USING OUR EMR (MOIS)

MOIS VIDEO INSTRUCTIONS

​You may wish to start by viewing these few short videos that will walk you through some of the essential ways we use our EMR. Please note: when you click the LINK, it will send an access request to one of our staff members who will grant you permission to view the videos. NB: You will only be able to view the videos when on a NH computer or via remote NH desktop.

Documenting Clinical Encounters

​To view your schedule for the day, open the "Scheduler" module (bottom left of MOIS interface) - this will take you to your same day schedule; you can select different days by clicking the arrows in the top left of the screen; you can also view another provider's schedule using the drop down menu, top middle of the screen (or by selecting another Day View from the Provider Schedules, top left, which allows you to view the day sheet of multiple providers at once),
documenting clinic visits
  • Please document ALL your encounters into the patient's MOIS chart (clinic, ER, inpatient rounds, home visits, telephone calls) - this ensures the best continuity of care.​
  • To create a new encounter line, go to Patient Chart -> Encounter -> New Record; select the type of encounter under "Code"  (R - regular visit, T - telephone call, ER - ER visit, I - inpatient visit, H - home visit, etc.), and write the time of visit (for ER visits, this time must match the time of ER registration which you will find on the paper ER record)
  • If the patient is a visitor and not in our system, right click on the encounter line and select "Quick Registration" - this will allow you to create a new patient file (just put in their name, PHN and DOB, no need to fill in all the fields!).
NB: Your PCA will usually room your patient and change their code in MOIS from "A" (arrived)  to "I" (in room); if, on occasion, you bring a patient into the room yourself, please mark them "I" so the PCA is aware and does not go looking for them; most importantly, mark them "D" when discharged so PCA or Clinic RN know that room is free for next pt. PCAs will not room patients for residents and students.
Documenting procedures
Document every procedure you perform (biopsy, joint injection) by creating a new encounter in the Procedures folder.
documenting emergency visits
  • Patients seen via the ER will also have a paper ER record; you do not have to double chart - just type your note in MOIS , print it and attach it to the ER record. Please sign the ER paper record and write on it "See attached MOIS encounter". 
  • When you create an encounter, use the exact time of ER registration, noted on the ER paper record (top left); you need to sign the paper ER record and mark the time of discharge, and then put it into the Med record box, at the nurse's station.
documenting facility admissions and discharges
Admissions - when you admit someone, there is an Acute Admission package (three options: General Acute, Detox and Mental Health) to complete (ask RN to pull it out for you & also print out the Medication Reconciliation form to review/order admission meds); create a new encounter in MOIS in which you can type your Admission (remember to print it for the hospital chart as hospital staff cannot access MOIS, or copy it into the patient's Power Chart). You can also dictate your admission by calling 1-833-613-1697 and following the prompts; facility ID is 27; Admission Hx is 01 and Discharge is 03. 
Discharge Summaries - when you discharge someone, please create an entry in the patient's "Facility Admissions" MOIS folder, and type/copy your discharge summary into it. This step is not necessary if you copy the note into Power Chart or dictate your discharge summary as Cerner will then deliver it electronically into MOIS. Please always copy your discharge summary to Skidegate Home Care for Skidegate residents (as our Med Records person to fax to Skidegate Health Home Care), as they do not have access to our MOIS or Power Chart. It is important that the discharge summary be faxed the same day as the Skidegate patient is discharged, to ensure continuity of care.
diagnostic codes
​Locums and Residents are required to enter DIAGNOSTIC CODES for each billable clinic encounter. These are entered in MOIS, on the encounter line, in the appropriate column. You can search for diagnostic codes in MOIS (hit the "..." associated with the relevant column) or refer to the cheat sheet below.

Creating Orders

***Please remember to copy your host/preceptor on ALL orders***
Ordering Labs
  • To order labs, go to "Orders" in the patient's chart, select "New Record"; under "Order Type", select "LAB"; under "Order for", write something that will give an idea of what you are requesting (Eg.: Urine culture, or Diabetic Screen) and then attach the general lab req (STANDARD OUTPATIENT LABORATORY REQUISITION) which you then populate and save;  
  • At the top of the requisition, please indicate the diagnosis relevant to your requested investigations  - the lab will not process requisitions without a diagnosis!
  • Please also ensure that your host/preceptor's complete info is entered in the top right corner of the form, including their phone number. 
  • if the results need to be copied to a specialist, please include their name and MSP # on the form (you can search for their info by clicking the relevant search button at the top left of the form).
  • Do not create standing orders - these should be delegated to the patient's MRP. 
  • Fax all Lab Requisitions for Northern Health Labs individually to ScanLab at 250-645-8061. You can do so directly from MOIS (ask us how to use the eFax option!).  If the test is due before 24hrs, print req and give it to the patient to take to the lab (as Scanlab takes up to 24hrs to process). 
Ordering IMAGING
  • To order imaging, from inside a patient's chart, go to "Orders" and select "New Record";  then under "Order Type", select "Imaging"; under "Order for" type the kind of imaging requested (for example, "CXR" or "CT Abdomen & Pelvis" - NB: when you save it, if MOIS tells you that they cannot find this reason, just hit "Cancel" and save to override MOIS) and then attach the relevant form which you then populate and save; next to your signature, be sure to note the name of your physician host or preceptor. 
  • Plain Xrays can be done locally - Fax the requisition via the EMR (ask us how!) or regular fax machine (FAX = 250-559-4924) and instruct patient to go to Xray Dept when it is open. No appt needed. Xray hours are on the requisition.
  • CT, MRI, Bone Scan, NM Scan require patients to travel off island - once you have complete the order, right click on it and TASK it to your preceptor/host's PCA (see Tasking Cheat Sheet below) with any relevant instructions (desired location, timing, etc) - don't forget to TASK it, as otherwise it will not get done! CT scans are usually done in Prince Rupert; MRIs and NM scans in Terrace. Wait times vary (days to weeks), but if you need urgent imaging done, contact the regional Radiologist on call.
CREATING A CONSUlt
To create a consult, from inside a patient's chart, go to "Orders" and select "New Record"; then under "Order Type" select "CONSULTATION"; under "Order to", search for the specific consultant you have chosen (if there is one); under "Order for", write the reason for consultation (NB: when you save it, if MOIS tells you that they cannot find this reason, just hit "Cancel" and save to override MOIS); attach letter template (use your host's/preceptor's template - ask us how, if you cannot find it) and then select the documents you wish to attach 
Once your referral letter is complete, you must TASK it otherwise it will not get processed - this is super important; TASK it to the PCA if it is for an OFF-island appointment, and to the Visiting Specialists group for ON-island appointments. Ask the PCA for the latest update of our Visiting Specialist schedule.  
For a directory of our most commonly referred to specialists (OFF-ISLAND and VISITING), see "Specialists" tab in this Excel Document.​
Ordering Out-Patient InfusionS
For IV infusions (immunotherapy, zoledronic acid, iron), please task PCIPT 1 DGS; antibiotic infusions need to register in the ER as "out-Patient"

Managing Medications

Creating prescriptions
​To create a new prescription, open the folder "Prescriptions" (ALT+S) and select "New Record", then click on F4 to open the Drug List; search for the drug you want, double click on it, then fill in Dose/Frequency and Amount columns; to print, highlight your entry and click on "Print Rx" (top right) - sign printed Rx and place in your outbox (you can also fax Rx directly from MOIS - ask one of us how!); please document all one-time Rx and all med refills in Prescriptions.
Long term medications - list maintenance
​Open the "Long Term Meds" folder; add or edit LTM meds as needed; click "Review" if you reviewed the LTM list during your visit; please enter even short trials of medications if they were started with the intention of continuing them long term (and please note in comments below why you made a change or discontinued a medication)
accessing medinet
​When accessing a patient's Pharmacare record on Medinet (www.medinet.ca), please ensure that you select the correct patient location from the drop down menu (HOSPITAL vs Emergency vs Primary Care Clinic). 

Accessing Results

Archived results
You can access archived results by clicking on the folders located along the left side of the screen, when you are inside a patient's electronic record.
  • Measures = Labs, path, ECGs (these appear only once they have been signed off on HeartStation), Holters, etc.
  • Imaging = Xrays, CT Scans, MRIs, etc.; you may need to click on attachment to view report
  • Consults = Scanned and electronically delivered consult reports; you may need to click on attachment to view report
  • Procedures = Surgery reports, c-scopes, etc.; you may need to click on attachment to view report
  • MAR = Imms
  • Facility Admissions = discharge summaries
New results to be reviewed and signed-off
To ensure that you get all results for our practice, you must blend your workspace with that of your host(s). To do so, go into "Workspace", click on "Workspace Summary" and then "Change W/S". Then make sure to select not only your workspace, but also that of your host (MDs you are covering for ). Then click "save as default" box at the bottom. Then click "Refresh" in the Workspace Summary and you should be good to go.
Within the Workspace Folder, inside your Basket, you will find a number of folders: Measures, Imaging, Consults, Procedures, etc. This is where new results and reports come in. Open each folder to view results and then CHECK them off as you review/act on them. They will disappear from your basket and will be archived in a given patient's chart. Be careful not to check off a result before you have had a chance to review/act on it - this is very easy to do and leads to potentially significant misses. 
This is also where you will also receive all digitally delivered consults. Please note that some consults may arrive in paper form into your clinic INBOX - these will get scanned AFTER you process them (i.e.: add relevant content into "Health Issues" summary +/- take any actions recommended by consultant, then initial the top right corner of the first page of the consult report). Once reviewed and signed off, paper reports will be scanned and archived into the patient's electronic chart.
accessing Results outside of MOIS
  • ECGs are read by the Internal Medicine Group in Terrace and will appear in your MOIS inbox once they have been signed off. You can also access them  in Power Chart at any time.
  • XRAYS (images and reports) can be veiwed within Power Chart; when in a patient's chart (Power Chart), go into Imaging folder, click on the study of interest, and then on the image icon in the top left corner.
  • OFF-ISLAND Consults, Admissions, etc. = When patients are seen/admitted off-island, the documentation of their encounters can be found on Care Connect; you can log into this via the patient's Power Chart records (via the eHealth Viewer, at the bottom of the menu on the left, when inside a patient's Power Chart). If need be, ask us how!

Communications in MOIS

MESSAGING IN MOIS
  • ​The "Message Board" is where you will receive most (if not all) of your messages from the PCA or other staff/MDs asking you to do something for them or for FYIs. Think of it as your "to do" list. When a message is coded "V", it is urgent and should be opened ASAP. 
  • Please use the Message function to handover patients (those from other practices you admitted overnight, or at the end of your locum/rotation). Simply right click from any encounter/result you wish to flag and message the MRP who needs to follow-up. Remember to code "V" if you want them to see your message asap (in which case, best to text or call them as well).
  • We discourage people from tasking MDs (we prefer messages), but on occasion someone will send you a Task - so check that folder periodically. 
CREATING TASKS in MOIS
  • We use Tasks to flag orders for our PCA.  Right click on the order,  select "Task", and then select appropriate Org Role from the LEFT upper corner drop down menu (see table below for who to task for what) ; it will open the task window which you can complete: title of task, content, and priority (V = same day, H = within 48hrs, M = within 1 week, L = when possible).
  • Remember to Task all orders that you do not process completely yourself, which is most of them. If you do not Task your order to someone, it will not get noticed or done! (sorry for the repetition but this is a critical step, and we all drop the ball here every now and then).
HANDOVERS
The physicians use the Signal App to communicate with each other via a Signal Group called "All DG Docs". MDs/Locums/Learners -> Please download the Signal App and request an invite to this group when you join us. We use the group for handovers and also to call for help if/when need be (such as when there is need for additional MDs to manage an unstable patient).
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