Normal ICANotes Security Settings

Anyone in a group can access a chart, look at the face of a chart, and go to a finished note and read it...just as would be possible with a paper chart in a filing cabinet.

Anyone can make a new note and electronically sign it.

Only assigned providers can go to a note made by somebody else and electronically sign it (i.e., co-sign it).

Anybody can assign themself to a case.

The Principal Provider is just a clinical title, suggesting who you might want to talk to about the care of this patient when notes have been made in the chart by a number of different clinicians.

Only a Supervisor (assigned in the Documents and Settings section of the program) can enter the work area of another clinician, make changes, and re-compile the note. The name at the bottom of the note will always be the person compiling the note.

New Features for Dietitians and Eating Disorders

A number of enhancements have been made to ICANotes for use by dietitians and for those working with patients with eating disorders. They are as follows:

1. There is now a work area for dietitians. It can be reached from the chart face, center bottom, "Dietitian's Note".

This work area contains sections regarding the patient's current weight and BMI, the patient's current diet, and notes regarding the patient's meal behavior, response to the program, goals, and mental status.

The finished note is titled a Dietitian's Note on the Chart Face.

2. There are now sections of the program where the patient's intake of food, behavior during meals and fluid intake and output can be entered. It is anticipated that these factors will be entered by technical staff, rather than by nurses or dietitians, although any discipline can, of course, use these new work sections.

These new sections are entered from the Behavior buttons, which are both on the work areas Progress Note, Prescriber and Progress Note, Non Prescriber. Once in the Behavior sections (there are two, one for In Patients and one for out Patients), there is a section called "Dietary Intake" with a See List button. The See List is a shrub where information about the patient's behavior during meals, the amount and type of food and calories eaten, and fluid intake and output can be entered.

Your suggestions regarding refinement or enhancements to these new work areas are, of course, welcome. Also, if you have any questions about how to use these new features please feel free to contact us.

The ICANotes Team

866-847-3590

support@icanotes.com

Group Therapy Session Remarks

There is new functionality in the Group Therapy section of the program.

In any Group Therapy session there is certain information that is the same for every group member's note.

For example, the type of group, the members present, and the therapists interventions should not have to be entered individually into each group members note.

Now, there is a way to create "Session Remarks" that can be added to each group member's note.

From the group therapy work area you can now push the "Session Remarks" button. That will now take you to a new work area where these session remarks can be created. You simple have to highlight the group for which the remarks are being created and then create the remarks by pushing, what else, the " add Session Remarks" button.  A shrub will appear which will allow basic information about the group to be entered into the Session Remarks field. In addition to the shrub, user buttons are available and, of course, additional information can be free texted into the note. Then, on returning to the patient's group therapy work area the Session Remarks can be added to each patient's group therapy note with a single push of the "add Session Remarks" button.

The part of the program where session remarks are created can also be used to create new group and assign membership to the group. So, this area can also be reached using the Settings and Directories button on the face of one of the small filing cabinets. In Settings and Directories Shared by All Staff tab / Therapy Groups sub tab, new groups can be created and members assigned to those groups. 

The ICANotes Team

Scales for Outcome Measurement in Psychiatry

Recently we asked ICANotes users for suggestions for outcome measurements. .

Here is a list of the suggestions we received: (The comments we received are below)

Thank you all for these suggestions.  We will look at all these scales and see if we can use them.

If there are other suggestions we welcome them. However, please keep in mind that it is not the test itself that will appear in ICANotes. Instead, there will be a way to enter the results of the test.  To see how this works, please see the Psych. Testiing section of the program, reachable from PN1, second column.

Test results that are a number range (eg 1-5 = Mild Depression, 6-10 = Moderate Depression, etc) work best.

Here are the scales or tests that were suggested:

     BSI-18
     ORS and SRS
     Beck Depression Inventory (Already in ICANotes under Psych Testing, PN 1, column 2)
     Short Form, Conners Scale, Parent rated
     YMRS
     Likert Scale 1-5
     GAF (a number of users suggested using this Axis V scale for outcome measurement and a number asked that it be
              graphed.)
     CGAS
     PHQ-9  (Already in ICANotes under Psych Testing, PN 1, column 2)
     GAD-7
     ASRS
     BPRS
     Y-BOCS  (Already in ICANotes under Psych Testing, PN 1, column 2)
     Beck Anxiety Inventory  (Already in ICANotes under Psych Testing, PN 1, column 2)
     CGI
     CDI
     Vanderbilt
     QOLI
     MyOutcomes
     Burns Depression Checklist
     Burns Anxiety Inventory
     Obsessive Compulsive Inventory
     Penn Inventory of Scrupulosity
     HBIPS-5


   
Here are the comments we received:


"A couple of outcome measures that I have used within the school setting are as follows:
When discussing appropriate eye contact, the student will demonstrate appropriate eye contact with other students are talking on 3 out of 4 occasions.
When discussing appropriate classroom behavior, the student will identify appropriate classroom behaviors during 3 out of 4 trials.
I'm not sure if this is what you are looking for, but here they are if you need them!
Nori C. Mora, Ed.D.


"Hello
In fact, we just purchased the Brief Symptom Inventory - 18 (BSI-18) from Pearson for this very reason.  Although we have not yet used this in our clinic, questions asked cover all the key points that the insurance is asking for.  The test is measurable and is nationally recognized.  We would love to see something similar to this be incorporated into ICA Notes!!!
Sincerely
Katie Gillies
Administrator"

"the work of barry duncan and scott miller is compelling. (ORS-outcome rating scale, and SRS-session rating scale)  duncan and miller used to collaborate but have gone their separate ways.  here are sites for both:
http://heartandsoulofchange.com/measures/
http://www.scottdmiller.com/?q=node/57
here is a site that has incorporated these scales:
https://www.mentalhealthpros.com/video/login/login_tutorial.htm" (Paula Tanis)

"likert scale 1-5 how effective was today's session? Do you feel session decreased symptoms?" (Dr. Cuellar)

"Becks Depression Scale
Shortform Connors Scale Parent rated
YMRS Young Mania Rating scale" (Kimberly Cotton)

"No expert on outcome measures here, but from working in mental health for county agencies I understand the GAF is important.
If you could also give us a CGAS (Childrens Global Assessment Scale) in addition to the GAF you provide us that would be very helpful.
It might also help to graph out the GAF and CGAS over time, but I'm not sure.
Thank you!
Ann Childers MD"

"I would like to be be able to graph the PHQ-9, the GAD-7, The ASRS for ADHD, the BPRS, liebowitz social anxiety scale and the Y-BOCS scales as a starting point." (Dr. Berger)

"Are you referring to rating scales? I have found the PHQ-9 very quick to administer and effective.  The GAD-7 is helpful as well.
Jeff Benzick MD"

"I would like to see the CGI scale.
Thanks,
Tina"

"Dear ICANotes Team:
Could you develop a system for tracking readmissions within 30 days of discharge." (Vista U/N: utilizationreview)

"Also, re: monitoring and outcomes, we are being told that one area being closely scrutinized by JCAHO as well as State Health and CMS is that of simultaneous use of two or more neuroleptic agents, particularly at discharge. This is an area we have started to monitor very closely. It's cumbersome to do manually. I'll forward the criteria when I get them from our P.I. person." (Norm Snyder)

"This is a very difficult problem in psychiatry, as there are not many measurable outcomes that correlate with quality of care. I spent 15 years on the Board of Mountain Pacific Quality Health, who are the Medicare Quality Improvement Organization for Hawaii, Montana, Wyoming, and Alaska, and we never could come up with much in the way of quality measures for psychiatry. Quality measures are easiest for chronic management of diseases such as diabetes and asthma with clear guidelines for tests and procedures that represent optimal care. Much of the outcomes in psychiatry are subjective and not easily measured. The national quality standards (HEDIS) use two measures - length of time patients started on antidepressants for newly diagnosed depression stay on their medications, based on pharmacy records, and whether or not patients hospitalized for depression are seen in outpatient follow-up within 30 days of discharge. On the first, the data are often bad, since patients may or may not take meds they pick up, many patients are given samples that don't show up on pharmacy claims, and for various reasons health plan data often show patients as "newly diagnosed depression" when they are actually long established patients, have mixed depression and other diagnoses, etc. On the second measure, patients hospitalized for depression are a very small part of most of our outpatient practices. These two "measures" therefore fail to accurately reflect quality for well over 90% of what we do. I don't know of anyone who has come up with better measures for psychiatry either.
This whole scheme to track "outcomes" and reward "quality" and implement "pay for performance" is unfortunately misguided and fails to take into account the fact that at least half of health care is too complex to allow meaningful measures of "quality" or "outcomes" via standardized tools. This is even more true for psychiatry than for many other specialties.
Steve Kemble"

"The PHQ (Patient Health Questionaire) has been a good measure for depression symptoms. There is a child/teen version.
The Vanderbilt is a good child assessment for ADHD symptoms.
The Child Depression Inventory (CDI) is also a good child rating for depression." (Lori Lowans-Wells)

"Here is an idea: build buttons into the assessment portion which would indicate improvement, e.g. for depressive dx, anxiety sx, psychotic sx, manic sx and GAF button.
Gather data from those buttons in some kind of printatlbe report, e.g. Jane Doe had depression which improved over a 6 month period, GAF went from 50 to 75.  The buttons are the key to making it easy." (Dr. DeLisle)

"compliance with medication" (Dr. Trachtenberg)

"Beck's Depression Inventory (and Anxiety) are quick and simple to score measures." (Dr. Machado)

"For psyche I use the GAF on Axis V." (Arleta Brown)

"It would be great if the outcome measure could be specific to the pathology being addressed in treatment (e.g. BDI) rather than an all encompassing measure.  Beck measures we have found to be particularly helpful." (Todd Bennett)


"QOLI (quality of life inventory) is a brief yet helpful scale that
would be easily built into the system" (Loren Malkasian)

"I don't have a good outcome measure, since the symptomatology is so
broad in my patient population.  One thing I would love to see,
though, is the ability for the patient to rate their response
independent of our clinical session.  Could they be on a separate
computer, enter into ICANotes somewhere and independently fill out the
survey/questionnaire.  Then when I see them, I have the results for
our session and part of the clinical record longitudinally.  This
would save time in session and increase the objective collection of
data versus rater biases (mine)
John R. Whipple, MD
Lawrence, KS"

"Your "outcome measure' idea interests me. I would be willing to offer
statistical consultation. Knowing what type of data is to be analyzed
will guide both development and refinement of the "measurement
instrument" you seek to create. For example, the data as input to the
clinical notes is nominal and not continuous in its scalar properties,
this must be considered in instrument development. Also,when designing
a measurement instrument it is critical to construct it so it has
statistical power, the latter "power" is a technical mathematical
question. Again, for example, depending on whether one uses nominal or
continuous data one must select the correct nonparametric or
parametric statistical tests, and the "power" is influenced by the
former selection. The consultation is offered gratis, although I do
not have the time to develop the "outcome measure(s)" themselves.
Notice that the plural "measures" was used, for it must also be
considered that the many different populations you serve may have
different types of data. Please keep me abreast of your development,
and good luck! it's a great idea if well thought out and properly
constructed." (John Vicedomini, PhD)

"I would love something that would graph data in the form of a line
graph." (Renee Terrasi)

"I utilize My Outcomes.  Perhaps a link can be integrated into each
account so an assessment can be "opened" while one has a chart open.
See https://www.myoutcomes.com/
This service costs less then $125 / year for a solo practitioner.  It
is convenient, helpful and VERY easy to use.  Also evidence based.
Contact:
Lowell Kasden or Caitlin Carlson
MyOutcomes®
Danya International, Inc.
8737 Colesville Road, Suite 1100 | Silver Spring, MD 20910
Phone: 240-645-1584 Fax: (240) 645-0970
www.danya.com | www.myoutcomes.com
If you're interested in learning more, please tell Lowell or Caitlin
that I recommended you.
John" (John Duggan)

"At our practice, we regularly use the Burns Depression Checklist,
Burns Anxiety Inventory, Obsessive-Compulsive Inventory-Revised, and
the Penn Inventory of Scrupulosity as repeated measures. We would very
much like to be able to somehow have those score integrated into
ICANotes.  I would be glad to send you copies of the checklists if you
want to view them.
Ted" (Ted Witzig)

"Yes, these would be very helpful. I tend to use the GAF scores as a
way to measure outcomes but if you all could convert these scores into
a graph form it would be much easier to show our patients there
improvement or lack thereof. Also, I have come up with depression,
anxiety, PTSD and ADD patient reported scales but I have found that
these are time consuming, paper intensive and they then have to be
scanned. I would love for you all to integrate these into your program
so that patients can complete these online or on a PC in our waiting
room. Good luck." (Emanuel Martinez, MD)


"From Liz:
I cannot say that this is either effective or easy to use but we are
under significant pressure to document to HBIPS- 5.  This is affecting
all inpatient psychiatrists and the goal is to document on discharge
(only) any patient who leave with a prescription for more than one
Antipsychotic agent.  The criteria for the psychiatrist to do this
legitimately are very rigid and not easily achieved.  There must be
documentation in the medical record that this patient has failed three
separate trials of monotherapy before going to the use of two agents.
I have been fooling around with the program and trying to come up with
a work around that will be an accurate account of the patient's
history with neuroleptic medications and that is clearly visible to
the provider as the notes are being made each day.  Falling back on
the med log works but only in a limited way.  Right now I have turned
the Notes and Risk Factors pink box on PN 2 into my mini-medication
tracking for the sickest patients.  I can add any neuroleptic drug to
the ongoing list and jot down the reason it failed and know that I
have a "live running record" that will always populate the future
progress note of these ill patients.  Plus, by using this box ONLY for
HBIPS-5 documentation, at discharge I am reminded that the this
patient requires specific documentation inside the DC summary.  The
pink box being next to the "turn this note into a DC summary" button
is great.
   There are some flaws as expected in a work around.  But, for some
odd reason, administration is having fits since I am not using the box
for the specific reason Ira labeled it for.  Tracking this stuff is an
administrative nightmare and I would be glad to talk to anyone who
wants to take this on.
 As for other outcomes, the HBIPS documentation has maybe 10 areas
that require documentation.  I think some of those areas are specific
to pharmacy and maybe nursing.
You guys know me, never a short answer.
Thanks, Liz" (Liz Lobao)

"Two Links for HBIPS: 5.  from Liz
Specific criteria for HBIPS-5
http://manual.jointcommission.org/releases/TJC2011A/MIF0120.html
Link below is the big, ugly picture.
http://manual.jointcommission.org/releases/TJC2011A/HospitalBasedInpatientPsychiatricServices.html
Ira, I have no idea if you are following this specific mess but the
practice period is over and the results will be posted quarterly on
the web.  Citizens will look and see if  a specific psychiatrist as
pass the quarterly inspection.  The entire subject annoys me to no
end, it is way too government telling docs how to practice medicine.
Anyway, it this is not the type of feedback you were looking for, I
recommend the DELETE button..
Having a tracking device for HBIPS would be a strong selling point for
the inpatient crowd.
Liz  :-)".

Step-By-Step Guide to ICANotes and Meaningful Use

Which Buttons Do I Push?

A Step-by-Step Guide to Achieving Meaningful Use

(More detailed information about how to use ICANotes to achieve meaningful use is contained in the document "Meaningful Use and ICANotes" which is on our blog entry for February 1st

First, lets make a Complete Psychiatric Evaluation and make sure to use the features that help achieve Meaningful Use.

1. Demographics: Be sure to include the following demographics. They are all on the main demographic page:

Ethnicity, Race and Preferred Language

You need to record these demographic items for 80% of your patients.

2. Medical History: Tobacco Use: In the Medical History use the button "Health and Behavior" and the second Column button "Tobacco." Record the patient's smoking habits.

You need to record this information for 50% of patients who are 18 or older.

3. Medical History: Drug Allergy: In the Medical History section use the button "Adverse Drug Reaction" and record the patient's drug allergy history, even if negative.

You need to record this information for 80% of your patients.

4. Mental Status Exam: Vital Signs. In the MSE use the button "Constitutional/Vital Signs. Record, at minimum, the patient's blood pressure, height, and weight. The program will automatically calculate the BMI and these numbers are stored in the Log area, where they are also graphed.

You need to record this information for 50% of your patients.

5. Finish Initial: Problem List: The problem list is your diagnoses. So, make a diagnosis in the Finish Initial Screen.

You need to make a diagnosis for 80% of your patients.

6. Finish Initial: Active Medication List: Order a medication, or indicate "No Medication Ordered"

You need to enter something in the medication fields for 80% of your patients.

7. Finish Initial: Medication Reconciliation: You can access the Medication Reconciliation form from the Finish Initial screen.

You need to use the Medication Reconciliation form for 50% of your patients.

8. Finish Initial: Electronic Prescribing: To use electronic prescribing, you need to sign up for this service. If you are signed up there will be a button on the Finish Initial so you can access and use Electronic Prescribing.

You need to prescribe 30% of your prescriptions using Electronic prescribing.

9. Finish Initial: Patient Education Forms: When you compile your note you may be offered patient education information.

You need to print 10% on these forms and make them available to your patients.

10. Preview Page: Clinical Summary: On the preview screen push the button "Create Clinical Summary".

Clinical Summaries are used to meet a number of meaningful use measures.

You need to make a clinical summary electronically available within three days to 50% of patients who request them. You can indicate that the patient requested a summary and when it was sent electronically on the Preview screen.

You need to make a clinical summary electronically available within four days to 10% of your patients, whether they request them or not. The date the summary was sent to the patient should be recorded on the Preview screen.

You need to give a clinical summary to your patients for 50% of their office visits. This does not have to be electronically transmitted, so you can print the clinical summary for the patient and give it to them during their visit. Again, when the record was made available to the patient can be recorded on the Preview screen.

Now, lets make a Progress Note and make sure to use the features that will help achieve meaningful use.

In Progress Note Part One: Many of the features that were used in the Initial Assessment can also be used in Progress Note Part One. These include:

1. Medication Allergy: An adverse drug reaction can be documented using the Drug Reactions button on the top of column two.

2. Smoking Status: This can be recorded in the "Behavior" portion of the program.

3. Vital Signs: These can be recorded using the button, "Vital Signs" in column two.

4. Incorporate lab results: Enter lab results using the button, "Test Results" in column one.

In Progress Note Part Two: Here too many of the features that were used in the Initial Assessment can also be used in Progress Note Part two. These include:

1. Problem List: If you didn't make a diagnosis previously, you can make one here in PN 2.

2. Medication List: If you haven't already, you can order medications here in PN 2.

3. Incorporate Lab Results: Lab tests can be ordered from PN2, section 2, using the button, "Lab Requisitions".

4. Medication Reconciliation: The button to reach this section of the program is on PN 2, upper right.

5. Patient Summary Record for Referrals: Make a referral or request a consult using the "Referral" button on PN2, section 2.

6. E Prescription: As noted in the Initial Evaluation section above, to use electronic prescribing, you need to sign up for this service. If you are signed up there will be a button on the PN2 so you can access and use Electronic Prescribing.

7. Clinical Summaries: A Clinical Summary can be made by using the button, "Compile this Note" at the bottom right of PN2 and then, on the Preview Screen, using the button, "Create Clinical Summary".

Again, the Clinical Summary is used to meet a number of Meaningful Use measures, as follows:

You need to make a clinical summary electronically available within three days to 50% of patients who request them. You can indicate that the patient requested a summary and when it was sent electronically on the Preview screen.

You need to make a clinical summary electronically available within four days to 10% of your patients, whether they request them or not. The date the summary was sent to the patient should be recorded on the Preview screen.

You need to give a clinical summary to your patients for 50% of their office visits. This does not have to be electronically transmitted, so you can print the clinical summary for the patient and give it to them during their visit. Again, when the record was made available to the patient can be recorded on the Preview screen.

Chart Face: Patient Reminders: Patient Reminders: To create a patient reminder, use the "Set or See Reminder" button on the chart face. Use the "New" button to set a reminder and indicate that it is a patient reminder. Set the date of the reminder, who it is to be sent to and why.

Once the reminder to the patient has been made, the ICANotes program must be informed. Do that by returning to "Set or See Reminder", opening the reminder in question by clicking on it, and indicating in the appropriate fields that the reminder was done and 

Meaningful Use and ICANotes

How to Achieve Meaningful Use

With ICANotes

As you make your notes using ICANotes, there are 16 measures that will be automatically calculated to determine if you are using electronic health records in a meaningful way. To get your incentive payments you will have to attest that you have met these measures.

In the ICANotes Reports menu please view the Meaningful Use report as you read this document.

In this document I will explain to you what you have to do to meet the Meaningful Use criteria. Many items are very easy to achieve by just doing what you normally do or by doing what is good practice.

1. Up To Date Problem List: The "Problem List" is the diagnoses you make for the patient. It’s as simple as that. When you do an initial evaluation and arrive at one or more diagnoses in the Finish Initial section for at least 80% of your patients, you have achieved this meaningful use measure.

2. Active Medication List: This measure is also very simple. Either order medication for your patient or indicate "No Medication ordered". If you take either of these steps for 80% of your patients, you will achieve this measure.

3. Active Medication Allergy List: Do you ask your patients if they have a history of Adverse Drug Reactions, or if they are "allergic" to any medications? Very likely you do. Their answer can be recorded in two places.

a. Initial or Complete Examination: Medical History. Use the shrub button "Adverse Drug Reactions."

b. Progress Note: Use the button at the top of column two, "Drug Reactions."

In either case, indicating what the adverse drug reaction is or indicating that there is no such history for 80% of your patients will achieve this measure.

4. Record Demographics: This measure is also very easy to achieve. When a new chart is begun and demographics are entered just be sure to include the following for 80% of your patients: ethnicity, race, and preferred language. That's all there is to it.

5. Patient Specific Education: This is new. When you make certain diagnoses for your patient, order certain medications, or record certain test results, you will automatically be offered the ability to print out a sheet providing educational resources for the patient. By simply printing those sheets for just 10% of your patients, you will achieve this meaningful use measure. The sheets contain links to web sites that we feel contain correct and useful information.

6. CPOE: Computerized Physician Order Entry is what this acronym stands for. This measure is to ensure that you can use your EHR to order whatever medications, lab tests, and imaging the patient needs. This measure is only concerned with the ordering of medications, so it is essentially the same as #2 above. Either order medication for your patient or indicate "No Medication ordered" and you will easily meet the 30% requirement of this measure.

7. Vitals, BMI, and Growth Chart: This may not be something you have been routinely doing. To meet this measure you are simply asked to record the Blood Pressure, Height, and Weight for 50% of your patients. ICANotes will automatically calculate the BMI and in the Patient Logs will create graphs of these vital signs if you wish to see them. That's all there is to this measure.

8. Record Smoking Status: Do you routinely ask and record your patient's smoking status? It can be recorded in the Medical History using the shrub buttons "Health and Behavior" and "Tobacco." While making a progress note, it can be recorded in the "Behavior" section. If you record the smoking status of 50% of patients 18 or older you will meet this meaningful use measure.

9. Incorporate Lab Results: This measure is to determine that the tests (chemistries, imaging etc) you order with ICANotes have their results recorded in ICANotes. To order tests use the "Lab Requisition" button on PN2, section 2. To enter test results, use the "Test Results" button on PN1, column 1. If 40% of the tests you order have their results recorded, you will meet this measure.

How to Make a Clinical Summary: The ability to make a clinical summary of your patients' conditions is an important and useful new feature in ICANotes. The summary contains information about your patients’ diagnoses, medications, drug allergies, recent test results, and medical conditions.

A number of meaningful use measures start by making a Clinical Summary. Here's how to do it. After you compile a note push the button called, "Create Clinical Summary" on the Preview Screen. That's it.

If you wish to have the summary included as part of your chart, then push the button "Compile This Note." We'll explain below when to push the button, "Compile This Note and Create a CCR."

This Clinical Summary can be sent to other providers when you request a consult or it can be put into a medical repository like Microsoft's HealthVault where it can, with the correct password, be accessed by other health professionals or by the patient. Giving the patient access to their Clinical Summary has proven to be good practice. Making this basic information available to other medical practitioners improves quality of care and helps avoid testing duplication.

How to Create an Account with Microsoft's HealthVault: In order to electronically share Clinical Summaries with your patient, both you and your patient should go to the HealthVault web site and create accounts for yourselves. It’s easy to do. Go to http://www.healthvault.com and push the button "Create a Free Account."

Important: When your patients create an account they need to add you to the account. Alert your patient that during the sign up process they need to do the following: When they arrive at their HealthVault Home page they should push the "Sharing" tab. Then, push the "Share with Someone You Trust" button. The patient should enter you as a person they trust and must include your email address. When asked to select your sharing level, they should indicate "Custodian". This will give you full access to their account, including the ability to upload documents into the patient's HealthVault.

10. Electronic Copy of Patient Health Information: This measure concerns itself with how quickly patients who request a copy of their Clinical Summary receive it electronically. You get credit for this measure if 50% of the patients who request a clinical summary have electronic access to it within 3 days.

Here's how to make a Clinical Summary electronically available to a patient: Make a Clinical Summary, as described above, and push the button, "Compile This Note and Create a CCR." CCR stands for Continuity of Care Record. It is your Clinical Summary in a standard format that can be electronically sent to HealthVault, other medical storage sites, or any location that has software set to receive and display it.

When you push the button "Compile This Note and Create a CCR", it puts a copy of your clinical summary, in CCR format, into the documents section of the patient's chart and into the patient's section of the upload site.

You will make a copy of the patient's Clinical Summary available to the patient by downloading it from the Upload site and then uploading it to the patient's HealthVault account

To download the CCR from the upload site, go to the patients chart on the upload site (Mozilla Firefox works best), identify the CCR, right-click on its image, and choose "Save File." It will download to your Downloads folder (or, if you prefer, to your desktop.)

Then, sign in to your HealthVault account and switch to your patient's account (you have been made a Custodian of that account (see above), so the patient's name will appear in your HealthVault home page. Once you are in the patient's account, click on "Add, View, or Edit Information." Indicate that you want to add a CCR document to the account, locate the CCR on your desktop, and upload it. That's it. The patient's CCR document is now the latest entry in his or her HealthVault account.

There is one more thing to do. You need to let the ICANotes program know that a summary has been posted in the patient's HealthVault account. Please go to the Preview screen for the patient's note. On the right border, you will see a check box for "Patient Requests a Summary" and "Date Summary Sent to Patient." Check the box and select a date. The program now has all the information it needs to correctly calculate this measure for you.

11. Medication Reconciliation: A medication reconciliation is simply the process of listing the medications the patient is taking at the time of your initial evaluation, deciding whether those medications will be continued, stopped or have their dosage altered, writing additional orders now that the patient is under your care, and arriving at a combined list of the medications you have continued and the new orders you have written.

ICANotes makes this process easy. First, create your medication orders as usual. Then, on PN2 upper-right or Finish Initial upper-right, there are buttons labeled "Medication Reconciliation". Use the Medication Reconciliation form to enter the medications, both OTC and prescribed, that the patient was taking prior to coming under your care. Indicate if you wish to continue, stop, or change the dosage of those medications. Then, push the button "Click Here to Reconcile the Two Lists." The resulting medication list, on both the Reconciliation form and on your clinical note will be the combined list of all medications being continued or newly ordered.

To achieve meaningful use, 50% of your patients should have their medications reconciled using the Reconciliation Form.

12. Patient Summary Record for Referrals: This measure asks a simple question: when you make a referral to another clinician do you send a Clinical Summary?

First, fill out a Referral form. The "Referral" button is on PN2, section 2. After filling out the Referral Form, make a Clinical Summary and include it with your referral form or make it available to the consultant, however you wish. Then, let the program know that the Clinical Summary was provided to the consultant by selecting a date in the "Date Summary Sent to Provider" field on the right margin of the Preview screen. That's it. Do this for 50% of your referrals and you will receive meaningful use credit for this measure.

13. Timely Access: This measure also involves making a Clinical Summary electronically available to your patient by posting it on his or her HealthVault account. Unlike #10 above, it doesn't matter if the patient has requested a Clinical Summary; all this measure requires is for at least 10% of your patients to have had Clinical Summaries posted within four days of your evaluation.

Directions for creating HealthVault accounts and how to post a clinical summary are above.

Please note that the summaries you post at a patient's request in #10 do count for this measure. Also, please note that no matter how many times you see a patient, if you just post a summary once, you will get credit for that patient toward your 10% requirement.

Once the Clinical Summary has been posted on the HealthVault account, you must fill out the "Date Summary Sent to Patient" field on the Preview screen so that the ICANotes program can calculate this measure for you (Please note that ICANotes is working on a simpler way to make Clinical Summaries electronically available to your patients. We will let you know when this new feature becomes available.)

14. Generate and Transmit E-Rx: Meaningful use requires that you use an e- prescription system and that 30% of your prescriptions be e-prescribed. If you use one of the e-Rx companies that ICANotes is integrated, with this measure will be automatically calculated for you, and meeting this measure will be easy.

15. Clinical Summaries: This measure again involves making a Clinical Summary available to your patients. This measure requires that a Clinical Summary be made available for 50% of every out-patient clinical contact, within four days. However, this summary does not require that the Clinical Summary be made available to your patient electronically. So, if you will simply print a Clinical Summary and give it to your patient (perhaps on their way out, or mail or fax it to them) within four days of the contact, you will meet this measure.

Please note: you need to let the program know when the Summary was given to the patient. You can do that by indicating the date in the "Date Summary Sent to Patient" field on the Preview screen.

16. Patient Reminders: This measure is odd because it only applies to patients who are younger than 5 or older than 65. In any case, it asks that you provide "appropriate" reminders to 20% of those patients.

To create a patient reminder, use the "Set or See Reminder" button on the chart face. Use the "New" button to set a reminder and indicate that it is a patient reminder. Set the date of the reminder, who it is to be sent to and why.

For example, you might send a reminder in one week to an office staff person to remind Mr. Jones (who is 65+) to get a lithium level. The office staff person would use the patient's preferred means of communication (set in Demographics) to remind Mr. Jones.

Once the reminder to the patient has been made, the ICANotes program must be informed. Do that by returning to "Set or See Reminder", opening the reminder in question by clicking on it, and indicating in the appropriate fields that the reminder was done and when it was done. That's it.

New Features: Calender and Demographics

New Calender Features:

1. It is now possible to make a short note that will appear when an appointment is made for a patient. The note appears in the Event Details window, where you ordinarily pick the type of appointment, length of appointment, etc. Messages such as, "Balance overdue. Discuss w. patient before making an appointment" explains the utility of this feature.

This message may be added by entering the Patient Demographic section, Patient Info tab., bottom left, "Calender Note." What you enter there will appear whenever an appointment is being made for the patient.

Unfortunately, this new feature does not work for Groups.

2. An Appointment reminder can now be printed for the patient. It contains the date and time of the appointment, the clinicians name, and the appointment's location. The "Print Reminder" button on the Event Details window in the scheduler will perform this function.

New Patient Demographic Field

In Patient Demographics, Other Contacts tab there is a new field "Patient Prefers Confidential Communication via"; It is a drop down. This will be used on the upcoming Patient Reminder Lists required for certification and will indicate how the patient wishes to be informed of confidential medical information. It will automatically be included in Patient Reminder Lists.