entries to the Pharmacist” in the Herbal/OTC/Non-VA Meds Documentation Release Notes that will be located on the VistA Documentation Library at http://www.va.gov/vdl under the Outpatient Pharmacy listings.

Items identified as "Non-VA Meds" are copied into the CPRS Orderable Items file when the Order Entry patch (OR*3.0*176) is installed at your site. Then, when CPRS GUI version 24 is installed, the item "Meds, Non-VA" is added under the Write Orders pane on the Orders tab. When the user selects the Meds, Non-VA option, the dialog displays the items that were marked as Non-VA Meds and copied into the CPRS Orderable Items file.

Different from Ordering Medications

Remember that entering Non-VA Medications is not the same as placing orders. Users simply enter information to provide a more complete view of what the patient is taking. However, once the items are available in the CPRS Orderable Items file, the process for entering Non-VA Medications is similar to entering other orders, but there are a few differences:

•	Almost any CPRS user can enter Non-VA medication information. However, sites can restrict access for those holding the OREMAS key by using the OR OREMAS NON-VA MEDS parameter. For more information about this parameter, please see the CPRS Technical Manual: GUI Version.

•	Users can enter Non-VA medication even if they only have partial information. The only required information is the non-VA or herbal medication name. The Medication name must be one that can be selected from the list. The Dosage, Route, and Schedule fields are optional and will accept free-text entries.

•	Non-VA medications are listed separately on the orders tab and the designation "Non-VA Med" is displayed at the beginning of the entry.

•	Users need to pick a reason why the patient is taking the Non-VA medication.

For the reason/statement that users should enter, developers sent out four reasons or statements at the package level of the parameter GUI Non-VA Med Statements/Reasons that were agreed upon by a workgroup:

•	Non-VA medication not recommended by VA provider.

•	Non-VA medication recommended by VA provider.

•	Patient wants to buy from Non-VA pharmacy.

•	Medication prescribed by Non-VA provider.

Authorized users can enter their own reasons/statements in the parameter by entering new statements at the System or Division level for this parameter. For more information about changing this parameter, see the CPRS Technical Manual: List Manager.

Related topics

Entering Non-VA Medication Information


Entering Non-VA Medication Information

1.	If you are not already there, go to the Orders tab by either clicking Orders or pressing Ctrl + O.

2.	In the Writer Orders list, select Meds, Non-VA.

Note: 	If encounter information has not been entered, the encounter information dialog will appear before the Medication Order dialog. You must complete the encounter information dialog before proceeding.

3.	In the Document Herbal/OTC/Non-VA Medications dialog, select the medication or herbal supplement by

a.	Typing a few letters of name or its synonym (if your site uses synonyms).

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

b.	Selecting the correct name from the list by double-clicking it or highlighting it and pressing <Enter>. You may need to scroll down to find the name.

Note:	If you do not know other information such as dosage, route, or schedule, you may enter only the name of the medication or herbal supplement.

4.	Enter a dosage (if known).

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. (The associated cost is displayed to the right of the dosage.)

5.	Enter a route (if known).

6.	Enter a schedule, including PRN if necessary (if known).

7.	Enter any comments.

8.	Select one or more Statements/Explanations as to why the patient is taking the medication or supplement.

9.	Enter a start date (if known).

10.	Review the information entered in the text box at the bottom of the dialog.

11.	Place the information into the patient’s record by clicking Accept Order or by tabbing to Accept Order and pressing <Enter>.

12.	(Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o	To proceed, select Accept Order.

o	To stop the ordering process and return to the dialog, Cancel Order.

13.	To enter additional Non-VA Medications into the patient’s record, repeat steps 3-12.

14.	When you are through entering Non-VA medications, exit the dialog using the Quit button.

Note:	Non-VA Meds do not require an electronic signature, but they will be presented at the end of the current CPRS session on the Sign screen. You can do the normal signing process or if you only have Non-VA meds, you might get OK and Cancel buttons on a dialog instead of the normal Sign screen. You can click on the checkbox in front of a Non-VA Med to deselect and not approve it.

Related topics

Non-VA Medications (Overview)


What's New in CPRS GUI v.24 (OR*3.0*190)

Combat Veteran Copay Exemption

Encounter Information (overview)--Placed explanatory text for copay exceptions

Entering Encounter Form Data--Added screen capture

Sign Selected Orders Command--Added new screen capture and brief text.

Review / Sign Changes Dialog--Added new screen capture and explanation of Combat Veteran eligibility criteria.

Non-VA Meds (Herbal Supplements, Over-the-Counter Medications)

Non-VA Medications (Overview)--Inserted general information about Non-VA Meds

Entering Non-VA Medication Information--Inserted step-by-step instructions on adding Non-VA meds into CPRS.

Patient Record Flags Pop-Up Box

Patient Record Flag: Overview--Added information about the pop-up box.

Viewing Patient Record Flags--Added screen capture of pop-up box, caption, and note about it appearing when users select a patient.

Notifications Processing and Sorting Changes

Notifications and Alerts--Added general information about Removing, Renewing, and Forwarding alerts.

Sorting Notifications and Viewing Comments of Forwarded Alerts--Added information about sorting.

Removing Notifications--Added a note about ORB REMOVE.

Viewing Expired Orders

Viewing Orders--Added the option to view expired orders and a note about the parameter that sets the hours back that CPRS will search for expired orders.

Remote Data Views

Viewing Remote Data--Added information about what users can get on the reports tab and a note, and the Department of Defense consults exception.

Adverse Reaction Tracking

 Entering Allergies--Updated information about entering allergies; users can no longer enter free-text allergy orders.


What's New in CPRS GUI v.25 (OR*3.0*195)

Clinical Indicators Data Capture (CIDC)

•	Entering Diagnosis Codes for Specific Orders (CIDC Overview)-This topic contains information about what was added for this project, including what kinds of orders it affects, what developers have added, and what feature have been included to make this easier for providers.

•	Changes on the Review / Sign Changes dialog-Changes were made here to document the new features for adding diagnosis information to orders.

•	Changes on the Sign Selected dialog-Developers also made changes to the Sign Selected dialog to help providers enter diagnosis information.

•	Creating and Maintaining a Personal Diagnosis List-Developers added a way for providers to create a personal list of often-used diagnoses to help them more efficiently enter these for the required orders.

•	Understanding Service Connection and Treatment Factors- This information helps explain what makes a patient service connected and what the various treatment factors mean.

•	Entering Allergies: New information about entering allergies via the Cover Sheet tab and changes to previous information about viewing and entering allergies via the Orders tab.

•	Postings: Updated information about postings (including information about viewing and creating new postings).

•	Inpatient Medications for Outpatients (IMO): Added screen captures to illustrate the two new display groups for IMO medications.

•	New Duration/Total Volume field. Added a new screen capture and instructions for the new Duration/Total Volume field on the IV Fluids dialog.


Entering Diagnosis Codes for Specific Orders (CIDC Overview)

Note:	Providers will not see most CIDC changes in CPRS until the site enables a system-level switch and IRM or CAC staff enables a user-level switch (parameter) for specific providers. Some changes for co-pay on service connection will be available as soon as patches from other packages are installed.

With Clinical Indicators Data Capture (CIDC), clinicians who hold the Provider key and the ORES key must enter at least one diagnosis, required service connection, and the appropriate treatment factors for specific types of orders, while clinicians who hold the Provider key and the ORELSE key will be prompted for the same information but not required to enter it before signature. CPRS will prompt for CIDC information for the following types of orders:

•	Laboratory (outpatient only)

•	Outpatient Pharmacy (outpatient only)

•	Radiology (inpatient and outpatient)

•	Prosthetic Consults (inpatient and outpatient)

Clinicians can enter up to four diagnoses for each order and designate one of these as the primary diagnosis.

Clinicians should use their best judgment to enter diagnoses that might be symptomatic when ordering tests rather than the resulting diagnosis after a test. They are not entering the suspected diagnosis, but the actual reason the patient was sent for the lab test or radiology procedure. For example, if a clinician sees a patient with a high fever and difficulty breathing, the clinician may believe that the patient has pneumonia, but if the clinician orders tests to verify the pneumonia, the clinician would enter a diagnosis of "fever", not "pneumonia".

When Will Providers See CIDC Changes?

For clinicians to use the new features to enter at least one diagnosis for these orders, the following four conditions must be met:

•	The site must install the appropriate patches.

•	The clinician must have the Provider key and the ORES key (CIDC entry required) or the ORELSE key (CIDC entry optional).

•	The site must enable the master Clinical Indicators Data Capture switch.

•	The individual Clinical Indicators Data Capture switch enabled for the clinician.

Instructions for enabling Clinical Indicators Data Capture at both the site and individual level are available in the CPRS Technical Manual: GUI Version.

Where Will Users See the Changes?

When the site enables CIDC at the site level and for individual clinicians, the clinicians who hold the Provider key will see the following changes in CPRS:

•	The Review / Sign Changes and Sign Selected dialogs will now have areas where diagnoses will be captured for the specified orders. These diagnoses and treatment factors will then be available on the Encounter form if the clinician signs the orders first.

•	The Encounter Form’s Diagnosis tab will enable clinicians to enter diagnoses for the encounter. These diagnoses will then be available on the orders tab if the clinician does the encounter form first.

•	Order detailed displays will now display the associated treatment factors and diagnoses.

•	A new Assign Diagnosis to Order(s) dialog has been added for clinicians to use in designating one or more diagnoses for each of the types listed above.

•	A new Personal Diagnosis List dialog to create a personal diagnosis list that providers can use as a source on the new Assign Diagnosis to Order(s) dialog.

What Features in CPRS Make Entering Diagnoses Easier?

CPRS has the following features to help clinicians assign diagnoses to orders:

•	Automatically copying the diagnoses, service-connection, and treatment factors when a user copies, renews, or changes an order.

•	Selecting a group of orders to assign diagnoses at the same time.  Clinicians can select a group of orders using the Windows conventions of Shift + Click to highlight a contiguous group of orders and Crtl + Click to add individual orders to the group. All of the orders can then be assigned the same primary and secondary diagnoses.

•	Copying and pasting diagnoses from one order to others. Clinicians who hold the Provider key can highlight an order on the signature dialogs, copy the diagnosis, highlight one or more additional orders, and paste the same diagnosis for them.

•	Providing multiple sources for diagnoses. CPRS displays multiple diagnoses sources for clinicians to locate the appropriate diagnoses:

o	Orders written today if on the Encounter form

o	Encounter diagnoses from today if writing orders

o	Personal Diagnosis List

o	National Encounter forms if defined

o	Problem List entries

o	The Lexicon search.

•	Automatically populating treatment factors for diagnoses selected from the Problem List. One possible source for diagnoses is the patient’s Problem List entries. If a problem has service connection and treatment factor information associated with it on the Problem List and the user selects that Problem List entry as the diagnosis, CPRS automatically places checks in the appropriate checkboxes on the signature forms. The provider can, of course, edit the checks.

•	Creating a personal diagnosis list. Developers provided personal diagnosis list that is specific to each clinician. Each clinician can quickly add diagnoses that he or she frequently uses so that they can be assigned quickly.

Related topics

Review / Sign Changes Dialog

Sign Selected Orders Command


Creating and Maintaining a Personal Diagnosis List

This option enables users to create and maintain a Personal Diagnosis List that displays as one option in the Assign Diagnosis to Order(s) dialog used with Clinical Indicators Data Capture (CIDC) features to assign a diagnosis to specific kinds of orders.

The Personal Diagnosis List dialog enables users to choose diagnoses from the patient’s Problem List entries, nationally defined encounter forms, and the Lexicon and add them to a personal diagnosis list for quicker entry of CIDC information.

To create or edit a Personal Diagnoses List, use the following steps:

1.	Bring up the Options dialog by choosing Tools | Options….

2.	Select the Lists/Teams tab by either clicking on it or pressing Ctrl + Tab until that tab is selected.

3.	Bring up the Personal Diagnoses List dialog by either clicking Personal Diagnoses List… or tabbing to that selection and pressing Space.

4.	To add diagnoses to your personal list using available sources other than the Lexicon, select a category (Problem List, national encounter form or today’s Orders) from the Diagnoses Section pane, highlight one or more diagnoses, and click Add or tab to that button and press Space. Repeat until you have the entries you want in your personal list.

-or-

To add diagnoses to your personal list using the Lexicon, click Other diagnoses… or tab to that button and press Space, type some letters that will help you find the appropriate diagnosis, and click Search or tab to Search and press Space. When you find the diagnosis, select it and press OK. Repeat until you have the entries you want in your personal list.

5.	To remove an unwanted item from your personal list, highlight the item (which will make the Remove button display) and click Remove or tab to that button and press Space.

6.	When you have the items you want on your personal list, click OK or tab to that button and press Space.

Related topics

Entering Diagnosis Codes for Specific Orders

Review / Sign Changes

Sign Selected Orders Command


Understanding Service Connection and Treatment Factors

Upon electronic signature, providers will need to deal with the various exemptions for copayment for qualified veterans. To help providers better understand service connection and treatment factors, the following information is provided.

Service Connected

The assignment of service connected percentage and disability code is based on the degree of disability as determined by the rating board decision following the submission of a claim that a veteran’s illness or injury was incurred in or aggravated by military service.

An adjunct condition, although not service connected, is medically determined to be associated with or is aggravating a disease or condition, which is service connected.  A veteran is eligible to receive treatment for an adjunct condition; however, because the adjunct is not a condition that is specifically rated, VA can bill the insurance carrier as well as those veterans responsible for copayments for treatment provided for the adjunct condition.

A secondary condition is defined as a condition that has been caused or is the result of a service-connected condition.  This condition is also nonservice-connected and treatment provided is also billable.

It is important that the clinician be aware of the patient’s service-connected conditions.  This information is available by clicking the patient’s name in the blue square in the upper left corner in CPRS.  It is also found on the encounter form.  If a patient is being treated for a service-connected condition during a visit, the provider should check the service-connected box on the encounter form "yes".

Compensable service-connected veterans are not charged an outpatient copayment.  However, nonservice-connected veterans and veterans rated less than 50% service-connected with income above the existing threshold may be charged a medication copayment if the medication is for a nonservice-connected condition.  If the veteran has health insurance, a claim will be submitted to the insurance carrier for the treatment of nonservice-connected conditions.

Treatment Factors/Environmental Indicators

The provider must make a clinical decision to determine if an encounter is for a SC condition or one of a number of special categories.  If the veteran is being treated during the encounter for a condition that the provider believes is for SC or a special category, the provider should check "Yes" next to the appropriate category on the encounter form.  The veteran will not be billed for the encounter if "Yes" is checked.

Medication(s) for one of these conditions should be indicated during the outpatient medication ordering process.  The veteran will not be charged a copayment for a medication that is for SC or a special category.

The Special Categories included are:

•	Combat Veteran (CV)

•	Agent Orange (AO)

•	Ionizing Radiation (IR)

•	Southwest Asia Conditions (SWAC) – includes Gulf War veterans

•	Shipboard Hazard and Defense (SHD)

•	Military Sexual Trauma (MST)

•	Head and Neck Cancer (HNC), after nasopharyngeal radium treatment in service.

Combat Veteran

Overview of Combat Veteran Status

To qualify for the Combat Veteran (CV) exemption, the veteran must have served in combat operations after the Gulf War or in combat against a hostile force after November 11, 1998. In addition, the condition for which the veteran is treated must be related to that combat, the veteran must have registered as a combat veteran, and be within two years of separation from active military service. Finally, the condition must not be already considered to be service related or that exemption should apply.

Note:	The Combat Veteran exemption is valid for two years from the date of separation from military service, not the registration date. For example, if a veteran registers for Combat Veteran status 18 months after the date of his or her separation, the veteran would be eligible for Combat Veteran exemption for six months only. For further details, see VHA Directive 2002-049, Combat Veterans Are Eligible for Medical Services for 2-Years after Separation from Military Service Notwithstanding Lack of Evidence for Service Connection.

Combat Veteran Markers

To help users better identify Combat Veteran eligible patients so that appropriate care and prioritization occur for them, CPRS has added several items where Combat Veteran status is more clearly shown. This is especially true in Consults. These markers are shown in various places in CPRS, such as the Patient Selection screen, the buttons available from any tab, the Consults dialog and details, the SF-513 form, etc.

•	Patient Selection Screen: When the user selects a patient with Combat Veteran status, CPRS indicates that patient is a combat veteran by displaying the letters CV and a date below the normal demographic information on the Patient Selection screen and above the Save Patient List Settings button. The marker is shown in the screen capture below surrounded by a red box.

•	New Service Consult/Request Notifications: The lower portion of the Patient Selection screen is the list of notifications for the user that is logged in. For a new consult or procedure request for a veteran with Combat Veteran status, the letters CV and the date display behind the abbreviated patient identifier in the Patient column. The Combat Veteran notification marker is shown in the above screen capture outlined in red.

•	Combat Veteran Button and Consult Details: Available from any CPRS tab, the Combat Veteran button displays the letters CV and the expiration date of Combat Veteran Status. The Button displays when the selected patient has Combat Veteran status. The button shares space with the Flag button. The Combat Veteran button only displays for patients with the status, otherwise, the Flag button is whole.

o	To get details, the user selects the button to display the Combat Veteran Details dialog. See Combat Veteran Details Dialog below.

o	When the user selects the consults from the treeview, the consults details show in the pane to the right. In this view, the Combat Veteran status is shown underneath the primary eligibility.

•	Combat Veteran Details Dialog: When the user selects the Combat Veteran button, the Combat Veteran Details dialog displays with the following items:

o	Service Branch

o	Status

o	Separation Date

o	Expiration Date

o	OEF/OIF (If the patient served in Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF)

•	Consult Order Dialog: The Combat Veteran status and expiration date display near the top of the Consult Order dialog.

•	SF-513 Form: Several changes were made to this form:

o	At the top of the page on the SF-513, the Combat Veteran marker displays with the demographic information.

o	The patient’s name was moved to the top of this form.

o	When printed, the patient’s identifying information will be printed at the top of each page.

o	When printed, a page number will be printed at the bottom of each page.

Agent Orange

Agent Orange (AO) is an herbicide that was used in Vietnam between 1962 and 1971 to remove unwanted plant life that provided cover for enemy forces.  The VA has recognized the following conditions as associated with but not necessarily caused by exposure to Agent Orange:

•	Diabetes (type 2)

•	Chloracne or other acneform disease consistent with chloracne (must occur within one year of exposure to AO).

•	Porphyria cutanea tarda (must occur within one year of exposure to AO).

•	Acute and subacute peripheral neuropathy. (For purposes of this section, the term acute and subacute peripheral neuropathy means temporary peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset.)

•	Numerous cancers:

o	Prostate cancer

o	Hodgkin’s disease.

o	Multiple myeloma.

o	Non-Hodgkin’s lymphoma.

o	Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea). (Must occur within 30 years of exposure to Agent Orange.)

o	Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma).

o	Chronic lymphocytic leukemia

Ionizing Radiation

Atomic veterans may have been exposed to ionizing radiation in a variety of ways at various locations.  Veterans exposed at a nuclear device testing site (the Pacific Islands, e.g., Bikini, NM, NV, etc.) or in Hiroshima and/or Nagasaki, Japan, may be included.  Atomic veterans with exposure to ionizing radiation are entitled to receive treatment for conditions for this exposure.  VA has recognized the following conditions by statute or regulation as being associated with radiation exposure:

Conditions Associated with Ionizing Radiation:

•	All cancers/malignancies

•	Posterior subcapsular cataracts

•	Non-malignant thyroid nodular disease

•	Parathyroid adenoma

•	Tumors of the brain and central nervous system

Note:	Atomic veterans do not have to receive an Ionizing Radiation Registry Exam to have these special treatment eligibilities.

Southwest Asia Conditions

Gulf War veterans were exposed to a wide variety of environmental hazards and potential harmful substances during their service in Southwest Asia.  These include depleted uranium, pesticides, the anti-nerve gas pill pyridostigmine bromide, infectious diseases, chemical and biological warfare agents, and vaccinations (including anthrax and botulinum toxoid), and oil well free smoke and petroleum products.  VA recognizes that there are other health risk factors encountered by Gulf War veterans. Veterans with service during the Gulf War are entitled to receive treatment for conditions for this service.

If the treatment provided during the encounter is for an illness or symptom that may possibly be associated with environmental contamination this should be indicated on the encounter form or medication order

Conditions Associated with Southwest Asia Conditions:

•	Persistent fatigue

•	Skin rash

•	Headache

•	Arthralgias/myalgias

•	Sleep disturbance

•	Forgetfulness

•	Joint pain

•	Shortness of breath/chest pain

•	Feverishness

•	Amyotrophic Lateral Sclerosis

Shipboard Hazard and Defense

Veterans with conditions recognized by VA as associated with Project 112/ SHAD, shipboard and land-based biological and chemical testing conducted by the United States (U.S.) military between 1962 and 1973 are eligible for enrollment in priority group 6, unless eligible for enrollment in a higher priority. In addition, veterans receive care at no charge for care and medications provided for treatment of conditions related to exposure.

Military Sexual Trauma

VA is authorized by law to provide counseling services to women and men veterans who experienced incidents of sexual trauma while they served on active duty in the military.  This Law defines a sexual trauma as sexual harassment, sexual assault, rape and other acts of violence. It further defines sexual harassment as repeated unsolicited, verbal or physical contact of a sexual nature, which is threatening in nature.

The provider must make a clinical decision to determine if a visit or medication is for MST.  If the veteran is being treated for any condition during this episode of care that the provider believes is for MST; the visit should be checked as related on the encounter form and the medication should be designated as for MST.  This will mean that the veteran does not have to pay a copayment for the visit or the medication.

Head and Neck Cancer

Veterans with cancer of the head and neck and a history of receipt of Nasopharyngeal (NP) radium therapy are eligible to receive treatment. There are very specific dates and locations where this activity occurred. Eligibility for this special class needs to be verified by HAS. (Not all veterans receiving head and neck cancer treatment fall into this treatment category.)

During the 1920s, nasopharyngeal (NP) radium therapy was developed to treat hearing loss caused by repeated ear infections. Radium-tipped rods were inserted into the nostrils and left in place for several minutes. Military physicians used NP radium to treat aerotitis media (barotrauma) in submariners, aviators, and divers.  It is estimated that between 8,000 and 20,000 military personnel received NP radium treatments during World War II and until the 1960s. Veterans also included are those with documentation of NP radium treatment in active military, naval or air service; those who served as an aviator in the active military, naval or air service before the end of the Korean conflict; or underwent submarine training in active naval service before January 1, 1965. Veterans with exposure to NP radium treatments are eligible to receive treatment for conditions related head and neck cancer

If the veteran is being treated for any condition during this episode of care that is for Head and Neck Cancer; the visit should be checked as related on the encounter form and the medication should be designated for Head and Neck Cancer.  This will mean that the veteran does not have to pay a copayment for the visit or the medication.

Related topics

Review / Sign Changes

Sign Selected Orders

CIDC: Entering Diagnosis Codes for Specific Orders


Ordering Inpatient Medications (Complex Dose)

Ordering medications now uses two dialogs in the ordering process and eliminates the dispense drug prompt. Inpatient medication orders now require a valid schedule. If users do not find the appropriate schedule in the list, they can choose to create a day-of-week/administration time schedule using the new Schedule builder. This feature also works for renewing, copying, and changing inpatient medication orders. The procedure for ordering medications is described below.

Note:	Because a valid schedule is required, if you attempt to modify an existing medication order that does not have a valid schedule, you will receive a message box stating that and will have to enter a valid schedule.

Note:	Your site’s IRM staff may have specified rules governing the status of inpatient medication orders when patients are transferred from one ward or service to another. It may have also specified the number of days an inpatient medication order remains active. Please check with your site’s IRM staff for information about these rules.

CPRS now requires a unique match in the Medication, Dosage, Route, and Schedule fields for inpatient medications before CPRS will auto-select an item from the list. For inpatient medications, the Medication and Schedule fields must be an item from the list, but the Dosage and Route can be a free-text entry (the route must be in the MEDICATION ROUTES file #51.2). If the desired schedule is not on the list, the user can build a day-of-week/administration time schedule using the Schedule Builder.

CPRS displays unit dose routes based on the following rules:

1.	If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.

2.	If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.

3.	If there is only one possible medication route, it will be used as the default.

4.	If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

Also, medications that are not in the formulary display in the list with the letters “NF” after the name or synonym, which is also displayed. CPRS checks for non-formulary dosages (e.g., the VA formulary may not have a 2.5 MG pill, but it may have a 5.0 MG pill) and for non-formulary orderable items (e.g., the VA may not carry a specific kind of allergy medication).

New Clozapine Requirements

With the Food and Drug Administration required changes for administering Clozapine, the following criteria must be met for a provider to order Clozapine:

•	The patient is part of the treatment program.

•	The patient has proper WBC (White Blood Count) and ANC (Absolute Neutrophil Count) lab tests within the past 7 days.

•	The ordering provider has the YSCL AUTHORIZED key.

•	The ordering provider has a valid Drug Enforcement Agency number or Veterans Administration number (DEA/VA#).

CPRS checks these criteria by calling an API provided by the Mental Health package that determines whether the patient should be permitted to receive the new prescription. CPRS gives order checks if the patient’s lab test values are in the mid or low range as shown below:

Lab Test Ranges

	Low Range	Mid Range	High Range
WBC	< 3	between 3 and 3.5	>3.5
ANC	<1.5	between 1.5 and 2	>2
The labs test results determine what level of override is needed for the patient to receive Clozapine:

•	High Range – No override needed.

•	Mid Range – Local override. This is like a normal medication order check and can be overridden at the local level.

•	Low Range – National Clozapine Coordinating Center (NCCC) override required. If the patient’s lab values are in the low range, the provider must contact the NCCC to receive an override that is valid for a single Clozapine order.

The other order checks related to Clozapine will continue to work as they have prior to these changes.

Additionally, the values of the Days Supply, Quantity, and Refills fields are restricted based on the type of patient that Mental Health designates in their files when the provider is ordering Clozapine. This can be a 7, 14, or 28-day recipient of the Clozapine drug. For refills, the following rules apply:

•	Patients on a 7-day monitoring frequency have no refills available.

•	Patients on a 14-day monitoring frequency can receive a full 14-day supply or a 7-day supply and ONE refill.

•	Patients on a 28-day monitoring frequency can receive EITHER a full 28-day supply, or a 14-day supply and ONE refill, or a 7-day supply and THREE refills.

CPRS now prevents the user from renewing outpatient and inpatient Clozapine orders.

To write a new Inpatient Medications order, follow these steps:

Note:	If the user attempts to order inpatient medications for an inpatient from an outpatient location, CPRS discontinues the order process and returns the user to original Orders or Meds tab display.

In a complex dose order, the user must define specific characteristics for the order. Because the dose can affect the quantity, for example, changing certain fields may cause the quantity field to either recalculate or reset to zero to force the user to enter the quantity.

1.	Select the Meds tab and select Action | New Medication.

-or-

Select the Orders tab and bring up the Inpatient dialog by clicking the appropriate item under the Write Orders box.

2.	Locate the desired medication or medication quick order.

Note:	CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3.	Select the quick order or medication name.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

Note:	CPRS now uses a look up from Pharmacy to check if the selected medication is a controlled substance that will require the signature of a provider with a DEA or VA number. A message will appear to the provider "Provider must have DEA# or VA# to order this medication" as shown in the graphic below. Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the dialog, change the provider, and then reenter the dialog.

Click here to see the new medication selection dialog.

4.	Select the Complex Dose tab.

Note:	Once you begin a complex order, you must remain on the Complex tab until you finish that order. Do not attempt to start from or switch back to the Dosage tab. If you do, all complex dosages will be erased and you will be forced to start again.

a.)	Select the appropriate dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

b.)	Enter the route.

c.)	Select the Schedule cell and enter how often the medication should be taken (click PRN if desired). To create a customized schedule, select Other and use these instructions.

When the user selects a regular schedule that does not have PRN, the administration times may display in the Schedule column. The administration times will display if they have been defined for the ward or if there is a default.

d.)	Select the Duration cell and enter a number and select units ("days" is the default) a patient should use the specified dose.

e.)	Add the appropriate conjunction: And, Then, Except (Except is only for Outpatient Meds) or no conjunction for the final line.

Note:	The conjunction “Then” requires a duration to be added.

f.)	Select the Dosage field in the next row and select a dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character “^” may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

g.)	CPRS will fill in the Route and Schedule fields. If necessary, select and change the Route and Schedule cells.

h.)	Select and enter a duration and a conjunction.

Note:	Your site’s IRM staff may have specified rules governing the status of inpatient medication orders when patients are transferred from one ward or service to another. It may have also specified the number of days an inpatient medication order remains active. Please check with your site’s IRM staff for information about these rules.

i.)	Repeat steps f-h until you have completed the complex dose.

Note:	You can also add or remove a row in the complex dosage. If you add a row, the new row will be placed above the selected row. To add a row, click the gray area in front of the row and click Add Row. To delete a row, click the gray area in front of the row to be deleted and click Delete Row.

5.	Add comments, as needed.

The date and time that the patient is scheduled to receive the first dose of the medication appears under the Comments field. (For example, CPRS cannot show an expected first dose for “on call” or schedules with PRN. On the complex tab, it will not try to determine an expected first dose after a THEN because the first item must be completed.)

6.	CPRS displays when the first dose of the medication is expected to be given. If you want to give an additional dose now, click to place a check in the "Give additional dose now" check box.

Note:	Make sure that you are careful about using give-additional-dose-now functionality. When you click the check box, CPRS creates two new orders and sends it to Inpatient Medications. Make sure the “Give additional dose now” and the regular order with the original schedule you entered do not overmedicate the patient. “Give additional dose now” is not available for ONCE, ONE-TIME, or NOW orders. It is also not available for delayed orders.

7.	Check to ensure that the dosage is okay and then select OK to close the dialog.

8.	Select a Priority from the drop-down list.

9.	Select Accept Order.

Note:	If you do not complete the mandatory items or if the information is incorrect, CPRS sends a message that tells you that the information is incorrect and shows you the correct type of response.

10.	(Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o	To proceed, select Accept Order.

o	To stop the ordering process and return to the dialog, Cancel Order.

11.	Enter another medication order

-or-

select Quit.

Note:	The order must be signed before it is sent to pharmacy. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Creating a Non-Standard (Custom) Schedule
Creating a Custom (day-of-week/administration time) Schedule

If you selected Other to create a day-of-week/administration time schedule, use the following steps:

a.)	Enter the days of the week by clicking the appropriate checkboxes in front of each day.

b.)	Enter the administration times by selecting the appropriate time, hour and minutes (when you select the minutes, the time will be added to the schedule field).

c.)	Repeat step b until you have entered all the times.

Warning:	The administration times in the Schedule field apply to each day of the week that is listed, such as TU-TH-SA@0800-2000, for example. To create a schedule such as TU@0800 TH@2000, users would have to enter two separate orders. Also, users may not enter a schedule with administration times and PRN but no days.

d.)	If you make a mistake while selecting an administration time, select the time in the Set Administration Time fields and click Remove (so to remove 08:00, you would have to select that time in the Set Administration Time fields not in the Schedule text box.) To remove the entire schedule and begin again with step a, Click Reset.

e.)	Review the Schedule field.

f.)	When you have the desired schedule, select OK.

g.)	When you have created the schedule, close this help window and return to the other instructions to complete the inpatient medication order.


Viewing Allergies/Adverse Reactions

CPRS displays a list of causative agents associated with patients’ allergies or adverse reactions in the Allergies/Adverse Reactions pane on the Cover Sheet tab. If patients have causative agents listed in this pane, CPRS also displays the word Allergies in the Postings pane and the letter A (for allergies) on the Postings button. To view more information about a specific allergy or adverse reaction, click on the associated causative agent in the Allergies/Adverse Reactions pane. CPRS displays a comprehensive listing of the details associated with the causative agent you click.

You can obtain less comprehensive information about allergies and adverse reactions by clicking the word Allergies in the Postings pane. When you do this, CPRS displays information about the causative agents, severity, and signs/symptoms associated with patients’ allergies and adverse reactions.

Related Topics

Entering Allergies

Cover Sheet

Postings (Overview)


Group Notes

A new application called Group Notes enables authorized users to write progress notes and enter encounter information for a group of patients. Users can enter text and encounter information that applies to the entire group of patients and then add information to individual patient’s notes and encounters, but sign all the notes at the same time.

Group Notes is a separate application from CPRS. Sites can put an icon on the desktop or authorized personnel at the site can place an item Tools menu. To use the Group Notes application, a user must be given a key (OR GN ACCESS) and choose a location that allows group notes (set in the OR GN LOCATIONS parameter). To find out more about Group Notes, please look for the manuals under Group Notes on the VistA Documentation Library (http://www.va.gov/vdl/).

Once the notes are signed in the Group Notes application, they are stored in TIU and displayed in CPRS like any other progress note. Thus, they are not a different kind of note, but simply notes created in a way that speeds text entry and signing for a group of patients that have the same treatment or therapy while still allowing personalization of each note and encounter for the patient.


About CPRS

When you choose Help | About, a window appears that shows you the version of CPRS you are using and the cyclic redundancy check (CRC) number. If you call Technical support, they will probably ask for the version number and the CRC to aid in any troubleshooting.


Ordering Outpatient Recurring Meals

Recurring meals for outpatients might be ordered if a patient comes to a clinic regularly for treatment during meal times.

When the users select the Recurring Meal menu item, the Outpatient Meals tab of the Diet Order dialog displays.

Sites must set up the Available Diets selections in the Nutrition and Food Service package through the List Manager interface. Sites can designate up to 15 diets, the first of which is the default. The 15 selections and their synonyms display under Available Diets for selection when the user selects the drop-down list. The first diet is the default and is displayed under Selected Diet when the user selects the Recurring Meal menu item.

To order a recurring meal, use the following steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders from the Write Orders pane.

4.	Select Outpatient Recurring Meal.

5.	Select the appropriate diet under Available Diets or if the default is correct, you may simply use it.

6.	Select the appropriate time (Breakfast, Lunch, or Dinner) under Recurring Meal.

The default is none selected.

7.	Select a Start Date.

8.	Select an End Date.

9.	Select the method of Delivery.

10.	Select the days of the week that the meal should be given.

11.	Review the order text in the field at the bottom of the dialog for accuracy.

12.	Select Accept Order.

13.	When finished, select Quit.

Related Topics

Ordering Diets and Outpatient Meals

Outpatient Special Meals

Ordering Outpatient Tubefeeding Meals

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Isolations/Precautions

Ordering Outpatient Meal Additional Orders


Ordering Outpatient Special Meals

Users order special meals for a meal that must be ordered today and is a one-time occurrence instead of a recurring meal. The same Available Diets and default diet that sites defined recurring outpatient meals are used in this dialog. Sites must set up the Available Diet selections in the Nutrition and Food Service package through the List Manager interface. If these outpatient diets are not set up, the user will not be allowed to order outpatient meals.

Sites can designate up to 15 outpatient diets, the first of which is the default. The 15 selections and their synonyms display under Available meals for selection when the user selects the drop-down list. The first diet is the default and is displayed under Selected Diet when the user selects the Recurring Meal menu item.

If a special meal order generates a meal voucher, the meal voucher requires a signature. If the user placing the order can authorize the meal voucher (holds the FHAUTH key), the meal voucher will be "signed" when that person signs the order in CPRS. If the ordering user cannot authorize it, the meal voucher is printed without a signature and must be manually signed.

To order a special meal, use the following steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders from the Write Orders pane.

4.	Select the Outpatient Special Meal menu item.

5.	Select the appropriate diet under Available Diets, or if the default is correct, you may simply use it.

6.	Select the appropriate time (Breakfast, Lunch, or Dinner) under Recurring Meal. The default is none selected.

7.	Select the method of Delivery.

8.	Review the order text in the field at the bottom of the dialog for accuracy.

9.	Select Accept Order.

10.	When finished, select Quit.

Related Topics

Ordering Diets and Outpatient Meals

Order Outpatient Recurring Meals

Ordering Outpatient Tubefeeding Meals

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Isolations/Precautions

Ordering Outpatient Meal Additional Orders


Ordering Outpatient Meal Tubefeeding

Outpatient tubefeeding orders must be associated with a recurring meal. If no recurring meal has been ordered for the selected patient, CPRS displays a message informing the user and the user cannot order tubefeeding.

To place a tubefeeding diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane.

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	If encounter information has not been entered, the encounter information dialog appears before the Diet Order dialog. You must complete the encounter information dialog before proceeding.

4.	Select the Tubefeeding tab.

5.	Select a tubefeeding product from the list.

6.	Enter strength and a quantity in the grid on the right side of the dialog.

CPRS will automatically complete the Amount field if it needs to multiplied as a result of the schedule. If there is a problem with the Quantity, CPRS displays a dialog with text to help the user know how to enter an acceptable value.

Note:	You can remove a product by selecting the product and clicking Remove.

7.	If you would like to cancel future tray orders, select the "Cancel Future TRAY Orders" checkbox.

8.	Select the specific meal for which the tubefeeding is being ordered from the Start Date drop-down list.

9.	Enter any special instructions.

10.	Select Accept Order.

Related Topics

Ordering Diets and Outpatient Meals

Order Outpatient Recurring Meals

Outpatient Special Meals

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Isolations/Precautions

Ordering Outpatient Meal Additional Orders


Ordering Outpatient Meal Early/Late Trays

Outpatient early/late tray orders must be associated with a recurring meal. If no recurring meal has been ordered for the selected patient, CPRS displays a message informing the user and the user cannot order the early/late tray.

Once these orders have been placed, they are separate from the order with which they are associated. These orders do not discontinue automatically if the existing order is discontinued.

To place an early / late tray diet order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders list box.

Note:	The encounter information dialog may appear before the Diet Order dialog if you have not entered encounter information. If the encounter information dialog appears, enter the necessary information and select OK.

4.	Select the Early / Late Tray tab.

5.	Select Breakfast, Lunch, or Evening from the Meal option group.

The appropriate meal times display in the Meal Times option group.

6.	Select a meal time.

7.	Select the specific meal this order applies to from the drop-down list.

8.	Select Accept Order.

Related Topics

Ordering Diets and Outpatient Meals

Order Outpatient Recurring Meals

Outpatient Special Meals

Ordering Outpatient Tubefeeding Meals

Ordering Outpatient Meal Isolations/Precautions

Ordering Outpatient Meal Additional Orders


Ordering Outpatient Meal Isolations/Precautions

To place an isolations / precautions order, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders in the Write Orders list box.

The Diet Order dialog will appear.

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	If encounter information has not been entered, the encounter information dialog appears before the Diet Order dialog. You must complete the encounter information dialog before proceeding.

4.	Select the Isolations / Precautions tab.

5.	Select a type of precaution.

6.	Enter any necessary instructions in the Instructions field.

7.	Select Accept Order.

Related Topics

Ordering Diets and Outpatient Meals

Order Outpatient Recurring Meals

Outpatient Special Meals

Ordering Outpatient Tubefeeding Meals

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Additional Orders


Ordering Outpatient Meal Additional Orders

To place an additional order for outpatient meals, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Dietetic Orders in the Write Orders list box.

The Diet Order dialog box will appear

Note:	The diet order may be labeled differently or may not be available from your Write Orders field.

Note:	If encounter information has not been entered, the encounter information dialog appears before the Diet Order dialog. You must complete the encounter information dialog before proceeding.

4.	Select the Additional Order tab.

5.	Enter the text for the order in the Additional Diet Order field.

6.	Select the specific meal that this additional order applies to from the Start Date drop-down box.

7.	Select Accept Order.

Related Topics

Ordering Diets and Outpatient Meals

Order Outpatient Recurring Meals

Outpatient Special Meals

Ordering Outpatient Tubefeeding Meals

Ordering Outpatient Meal Early/Late Trays

Ordering Outpatient Meal Isolations/Precautions


Patient Insurance and My HealtheVet Information

The Patient Insurance and My HealtheVet information are available from the button to the right of the Primary Care button. This button displays only if the patient’s insurance information has been entered or if the patient has entered information through My HealtheVet. If the patient does not have either of these types of information, the button does not display.

 The Patient Insurance and My HealtheVet button is visible only when the patient has one of these kinds of information. It is located next to the Flag button.

When this button does display, it will look different based on what information the patient has. If the patient has only patient insurance information, the button will read "Pt Insur" and clicking the button will bring up a detailed display containing the insurance information.

If the patient has only My HealtheVet information, the button displays "MHV" and clicking the button will bring up a browser windows with the patient’s information.

If the patient has both patient insurance and My HealtheVet information, the button will appear to be split in half vertically. The top button will read "MHV" and the bottom will read "Pt Insur" The buttons work the same as if they were full size.


Searching for Text (Within Current View
Searching for Text (Within Current View)

CPRS can search for the exact text that users enter, search the notes listed in the current view, and filter the treeview to display only those notes that contain the exact text entered. Users should be careful to enter text that will give them the desired notes. If users know the exact text, this is simple. If they do not know the exact text, they will need to enter something broad enough to bring up the desired notes.

For example, if the user knows that the exact text “strangulated hernia” without the quotes, but with the space, is in the note, the user can enter that exact phrase without the quotes and the appropriate note should be found. However, if the user is uncertain of the exact text, the user might want to search for “hernia” or even “hern” to ensure that the appropriate notes will be found. This search would find words such as hernia, herniated, etc.

To search for specific text in the current view, use these steps:

1.	On the notes tab, select View | Search for Text (Within Current View).

2.	In the List Signed Notes by Author dialog, enter the text for which CPRS should search.

3.	Press OK.

CPRS will then search the current view of notes and filter the treeview so that only those notes with the exact text are displayed.

Related topics

Viewing Progress Notes

Viewing all the Progress Notes Under a Particular Heading

Viewing all Signed Notes, All Unsigned Notes, or All Uncosigned Notes

Viewing all Signed Notes by a Specific Author

Viewing all Signed Notes for a Date Range

Finding Specific Text in a Document


Graphing: Overview

CPRS includes graphing functionality that enables you to create visual representations of relationships between many types of patient data. Specifically, CPRS graphing supports data from the following indexed sources:

• Admissions	• Lab tests	• Patient education	• Surgery
• Allergies	• Medication *	• Problems	• Visits
• Anatomic pathology	• Medicine	• Procedures	• Vitals
• Blood bank	• Mental health	• Purpose of visit
• Exams	• Microbiology	• Radiology exams
• Health factors	• Notes	• Registration **
• Immunizations	• Orders	• Skin tests

* Includes BCMA, inpatient, non-VA, and outpatient

** Includes Dx and Op/Proc
What You See and What You Get

CPRS graphing uses different representations for different types of items. Following is a brief discussion of selected items and their corresponding representations.

_______________________________________________________________________________________________

Admissions and Visits:	CPRS graphing displays visits and admissions on the horizontal (date/time) axis as lines or bars that indicate the duration of the visits and admissions. Bars representing hospital admissions begin at the date and time of admission and end at the date and time of discharge. Visit representations begin at the appointment date and time and end at the date and time of the visit’s end. Because visit durations are often short, visit representations are typically vertical lines, rather than bars. When visit durations are unavailable, CPRS graphing uses its default duration of one hour.
_______________________________________________________________________________________________

Events:	CPRS graphing displays as single events all items that are not laboratory tests, vitals measurements, medications (inpatient, non-VA, or outpatient), or visits. Like representations for admissions and visits, representations for single events use only the horizontal axis. CPRS graphing uses triangle-shaped representations to mark these items. (Color, shape, and height differentiate item markers.) It graphs administration times for BCMA medications as events.
_______________________________________________________________________________________________

Medications:	As it does with admissions and visits, CPRS graphing displays medications as bars that indicate a period of time. In the case of outpatient medications, bars begin on the horizontal axis at the release date of the medications. End dates are based on the following calculation: medication release date + number of days supply = end date. For inpatient and non-VA medications, bars begin at medication start times and dates and end at medication stop times and dates. In the case of non-VA medications, if no stop date exists, CPRS graphing uses the current date as the stop date. CPRS graphing differentiates multiple medications by color and vertically offsets them to ensure the visibility of overlapping bars.  Important: Healthcare professionals have no reliable way to determine whether patients do or do not take their outpatient medications. Use caution when graphing relationships between outpatient medications and other items.
_______________________________________________________________________________________________

Vitals:	CPRS graphing displays vitals measurements as points on two axes. If more than one measurement exists for a given date and time, CPRS graphing connects measurements for like items with a line.

_______________________________________________________________________________________________

Labs:	CPRS graphing also displays as points on two axes laboratory tests that have results with numerical values. Lines connect like items.  CPRS graphing displays lab tests with non-numerical results (positive and negative results, for example) as points on the horizontal axis. It does not connect like items that have non-numerical results. To keep them out of the way of numerical data, CPRS graphing displays non-numerical results above or below the numerical values and line. Values beginning with > are located at the top margin; others are graphed at the bottom margin. Free-text values display by default as do comments. To hide or show free-text values, click on the “free-text values:” label. Comments are displayed in yellow boxes on the date axis, while the **comments label shows that there are comments. Clicking this label will show details of all items on the graph. CPRS graphing includes reference ranges in graphs of laboratory test results. Reference ranges are displayed as dashed horizontal lines.
Related Topics

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Starting CPRS Graphing

CPRS displays its graphing functionality as a detached window or a group of panes embedded within the Reports tab. (CPRS supports one detached instance of the graphing window and one Reports-tab instance per session.)You can resize and move the detached window, which enables you to set up graphs as a reference that you can view as you navigate your patient’s chart in CPRS.

You can start CPRS graphing in any of the following four ways:

•	From any tab: click Tools on the main menu and then click Graphing. CPRS displays the detached graphing window.

•	From any tab: simultaneously press the <Ctrl> and <G> keys. CPRS displays the detached graphing window.

•	On the Reports tab: click Graphing (local only) under Available Reports. CPRS displays embedded graphing panes.

•	On the Labs tab: click Graph under Lab Results. CPRS displays the detached graphing window.

You can then display graphs by clicking items in the View or Item lists (located in the graphing window’s left-hand pane).

The Graphing Window is a stand alone window where users can review data and configure their graphing. It has many options for view data. Users should use the Setting button to configure the windows display and Select/Define… to create personal or shared views.

Related topics

Graphing Overview

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Configuring Settings

CPRS graphing offers many options for selecting and displaying graphed data. Select the item to configure below:

•	Setting Display Options on the Main Window

•	Create, edit, delete, and rename predefined views (personal or public)—or save collections of items for reuse

•	Display individual or multiple items in a single graph

•	Display graphs in one single or two separate panes

•	Use the Graph Settings dialog box to specify data sources and display options

Related topics

Graphing Overview

Start CPRS graphing

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Main Window Display Options

Setting Display Options on the Main Window

You can set several display options directly from the main window, including the following options. For further instructions, select one of the items below:

•	Date range

•	Individual or multi-item graphs

•	Single- or split-pane display

•	Pane size

Selecting a Date Range

If the user has not specified a date range using the Graph Settings dialog and saving the items as a personal default and a public date range has not been defined, CPRS graphing uses a date range (All Results) that encompasses all available items for the selected patient. However, all results may bring in a lot of data depending on the Items or View defined. Users can set a default date range by selecting the Settings… button or using the Tools | Options… menu items, selecting the Graphs tab, and selecting Default Graph Settings….

For the current view, users can change this date range by selecting a new date range from the Date Range list (one week, six months, two years, All Results, etc), or by using the Date Range dialog box to define a range.

To access the Date Range dialog box:

•	Select Date Range… in the Date Range list. This sets the date range for the current view.

Keep in mind the following information when selecting a new date range:

•	CPRS graphing automatically displays all available items for the selected date range. If no items appear in the Item list, the system has no items that fall within the date range you’ve selected.

•	Date ranges apply to all graphs. That is, you cannot simultaneously graph items using multiple date ranges.

•	If items cover a date range that extends beyond the range you’ve selected, the graphing tool uses the absence of boarders to visually suggest that the items continue beyond the selected date range.

Displaying Individual or Multi-Item Graphs

Each graph in the display area (or split-pane areas) can include one or multiple items.

To create graphs that include only one item on each set of axes:

•	Select the Individual Graphs checkbox (located in the upper left-hand section of the main graphing display).

To create graphs that include multiple items on each set of axes:

•	Cancel the selection of the Individual Graphs checkbox.

While you can graph one or more vitals and lab measurements on the same set of axes, you cannot graph vitals and lab measurements on a set of axes that includes other types of items.

Creating a Split-Pane Display

CPRS graphing offers a split-pane display that enables you to create separate graphs in the top and bottom panes. Each pane includes its own Individual Graphs check box, View list, and Item list.

To create a split-pane display:

•	Select the Split Views check box located in the lower left-hand section of the main window.

To return to a single-pane display:

•	Cancel the selection of the Split Views check box.

Resizing Panes and Item-Selection Columns

Take the following steps to resize panes and item-selection columns:

1.	Point to the border between panes or columns.

2.	When the pointer becomes a [image] or

, click and hold the left mouse button.

3.	Drag the border to its new location and release the mouse button.

Related topics

Graphing Overview

Configure graphing settings

Start CPRS graphing

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Predefined Views

With CPRS graphing, users can create and maintain views, which are predefined graphs that they can select with a single click. Views can help users to find the information they need quickly. CPRS supports public and private views. Public views are created by authorized users and are available to all users. Private views are created by each individual user for personal use. Choose from the items below:

•	Creating predefined views

•	Editing predefined views

•	Renaming predefined views

•	Deleting predefined views

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Creating Views

CPRS graphing provides predefined graphs through its View tab, which is located in the upper left-hand pane of the main window. This tab includes all predefined views from the following sources:

•	Public views you or others—your site’s IRM staff, for example—have created. (Only authorized users can create public views.)

•	Private views you have created.

•	Personal Lab Groups that you have created. These lab groups are defined in the Lab Worksheet report.

Users can now also access other users’ personal views and lab groups that they have defined to build new views. Users with proper authority can save personal views as public views by simply renaming and saving as a public view. Users can also save public views as a personal view and then alter it to suit their personal preferences.

To display view definition, use these steps:

1.	Highlight the view name.

2.	Select View Definition from the pop-up menu.

The definition with them display in a pane below View list.

Take the following steps to create new views:

1.	Access the Define Views or Select Items and Define Views dialog box using one of the these four methods.

2.	Select All Items in the Select Items using area located at the top of the dialog.

3.	Select a data source from the Source list.

CPRS displays in the Items list all items associated with this source.

4.	If you know you want to include all items, double-click the source to add it—and its associated items—to the Items for Graphing list. You can also add all items for the source by clicking the [image] button.

-or-

Double-click individual items you want to add to the Items for Graphing list. You can also select individual items by highlighting them and then clicking the [image] button.

Other tips for adding items to the Items for Graphing list:

o	Select Drug Class in the Source list to make available for selection all drugs (inpatient, outpatient, non-VA, and BCMA).

o	Select Medication, Bcma; Medication, Inpatient; Medication, Outpatient; or Medication, Non-VA to display only medications for these sources. For example, if you want to select a specific outpatient medication, click Medication, Outpatient and then add the medication to the Items for Graphing list.

o	In the Source list, Anatomic Pathology and Microbiology include sub sources. When you click the primary sources (Anatomic Pathology or Microbiology), CPRS graphing displays their sub sources in its Items list. If you add to the Items for Graphing list sub sources from the Items list, you automatically add all items associated with the sub sources. To add individual items associated with sub sources, select the sub sources from the Source list.

o	CPRS moves all selected items to the Items for Graphing list. If you select duplicate items from different sources, CPRS merges the duplicate items when you add them to the Items for Graphing list.

5.	(Optional) You can remove items from the Items for Graphing list by double-clicking them. You can also use the [image] button or the [image] button to remove items.

6.	Repeat steps 2–5 until you have selected all items that you want to include in your view.

7.	Select Save Personal to save these items in a personal view or, if you are authorized to do so, select Save Public to save the items in a view that is available to all users.

8.	In the Save your Personal View or Save this Public View dialog box, type a name for your new view. CPRS saves view names in all capital letters and displays them using title caps. Therefore, you cannot use capitalization schemes to save different views that have the same name. You must give each view a new name unless you plan to overwrite an existing view.

9.	Select OK.

Your view is now available on the Source list in the Select/Define and Select Items and Define Views dialog boxes. It is also available on the View list

Related Topics

Graphing: Editing Predefined Views

Graphing: Renaming Predefined Views

Graphing: Deleting Predefined Views

Graphing Overview

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Edting Predefined Views
Graphing: Editing Predefined Views

Take the following steps to edit predefined views:

1.	Access the Define Views or Select Items and Define Views dialog box using one of the these four methods.

2.	Select the view you want to edit. (Views are located near the bottom of the Source list.) CPRS displays the view—and the items that comprise it—in the Items list.

3.	Double-click items you want to keep in the view. CPRS displays these items in the Items for Graphing list. (You can also use the [image] or [image] buttons to move items from the Items list to the Items for Graphing list.)

4.	Make additional changes to the Items for Graphing list as needed. (Add items from additional sources by clicking sources in the Source list and then selecting associated items from the Items list.)

5.	Select Save Personal or Save Public, depending on whether you are editing a personal or public view. (Again, only authorized users can create or edit public views.) You can modify and/or save public views as personal views simply by selecting Save Personal.

6.	Type the name of the view you are editing. (If you are saving a public view as your personal view, the personal view can have the same name as its public counterpart.)

7.	Select OK.

CPRS displays the Confirm dialog box, which warns you that you are about to overwrite an existing view.

8.	To overwrite (edit) the existing view, select Yes.

Related topics

Graphing: Creating Predefined Views

Graphing: Renaming Predefined Views

Graphing: Deleting Predefined Views

Graphing Overview

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Deleting Predefined Views

Take the following steps to delete predefined views:

1.	Access the Select Items and Define Views or Select/Define dialog box using one of these methods.

2.	In the Source list, select the name of the view you want to delete.

3.	Select Delete.

CPRS displays the Confirm dialog, which asks if you want to delete the selected view.

4.	To delete the view, select Yes.

Related topics

Graphing: Creating Predefined Views

Graphing: Editing Predefined Views

Graphing: Renaming Predefined Views

Graphing Overview

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Renaming Predefined Views

Take the following steps to rename a predefined view:

1.	Access the Select Items and Define Views or Select/Define dialog box using one of these methods.

2.	In the Source list, select the name of the view you want to rename.

3.	Select Rename.

CPRS displays the Rename your Personal View or Rename this Public View dialog box.

4.	Type a new name for your personal or public view.

5.	Select OK.

CPRS displays the Confirm dialog box.

6.	To change the name of your view, select Yes.

Related topics

Graphing: Creating Predefined Views

Graphing: Editing Predefined Views

Graphing: Deleting Predefined Views

Graphing Overview

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Setting Display Options with the Graph Settings Dialog

The Graph Settings and the Graph Settings dialog boxes enable you to specify particular sources that you want CPRS graphing to display in the Item list (main window). In addition, these dialog boxes include several display settings.

As its name implies, the Graph Settings dialog box enables you to specify only default settings. The Graph Settings dialog box, on the other hand, enables you to specify default either settings or temporary settings that apply only the currently active graphing window.

Changing Default Settings through the Graph Settings Dialog Box

1.	Select Tools on the CPRS GUI main menu.

2.	Select Options.

CPRS displays the Options dialog box.

3.	On the Graphs tab, select Default Graph Settings.

Note:	Changes you make using this dialog box from the Tools menu take effect only after you close and restart CPRS.

4.	Continue with Step 2 below under Access the Graph Setting Dialog Box.

Changing Settings through the Graph Settings Dialog Box

You can access the Graph Settings dialog box in any of the following three ways:

1.	Select the Settings button located on the bottom bar of the main window.

-or-

Select Settings on the right-click menu.

-or-

On the Reports tab, select Graphing (local only) and then click the Settings button located below the Available Reports list.

Note:	When you access the Graph Settings dialog box from the Reports tab, changes apply only to graphs you create from the Reports tab.

NOTE:	Regardless of how you access the Graph Settings dialog box, CPRS applies your changes only to graphs you create during your current CPRS session unless you save them as your default settings.

2.	You can specify which sources CPRS graphing uses to display items by taking the following steps:

a)	In the Sources Displayed list, select the checkboxes adjacent to the sources you want to include.

b)	To select all available sources, select All.

c)	To cancel the selection of all sources, select Clear.

3.	Set any of the Display Options as you choose:

3D:	Select this option if you want your graphs to appear three dimensional. This option is also available on the right-click menu.
Clear Background	Select this option if you want your graphs to appear on a plain white background.
Dates	Select this option if you want to display dates along the horizontal (time/date) axis.
Fixed Date Range	Select this item if you want always to display the selected date range.
Gradient	Select this option if you want to display graphs against a gradient blue background.
Hints	Select this option if you want CPRS graphing to display hover hints that contain a brief description of items to which you are pointing.
Legend	Select this option if you want your graphs to include a legend that identifies graphed items.
Lines	Select this option if you want graphs to include vertical lines along the horizontal (date/time) axis. (Lines can help orient graphed items in time.)
Sort by Type	Select this option if you want CPRS graphing to sort items in its Item list by type.
Stay on Top	Select this option if you want the detached graphing window to stay on top. This option is also available on the right-click menu.
Values	Select this option if you want to display values for graphed items.
Zoom, Horizontal	Select this option if you want the ability to select and expand graphed items with respect to the horizontal (date/time) axis.
Zoom, Vertical	Select this option if you want the ability to select and expand graphed items with respect to both the vertical and horizontal axes. (You can select this option only if you have also selected the Zoom, Horizontal option.) This option is also available on the right-click menu.
Max Graphs in Display	Select the maximum number (1–20) of graphs that you can display simultaneously.
Minimum Graph Height	Select a minimum height (10–1000 pixels) for each graph.
Max Items to Select	Select the maximum number of items (1–1000) you can include in a single graph.
Outpatient Date Default	Select the date range for outpatient data (Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, All Results)
Inpatient Date Default	Select the date range for inpatient data (Today, One Week, Two Weeks, One Month, Six Months, One Year, Two Years, All Results).
4.	(Optional) To save changes for future CPRS sessions, select the Personal or Public buttons in the Save as Default area. You can save settings as public defaults only if you are authorized to do so.

Note:	CPRS applies defaults only after you close and subsequently restart CPRS. When you do this, CPRS applies your personal default settings. It applies public default settings only if you have not saved personal default settings.

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Choosing Display Items on the Select Items and Define Views Dialog

CPRS graphing enables you to display graphs directly from the Select Items and Define Views dialog box. Using this dialog box, you can specify the following display options:

Top	Select this option to display your graph in a single-pane view, or to display it at the top of a split view if the Split View checkbox on the main window is selected.
Bottom	Select this option to display your graph on the bottom pane of a split view.
Both	Select this option to display your graph in both the top and bottom panes of a split view.
No Change	Select this option if you want to use the display settings you’ve selected in the main window.
Related Topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Graphing Items from the Main Window

When you create graphs from the main window, you select items from the View and/or Item list. The View list contains predefined groups of items that you have saved as personal views, or that you or other users have saved as public views. (See the “Creating Predefined Views ” section for more information about creating views.)

The Item list contains only items that are available for the patient and date range you have selected. If no items appear on this list, try adjusting your data-source settings. (See “Step 2 below under Access the Graph Setting Dialog Box” for information about increasing the number of sources available for the Item list.) You can also try expanding the date range you have selected.

If you haven’t already done so, set graphing display options. (See “Graphing: Configuring Settings ” for information about setting up display options.)

To graph a view or single item:

•	In the Item or View list, click the item or view you want to graph.

To graph multiple items, take the following steps:

1.	(Optional) Sort items in the Item list by clicking a column header. (You can resize columns by dragging—or double-clicking—the border between column headers.)

2.	In the View or Item list, select a view or first item. If you click a view, CPRS graphing automatically selects and sorts at the top of the Item list the items that comprise the view.

3.	If you are selecting items from the Item list, press and hold the <Ctrl> key or, if the items you want to select are sorted to appear sequentially, press and hold the <Shift> key.

4.	If you are pressing the <Ctrl> key, click each additional item you want to add. (You can cancel the selection of an item by clicking it again.) If you are pressing the <Shift> key, click the last item in the sequence of items you want to add.

5.	When you are finished selecting items, release the <Ctrl> or <Shift> key. CPRS graphing displays your graph (or graphs) in its right-hand pane.

Once you have graphed one or more items, you can change the graphing display in various ways. See Graphing: Adjusting the Display to learn about change what items are in the split screen, separating numerical and event data, and removing items from the graph.

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Adjusting the Display

CPRS graphing automatically scales graphs to fit the pane. However, you can resize the main window, or resize the pane. (See “Resizing Panes and Item-Selection Columns ” in “Graphing: Main Window Display Options”.)

To split numerical items in your graph from event-based items:

•	Select Split Numerics/Events on the right-click or popup menu.

To reverse your split-screen view:

•	Select Swap on the right-click or popup menu.

To move a particular item from the bottom to the top of a split-pane view, or vice-versa, or to separate a particular item from a multiple-item graph:

•	Point to the item and select Move on the right-click or popup menu. If you are separating an item from a single-pane view, CPRS graphing automatically displays the item in the bottom pane of a split-pane view.

To move all items from the top to the bottom pane of a split view, or vice-versa:

•	Point to an unpopulated area of the pane containing the graphs you want to move and select Move from the right-click or popup menu.

To remove a graphed item:

•	Point to the item and select the Remove selection on the right-click or popup menu.

To remove all graphed items:

•	Point to an unpopulated area of the pane from which you want to remove all graphed items and select the Remove selection from the right-click or popup menu.

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Graphing Items from the Select Items and Define Views Dialog Box

When you create graphs from the Select Items and Define Views dialog box, you first select data sources that include the items you want to graph. The Source list contains all data sources—including all saved public and private views. The patient you have selected may not have items in a given source.

If you have not already done so, set graphing display options. (See the “Graphing: Configuring Settings ” for information about setting up display options.)

Take the following steps to create graphs from the Select Items and Define Views dialog box:

1.	Select Patient Items in the Select Items using area located at the top of the dialog.

2.	Select a source from the Source list.

If the patient you have selected has items from this data source, CPRS displays the items under the source’s name in the Items list. Otherwise, it displays only the source’s name.

3.	Double-click individual items you want to include in the Items for Graphing list. You can also add items to this list by using the [image] and [image] buttons. (The [image] button adds individual items to the Items for Graphing list, and the [image] button adds all items.)

4.	(Optional) Use the [image] or [image] button to remove items from the Items for Graphing list. You can also double-click items on this list to remove them.

5.	Repeat steps 2–4 as necessary to add items from additional sources.

6.	Select Close and Display.

CPRS displays the resulting graph (or graphs) in the main window. (See “Graphing: Adjusting the Display ” for information about adjusting this display.) It also displays graphed items (selected and sorted at the top) in the Item list and the temporary view in the View list. Temporary views are available for creating subsequent graphs only during the current CPRS session.

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Displayed Details for Graphed Items

CPRS graphing offers several options for displaying details associated with graphed items. The following list describes these options.

•	Hints: If you have selected Hints in the Graph Settings dialog box, hover hints containing summary information appear when you point to graphed items.

•	Values: If you have selected Values in the Graph Settings dialog box—or if you’ve selected Values on the right-click menu—CPRS graphing displays informational labels for each graphed item.

•	Display details: When you click on a graphed item, CPRS graphing displays details associated with the item.

•	Click on legend: When you click on a graph’s legend, CPRS graphing displays a limited-data listing for all items that appear on the legend.

•	Display point details on right-click menu: CPRS graphing displays all results associated with specific types of points when you right-click on the points and then click Details. For example, if you right-click on a point that represents a vitals measurement for the selected patient—his body temperature on July 24, 2000, say—and then click Details, CPRS graphing displays the results of all vitals measurements entered for July 24, 2000.

•	Display all details via the right-click menu: CPRS graphing displays details for all graphed items when you when you right-click on an unpopulated area of the graph and then click Details on the right-click menu.

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Using the Zoom Feature

CPRS graphing’s zoom feature provides a way to visually expand areas of interest. To enable this feature for the horizontal axis, select the Zoom, Horizontal checkbox in the Graph Settings dialog box. To simultaneously expand areas of interest along the vertical axis, select Zoom, Vertical in the Graph Settings dialog box or Vertical Zoom on the right-click menu.

Take the following steps to visually expand (zoom in on) areas of interest:

1.	Point to the upper left-hand corner of the area you want to visually expand.

2.	Click and hold the left mouse button.

3.	Drag the mouse pointer downward and to the right until you have described the entire area of interest.

4.	Release the mouse button. CPRS graphing expands the horizontal and (if applicable) vertical axes of all graphs accordingly. In its information bar, CPRS graphing displays the new (zoomed) date range.

5.	(Optional) Repeat steps 1–3 as needed to further expand the area of interest.

Reversing the Zoom Process

To instantly return all graphs to their original state:

•	Select Reset Display on the right-click menu.

Alternately, you can return all graphs to their original state by taking the following steps:

1.	Point to any area on a graph.

2.	Click and hold the left mouse button.

3.	Drag the mouse pointer upward and to the left.

4.	Release the mouse button.

To step backward through the zoom process (reverse the process by increments):

•	Select Zoom Back on the right-click menu. (When you’ve stepped backward through the entire zoom process, this menu selection is unavailable.)

Related topics

Graphing Overview

Start CPRS graphing

Configure graphing settings

Start CPRS graphing

Configure graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Copy and Paste or Print Graphs

Graphing: Exporting Data


Graphing: Copy and Paste or Print Graphs

The graphing tool relies on Microsoft Word’s copy, paste, and print features. If Word is not installed on your machine, these features are not available for you to use.

To copy all of the graphs in the main window—including graphs that lie outside your scrolled view:

•	Select Copy on the right-click menu.

To paste copied graphs into any application that accepts copied images from the system clipboard:

•	With the application active, simultaneously press the <Ctrl> and <V> keys.

Note:	You cannot paste graphs into progress notes and other text-entry components of CPRS GUI.

To print all of the graphs in the main window—including graphs that lie outside your scrolled view:

•	Select Print on the right-click menu.

Related topics

Graphing Overview

Start CPRS Graphing

Configure Graphing settings

Start CPRS Graphing

Configure Graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Exporting Data


Graphing: Exporting Data

Graph patient data can also be exported to a spreadsheet. From the right click menu, Export Data automatically puts data into an Excel spreadsheet. The Excel script uses a common auto-format after data is copied. The user can then manipulate the data in the Excel spreadsheet (making other graphs, sorting, applying functions, etc.). The patient info (same as used with Word) is in Excel’s header and footer. The header and footer are only visible when printing or doing a print preview.

The exported data is just a work copy, and any edits the user makes in Excel do not affect the patient’s permanent record. Users can also adjust the column width or do other formatting actions for more readable printouts.

To export the data into an Excel Spreadsheet, use these steps:

•	After the selected data has been displayed in a graph, select File | Export Data….

Excel will then be launched and the data from the graph will be displayed in the spreadsheet.

Related topics

Graphing Overview

Start CPRS Graphing

Configure Graphing settings

Start CPRS Graphing

Configure Graphing settings

Predefined Graphing Views

Graphing Items from the Main Window

Graphing Items from the Select Items and Define Views Dialog Box

Graphing: Adjusting the Display

Graphing: Displayed Details for Graphed Items

Graphing: Using the Zoom Feature

Graphing: Copy and Paste or Print Graphs


Graphing popup Access the Define Views or Select Items and Define Views Dialog Box
Graphing: Access the Define Views or Select Items and Define Views Dialog Box

•	On the CPRS main menu, select Tools and then select Options. CPRS displays the Options dialog box.

a)	On the Graphs tab, select View Definitions. CPRS displays the Define Views dialog box.

-or-

•	Select Select/Define on the right-click menu. CPRS displays the Select Items and Define Views dialog box.

-or-

•	Select Select/Define at the bottom of the graphing window. CPRS displays the Select Items and Define Views dialog box.

-or-

•	On the CPRS Reports tab, select Graphing (local only) in the Available Reports list. CPRS displays embedded graphing functionality.

a)	Select the Select/Define button. CPRS displays the Select Items and Define Views dialog box.


Features Available from Any Tab

There are several items located at the top of the CPRS window that are available from any tab. These items are: the CCOW icon, the Patient Inquiry button, the Encounter Provider and Location button, the Primary Care button, the Patient Insurance/My HealtheVet button (which is hidden if the patient has no insurance nor My HealtheVet information), the Flag button, the VistaWeb button, the Remote Data button, the Reminders button, and the Postings (CWAD) button.

Note:	When a user resizes the CPRS window enough, the buttons can be hidden although they are still there. To ensure that users can still get to the information that these buttons provide, an Information menu item was added to the View menu. This item enables users to access the information from these buttons, even if the buttons are not visible because of screen size.

A detailed explanation of each of these buttons is included in this help file.

Items available from any CPRS tab

Related topics

Context Management (CCOW) in CPRS

Additional Patient Information (Patient Inquiry)

Patient Insurance and My HealtheVet

Viewing Patient Record Flags

Remote Data Overview

How Do I Know a Patient Has Clinical Reminders?

Patient Postings (CWAD)


Entering Dates and Times into CPRS

CPRS generally allows users to enter time in several different formats. Users can often enter month-day-year dates (such as 05/01/65) or users can sometimes spell out the month (November 22, 2001) or as a date referenced from today (t-30 for a month in the past, today minus 30).

Users often can enter a time as well as a date. For tasks such as medication ordering and administration, entering a time can be critical. Times are entered as a 24-hour time, not with a 12-hour clock and an a.m. and p.m. For example, the time 8 a.m. is entered as 08:00:00, whereas 8 p.m. is entered as 20:00:00.

Note:	The time 00:00 presents a challenge because it can be ambiguous as to when it is. To address this issue, CPRS changes the time of 00:00 to 00:01. This makes the time belong to a specific day, increasing clarity. Similarly, if a user selects Midnight, CPRS makes the time 23:59.

In some cases, users can also enter a date with no known time (T@U). CPRS used to assign a time of 00:00 to this entry, but now, it will not put a time in for this case.


Other Medication Actions

To take other actions, such as ordering a new medication, changing a medication order, or changing a medication order status (discontinue, hold, or renew), you use the Action menu or right-click a medication to display a popup menu. You can also place orders for new medications from the Orders tab.

Note:	When a user takes actions on an order, such as renewing, changing, or discontinuing it, an infrequent error sometimes occurs where the order number in CPRS and the order in Pharmacy do not match. In this case, CPRS displays a warning that there is an “invalid pharmacy order number” and instructing the user to contact someone in the Pharmacy service to complete the action.

Using the right-click or popup menu on the Meds tab, if the user selects several items and the right-clicks either on the items or elsewhere in the list, CPRS displays a popup menu. When the user selects an action from the popup menu, the action applies to all selected items. For example, if the user selects three inpatient medication orders and selects Discontinue, the dialog appears with those three orders listed for discontinuation.

However, if no items are selected (highlighted in blue) and the user right-clicks on an item, it is selected and the popup menu appears. In addition, CPRS treats each section, Inpatient, Non-VA meds, and Outpatient, as a unique area so that if the user has an item selected in, for example, Outpatient, and then right-clicks on an inpatient medication, the outpatient selected will be deselected and the inpatient item will be selected and the popup menu displays.

The popup menu includes the following items:

•	Details…

•	Administration History…

•	Change…

•	Discontinue…

•	Refill…

•	Renew…

•	New Medication…

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Refilling a Medication


Sorting the Medications View

CPRS enables users to get different views of the medications a patient is taking based on different sorting criteria. CPRS remembers the value selected by the user for the Meds tab sort. The first time a user signs into CPRS 27 the Meds tab will default to the original sort. The sort name will be display on the meds tab.

Sort by Status/Exp Date (IMO first on Inpt)

The first format is the existing functionality and is sorted by Location, then by Status Group, then by Stop Date/Expiration Date. The existing functionality uses the following status groups:

•	Pending

o	NON VERIFIED

o	NON-VERIFIED

o	PENDING

•	Active/Hold

o	ACTIVE

o	ON CALL

o	REFILL

o	REINSTATED

o	RENEWED

o	SUSPENDED

o	HOLD

o	PROVIDER HOLD

o	DONE

o	DRUG INTERACTIONS

•	Expired

o	EXPIRED

•	Discontinued/Deleted

o	DATE OF DEATH ENTERED

o	DELETED

o	DISCONTINUED

o	DISCONTINUED (EDIT)

o	DISCONTINUED (RENEWAL)

o	DISCONTINUED BY PROVIDER

o	PURGE

Sort by Status Group/Status/Location/Drug Name

The first new view is sorted by Status Group, then by Status, then by Location, then by Drug Name. The first new view uses the following Status Groups:

•	Active

o	Active

o	Refill

o	Hold

o	Suspended

o	Provider Hold

o	On Call

•	Pending

o	Non-verified

o	Drug Interactions

o	Incomplete

o	Pending

•	Discontinued

o	Done

o	Expired

o	Discontinued

o	Deleted

o	Discontinued By Provider

o	Discontinued (Edit)

o	Reinstated

o	Renewed

Sort by Drug (alphabetically)/status active/status recent expired

The second new Meds tab view within CPRS is sorted alphabetically by Drug:

•	Sort by drug name

•	Status active

•	Status recent expired (using ORCH context meds stop date)

Medications will sort Inpatient, Outpatient, and Non-VA meds. Each group will sort in their own section on the CPRS Meds tab.

To sort the medications, use these steps:

1.	Select the Meds tab.

2.	Select the appropriate sorting method:

o	Sort by Status/Exp Date (IMO first on Inpt)

o	Sort by Status Group/Status/Location/Drug Name

o	Sort by Drug (alphabetically)/status active/status recent expired

Related Topics

Viewing Medications

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Changing or Copying IMO Orders

Users can also change, copy, and renew inpatient medication orders for outpatients (IMO) if the user is ordering from an authorized IMO location. If the patient’s location is not an authorized IMO location (even if the patient is an inpatient), users will not be able to change, copy, or renew the IMO orders. To change or copy inpatient medication orders for outpatients, follow the instructions in the Changing an Order or Copying Existing Orders respectively.


Refilling a Medication

Users can order a refill of outpatient medications if:

•	The medication is an outpatient medication.

•	The provider originally wrote the order with refills and there are refills remaining.

•	The expiration date is in the past.

To order an outpatient medication refill, use these steps:

1.	Go to the Meds tab.

2.	Select the medications you wish to refill that meet the above criteria.

3.	Select Action | Refill… or right-click on the orders and select Refill… from the popup.

The following dialog displays.

In the Refill Orders dialog, CPRS displays the medications the user selected to refill and enables the user to choose the pick method.

4.	In the Refill Orders dialog, choose the Pick Up method (at Window, by Mail, or in Clinic).

5.	Select OK.

Related Topics

Viewing Medications

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Blood Products (Overview)

Note:	Providers will be able to order blood products in CPRS after sites install and implement OR*3.0*243 (CPRS GUI v.27), OR*3.0*212, and the VistA Blood Establishment Computer System (VBECS) software.

With the release of CPRS GUI v.27 and patch OR*3.0*212, CPRS will have a new dialog that providers can use to order blood products. The Blood Components and Diagnostic Test Orders dialog has three tabs: Patient Information, Orders, and Lab Results. Because this dialog is modal, meaning that it stays on top of CPRS, these tabs enable the provider to have the necessary information at the time of ordering.

If the user selects an item under the Order tab’s Write Orders pane or from an order menu, the Blood Components and Diagnostic Test Order Form dialog opens to the Patient Information tab. But, if the user selects a quick order that is not an auto-accept quick order or elects to edit or copy an existing order, the dialog will open to the Blood Bank Orders tab.

You can either read this entire section or go to the specific area of interest using the links below:

•	VBECS Patient Information tab

•	VBECS Blood Bank Orders tab

•	VBECS Lab Test Results tab

The PatientInformation Tab

The Patient Information tab displays identifying information for the selected patient (name, social security number, and blood type), along with the following information:

•	Lab Specimen – The Lab Specimen ID number and the expiration date for the specimen taken from the patient for diagnostic tests, such as type and screen. The expiration is 3 days from the time the specimen was accessioned. 3 days is a default that sites can change using a CPRS parameter.

•	Antibodies Identified – Any antibodies identified in the type and screen are displayed here.

•	Transfusion Requirements – VBECS provides any necessary instructions or needs for transfusion display here.

•	Transfusion Reactions – Any reactions the patient had during a transfusion are shown here.

•	Available Units

o	Unit ID – The blood bank number assigned to the unit.

o	Component – This shows the type of component.

o	Status – There are 4 statuses:

•	Assigned – A unit identified for a patient, but has not been crossmatched.

•	Crossmatched – The unit has been designated as typed and crossed.

•	Autologous – The unit is the patient blood that was previously donated for the patient’s use.

•	Directed – This unit was donated with the intention that it would be given to this patient.

o	Expiration Date – This date represents when the unit is no longer good.

o	Division – The name of the division where the blood component is located.

Links to items in this topic:

•	VBECS Patient Information tab

•	VBECS Blood Bank Orders tab

•	VBECS Lab Test Results tab

•	Back to the top

The BloodBank Orders Tab

On the Blood Bank Orders tab, providers can place orders for blood components and diagnostic tests that need to be done before the components can be given to the patient. As with many types of orders, the user can create personal quick orders for blood components and tests the user frequently orders.

On this dialog, the user specifies:

•	Blood Components – The list of items comes from CPRS from a parameter and shows what blood products can be offered. Items might include:

o	Red blood cells

o	Fresh frozen plasma

o	Platelets

o	Cryoprecipitate

o	Whole blood

o	Other

•	Modifiers – The modifiers are controlled by a parameter that is set at each site. It might include things such as washed, irradiated, etc.

•	Date/Time Wanted* - The date and time when the blood component should be ready that enables the user to order the blood for a future date, such as for a surgery.

•	Urgency* – This list comes from CPRS and might include items such as Routine, Pre-op, ASAP, or STAT. The urgency applies to all components and diagnostic tests listed under the Selected Components and Tests area.

•	Surgery (conditional) – If the user selects Pre-Op for the urgency, the Surgery field becomes active and the provider can select the surgery to be performed from the drop-down list or enter it manually. If the surgery is not listed, the provider may enter a surgery (the field accepts free-text) because this is not a comprehensive list of surgeries.

•	Reason for Request* – The user can choose a reason from the drop-down list (sites define items in the list using a parameter) or type a free-text entry. This reason for request applies to the entire order.

•	Comment* – If the provider has information that should be passed on with the order, the comments can be added in this field. The comments apply to the entire order. (This is a required field if the user selects the Blood Component “Other”.)

•	Diagnostic Tests – The items on this list comes from CPRS and enable the provider to request specific tests associated with blood component ordering. When the user selects this item, the fields under blood components are then cleared. The user can see those items again by highlighting the blood component under Selected Blood Components and Tests.

•	Collection Type* – The collection type determines how the specimen should be collected: Lab collect, Ward collect, Send patient to Lab, or Immediate collect, for example.

•	Collection Date/Time* – The date and time enable the user to specify when the sample should be collected.

Items required to order each blood component or diagnostic test are marked with an asterisk (*) after the name of the field, such as Reason for Request*.

How the Blood Orders Tab Works

Ordering blood components and diagnostic tests is different than ordering other items in CPRS because users can place orders for several different blood components and tests in one dialog at the same time. For example, if a user wanted to order platelets, whole blood, and a type and screen, the user could do all of that in the dialog at the same time.  To accommodate ordering of multiple items, the Blood Bank Orders tab creates a list of items ordered under the Selected Components and Test area.

When the user selects a blood component from the Blood Component drop-down list, the item is immediately added to the Selected Components and Tests area (think of this as a shopping cart like some web sites use). The user can then detail the necessary information for that component, such as quantity, modifiers, date and time wanted, the urgency and reason for request, etc.

When the user puts in data for these fields, these values will stay in when the user switches between components or tests. Because the values that apply to the entire order continue to display, the user can select items and enter the other values for each component and diagnostic test.

Alternatively, the user could select all of the components and tests first, then select each item under the Selected Components and Tests list and fill in each individually. To edit any item, the user must either fill in the fields as soon as the item is selected from the drop-down list, or highlight the item in the Selected Components and Tests list and then edit the fields.

Under the Selected Components and Test area, the user can also remove a single item by selecting the item and selecting the Remove button, or if the user wants to remove all the items, the user can select the Remove All button.

Based on the set up, CPRS may prompt the user that the selected blood component requires a specific diagnostic test. For example, if the user selects whole blood and the patient does not have a Type and Screen within the last 3 days (3 days is a default, clinical coordinators at the sites can set the number of days based on local policy), the user will see a message under the diagnostic test drop-down box stating that a Type and Screen is required.

As the user enters orders, the order text is built in the field at the bottom of the dialog. Thus, the user should review this area to ensure that all necessary information is included with each item.

To help the user edit the values that go along with each component and test, several values that apply to the entire order now remain visible:

•	component Date/Time Wanted

•	diagnostic test Collection Type

•	diagnostic test Collection Date/Time

•	Comments

•	Reason for Request

•	Urgency

The date wanted can be set for all blood components and also defaults for the diagnostic tests. Modifiers apply only to blood components.

Also, when the user moves the focus to either the Blood Components or the Diagnostic Tests area, values for the last item entered in that area display so that user can edit the values. If the user wants to edit another item, the user must select it from the Selected Components and Test area first.

Configuring the VBECS Dialog

Each site can configure some areas of the Blood Component and Diagnostic Test Order Form dialog. A CPRS parameter lets sites decide if the Blood Component area or the Diagnostic Test area is shown on the left of the dialog. The other area then displays next to the first area on the right of the dialog.

Sites can also customize the order of the following lists:

•	The Blood Components

•	The Diagnostic Tests

•	The Reason for Request

The order of items in these lists is controlled by parameters set by Clinical Application Coordinators (CACs). CACs can therefore put the most used items earlier in the list.

Links to items in this topic:

•	VBECS Patient Information tab

•	VBECS Blood Bank Orders tab

•	VBECS Lab Test Results tab

•	Back to the top

The LabResults Tab

The Lab Results tab enables clinicians to view the lab results associated with the selected blood component. If there are lab results in the system when the user selects a blood component, the tab name changes to Lab Results Available. This tab then shows the results from the lab tests designated in VBECS by the administrator at each site. So, for example, the user might see different lab test results based on whether the user selected whole blood or platelets.

Note:	The most recent results are displayed, but these results may be from test done some time in the past. Users should use good judgment as to whether they should order a new test.

Links to items in this topic:

•	VBECS Patient Information tab

•	VBECS Blood Bank Orders tab

•	VBECS Lab Test Results tab

•	Back to the top

Related Topics

How to Write Orders

Ordering Blood Components and Diagnostic Tests


Ordering Blood Components and Diagnostic Tests

Use the following instructions to order blood components and associated diagnostic tests. Remember that from this dialog, unlike other CPRS ordering dialogs, you can order several different items from the same dialog.

As with many CPRS order dialogs, users can create personal quick orders and then use them to place these orders. A Clinical Application Coordinator (CAC) at your site can also create quick orders and place them on an order menu for users.

Items within this topic:

•	Ordering Blood Products and Diagnostic Tests

•	Creating Blood Bank Personal Quick Orders

•	Placing Blood Bank Personal Quick Orders

To order blood components and diagnostic tests, use these steps:

1.	Go to the Orders tab, by clicking on the tab or pressing Ctrl + O.

2.	Under Write Orders, select Blood Bank (or whatever your site names the VBECS item).

3.	Review the Patient Information tab for pertinent information.

4.	Select the Blood Bank Orders tab.

The Blood Component and Diagnostic Test Order Form displays.

This dialog enables users to electronically enter orders for blood products and diagnostic tests, view information about blood products related to this patient, and view lab information, if available, related to the blood product or test selected. The location of the Diagnostic Tests and Blood Components areas might be switched at different sites because this can be configured at each site.

5.	Select the needed blood component from the drop-down list. (When the user selects a blood component or a diagnostic test, the quick order field is no longer displayed).

Note:	For some blood components, a message may appear under the Diagnostic Test drop-down list indicating that a diagnostic test, such as a type and screen, is needed. However, you may want to complete all of the fields for the blood component first. Otherwise, you will have to switch back to fill out the needed fields. Also, if there are lab results, they will now be on the Lab Results Available tab.

6.	Enter the quantity.

7.	(Optional) Select a modifier from the list if needed.

8.	Indicate when the blood product is needed by accepting the default of Now, typing in date or using the calendar control (the button with three dots) to select a date and time.

9.	Select the urgency from the drop-down list.

10.	If you select Pre-Op, you must select a surgery from the drop-down list.

11.	If you select Pre-Op and choose a surgery, the Reason for Request field is automatically populated with the surgery. However, you can also type in a reason for request. (It must be less than 76 characters.)

Note:	If you select a surgery that is listed in the MSBOS as not requiring blood components, CPRS displays a dialog warning that no blood is required for the surgery. The MSBOS contains a list of how many units of blood are generally used for the specified surgery.

12.	Under Comment, type any needed comments.

13.	If a diagnostic test is needed, select the appropriate test under Diagnostic tests.

Note:	When you choose a diagnostic test, the fields relating to the blood component are cleared. If you want to see or edit them again, highlight the blood component under the Blood Component and Diagnostic Test area.

14.	Select the collection type from the drop-down list.

Note:	Which collection type the user selects first affects the default start time that displays. If Ward Collect is selected first, the default is NOW and stays NOW even if Send Patient is then selected.  If Send Patient is selected first, then the default is TODAY and stays TODAY even if Ward Collect is then selected. Immediate collect defaults to a time 10 minutes in the future.

15.	Enter the time and date for the specimen collection.

16.	To order more blood components, repeat steps 5-12.

17.	To order additional diagnostic tests, repeat steps 13-15.

18.	When you have finished, review the order text at the bottom of the dialog.

19.	When you have the order defined as wanted, select Accept Order.

Note:	For nursing administration orders, sites will have to create their own orders.

Other items within this topic:

•	Creating Blood Bank Personal Quick Orders

•	Placing Blood Bank Personal Quick Orders

•	Back to top

To create blood component and diagnostic test personal quick orders, use these steps:

1.	Follow steps 1-18 above.

2.	Instead of selecting Accept Order, go to the main CPRS window and select Options | Save as Quick Order….

3.	In the Add Quick Order (Blood Bank) dialog, type the name for your personal quick order.

4.	If you want to change where the order will appear in the list, highlight the order and use the arrow buttons on the left of the dialog to move it up or down in the list.

5.	Select OK.

After creating the personal quick order, the next time you open the Blood Components and Diagnostic Tests Order Form, your personal quick orders will be listed in the first field.

Note:	For nursing administration orders, sites will have to create their own orders.

Other items within this topic:

•	Ordering Blood Products and Diagnostic Tests

•	Creating Blood Bank Personal Quick Orders

•	Placing Blood Bank Personal Quick Orders

•	Back to top

To place blood bank orders using personal quick orders, use these steps:

1.	Go to the Orders tab, by clicking on the tab or pressing Ctrl + O.

2.	Under Write Orders, select Blood Bank (or whatever your site names the VBECS item).

3.	Review the Patient Information tab for pertinent information.

4.	Select the Blood Bank Orders tab.

5.	Select the appropriate personal quick order from the drop-down list.

Note:	If you inadvertently select the wrong quick order, you can choose Remove All or Cancel to exit the dialog and then reenter the dialog.

6.	Make any changes or additions as needed. Remember that to change part of an order you must highlight that item in the list first.

7.	When finished, select Accept Order.

Note:	For nursing administration orders, sites will have to create their own orders.

Other items within this topic:

•	Ordering Blood Products and Diagnostic Tests

•	Creating Blood Bank Personal Quick Orders

•	Placing Blood Bank Personal Quick Orders

•	Back to top

Related Topics

How to Write Orders

Blood Products (Overview)


Placing Continuous Infusion Orders

Continuous infusion orders run at a specified rate. As the user selects a solution and/or additive, the items from that list are displayed to the right under Solution/Additive. For continuous infusion orders the only optional fields are the Comments and the Duration or Total Volume fields. The schedule field is not available.

With the CPRS GUI v.28, a new Additive Frequency field was added to the Infusion Order dialog. Users must select from this field into which IV bag the additive should be placed:

•	1 Bag/Day: The additive should be put in one bag for 24 hours, normally the first bag.

•	All Bags: The additive should be placed in all bags given to the patient.

•	See Comments: The provider wants something other than the above options and will put appropriate instructions in the Comments box.

Note:	If the user selects “See Comments” for the Additive Frequency but does not enter appropriate instructions in the Comments box, Pharmacy may interpret that as All Bags.

To order IV fluids and infusions, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Infusion (or your site’s equivalent) in the Write Orders list box.

Note:	The IV fluids order may be labeled differently or may not be available from your Write Orders list box.

The Infusion Order dialog displays.

The Infusion Order dialog for continuous infusion orders does not use a schedule, but it does have an infusion rate. For continuous infusion orders, the new Additive Frequency field enables providers to indicate into which IV bag the additive should be placed.

Note: 	If encounter information has not been entered, the encounter information dialog will appear before the IV Fluid Order dialog. You must complete the encounter information dialog before proceeding.

4.	Select a solution from the Solutions tab.

After you select a solution, CPRS automatically moves to the Additives tab.

5.	Select an additive from the list (if necessary) and edit the strength if needed.  Repeat for additional additives if necessary. How users can edit the strength field will depend on the values for strength defined in the pharmacy files as follows:

o	If a single strength is defined, users cannot edit the field.

o	If multiple values for strength are defined in the pharmacy files, the field will have a drop-down list from which users can choose a strength.

o	If no values have been defined, users can type in a strength. If a strength includes a decimal point, the value must begin with a number: so, .5 is not valid, but 0.5 is.

The solution and additives you select will appear in the Solution/Additive grid.

Note:	To remove an additive or solution, select the solution or additive and select Remove.

6.	Enter a volume and strength in the Solution/Additive grid (if necessary).

7.	Select the Additive Frequency from the list:

o	1 Bag/Day: The additive should be put in one bag for 24 hours, normally the first bag.

o	All Bags: The additive should be placed in all bags given to the patient.

o	See Comments: The provider wants something other than the above options. Enter the appropriate instructions in the Comments box.

8.	Select a Route (such as intravenous, epidural, IV piggyback, etc.) If the desired route is not available, select the Other option in the list of routes to bring the expanded med route form that lists all possible IV routes.

9.	In the Type field, select Continuous.

Note:	If you change the IV Type from Continuous to Intermittent, the Schedule field becomes available and the Infusion Rate field becomes the Infusion over Time field.

Note:	For a definition of Continuous and Intermittent orders, select the IV Type Help link and a message box will display with a short definition of what the terms mean.

10.	Enter an infusion rate in ml/hr.

11.	Select a Priority.

12.	(Optional) Enter a number for the duration or total volume.

13.	Select the appropriate unit (liters-L, milliliters-ml, days, or hours).

Note:	If you change the units, the value in the Duration or the Total Volume field will be removed and you will need to enter it again. This is a safety feature to insure the patient does not receive a dangerous amount of fluid.

14.	Enter any comments (if necessary).

15.	Review the order text at the bottom of the dialog to ensure that it is correct.

16.	Select Accept Order.

17.	Enter another order

-or-

Select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Ordering Infusions

Placing Continuous Infusion Orders

Copying, Changing, or Renewing Continuous Infusion Orders

Placing Intermittent Infusion Orders

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Copying, Changing, or Renewing Continuous_Infusion_Orders
Copying, Changing, or Renewing Continuous Infusion Orders

Users can copy, change, and renew Continuous Infusion orders.

A user will not be able to renew an existing Continuous IV Order if the additive frequency value is not defined. The user will be forced into the order dialog when taking another action (Copy, Change, Transfer) on an existing Continuous IV Order that does not have an additive frequency value defined.

However, if the continuous infusion order with an additive frequency was placed previously, the order will come back into the dialog with the additive frequency with which Pharmacy finished the order in the Prev. Add. Freq. field that is not editable.

This screen capture shows the Infusion Order dialog when the user tries to change or copy. A new field displays what the additive frequency was previously. This can help the user decide what additive frequency to select.

If Pharmacy did not place anything in that field, it was the same as putting All Bags, but the field will not read All Bags. Additionally, the pharmacist could have entered a value that is acceptable in Pharmacy, but not in CPRS, such as “second bag”.

If the value was accepted before, it will come into the dialog and will display, but it may not be accepted.

The only acceptable values for Additive Frequency in CPRS are 1 Bag/Day, All Bags, or See Comments. And if the user put See Comments, there must be something entered in the Comments box.

Related topics

Viewing Medications

Ordering Infusions

Placing Continuous Infusion Orders

Placing Intermittent Infusion Orders

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Placing Intermittent Infusion Orders

Intermittent infusion orders have many of the same required fields as continuous orders, but there are some important differences. Intermittent refers to an infusion order administered at scheduled intervals (Q4H, QDAY) or One-Time only, “over a specified period of time” (e.g., “Infuse over 30 min.”). For intermittent infusion orders, as the user selects a solution and/or additive, the items from that list are displayed to the right under Solution/Additive. For Intermittent infusion orders the only optional fields are the Comments, Infuse Over, and the Duration or Total Volume fields.

However, for intermittent orders, the Infusion Rate field changes to the Infuse Over Time field where the user enters either a number of minutes or hours. the schedule field is not available.

To order intermittent infusion orders, follow these steps:

1.	Select the Orders tab.

2.	Select the active orders view from the View Orders pane

-or-

select View | Active Orders (includes pending, recent activity).

3.	Select Infusion (or your site’s equivalent) in the Write Orders list box.

Note:	The IV fluids item may be labeled differently or may not be available from your Write Orders list box.

The Infusion Order dialog displays as shown below.

The Infusion Order dialog for continuous infusion orders

Note:	If encounter information has not been entered, the encounter information dialog will appear before the Infusion Order dialog. You must complete the encounter information dialog before proceeding.

4.	Select a solution from the Solutions tab.

After you select a solution, CPRS automatically moves to the Additives tab.

5.	Select an additive from the list (if necessary).  Repeat for additional additives if necessary.

The solution and additives you select will appear in the Solution/Additive grid.

Note:	To remove an additive or a solution, select the solution or additive and select Remove.

6.	Enter a volume and strength in the Solution/Additive grid (if necessary). If the desired route is not available select the Other option in the list of route to bring the expanded med route form that list all possible IV routes.

7.	Select the Route (for example, intravenous, epidural, IV piggyback, etc) from the drop-down list.

8.	In the Type drop-down box, select Intermittent.

Note:	If you change the IV Type from Intermittent to Continuous, the Schedule field becomes unavailable (greyed out) and the Infusion over Time field becomes the Infusion Rate field.

Note:	For a definition of Continuous and Intermittent orders, select the IV Type Help link and a message box will display with a short definition of what the terms mean.

9.	Select a schedule from the list or create one using the Day-of-Week schedule builder.

Note:	When a user writes an intermittent infusion order with a schedule of ONCE, the following will happen in CPRS:

•	The DURATION field will be disabled.

•	The Give Additional Dose Now option will be disabled

•	Expected First Dose and Administration Times will not be displayed

Note:     When a user writes an intermittent infusion order with a schedule of On Call or a PRN, the following will happen in CPRS:

•	Expected First Dose and Administration Times will not be displayed

10.	If you selected an existing schedule, skip to step 13. If you selected OTHER, CPRS displays the Order with Schedule ‘OTHER’ dialog. Take the following steps:

a)	Select one or more checkboxes by the appropriate days of the week.

b)	If the schedule requires specific administration times skip to steps c and d. To select a schedule from the list, highlight the schedule and select Add.

Note:	Users can assign either a schedule from the list or specific administration times, but not both.

c)	To use a specific administration time, select the hour and minutes (if the user only selects the hour, the minutes will default to zero) and select Add.

d)	Repeat step c until you have entered all required administration times.

Warning:	The administration times in the Schedule field apply to each day of the week that is listed, such as TU-TH-SA@0800-2000, for example. To create a schedule such as TU@0800 TH@2000, users would have to enter two separate orders using the complex medication order dialog. Also, users may not enter a schedule that only has administration times and PRN but no days.

e)	If you make a mistake while selecting an administration time or schedule, do one of the following to remove it:

•	For a single administration time, highlight the hour and minutes in the Set Administration Time fields and select Remove (so to remove 08:00, you would have to select that time in the Set Administration Time fields not in the Schedule text box.)

•	To remove the schedule, highlight the schedule and select Remove.

•	To remove the entire schedule and begin again with step a, select Reset.

f)	Review the Schedule field.

g)	When you have the correct schedule, select OK.

11.	If necessary, select the PRN checkbox.

12.	Enter the number for the duration over which to infuse the medication.

13.	Move to the next field and select the unit of time (the units can be only Minutes or Hours) over which the infusion should be given.

For example, you might enter 30 for the number, move to the next field, and then select minutes to define infuse over 30 minutes.

14.	Select the Priority.

15.	Enter a number for the duration or total volume.

16.	Move to the next field and select the appropriate unit (liters-L, milliliters-ml, days, hours, or doses).

Note:	If you change the units, the value in the Duration or the Total Volume field will be removed and you will need to enter it again. This is a safety feature to insure the patient does not receive a dangerous amount of fluid.

17.	If necessary, select the Give additional dose now checkbox.

Note:	Make sure that you are careful about using give-additional-dose-now functionality. When you click the check box, CPRS creates two new orders and sends it to Inpatient Medications. Make sure the “Give additional dose now” and the regular order with the original schedule you entered do not overmedicate the patient. “Give additional dose now” is not available for ONCE, ONE-TIME, or NOW orders. It is also not available for delayed orders.

18.	Enter any comments (if necessary).

19.	Review the order text at the bottom of the dialog to ensure that it is correct.

20.	If the order text is correct, select Accept Order.

21.	Enter another order

-or-

select Quit.

Note:	The order must be signed before it is sent. You can either sign the order now or wait until later.

Related topics

Viewing Medications

Ordering Infusions

Placing Continuous Infusion Orders

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)


Editing a Progress Note

To edit a progress note, follow these steps:

Note:	Progress Notes can only be edited if they have not been signed. Signed notes cannot be editing. To add to a note, an addendum would have to be created.

1.	Select the Notes tab.

2.	Select a document title from the left side of the screen. (Click the “+” sign to expand a heading.)

Note:	If a note has an addendum, the [image] icon will appear in front of the note title. You may view the addendum by clicking the “+” sign to expand the note title and then selecting the appropriate addendum.

The text of the progress note will be displayed on the right side of the screen.

3.	Select Action | Edit Progress Note….

You can now edit the progress note.

Related Topics

Progress Notes

Write a New Progress Note

Sign Document Now

Opening and Reviewing Progress Notes

Adding to Existing Progress Notes (addendum)

Replacing Specific Text in an Unsigned Document

Document Templates (overview)

Creating Personal Document Templates

Creating Shared Document Templates


Replace Specific Text in an Unsigned Document

Note:	Users can edit only unsigned progress notes. Once a note is signed, it cannot be edited.

1.	Select the Notes tab.

2.	Select a note title from the left side of the screen. (Click the “+” sign to expand a heading.)

The text of the Note will be displayed on the right side of the screen.

Note:	If a note has an addendum, the [image] icon will appear in front of the note title. You may view the addendum by clicking the “+” sign to expand the note title and then selecting the appropriate addendum.

3.	Select Action | Edit Progress Note….

4.	Right-click the text of the progress note and select Replace Text.

The Replace dialog displays.

5.	Enter the text you wish to replace in the Find what field.

6.	Enter the new text in the Replace with field.

Note:	Check the Match whole world only or Match case check boxes to search using these options.

7.	Select either Find Next, Replace, or Replace All.

If the text is found it will be highlighted (if you selected Find Next) or changed (if you selected Replace or Replace All).

Related Topics

Surgery Tab

Customizing the Surgery Tab

Creating an Addendum to a Surgery Report

Editing an Unsigned Progress Note

Signing a Surgery Report

Viewing all Surgery Cases for a Patient

Viewing Progress Notes

Searching for All Notes that Contain Specific Text


Using Mental Health Assessments in CPRS

When sites install CPRS v27 and the Mental Health dynamic link library (YS_MHA.dll), mental health providers will have enhanced mental health assessment tools. Mental health providers can use these tools through Reminders in CPRS if the following have occurred:

•	Several patches must be installed, including: YS*5.01*85 (which distributes YS_MHA.dll), PXRM*2.0*6, GMTS *2.7*77, and OR*3.0*243.

•	YS_MHA.dll must be in the correct location.

•	Users need to be assigned an additional secondary menu by a Clinical Applications Coordinator (CAC) or similar individual who performs this kind of set up at the site.

Related topics

Reminders Overview

Processing a Reminder


Primary Care Button

To the immediate right of the Visit Encounter button is the Primary Care button, which displays the primary care team, primary provider, the attending, and the associate provider assigned to this patient. Only the information that is available to CPRS is displayed. If the various providers have not been entered, only what has been entered will display. The message “Primary Care Team Unassigned” is displayed if a primary care team has not been assigned.

  The Primary Care button

For more information on the primary care team, primary care provider, the attending physician, or the associate provider, select the Primary Care button.