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Clinical Guide: General Practitioner

These notes provide a simple overview of key activities within MMEx that are likely to be relevant to a General Practitioner.

Acknowledgement of IUIH

We would like to thank the Institute of Urban Indigenous Health (Queensland) for sharing their clinic workflows which are the framework for these workflow pages.
These workflows are intended as a guide only, to show how you might use MMEx to efficiently manage patients and workload.

Suggested Workflow / Routine

When you first log on,

  • Check your Inbox for messages
  • Check Results
  • Check Tasks

These activities will give you an indication of the activities and tasks that need to be completed by you for that day.

When you open a patient file:

  • Check the To Do List – for Tasks and Care Plan Activities that are due
  • Check Results for results that may have been received since the last visit
  • Check Progress notes for information about previous consultations.
  • Check Medications for any that require review

Reviewing Diagnostic Results

Viewing Results

To access the Diagnostics Results worklist at an organisation level click on Diagnostics/Reports in Facility sub-menu.


Multiple Filters:

  • Search by Keywords (Search Doctor, Patient Name (both assigned patient and patient name field of pathology result, Test Name, Facility columns)
  • Type (Pathology, Imaging, Any)
  • Filter By Org/Clinician
  • Show Current or Archived
  • Show All, Reviewed or Pending
  • Show All, Assigned or Unassigned

Clicking on the Doctor, Patient Name, Test Name, Requested, Collected or Facility headings will sort the results in ascending or descending order ( alphabetical, date-order ).

A blue Patient Name indicates the result is linked to a Patient Record. Clicking the name hyperlink will open the linked patient's record.

MMEx uses a range of colours and status icons to assist with quickly identifying the status of the result:

  • Lines highlighted in pink indicate an abnormal result - result outside of the stated reference range
  • Result has been reviewed -
  • Results have been attached to the request, but not marked as matched -
  • Result has been attached to a request and marked as matched -
  • Results have been marked as “Given to Patient” -
  • There is an error in the processing of the result -

Name

The Action button allows the user to:

  • View - view the result.
  • Reassign Recipient - when the result needs to be assigned to a different clinician
  • Assign Patient - For a result that is not assigned to a patient record, select the correct patient
  • Unassign Patient - To change the patient record the result is assigned to
  • Match to Request - Match this result to the request that prompted it
  • Archive - archive the result
  • Delete - permanently delete a result. Used for results received in error. Visible to users with Diagnostics/Reports Write permission.
  • Restore - un-archive the result and move it back to Current state
  • Move to Reports - enables you to manually move a HL7 message from results to reports if it has been incorrectly filed.

Imaging Results

Results will be categorised as “Imaging” if the report title contains one of the following words:

  • XRAY
  • X-RAY
  • ULTRASOUND
  • SCAN

Assign a Result to a Patient Record

MMEx will only assign a result to a patient record if there are sufficient identifying details in the HL7 message that is received - this is usually patient name, date of birth and Medicare Number. If any or all of these are missing, MMEx will not automatically assign the result to a patient record. This will need to be done manually.

If the result is not already assigned to a patient record, MMEx will suggest a patient record to assign the result to. and you can click Match this patient to accept or you can select Match a different patient.

It is recommended that Health Services designate a staff member(s) who are responsible for regularly reviewing the organisation’s Results / Reports in MMEx and to assign them to patient files or to new recipients if needed.

Populating the Clinical Record with results

Where a pathology result is received that has a valid LOINC code and pathology result recorded, the result will automatically populate the clinical record. You will be advised how many of the received results have populated the patient clinical record (been successfully processed).
Where results are not able to be automatically populated - e.g. text or has no LOINC code attached, you will see a red text alert advising that MMEx couldn’t read the result and a button that provide an option to add the result into the system manually.

Select the required observation from the observation list, enter the value and click update observation results.

You will see new text that advises the observations have been updated.

Linking Results to a Request

Click on the result that you wish to link to a request, the result will open.

The Match a Request button will appear below related requests.
Clicking it will display a popup window where you can choose a date range and pick a request to associate to this result from the list displayed.
NB: A result can only be associated with one Request, but a request can be associated with multiple results.

Reviewing Results:

When a result has not yet been marked as reviewed, you may select a result, enter comments and add tasks. The Red outlines on the image below show the fields that may be modified prior to marking a result as reviewed.

If you cannot see a blue Mark as Reviewed button at the top of the result then the result has either:

  • already been reviewed by someone else
  • you do not have permission to review results - speak with your Organisation Administrator
  • your organisation is following alternate workflow that requires reviewing of results to take place in an alternate system - please speak with your Organisation Admin to determine this.

The details of who reviewed the result will display at the top of the page.

Once you have reviewed and recorded the required details, click Mark as Reviewed. This will:

  • mark the result as reviewed
  • remove the Review button
  • lock the result field, tasks button and comments fields within that result
  • put a green tick next to the result in the results view
  • archive the result (providing it has been assigned to a patient record)
  • move you on to the next patient result in the list.

You may only review a result once. You may mark a reviewed result as “Given to Patient” at any time before or after reviewing.

Each organisation may wish to develop a specific clinic “Test Result Recall Protocol” that may be referred to for Local Instructions.

Results for reviewed pathology and electronic letters will now be visible in the patient’s file in the Results tab.

Generating Tasks from Results

Whilst reviewing a result, if you wish to assign a task to yourself or a co-worker that relates to this result, click the button located to the right of the page labelled Add Task.

Tasks can only be created for a result BEFORE it is marked as reviewed.

A popup will appear, allowing you to fill in all the task details.
By default the Assigned by and Worker will default to you, the Checkbox to Send an MMEx message will also be selected - this will notify the recipient that a task has been assigned to them.

If the result is assigned to a patient record, the patient details will be linked to the task automatically.

Clicking “Add” will create the task, add it to the facility level Tasks Worklist, the patient's to-do list and will append it to the result.

Additional information about Results is available here.

Additional information about using and managing Tasks can be found here.

Medications

While in the patient record, via the navigator select, Medications the drop-down box offers options of:

  • Current Medications - lists all medications patient is currently prescribe
  • Scripts -provides a list of all the patients’ prescription
  • Dispensed, Supplied, Administer Medications – from Imprest stock
  • Dose Administration Aid - Create and list DAA
  • Variable Dose Medication
  • Immunisations

Prescribing

You can create a new script in two ways.

  1. Click New Script to both prescribe and add a new drug (it is advisable to not use the Add Med button as this doesn't show the PBS Indication Filter)
  2. Right click on any Medication listed in the Current Medication view to choose the following options: Prescribe, Dispense, Quick Change Med, Change Med, Archive, View, Drug History. Select Prescribe to write a new Prescription

Tips:

  • Follow through the Script Pop-up box from top to bottom. When working through medications, and the pop-up box is loading (circular symbol), wait until the page is loaded before proceeding
  • Alerts will show and prevent you adding or printing if you forget to enter a required field
  • Enter Drug Name
  • Select Indication (this is PBS Indication and opens a short list of relevant medications). This will enter the drug name below.
  • Any drug interactions will then be visible
  • Click Administration type. This is often missed by users.
  • Select Number (dosage) and Frequency (select Other to enter dosage per weight/ different am and pm doses).
  • Indications shows the patient’s medical history. Selecting Other allows you to add new medical history – tick the box to add to Medical History List
  • Quantity will auto-default but can be changed. To add Repeats tick boxes as relevant
  • Authority, Streamlined and Restricted medications will generate additional fields at the bottom of the box. Restricted Drug Prescription / Streamlined Authority– select the relevant restriction
  • Authority – enter authority number in relevant field. Phone number is listed.

Then:

  • Add will just add the medication, and allow you to add another medication.
  • Add and Print will print the prescription
  • Add and Close will return to Current Medications without printing.

If you need to revise a script (e.g. scheduling, quantity or method), right click, select Quick Change Med and make the required changes. Click Update to save.

Re-prescribe one existing medication:

  • right click on the medication > select Prescribe from the drop down menu

Re-prescribe multiple medications:

  • tick the relevant boxes t the left of the medication name, Click the Bulk Prescribe button.
  • This will enable all selected medications to be printed on one script (this opens a pdf print window)

Phone Orders: MMEx Facility and content coming soon

Reviewing Medications

A red flag next to a medication indicates that it is due for review.

Click the Review All Meds button to quickly review and update and re-prescribe medications.

Make any changes, then click Update.

Add a Medication as information only

If adding a medication that has not been prescribed by the Health Service, but that the Patient advises you they are taking.

Additional Information about Medications is available here.

Closing the Gap numbers

Prescriptions for ATSI patients will automatically print the CTG number if CTG consent is current. You can check this by looking at the Patient Demographic header. Hover mouse over the speech bubble icon.

Click on the person and you can see if consent has been given and is current

As the consent is not there, you should obtain it and document it by clicking on Add Consent Ensure PIP CTG Copayment Measure is selected. If you have written consent, you may upload a scanned copy of that consent from this window.

You can now see that PIP CTG Copayment Measure consent is current, the number will now populate scripts.

If configured correctly, you will also see the CTG icon in the status field.

Progress Notes

Always click Save when notes have been entered, and wait for the page to load and save properly.

Privacy Levels can be changed, the options available depend on your role.

Ensure either Subject or Reason for Contact is entered.

Your organisation will have configured some fields for your to complete to record specific data about your progress note such as Reason for Contact, Visit Type, Mode etc. Refer to your Organisation Administrator for additional information about these fields and what is required of you. If you require a particular template that is not created contact your organisation’s MMEx support person for assistance.

Place your cursor in the Progress note text box and start typing. Your notes will save periodically.

Other Features:

  • Draw Sketch button opens pop-up box to highlight body areas
  • Change Show 1 to All Notes to see all notes in the box on the right hand side of the screen. Print button allows you to select relevant notes to print from PDF
  • Search function searches within the progress notes and from subject / reason for contact, for a term that you enter into the Search field.
  • Progress notes are able to be formatted in much the same way that Word documents are.

More detailed information about Progress Notes is available here

Care Plans

All patients have a Lifetime Surveillance Care Plan (either Aboriginal or Non-Aboriginal; male or female)

They are age and diagnosis specific so it is important to start Lifetime Care Plans from the Date of Birth, and Disease Management Care Plans from the date of Diagnosis. This forms the basis of planned/routine care for the patient, and feeds into the To Do List and Care Plan Activities

Check that ALL relevant Disease and Management Care Plans are allocated to the patient.

To add a new care plan, click Add New Care Plan, select the relevant care plan from the list.
Enter the date of diagnosis of the chronic health condition and the start date of the care plan.
In most cases, the care plan should start the day of diagnosis, however for lifetime plans, the start date should be the same as the Date of Birth
Click on Choose This Care Plan for This Patient

Clicking on one individual care plan will show an overview of a 2 yearly plan of activities for that care plan only. Clicking on View All Activities will show all activities for all care plans that have been applied to the patient.

The 2 year view uses coloured boxes to indicate what activities have been completed (green box) what is overdue (red box) and what is pending (blue box). The Legend in the top right corner explains what each means if you hover the mouse over a colour. The overdue and near pending activities are also visible at a glance in the To Do List, Care Plan Activities Tab.

To complete a care plan activity click on a coloured square, then the hyperlinked date. Enter today's date, change the status to Completed and record any other requested information. Click Save

Individualise a Care Plan

To add a specific activity that is not in a care plan (eg Colonoscopy) or GPMP where there is not a chronic disease care plan available (ie no chronic pain care plan), click on the care plan name to open the schedule, then click Add.

Select the activity you wish to add from the list (use search option if required).

Select the relevant activity, click the Select button, adjust parameters if required and click Update button

Completing Care Plan activities

The majority of Care Plan Activities are automatically updated / completed when an activity is undertaken in MMEx. ‘Pap Smears’ (located towards the bottom of the Care Plan Activities list) are one exception that needs to be manually updated. Click on Care Plan Activities button to show all outstanding activities.

If the activity was conducted today, tick Mark as complete, record the result and click Save Selected Activities.

If the test or activity took place on a different date (or at another clinic), click on Specify Date at the top of the Care Plan Activities box (wait for the page to reload), locate the activity. Click Expand, set the date the activity took place, select the result from the drop down box, click Mark Completed, then Save Selected Activities at top of screen.

This will update the Care Plan tab

Additional Information about Care Plans is available here.

Tasks

Tasks are like ‘sticky notes’. They are used for patient recall or reminders for non-routine activities (ie not already generated through ‘Care Plan Activities’)

You'll find the Tasks link on Facilities on the left side menu.

You can search by your name to find the tasks you have allocated or have been allocated.

Individual patient-related Tasks are located in the To Do List of their file.Opening the To Do List will default to the Tasks view pane and show any tasks currently assigned for the patient

To create a task, the user should click on New Task.

User enters the details in the popup and add the task.

Designating the Importance as Urgent will highlight the task with Pink.

Additional Information about Tasks can be found here.

Forms

Forms can be found by clicking on Forms & Reports in the Side Menu.

To find a particular form, select All Forms from the relevant menu.

It will take you to a page where you can choose which form to use. Type the name (or part of the name) of the form you are looking for in the search box at the top.

The form you are looking for will show up below the search box, click the link to open up the form.


Click on the yellow star next to a form name to designate it as a favourite. This will make them appear on the forms sub-menu

Forms created by your organisation will appear under the Custom Forms section.

Additional Information about Forms is available here.

Letter Writer

All documents generated in Letter Writer save into the Documents list. Give the document a name that will make it easy to identify and search for if required at a later date. For example Referral Orthopaedics RPH- Knee is a better title than Referral.

You can access the Letter Writer from the tools section of the Messaging menu

NB: Previous versions of the letter writer are no longer available.

When you open the Letter Writer you will see this page. Make your selection and click OK.

Templates can be formatted in the same way as Word documents.

At the right hand side of your letter, you will see Insert Content options.

Place your cursor where you want the content to be inserted and click on the desired content button. The following content opens a pop up where you can select and refine what you want displayed.

  • Results - use filters to find the information you want to insert, mark the desired results with a checkbox. This will insert the entire pathology report.
  • Observations - select your date range and all observations recorded during that time period will display for you to select the ones you wish to include. This may be your preferred way of displaying results as the result value only.
  • Observations graph - select your date range and the observations you wish to include in the graph.

Use Create a letter from a template within an open patient record to generate Medical Certificate, Centrelink Medical Certificate, Patient Summary, Referral letters, Allied Health Referral forms after Health Check and GPMP/TCA, and other word and template generated Letters.

Additional Information about Letter Writer is available here.

Health Checks

Located by clicking on Forms & Reports in the Side Menu and selecting All Forms to locate your Health Check for completion.

Clicking Complete at the bottom of the form will lock and save the form in Documents.

GPMP/TCA Reviews

When a patient has had a GPMP/TCA undertaken, the Management Plan tab will be visible via the Navigator menu

The GPMP will be visible on the page. Clicking the Select previous GP Management Plan from the drop down menu will open the GPMP

To review a GPMP click Create Review at the top of the GPMP form to open up the GPMP. Select the relevant item Type (located just above the Problem list). Click EPC Referral to generate Allied health referral form (this will open a new tab). Click Completed when finished to lock the form.

When completed the form will save, and can be opened in Documents.

Additional Information about the Management Plan tab is available here.

Women's Health

Create a new antenatal record from inside the Patient Record and click on Patient Widget, from the Speciality menu select Women’s Health, then the New Pregnancy button.

Scroll down to Dates and enter the LMP.

You can enter additional information at this time if you wish, or can complete the Pregnancy record over time. Then click Add Pregnancy

Antenatal visits are recorded by clicking on the Antenatal Visit tab and then the Add Visit button.
To finalise a pregnancy record, enter the birth / baby information into the Outcome Details section at the bottom of the antenatal record, Add an Outcome and Save the pregnancy record.

Additional Information about Pregnancy and Antenatal Records is available here.

Child Health

From inside the Patient Record click on the Patient Widget, from the Speciality menu select Child Health.

At the first visit for a newborn baby, enter birth details by clicking on Visits which opens a new box.

Clicking on New Visit on the right hand side, brings up a drop down menu which provides options for selecting an appropriate template for the visit depending on the age of the baby.

Additional Information about Child Health is available here.

Workers Compensation

From inside the Patient Record click on the Patient Widget, from the Speciality menu select Injury Management.

Click Add Problem for a new WorkCover issue.

Select the problem from the list when there is an existing WorkCover Case in place.
This will open the Injury Management section. Work through the form. You cannot save until all areas marked with a red asterix are completed.
Once finished tick the Completed box, then Save Assessment and Close Assessment.
You can print the certificate and claim forms. These will save to the Documents

Additional Information about WorkCover is available here.

manual/workflows_gp.txt · Last modified: 2019/06/30 23:40 by sarahb