Job Aid - Nurse Workflow

Prepare Chart Before Patient Visit

1. Open the patient’s electronic chart
a. Click the Menu button next to the patient’s appointment and click Patient EHR.
2. Review Patient Portal/Kiosk Documents.
a. Click the Health Forms tab on the patient dashboard.
b. Review documents.
3. Enter the Problem List (if documented) from Patient Portal/Kiosk Documents.
a. Click the Summary tab on the patient dashboard.
b. Access the Problem List panel.
c. Click the New button on the Problem List toolbar.
d. Complete the Patient Problem information and click Save.
4. Enter the Current Allergies (if documented) from Patient Portal/Kiosk Documents.

a. Click the Summary tab on the patient dashboard.

b. Access the Allergy panel.
c. Check discontinued Allergies (if any) and click the Discontinue button on the
Allergies bar.
d. Click the Maintenance button on the Allergies bar, hover over Add New, and click
the applicable type of allergy.. OR .. Click the No Known Drug Allergy NKDA as
applicable.
e. If adding an allergy the ADVERSE REACTIONS window opens.
i. Type the Drug or Category, Reaction, and Notes on the right side of the window.
ii. Click the Drug button below the Notes and search for the specific drug or
category in the list.
iii. Click the Save & Close button at the bottom of the screen.
5. Enter the Current Medications (if documented) from Patient Portal/Kiosk
Documents.
a. Click the Summary tab on the patient dashboard.
b. Access the RX panel.
c. New medications.
i. Click the Maintenance button on the Medications bar
ii. Click Add New
iii. Double Click on medication in the Favorites list .. OR .. Manually lookup
medication.
iv. Complete the SIG information.
v. Select Currently Taking in the Change Rx Type box.
vi. Type or select the prescribing Physician.
vii. Click the Prescribe button.
viii. Continue with additional medications, then click Cancel/Exit button.
d. Valid/No Valid current medications
i. Check all valid current medications the patient is still prescribed if any.
ii. Click the Maintenance on the Medications bar

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iii. Click Mark Selected as Reviewed .. OR .. Click the No Current Medications as

applicable.
6. Link Current Medications to Rx History.
a. Click the Rx button on the top toolbar.
b. Click the Eligibility Request button on the top right toolbar.
c. Select a Registered Physician using the drop down list.
d. Click the Request Eligibility Info button.
e. Click the Done button.
f. Collapse the Coverage Summary by clicking the Left Arrow button below the
Formularies list.
g. Click the Validate External Rx History Records button
below the current medications list.
h. Click the Show Records down Arrow button and click Not Linked Only in the list.
i. For each medication in the History Items Obtained from Rx Hub list, link to a Current
Medication
7. Check Immunizations.
a. Click the Immunizations button on the patient dashboard toolbar.
b. Click the Due tab.
c. Pediatric: If no scheduled meds are loaded, click the Calculate All Due Dates
button on this window’s toolbar and select the applicable Rule Set(s), then click the
Apply button.
d. Administer Existing Immunizations from Portal Documents.
i. Double Click on the immunization in the due list if found.. OR.. click the New
button on the toolbar.
ii. Complete the immunization information and click the Save button on the
immunization window.
iii. Click Exit on the immunization toolbar.
8. Apply Health Maintenance Measures.
a. Click the Health Maintenance tab on the patient dashboard.
b. Click Apply Measure button on this tab’s toolbar.
c. Check the applicable measures in the Health Maintenance window and then click
Apply Measure button on this window’s toolbar.
9. Review Current Orders and Results.
a. Click the Orders tab on the patient dashboard.
b. Review the Ordered and Incomplete orders and request results.

Room the Patient

1. Locate the patient in the exam room.
a. Click the Menu button next to the patient’s appointment and click Patient Location.
b. Click on the applicable location in the Select Location list.
c. Click the With: (your name) radio button.
d. Click the Move button on the toolbar.
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2. Open the patient’s electronic chart.

a. Click the Menu button next to the patient’s appointment and click Patient EHR.
3. Review forms submitted from Kiosk at check in.
a. Click the Health Forms tab on the patient dashboard.
b. Review documents.
4. Review Continuity of Care Document.
a. Click the CCD tab on the patient dashboard.
b. Review imported CCD if on file.
c. Document imported CCD into the applicable chart sections.
5. Review and Update Problem List.
a. Click the Summary tab on the patient dashboard.
b. Access the Problem List panel.
c. Click the New button on this tab’s toolbar.
d. Complete the Patient Problem information and click Save.
6. Review and Update Current Allergies.
a. Click the Summary tab on the patient dashboard.
b. Access the Allergy panel.
c. Check discontinued Allergies (if any) and click the Discontinue button on the
Allergies bar.
d. Click the Maintenance button on the Allergies bar, hover over Add New, and click
the applicable type of allergy .. OR .. click the No Known Drug Allergy NKDA as
applicable.
e. If adding an allergy the ADVERSE REACTIONS window opens.
i. Type the Drug or Category, Reaction, and Notes on the right side of the window.
ii. Click the Drug button below the Notes and search for the specific drug or
category in the list.
iii. Click the Save & Close button at the bottom of the screen.
7. Review and Update Current Medications.
a. Click the Summary tab on the patient dashboard.
b. Access the RX panel.
c. New medications.
i. Click the Maintenance button on the Medications bar
ii. Click Add New
iii. Double Click on medication in the Favorites list .. OR .. manually lookup
medication.
iv. Complete the SIG information.
v. Select Currently Taking in the Change Rx Type box.
vi. Type or select the prescribing Physician.
vii. Click the Prescribe button.
viii. Continue with additional medications, then click Cancel/Exit button.
d. Valid/No Valid current medications.
i. Check all valid current medications the patient is still prescribed if any.
ii. Click the Maintenance on the Medications bar

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iii. Click Mark Selected as Reviewed .. OR .. click the No Current Medications as

applicable.
e. Discontinue old medications.
i. Check all discontinued medications.
ii. Click the Discontinue button on the Medications bar.
iii. Click the applicable Discontinue .. OR .. Discontinue w/Allergy and complete
the allergy information if selected.
8. Review Patient History.
a. Click the History tab on the patient dashboard.
b. Review histories and Double Click on a History Pane to open the History Management
form.
c. Click the Forms tab on the History Management window.
d. Select the applicable histories for each of the tabs on the form.
e. Click the Save button on the form toolbar.
9. Record Vitals.
a. Click Vitals/Graphs tab on the patient dashboard.
b. Click the Vitals button on the tab’s toolbar.
c. Enter the relevant vitals and click the Save button.
10. Non-Procedure Visit - Start Point of Care Encounter.
a. Click the Point of Care button on the patient dashboard toolbar.
b. The POC window opens. Click the Cite Hist button on the POC toolbar.
c. Check the applicable histories and then click the Cite button on this window’s
toolbar.
d. Click the Cur Rx button to cite the current medications into this encounter.
e. Click the Pat Allergy button to cite the current allergies into this encounter.
f. Click the Save button on the POC toolbar.
g. The Save Encounter Options window opens.
h. Select In Progress in the Save Mode.
i. Click the Save & Exit button on this window.
11. Exit the Patient Dashboard.
12. Locate the patient as Ready for Physician.
a. Click the Menu button next to the patient’s appointment and click Patient Location.
b. Click the Doctor radio button.
c. Click the Save button on the toolbar.

Check Out the Patient

1. Review Appointment list on the user dashboard for “Ready for Nurse” status.
2. Locate the patient with you.
a. Click the Menu button next to the patient’s appointment and click Patient Location.
b. Click the With: (your name) radio button.
c. Click the Save button on the toolbar.
3. Open the patient’s electronic chart.
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a. Click the Menu button next to the patient’s appointment and click Patient EHR.
4. Review new tasks generated by the visit.
a. Click the Tasks tab on the patient dashboard.
b. Review open tasks for today and complete, forward, or reassign as applicable.
c. New Orders Task.
i. Click the Orders Link in the task.
ii. Complete the Diagnoses section or click Get Chronic Dx if applicable.
iii. Select the desired Destination.
iv. Select the desired Lab Form beside the Show List button on the toolbar.
v. Click the Show List button on the toolbar.
vi. Check the desired orders.
vii. Complete the ordering information on the right side of the window.
viii. Click the Save button on the toolbar and click Save & Exit.
5. Review the Encounter.
a. Click the Progress Notes tab on the Patient Dashboard and review the note depending
on the type of visit.
i. Review the Encounter Note Plan section … OR …
ii. Review eNote Procedure Note.
b. Enter New Orders (if applicable).
i. Click the Orders button on the toolbar.
ii. Complete the Diagnoses section or click Get Chronic Dx if applicable.
iii. Select the desired Destination.
iv. Select the desired Lab Form beside the Show List button on the toolbar.
v. Click the Show List button on the toolbar.
vi. Check the desired orders.
vii. Complete the ordering information on the right side of the window.
viii. Click the Save button on the toolbar and click Save & Exit.
c. Administer New Immunization (if applicable).
i. Click the Immun button on the toolbar.
ii. Click the Due tab.
iii. Double Click on the immunization in the due list if found.. OR.. click the New
button on the toolbar.
iv. Complete the immunization information and click the Save button on the
immunization window.
v. Confirm and Check the Parental Consent to Release for State Registry.
vi. Click the Print button on the toolbar and select the desired report to print for the
patient.
vii. Click Exit on the toolbar to return to POC.
d. Generate Documents and Education Care Plan Instructions.
i. Click the Document Generator button on the toolbar.
ii. The Encounter Documents window opens. Check the desired documents in the
Narrative Templates list.
iii. Click the Save & Route button on the top toolbar.
iv. Click Send for Review and route to the applicable recipient physician.
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e. Print Referral Out Form.

i. Click the Name link on the Patient Header.
ii. Click the Other button on the toolbar.
iii. Click Referral Out.
iv. Complete the “Effective Date”, “Referring Provider”, “Referred To Provider”,
“Referral Form NO”, and “Type”.
v. Select “SAVE”.
vi. Then Highlight the item in the list and select “PRINT” to print the form.
vii. Once the form prints, select “EXIT”.
f. Exit Patient Dashboard.
6. Locate the patient to Check Out.
a. Click the Menu button next to the patient’s appointment and click Patient Location.
b. Click on the Check Out location in the Select Location list.
c. Click the Move button on the toolbar.

Daily Tasks
1. Make New Appointments.
a. Click the Actions button on the Appointment List toolbar.
b. Click New Appointment.
c. Enter the patient’s name, i.e. “Smi,J” for John Smith. And press the arrow button.
i. IF the patient is not found in the list press the “ADD” button.
1. “Demographics” tab.
a. Last Name, First Name, Middle Initial, Sex, DOB, Address, Phone
Numbers, Assigned Doctor.
b. Please make the effort to obtain other information such as SSN.
2. “Referrals” tab.
a. Enter the current Referring Physician information.
b. IF Referring Dr NOT in the list, add the Doctor, Phone to the
Appointment REASON and send message to administrator with
complete Referring Physician information and Patient.
ii. Press the “Select” button to select the patient.
d. READ the “Warnings and Copays” messages. IF the patient has a “Recall” listed at the
bottom of the “Warnings and Copays” screen and this appointment is fulfilling the recall,
put a check in the box next to the recall.
e. Enter the “Reason” for the appointment. Add the Insurance name if this is a new
patient.
f. Select “Auth No.” from existing list if this applies by clicking the right arrow next to Auth
No.
g. Select “Episode” from existing list if this applies by clicking the down arrow next to
Episode.
i. Create a new OB episode for a new pregnancy.
h. (Optional): Mark “Incomplete” if you did not get the referring doctor, Insurance
Information, or if you know that this patient will require an authorization.
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i. “Save” the appointment.

2. Update Patient Demographics.
a. Click the Name link on the Patient Header.
b. Update patient record.
c. Click the Save button on the toolbar.
d. Click Exit.
3. Phone Call Tasks.
a. Click the My Day tab on the user dashboard.
b. Access the Phone Call Tasks panel.
c. Double Click on task to open.
d. Click the Chart Link to open the patient dashboard.
e. Click the Phone button on the patient dashboard toolbar.
f. The Appointment Selection Confirmation window opens.
g. Select Create a New Non-Encounter and complete the other information.
h. Click the Select button on the window’s toolbar.
i. Click the Forms tab on the POC window.
j. Complete the POC form.
k. Click the Save button on the POC toolbar.
l. The Save Encounter Options window opens.
m. Click Finalize in the Save Mode… OR… Validate and Task and select a recipient.
n. Click Save & Exit.
o. Close the task.
4. Other Tasks.
a. Click the Tasks tab on the user dashboard.
b. Double Click on task to open.
c. Depending on the task type, click the Subject link to open the linked module, complete,
and exit back to the open task.
d. If desired, click the Chart Link on the patient header to open the patient
dashboard.
e. Click the Notes tab on the Task window.
f. Review/Add Notes
i. Click New on the tab’s toolbar to add notes.
ii. Enter Note.
iii. Click Add on the tab’s toolbar to save the note.
g. If task can be closed, Click the Complete button on the task toolbar.
h. Click Forward or Assign depending on the task type to send the task on to another
user.
i. Click the Add User/Group button.
ii. Select the desired Filter By criteria.
iii. Click on the user/group in the list.
iv. Click the TO>> button.
v. Click the OK button.
vi. Add a Note as desired.

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vii. Click the Assign or Forward button as applicable.

i. Click Exit on the Task toolbar.
5. Review Orders.
a. Click the Orders tab on the user dashboard.
b. Review the outstanding Ordered and Incomplete orders and request results.
6. Review Routed Documents and Images.
a. Click the Documents for Review tab on the user dashboard.
b. Annotate/Attach/Route Order Result Images.
i. Double Click on the image to open it in the viewer.
ii. Annotate image as desired and click the Update button on the window’s toolbar.
iii. Click the Menu button on the window’s toolbar.
iv. Click Attach as Order Result.
v. Select the applicable order in the Orders List and then click the Attach button
on the Orders List toolbar.
vi. Click the Exit button on the Orders List toolbar.
vii. Click the Menu button on the Image toolbar.
1. To Route: Click Send For Review and select the recipient.
2. Otherwise Exit.
c. Route, Sign or Finalize documents.
i. After reviewing the document click the Save & Route button on the
documents toolbar.
ii. Send for Review, Sign or Finalize as applicable.
7. Review Fax Status and E-Prescribing Tasks.
a. Click the Fax Status tab on the user dashboard.
b. Review the Fax Status items.
i. Right Click on Failed jobs and click Resend Fax Job or Reroute Fax Job as
applicable.
ii. Right Click on Failed Conversion jobs and click Reconvert Fax Job.
iii. Cancel or Delete jobs as applicable.
c. Review the E-Prescribing Tasks.
i. Review eSIG-Error tasks and fax or print eRX as applicable.
8. Review RX Renewal Tasks.
a. Open RX Renewals tab on the user dashboard.
b. Open a task and click the Subject link.
i. Deny
1. Click DENY as applicable
ii. Approve
1. Complete the Total # of Approved Dispensing.
2. Click the Approve button on the renewal toolbar
3. The Rx Module opens, right click on the medication in the current
medications list and click Renew
4. Complete the prescription and click Prescribe button
iii. Rx to Follow
1. Click the Rx To Follow if a new prescription is required.
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2. The Rx Module opens, prescribe the medication as normal.

9. Attach In-Bound Faxed Documents/Images.
a. Open PulsePro.
b. Click the Processing item on the top menu.
c. Click Images.
d. Click Restore Path button on images toolbar.
e. Click on a file in the list.
f. Click the Attach button on the images toolbar.
g. Enter the Patient, Type, Description, and other header information.
i. Click the Orders button to attach Result Images to an order.
ii. Select the applicable order in the Orders List and then click the Attach button
on the Orders List toolbar.
iii. Click the Exit button on the Orders List toolbar.
h. Check the desired Pages to be attached in the Page list.
i. Click the Attach button on the window’s toolbar.
j. Select the desired status.
k. Click Exit.
10. Review Outstanding Import Lab Results.
a. Open PulsePro.
b. Click the Processing item on the top menu.
c. Click Import Lab Results.
d. Select a Lab on the top toolbar.
e. Work the messages in Date/Time received, correcting the oldest messages first as to
not process a message with Final results prior to one with Preliminary results.
f. Click on a message in the list.
g. Review and Reconcile each tab section at the bottom of the window for the message.
i. Patient Information – Assign Patient.
ii. Provider Information – Assign Provider.
iii. Order Information – Assign Order.
h. Click Apply Changes on the top toolbar.
i. When finished click Exit on the top toolbar.
11. Apply Measures for CMS Physician Quality Reporting System.
a. Open PulsePro.
b. Click the Administration item on the top menu.
c. Click PQRI.
d. Select the Reporting Year.
e. Click Apply Measures and select the applicable provider.
f. Select the configured Measure Type for this provider - Individual Measure or Measure
Group.
g. Click on the Measure Id in the displayed list.
h. Double click on any patient identified with a status of Undetermined.
i. Answer the measure questions and click the Save button to finish …or… click the
Green Right Arrow button to save this patient’s answers and display the next
patient listed within the Apply Measures window.
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j. Complete all patients with status = Undetermined.

k. When finished click the windows close (X).

Monthly Tasks
1. Batch Health Maintenance Recalls - Send preventative/follow up care reminders
to patients.
a. Click the Health Maintenance tab on the user dashboard.
b. Select the Criteria Sex and Age, Appointment Date, and or Patient.
c. Click the Count button on the tab’s toolbar.
d. Click the Apply Measure button on the tab’s toolbar.
e. The Health Measures list window opens. Click on the desired measure in the list.
f. Click the Select button on the window’s toolbar.
g. Click the Check All button on the tab’s toolbar to select all of the qualifying patients.
h. Click the Send to Recall button on the tab’s toolbar.
i. The Recalls List window will open if no Recall Type was associated with the
measure.
ii. Click the applicable Recall Type in the list.
iii. Click the Select button on the Recall’s toolbar.
i. Repeat the process for other desired Health Maintenance Measures.
j. Launch PulsePro.
k. Click the Administration tab on the navigation bar.
l. Click Recalls in the administration group. The Recalls window opens.
m. Click the Manage Recalls button on the Recall’s toolbar.
n. Select the desired From and To Dates and other criteria.
o. Click the Filter button on the toolbar.
p. Check the Check All button.
q. Click the Notify button on the toolbar and the recalls will print/email if configured or
Manually Call the patient’s if this is your practice’s rule.
r. Click Exit on the toolbar.

KEY
= Meets Requirement for Meaningful Use

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