Thursday, 5/14/20: New Version of LaunchPoint - 4.4.

Printable Version of What's in LaunchPoint 4.4

What is changing/or what needs to be communicated?

The My Patient and Unassigned filters now work correctly. They will show patients unassigned to your role - for example, if you are a physician they will show patients assigned to residents and APPs but not physician. You must select "My Role Unassigned" in the dropdown next to the Unassigned filter button. Physician Unassigned will continue to show you only those patient who have not been assigned to a qualified medical provider.

***This filter will also work for nurses - showing only those patients who have not been assigned to another nurse.

Why it's changing?

This will allow physicians and nurses to more correctly see those patients they need to assign themselves to.

Who will it impact?

All ED physicians, residents, advanced practice providers, nurses and techs.

When it's changing?

March 19, 2020

Who to contact if they have questions?

iCentra Users: Contact your local CTIS rounding resource, or call x-3456 option 2.

Care Transformation Caregivers: ED Clinical Informatics Team

Log into a computer like you usually do, and then make sure FirstNet, the ED portion of iCentra, knows you're acting as an ED provider. Make sure your role is set to "Physician - Emergency" (or APC equivalent). That way you see the LaunchPoint board, a highly organized and informative view of all ED patients. Sign up for a patient so that your initials show on the LaunchPoint board, and see a nice summary of their info before going to see them.

Place lab/med/radiology orders, if needed, using a very specialized adult or pediatric Quick Order MPage. Results will be visible on LaunchPoint without needing to enter a patient's chart.

Send patient home, or admit them. If discharging patient, use one of the Quick Visits on the Disposition Workflow page to make this easier and quicker.

Log on to any computer and click the iCentra icon. Click the red "FirstNet Dragon DMO" icon (NOT the blue PowerChart one)

FirstNet opens, the part of iCentra customized for ED use. Ideally, you see LaunchPoint, the ED patient tracking view. If not, go to My Experience, and choose the Physician - Emergency role:

On the right side of the page, choose Launchpoint as My Default Organizer View

If you exit the program and log back in again, you should have LaunchPoint as your default view.

See below for tutorial.

LaunchPoint, a.k.a, "The Board," is the best thing about FirstNet. It's a powerful search engine that is constantly looking into the charts of all ED patients and making information visible.

Left click on a patient's name, and you'll go to the left-most tab in a patient's chart. But right-clicking on anything in a patient's row is much more powerful - it opens a menu of options that lets you navigate to all the locations you'll need, with a single click. It's the reason ED staff use the dark gray menu less than most iCentra users.

When you log in, you'll see empty beds and won't see the waiting room. Change this setting by unchecking the Empty Beds and checking the WR header buttons:

A variety of alerts and background colors appear in the Room column, including Sepsis, Isolation, Out of Network, Critical Labs, COVID positivity or pending, High Utilizer, etc. A yellow box appears around the name of patients who have previously earned a Disruptive Behavior alert.

Vital signs are collapsed in the column with the heart:

See below for tutorial.

To the right of patient names in LaunchPoint are columns labelled MD (and APC, in some EDs) where you sign up for patients.

Click in that patient's row to assign yourself as their provider, and a sign in box opens:

If it's your first patient of the day, click the blue "check in" text to open the "Provider Checkin" box. This lets you 1) enter your name (if it isn't listed, hit the magnifying glass to find it), 2) pick your Display Name (1 to 3 initials), 3) set your Provider Role (choose ED Provider or ED Midlevel), 4) set your Default Relation (choose ED Physician), and 5) pick the color of the box your initials will appear in. Thankfully, after doing this you will not have to repeat the process; iCentra remembers the info.

Before seeing the patient, click near (but not on) the patient's name to open the LaunchPoint multi-pane "floating window" for that patient. The first pane (Patient Summary) shows you lots of info without having to enter the patient's chart, including allergies, isolation info, critical notes, any recent ED visits, triage information, vital signs, and medical and other histories:

See below for tutorial.

Go to the adult or pediatric ED Quick Order MPage by right clicking on the patient's name. Alternatively, you can go into the patient's chart by clicking on patient name on LaunchPoint, and choosing the ED Adult Orders or ED PED Orders page from the MPage tabs. The Quick Order MPage can look a bit dense at first, but it's a well-organized set of commonly used orders that will save you time, and most importantly, protect patients from dosing and other errors. Each colored tile contains folders of medication (blue), lab (teal), and imaging (gray) orders. The yellow frequent conditions tile groups all these types of orders by common condition. It is very rare that an ED doc has to type a new order into the New Order Entry search box. If you can't find what you are looking for by opening a few folders, ask another ED provider.

The pediatric page mirrors the adult one, but with different diseases in the frequent conditions tile and widespread weight-based dosing. Orders can also be placed from the LaunchPoint board, from the Order Favorites listed on the right side of each pane of each patient's floating window.

See below for tutorial.

The vast majority of results can be seen by clicking on these symbols in a patient's row on the right side of the LaunchPoint board:

This opens the patient's floating window, which you use to view results or actions: If you need to actually get into the patient's chart, clicking on the blue words in these info panes ("Labs" in the example) gets you there with one click.

See below for tutorial.

Right-click on the patient's name in LaunchPoint and choose the Disposition Workflow MPage. You need to add info to Disposition Diagnosis, Patient Education, Medications (if indicated), and Follow Up. Sliding these components into the order shown will help you march down the page in a logical order. More on Quick Visits later.

Discharge diagnoses can be added in the Disposition Diagnosis section of the Disposition Workflow page:

or by clicking on the reason for visit on the LaunchPoint board and typing it in there. Diagnoses are visible in the ED note, but cannot be added within it.

Based on the discharge diagnoses, patient education will be suggested and can be clicked on to add to the discharge handout

Prescriptions can be added during the next step. It is very rare for an ED provider to create a prescription from scratch. Commonly used adult and pediatric prescriptions are accessed by typing several letters of the drug name, adding a space, then typing ".er", this filters your results to the pre-built dosage and duration options used most frequently.

Not sure what to prescribe? Click the Adult or Pediatric folder icons to see common classes of meds by organ system. All pediatric prescriptions in the .er list or common folders are weight-based already. Your prescription options are added to the shopping cart and you will be asked to sign them when printing the discharge handout. The use of iCentra's E-prescribe capabilities is not common in the ED, although you can use this if you desire. And medication reconciliation is not done in the ED.

You have to include some Follow-Up instructions; common ones are listed in the Quick Picks portion of the Follow Up section.

After filling in the above information, you can click ED Discharge Handout in the Create Note section toward the bottom of the left side menu to print out the patient discharge instruction packet. You will be prompted to sign prescriptions at this point as well. After printing this out, remember to right-click on the patient's name in LaunchPoint and order the discharge.

When sending a patient home, make sure there isn't a key symbol in the status column, which signifies that the patient has not been registered. If you can't remember this cryptic system, just sort the patients by length of stay - you'll notice the key disappears on the patients that have been there awhile.

See below for tutorial.

Quick Visits are diagnosis-specific streamlined workflows that will save you tons of time. Click on Emergency Medicine to see the 85 we have built for ED use, grouped by Adult/Peds, Illness vs Injury, or type in a common discharge diagnosis into the search box.

Each of Quick Visit contains a discharge diagnosis, discharge order, suggested meds (some checked, others not), patient education in English (checked) and Spanish (unchecked), a work/school release, and a Follow Up in [insert time interval] FollowUp sentence. Here's the new one for COVID:

Use Quick Visits them whenever possible. They also offer decision support, since the prescriptions included follow Intermountain CPMs and other clinical guidelines. If you don't use a Quick Visit, you must manually place the order to discharge by right clicking on their name in LaunchPoint and selecting Discharge Patient (or Transfer if transferring patient).

See below for tutorial.

Choose Admit by right clicking on the patient's name. Click on the chief complaint entered in triage and replace it with admitting diagnoses.

Write the admitting provider's name and admitting destination (Med/Surg, ICU) in the comments section of a patient row by clicking on the comments box and typing comments in the window that opens:

Choose the Transfer option for that disposition type, and add the details in the comments section, just like with admitted patients. Don't forget to fill out the paper EMTALA form (and have a doc-to-doc call) for those patients.

See below for tutorial.

Start a new note from the LaunchPoint board by clicking the blank note icon at the right side of the screen in the "Doc" column. This icon changes to show if a note has been partially done, or finished and signed.

You'll only use 2 note types, ED Note, and ED Supervision/Handoff Note (for when you assume care of a patient started by another provider), so you should favorite those:

When you start an ED note, much information is pulled in automatically. If you type two semicolons in any note field, you can see the long list of ED-specific macros for physical exam, medical decision making, procedures and discharges that have been created to speed documentation.

Before signing your note after a patient leaves the ED (so discharge information is pulled in), refresh it to make sure the most up to date info is added. Be careful refreshing the notes of admitted patients if time has elapsed since they left the ED - you don't want to pull results obtained upstairs into your note, that you weren't aware or when treating the patient (if this happens, say so in your note).

Clicking on the Patient Lookup tab (located above the VS column) shows you a different LaunchPoint board of only patients who have left the ED. This is really helpful if you didn't start a note before a patient left the ED, or if you want to see the status of all your charting during a shift, which appears in the left most columns.

See below for tutorial.

Please send questions or suggestions to Doug Nelson and/or Tamara Moores Todd.