24 May 2021

ieMR Code Upgrade - Coming Soon

ieMR Code Upgrade (Millennium 2018.06 & MPages 7.1 ieMR Code Upgrade)

What is the code upgrade and why do we need it?

The code upgrade will update the ieMR to the latest software version, which will deliver system enhancements, updates, and new features, as well as fixing items that exist in the current code.

What does this mean for me?

Some general changes that all users will experience are:

  • Visual enhancements and improvements, such as a different colour scheme, and optimised icons.
  • Advanced documentation actions such as revising a document with tracked changes and sharing autotext.
  • Optimised alerts and decision support

Check back to this page for ongoing updates and additional information. The individual stream tabs listed below outline enhancements and changes staff will see with the new code upgrade.

General Updates

Visual Improvements

Current vs Future State Code Upgrade

Clinical Documentation

Auto Save Dynamic Documentation Notes

The Dynamic Documentation Editor will automatically save notes as they are being created, at 1 minute intervals.

Auto Save Dynamic Documentation Notes

Auto saved notes are only visible to the user who originally created the note. Draft notes which are manually saved will continue to appear for other end users.

The note can be recovered by double-clicking and opening the auto saved entry. Below is an example of a message which may appear when attempting to recover an auto saved note. Other messages are outlined in Appendix 1.

Advanced Documentation

Revise Notes with Tracked Changes

  • After a Dynamic Documentation note has been signed and authenticated, a new ‘Revise’ option is available to modify or revise the body of the note.

Notes can only be revised for up to 1 day after they have been signed.

  • When a user attempts to modify a note within one day from when it was signed (including notes from other users), they are presented with an additional ‘Revise Note’ option in the modify window:
Revise notes with trackchanges

Ensure the ‘Show Tracked Changes’ button is enabled before using the revise function

Revisenotes with track changes

 

Dynamic Documentation Note with Tracked Changes Enabled

Clinical Documentation Dynamic Documentation Note w Tracked Changes

Auto Text Utility

  • A new utility is available to allow sharing or copying of user-level custom Auto Text phrases from one user to another.
Auto Text UtilityAuto Text Utility

Multiple Auto Text phrases can be selected and copied simultaneously, with the ability to update the abbreviations and descriptions of the Auto Text phrases being saved to your personal library.

Auto Text Utility

Message Centre 

Show Tracked Changes for Forwarded Documents in Message Centre

Message centre
  • This allows clinicians to view any revisions on previously signed notes which are forward to their Message Centre inbox for review or co-signature.
message centre

Alert History Window Uplift

The display of Alert Type and Alert Severity has been updated in the Alert History window.

alert history window

Current state

alert history window current state

Future state

alert history window future state

Locked Vocabularies for Allergy Substances

  • When searching for an allergy substance, the vocabulary can no longer be changed, restricting the search to the recommended vocabularies of Allergy, Multum Allergy Category and Multum Drug.
locked vocab allergy substances

Discern Reporting Portal 

  • The discern reporting portal replaces Explorer Menu. View the quick reference guide for more information - click here.

 

 

Allied Health Updates

Multi-Patient Task List – Date of Birth & Name Alert

The Multi-Patient Task List (MPTL) has been enhanced to display the following information in the Patient Name column:

multi patient task list
  • Date of Birth
  • Italicised font when more than one patient in the list share the same last name
  • *Name Alert when more than one patient in the list share the same last name
mptl

 

 

Anaesthesia Management

Positive Patient Identification (PPID) in Case Selection

  • Clinicians are able to scan a patient wristband barcode in the Select Case dialog box to display cases related to the patient.

‘Start Next Infusion’ Action for Medication Infusions

  • A new ‘Start Next Infusion’ option is available to commence an additional bag or syringe from an administered medication infusion, either via right click on the infusion or within the Modify Medication Administration window.
Start Next Infusion’ Action for Medication Infusions
  • Launching ‘Start Next Infusion’ via right click:
Start Next Infusion

New ‘Monitors’ and ‘Values’ Buttons on the Toolbar

  • The toolbar within SurgiNet Anaesthesia has two new buttons available to enable for quick access to the ‘Monitors’ and ‘Values’ functions.
new monitor values - anaesthesianew monitors and values buttons on toolbar

New ‘Monitors’ and ‘Values’ buttons must be manually added via ‘Customise Toolbar’

Multi-Patient Task List – Date of Birth & Name Alert

The Multi-Patient Task List (MPTL) has been enhanced to display the following information in the Patient Name column:

multi patient task list
  • Date of Birth
  • Italicised font when more than one patient in the list share the same last name
  • *Name Alert when more than one patient in the list share the same last name
mptl
 

Emergency Department Updates

Emergency Medicine

Detached Prearrival Automatically Updates Note to ‘In Error’

FirstNet available via AppBar

FirstNet AppBar upgrade changes

Accessing Patient Summary Report and Discern Reports

  • The menu at the top right corner of ED LaunchPoint now includes options to generate the Patient Summary Report and Discern Reports.
Accessing Patient Summary Report and Discern Reports

ED Triage Review Component

  • In the ED Doctor View MPage, the Triage Documentation component will be replaced with the new Triage Review component.
ED Triage Review Component

ED Launch Point enhancements

Usability improvements

  • When a patient is selected, the appropriate row remains highlighted while in the context of a separate window, rather than being obscured by the dark grey shading.EDLaunchpoint_usabilityimprovements
  • The patient chart can be directly accessed from within the Patient Summary window with a patient hyperlink as well as a new 'Open Patient Chart' button.
EDLaunchpoint_usabilityimprovements
  • Clinical Documentation section has been re-sequenced above the Visits Section in the Patient Summary window.
EDLaunchpoint_usabilityimprovements Clinical documentation
  • Quick access button linking to the Orders profile has been re-positioned to be in context of the order selection.Quick Access

Document Management Enhancements

  • The Document Management column is split into two separate columns to differentiate a clinician’s own documentation from documents created by other clinicians. 
ED_Document management enhancements
  • When there are multiple documents related to the ED presentation, a new documents window is launched when either column is selected, allowing for easier review, selection and continuation of notes without having to navigate to the Documentation tab in the patient chart. This window also displays whether a note is forwarded for co-sign.
ED_Document management enhancements

Critical Indicator for ECG Reports

  • For ECG reports interpreted with a ‘critical’ result, the ECG symbols are now displayed in red both face-up in LaunchPoint as well as in the Patient Summary window.
Critical indicator for ecg reports

Enhanced Unassigned Filter

  • The Unassigned filter is enhanced with options available to display unassigned patients based on unassigned Senior Medical Officer, the role of the current user or a combination of both.
enhanced unassigned filter

Pre-Arrival Status Uplift

  • The Pre-Arrival status is uplifted visually with a solid purple background that is more prominent.
Prearrival status uplift
 

Nursing

Discern Notifications Layout

  • Discern Notifications are re-designed to focus the display on the newly triggered Discern Notification text and provide clearer options for deleting the message, rather than only closing the message.

nursing - discern notifications layout

Improved Display of Allergies in CareCompass

  • Display of allergy status within CareCompass is uplifted with improved use of text formatting, colour and symbols to represent patient allergy status.
improved nursing display of allergies

Help Icon Removed from CareCompass

  • To reduce confusion, the Help Icon has been removed from CareCompass. Previously, this icon was present and provided a hyperlink to CareCompass Cerner Help pages where the URL was most often ‘broken’ and not routinely updated. Only users with Cerner Wiki access could access these Cerner Help pages when functional.
carecompass icon/allergies display
  •  The ‘Orders for Review’ icon is unchanged.

Demographics Bar in CareCompass Updated to One Cerner Style

For visual consistency with the uplifted PowerChart framework, the demographics bar within CareCompass has been updated to reflect the One Cerner Style.

demographics bar care compass

 

Duplicate Checking Alerts (Non-medication orders)

  • The Duplicate Checking Alert window now displays the order status, department status and start date/time for any duplicate non-medication orders (consult, pathology and radiology orders) with the new ‘Status’ and ‘Start’ columns. This may assist with identifying true duplicates and distinguishing them from orders intentionally scheduled for a later time.
duplicate checking alerts

Consolidated PowerPlan Order History

  • Order History is now available for orders within a PowerPlan placed into a ‘Planned’ state via ‘Plan for Later’.
  • The Order Information now captures and displays all actions taken against an order within a PowerPlan, including from when it is placed into a ‘Planned’ state and before it is initiated. This addresses a gap in the current workflow as the Order Information History only captures actions after the order has been initiated. This enhancement clarifies when and by whom orders were initially planned and then initiated, and any modifications to orders prior to the plan initiation. This is particularly important if multiple clinicians are involved (e.g. Clinician A plans the order, Clinician B modifies the planned order and Clinician C performs the initiation of the order).
consolidated powerplan

Updated Order Icons in PowerPlans

  • Icons associated with orders within PowerPlans are updated to more accurately distinguish the order type, specifically for medications and continuous infusion orders.
Updated order icons - powerplans

Filter Active Outcomes from Document in Plan

  • When documenting against outcomes within ‘Document In Plan’ in an Interdisciplinary Plan of Care, users can now filter outcomes by active, discontinued, expired status or for a particular date range.
Filter active outcomes - document in plan

 Clinical Reporting Displays PowerPlan Signatures

  • The ‘Orders’ and ‘Orders – Medications’ sections within the Clinical Reporting output (i.e. Medical Record Request) now displays signatures associated with PowerPlan actions, including placing orders within a PowerPlan into a ‘Planned’ state.

Clinical reporting - Powerplan - orders

Enhanced Medications Rescheduling 

  • Reschedule options when rescheduling all administration times for a medication order with a scheduled frequency (e.g. TWICE a day) are re-designed and easier to understand with an enhanced interface and new timeline. The options more clearly display impacts of administration time changes upon the schedule for next and upcoming administration times. This is particularly beneficial for orders with a defined duration.

Enhanced Meds Rescheduling - Nursing
  • The graph displays previously administered doses along with the current date/time with a yellow bar to help orientate the clinician to previous and future doses in the schedule:
enhanced meds - reschedule - graph

 Locked Route and PRN Reason in Administration Window

  • When documenting a medication administration, a clinician can no longer change the route of administration or PRN reason as specified on the order.nursing-lockedroute-prn

     

 

Obstetrics, Maternity and Newborns

Auto Close Pregnancy Post Delivery

  • Pregnancies which remain open in the mother’s chart after the birth date/time is documented will be qualified to be automatically closed at 10 weeks post delivery.
Auto Close Pregnancy Post Delivery

 A pregnancy summary document is generated with the auto-closure and the pregnancy history is populated with the following information:

  • Gestation Weeks
  • Pregnancy Outcome
  • Neonate Outcome
  • Birth Date/Time

Historical Partogram

  • A partogram from a previous labour of a closed pregnancy can now be viewed via the Histories component in Workflow MPages (including the Obstetric View, Gynaecology View and Doctor View). When the pregnancy is selected from the ‘Pregnancy’ tab in the Histories component, the side panel will include a new button ‘View Historical Partogram’ which launches a separate MPage tab containing a read-only view of the previous partogram.
maternity historical partogram

 

historical partogram

 

historical partogram

End Partogram Indicator

  • When the birth date/time is documented, the partogram components will display a red line to denote the end of the partogram (known as the end partogram indicator).
end partogram

Neonate Workflow MPage

  • A Neonate Workflow MPage will be implemented to replace the existing Neonate Summary MPage, with an equivalent design.
neonate workflow

 

neonate workflow

Order Sentence Filtering based on Post Menstrual Age (PMA)

  • When prescribing for a neonate with a gestational age documented and they qualify for at least one PMA-filtered order sentence, only order sentences with a PMA order sentence filter will be displayed in the orders search. This behaviour applies to PowerOrders, MPages New Order Entry and PowerPlans.
  • Current State – 7-day old neonate with Gestational Age 31 weeks, PM A = 32 weeks:
Current state - order sentence
  • New Behaviour – 7-day old neonate with Gestational Age 31 weeks, PMA = 32 weeks:
maternity future state order sentence

 

Workflow MPage Enhancements

Component Highlight in Workflow MPages

Components within Workflow MPages that are selected in view are denoted by a coloured blue bar, in place of the entire component label being shaded blue.

mpage maternity current and future state

Continuous Scrolling in Workflow Documents Component

Onset Date in Workflow Problems Component

  • The onset date associated with a Problem or Diagnosis is now displayed in a new column within the Workflow Problems component.

Cumulative Fluid Balance in Workflow Intake and Output Component

  • The cumulative fluid balance since admission is displayed in the header of the Workflow Intake and Output (Fluid Balance) component. Weight measurements can also be configured to display in this component.
Continuous Scrolling in Workflow Documents Component
 

Paediatrics

Advanced Growth Chart Improvements

  • The age-appropriate Growth Chart is displayed by default when accessing Advanced Growth Chart, depending on the patient’s age:
    • WHO for patients 0 – 2 years of age
    • CDC for patients 2 – 20 years of age
    • Fenton for premature infants up to 50 weeks
  • Once a premature neonate is older than 50 weeks, the most appropriate growth chart is displayed by default when accessing Advanced Growth Chart.
  • Printing of tabular data from the Advanced Growth Chart is now supported.
  • Rendering of the Advanced Growth Chart graph is improved (e.g. solid gridlines).
 

Pharmacy

 

Order-Centric View in Pharmacy Patient Monitor

  • The Pharmacy Patient Monitor (PPM) has been enhanced with a new Order-Centric View which is accessed via a toggle at the top left of the PPM () which allows end users to quickly switch between the Patient-Centric and Order-Centric views.
pharmacy - order centric viewpharmacy - order centric view

Additional Details in Pharmacy Patient Monitor

Pharmacy Patient Monitor (PPM) now displays further information face-up:

  • Room and bed number
  • Last unverified order action
pharmacy inpatient order

Uplift Pharmacy Care Organiser to Responsive Worklist

The Pharmacy Care Organiser will maintain its existing design and columns, however it will be uplifted to the Responsive Worklist Framework which provides an improved user interface as well as additional worklist functionality:

  • Dynamic resizing of columns depending on screen size along with improved use of icons to allow more information to be viewed with less need to scroll
  • Ability to adjust the amount of information displayed face-up using row height
  • Ability to undertake patient list maintenance directly from within the worklist
  • Ability to select multiple patient rows for the purposes of:
    • Removing patients from a list where the list is modifiable (e.g. custom list)
    • Adding selected patients to another existing worklist
  • Filtering patients by age and diagnoses
  • Viewing additional details in a side panel when a cell is selected

Additional information is available in the ‘MPages Automatic Enhancements’ section

pco - pharmacy care organiser

Filters in Manual Product Assignment Window

  • Filter options are now available in the Manual Product Select window in Pharmacy Medication Manager to filter products available to assign based on route-dose form compatibility or restricted specifically to the dose form on the order.
manual product assignment window

Display Final Normalised Dose During Verification

  • The actual normalised dose (weight or BSA-based) associated with the final dose of a medication order will now be displayed during verification in Pharmacy Medication Manager, rather than the target dose.
normalised dose - pharmacy

Viewing Related Results in Pharmacy Medication Manager

  • When verifying medication orders in Pharmacy Medication Manager, pharmacists can now view related laboratory results and assessments within the application by launching the Related Results window via the new Related Results button  positioned next to the medication name in the Verify Med Order window.
meds management

Order Indication Available in Pharmacy Medication Manager

  • The ordered indication for a medication or continuous infusion order is now displayed in Pharmacy Medication Manager during the verification workflow, within the Comments window. Pharmacists are able to modify the indication of a medication or continuous infusion order in the ‘Comments’ window during the verification workflow in Medication Manager, if it is within their scope of practice to do so.
order indication - medication management

Supress Unverified Action History Window

  • The Unverified Action History window will no longer appear during the verification workflow.
supress unverified action history window

Inactive Orders Toggle in Pharmacy Medication Manager

  • A new toggle is available in the PharmNet Acute Profile to quickly filter the profile to display only active or inactive orders within this view and apply a time range.
pharmacy - inactive orders

 

 

PowerTrials

Pre-Screening Enhanced with Health Expert Rules

PowerTrials now leverages the more sophisticated Health Maintenance architecture and Health Expert Rules for protocol pre-screening to efficiently screen patient populations within the ieMR database and pre-identify potential trial candidates when a protocol is launched within Patient Protocol Manager (PPM). This introduces a number of benefits to the pre-screening process, including:

  • Identifying qualifying patients can be immediately initiated once the Health Expert pre-screening rule is made available, avoiding the need to manually initiate the pre-screening job in PPM
  • Filter options are available to further refine the pre-screened patient list, including date and facility parameters. These filter options can be shared with other users who have access to the selected protocol.
  • The list of eligible candidates identified by the screening algorithm is continuously updated based on the qualifying parameters, avoiding the need to run additional pre-screening jobs.
  • The number of patients displayed per page in PPM can be adjusted.

The above enhancements only apply to new pre-screening rules created following the upgrade using Health Expert Rule Builder. There are changes to how existing pre-screening rules for current protocols are executed, however.

Running Existing Pre-Screening Rules

  • The pre-screening icon is no longer available where it is currently located in Patient Protocol Manager. To run a pre-screening job for a current protocol following the upgrade, the PowerTrials Screening Job Status window must be launched, where the pre-screening icon  is available, opening the pre-screening parameters window from which the pre-screening job can be executed.
existing screening rules

 

 

Prescriber

Code upgrade changes for prescribers

If you are an ED doctor, Anaesthetist or Obstetrician, please also refer to the department specific info in the above tabs.

Doctor Workflow

Carry Forward Unused Workflow Documentation

  • Documentation that is entered in a Workflow MPage Dynamic Documentation component (e.g. in Doctor View), but not included in a note, is saved within the relevant Workflow MPage component for subsequent use in a future note.

Prescriber - Doctor Workflow - Carry Forward unused workflow in documentation

Continuous Scrolling in Workflow Documents Component

  • The Documents component within Workflow MPages now supports continuous scrolling through documents when viewing through the side pane launched after a document is selected. This is enabled via a checkbox within the document viewing pane.

Continuous Scrolling in Workflow Documents Component
  • The onset date associated with a Problem or Diagnosis is now displayed in a new column within the Workflow Problems component.

 Continuous Scrolling in Workflow Documents Component

Cumulative Fluid Balance in Workflow Intake and Output Component

  • The cumulative fluid balance since admission is displayed in the header of the Workflow Intake and Output (Fluid Balance) component. Weight measurements can also be configured to display in this component.
Cumulative Fluid Balance in Workflow

Improved Scrolling in Workflow Pathology Component

  • Fixed height has been introduced into the Workflow Pathology component, ensuring headers remain fixed and visible when attempting to scroll vertically and horizontally through the flowsheet. This is particularly valuable when many results are available.
Scrolling in Workflow Pathology

Orders Management and PowerPlans

Consolidated PowerPlan Order History

  • Order History is now available for orders within a PowerPlan placed into a ‘Planned’ state via ‘Plan for Later’. This enhancement clarifies when and by whom orders were initially planned and then initiated, and any modifications to orders prior to the plan initiation.
Consolidated PowerPlan Order History

Updated Order Icons in PowerPlans

  • Icons associated with orders within PowerPlans are updated to distinguish the order type more accurately, specifically for medications and continuous infusion orders.

Updated Order Icons in PowerPlansUpdated Order Icons in PowerPlans

Medications Management

Reconcile and Plan for Home Medications

  • Proposed actions for home medications (e.g. discontinue) can now be saved using the Reconcile and Plan function in Medication Reconciliation, without committing the action.
Reconcile and Plan for Home Medications

Enhanced Medications Rescheduling

  • Reschedule options when rescheduling all administration times for a medication order with a scheduled frequency (e.g. TWICE a day) are re-designed and easier to understand with an enhanced interface and new timeline.
Enhanced Medications Rescheduling
  • The graph displays previously administered doses along with the current date/time with a yellow bar to help orientate the clinician to previous and future doses in the schedule:

Enhanced meds rescheduling

Message Centre Functionality

Result Comments Display

  • When endorsing results, any comments associated with the result are now directly viewable within Message Centre, through a new hyperlink next to the result which launches a Comments pane.
message centre functionality results comments

An issue with display of AUSLAB result comments in this view is under investigation

Textual Result Indicator

  • In the ‘Endorse Results’ window, when a result for endorsement is associated with a text report (e.g. radiology), a new red asterisk indicator is introduced to visually distinguish these from alphanumeric results, prompting the clinician to launch the report prior to endorsing.
Textual Result Indicator