Health Information Technologies and Processes

Meditech Expanse eChart

  • 1.  Meditech Expanse eChart

    Posted 12-16-2020 08:26
    Edited by Ashley Friedrich 12-17-2020 15:49

    I am looking for a few in the HIM field who are utilizing Meditech Expanse for both acute and ambulatory practices.  We implemented Meditech Expanse in November 2019 and several questions have arose regarding the use of eChart.

    • Do you consider eChart to be your 'legal record'?
    • Should messages from messaging/tasks be incorporated into eChart?
    • Are some 'Notes' excluded from eChart? 
    • In ambulatory, where to refills file to the eChart, 'legal record'?
    • In ambulatory, do you have an OM Summary? 


    Thank you for help with these!

    ------------------------------
    Ashley Brown, RHIA
    ------------------------------



  • 2.  RE: Meditech Expanse eChart

    Posted 12-17-2020 08:28

    Hi Ashley,

    I have some of the same questions as you. We moved to 6.15 in January of 2018. The AMB module seems to be underdeveloped in some aspects though new changes seem to be coming frequently now. We are still modifying and improving 3 years later. I don't have all of your answers, and may not be able to answer any of your questions actually. I still have some of the same questions as you, but maybe someone else will chime in and help us both.

    • We do consider the eChart to be our "legal record."
    • We would like our messages/tasks to be incorporated into the eChart. I was able to get calls from the EDM/PCS call logs into the record so the AMB messages/tasks are going to be my next hurdle
    • We don't exclude any notes that I am aware of.
    • In AMB I believe the refills will file to the eChart once we are able to get the messages/tasks to file
    • I am not aware of an OM Summary type of document for AMB. The expectation of our staff is that they create a message and order from that message if they aren't ordering from an actual visit. Hopefully that would capture the details surrounding the order action.



    ------------------------------
    Kathryn Wood, RHIA
    Assist Dir of Information Systems/Privacy Officer
    War Memorial Hospital
    ------------------------------



  • 3.  RE: Meditech Expanse eChart

    Posted 12-17-2020 13:54

    Hi Ashley,

    We have been using Expanse for ambulatory and acute since April of 2019. I have struggled and continue to struggle with those same questions also.

    • We have not officially defined our legal record, but we do unofficially consider the echart to be our legal record.
    • I've gone back and forth on having messages be incorporated into the echart. Once Meditech explained to me how to easily sort Activity in the AMB chart and filter by workload messages/tasks, that made me more comfortable giving my staff guidance on how to release those to an authorized requestor if needed. So they are not archiving to the echart.
    • I'm not sure what you mean by 'notes.' 
    • Ambulatory refills do not file to the echart (that I am aware of). That is one area I never thought of. The whole ambulatory world is new to me! I was the director of HIM for the hospital, but since Expanse has "one patient record", we combined our clinic and hospital HIM/medical record departments into one.
    • We did have an OM Summary for ambulatory orders archiving to the echart, but we had it turned off because it was blank. I've been told that ambulatory orders do not work well for archiving to the echart. 

    I've been frustrated with many aspects of ambulatory archiving to the echart. I was not given any training, education or suggestions on it when we went Live, so I've had to figure it as we've gone along. While it is awesome to have one chart for acute and ambulatory, it seems as if Meditech has not clearly defined how that one chart should operate for the echart. Ideally, it would all archive. That is not the case.

    We also struggle with ambulatory referrals not archiving. We use them as the order for rehab therapies in the acute side (among other referrals), and they do not archive to the echart.

    I don't feel like I'm much help, but it's nice to know I'm not alone in my struggles!



    ------------------------------
    Judy Wesely CCS-P
    Him Director
    GlasgowMT
    ------------------------------



  • 4.  RE: Meditech Expanse eChart

    Posted 12-17-2020 15:58

    Thank you Kathryn and Judy for your responses! It is comforting to know that I am not alone with these types of questions.

    It does sound like we are all on the same page and would like to consider eChart to be our "legal record".  However, it seems like there are many inconsistencies with what archives to eChart which makes it difficult to define.  We initially educated staff that all information should be released only from eChart to ensure that we are releasing consistent copies/formats.  However, we find ourselves struggling to release information from eChart often.  On the ambulatory side, office staff mostly utilize WEB and are unfamiliar with eChart.  On the acute side, specifically with PCS nursing notes in which all notes archive to one summary that can become very lengthy, staff prefer to release information from EMR where they can print the specific note they are looking for, such as a note for therapy.  Thoughts? 



    ------------------------------
    Ashley F.
    ------------------------------



  • 5.  RE: Meditech Expanse eChart

    Posted 12-17-2020 16:41

    Hi Ashley,

    You are correct with all of your statements. Our Long Term Care (Skilled nursing facility) MDS Coordinators use the PCS Print Report formats to get specific info needed for insurance companies when they have to appeal or show supporting evidence for therapies. Once we set that up, our HIM Team decided this would be helpful for them for specific audits as well, so they often use this feature. The rest of the information is generally printed from the eChart and released. However, it is not the one stop shop we thought we were getting. Excluding HIM ROI functions, the only other things that are printed from PCS and released would be transfer related documentation, either nursing home or acute care transfers. I recently watched a Meditech Clinical Roadmap presentation, and I can't remember where in the process they are with this, but they are programming the ability to print date ranges from PCS so that will improve that piece for the future. I hope they roll that functionality into the eChart.

     

    Katie Wood, RHIA

    Assistant Director of Information Systems/Privacy Officer

    War Memorial Hospital

    500 Osborn Blvd

    Sault Ste. Marie, MI  47983

    p: 906-635-4663   khwood@wmhos.org

     


    Confidentiality Notice: This is a transmission from The Chippewa County War Memorial Hospital, Inc. This message and any attached documents are confidential and may be protected by legal privilege, furthermore this communication may contain information protected by state and federal medical privacy statutes. They are intended only for the use of the addressee. If you are not the intended recipient, any disclosure, copying, or distribution of this information is strictly prohibited. If you received this transmission in error, please notify the sender and delete/destroy this copy from your system. Thank you.   ­­  





  • 6.  RE: Meditech Expanse eChart

    Posted 6 days ago
    Question for Meditech facilities- how do you have your reports set up for co-signers? We have recently noticed issues with reports such as progress notes, Discharge Summaries etc not going to the NP/PA sign queue  if they happen to be signed first by the physician? It remains on the incomplete chart desktop but does not appear in the NP/PA sign queue.   Meditech says there is a setting to not allow it to go to the physician queue until the midlevel signs.  Wondering how you all have your reports set up and any issues you may run into with counter signatures.

    thanks

    ------------------------------
    Trinity Farr
    Director of Him and Mso/Privacy Officer
    Anderson Regional Medical Center
    ------------------------------



  • 7.  RE: Meditech Expanse eChart

    Posted 6 days ago

    Hi Trinity,

    You are experiencing a known issue. Meditech does have the "queue co-signer second" feature, but all this will do is NOT send it to the provider's sign queue until the NP or PA signs off first. If the provider happens to access the report outside of the sign queue (through the EMR patient record) and signs it, it will block it for the NP or PA. We have been trying to teach all providers to ONLY co-sign through the sign queue. I thought we had an IDEA on file, but I can't find documentation of that at the moment. If you also ask for an IDEA to allow both providers to sign regardless of timing, we would gladly support it.

     

    Katie Wood, RHIA

    Assistant Director of Information Systems/Privacy Officer

    War Memorial Hospital

    500 Osborn Blvd

    Sault Ste. Marie, MI  47983

    p: 906-635-4663   khwood@wmhos.org

     


    Confidentiality Notice: This is a transmission from The Chippewa County War Memorial Hospital, Inc. This message and any attached documents are confidential and may be protected by legal privilege, furthermore this communication may contain information protected by state and federal medical privacy statutes. They are intended only for the use of the addressee. If you are not the intended recipient, any disclosure, copying, or distribution of this information is strictly prohibited. If you received this transmission in error, please notify the sender and delete/destroy this copy from your system. Thank you.   ­­  





  • 8.  RE: Meditech Expanse eChart

    Posted 5 days ago

    Hi,

     

    In addition, the added issue we experience is when the provider signs first and now block the other care providers, they deficiency does not close out. So not only can they not sign, they have a defic on their incomplete records report for HIM, but nothing on their sign queue. Meditech is aware and this has been going on for years. Nothing will ever be done.

     

    Thanks,

    Karla

     






  • 9.  RE: Meditech Expanse eChart

    Posted 5 days ago

    I appreciate your issues, which I am making note of.  We are starting the process this spring to implement Expanse so this issues you experience are very helpful!

    Donna

     






  • 10.  RE: Meditech Expanse eChart

    Posted 4 days ago
    Edited by Trinity Farr 4 days ago
    Karla - yes, that is what we are experiencing now is a lot of unsigned documents on the incomplete records report but no document in sign queue to sign.
    When this does happen what are you doing in order to get the NP/PA's signature on the document?

    ------------------------------
    Trinity Farr
    Director of Him and Mso/Privacy Officer
    Anderson Regional Medical Center
    ------------------------------



  • 11.  RE: Meditech Expanse eChart

    Posted 3 days ago

    So we use a manual workaround and use it as needed. We do two things:

     

    1)    If the report does not have an addendum, we put it back in draft and ask the NP/PA to sign it right away. That allows for the process to work correctly. If we cannot do that then we

    2)    Add a manual signature deficiency to the report (that we have created as a PDF and re-uploaded as a second document) for the provider to sign

     

    Hope that is helpful.

     

    Thanks,

    Karla

     






  • 12.  RE: Meditech Expanse eChart

    Posted 2 days ago
    Thanks Karla, we are currently doing the same as option 2 above but just are seeing more and more that we are having to do like this. Very frustrating.

    ------------------------------
    Trinity Farr
    Director of Him and Mso/Privacy Officer
    Anderson Regional Medical Center
    ------------------------------



  • 13.  RE: Meditech Expanse eChart

    Posted 2 days ago

    We are having the advanced practitioner add an addendum stating that it was signed by the doctor before they could authenticate. Then they sign it and the addendum goes back to the doctor for the final signature.

     

    Katie Wood, RHIA

    Assistant Director of Information Systems/Privacy Officer

    War Memorial Hospital

    500 Osborn Blvd

    Sault Ste. Marie, MI  47983

    p: 906-635-4663   khwood@wmhos.org

     






  • 14.  RE: Meditech Expanse eChart

    Posted 2 days ago

    It definitely is very frustrating!

     






  • 15.  RE: Meditech Expanse eChart

    Posted 5 days ago

    We're just in the process of implementing Expanse.   We have a similar issue with our current set-up in Magic so I was very focused on how to avoid this in Expanse!  The setting is in the Person dictionary and is called "Queue Co-Signer Second".  This prevents the co-signer from being able to sign the document prior to the signature of the mid-level provider. 

     

    Shelley Hurst, RHIA, CCS, CRCR

    Administrative Director

    Health Information Management

    DCH Health System

    809 University Blvd. E.

    Tuscaloosa, AL  35401

    (205) 330-3718 (Office)

    (205) 759-7578 (Fax)

    Shelley.Hurst@dchsystem.com

     

    DCH Official Communication, the information contained in this email message is confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, the reader is hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited.