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Phoenix Ortho

Preference for Lumbar Spine Exam Saving and Use

 

 

 

This article describes how to create and use a Body Part Exam Impression Preference. This document is meant to be used as a reference guide. Your project manager will discuss your practices specific needs during your training sessions.

Tips 

 

  1. Naming Options: To bring your saved Impression preferences to the top of the drop down list, put one space and your initials in front of your preference name. Your practice should adopt a Preference Naming convention for use by the Providers to maintain consistency.  
  2. Important: Have one single body part selected to use from the Home Dashboard prior to setting any preferences.
  3. Prior to saving Exam Impression Preferences:  Discuss with your provider if he/she would like the normal values on the opposite side populated, or to remain empty.  This will determine how you save the abnormal exams.  If the provider does not want the normal values saved with the preferences on the opposite side, do not drop in the body side Normal. Delete each field on the opposite side and save with empty values.
  4. Each Exam Impression Preference can be saved to Bilateral, Right and Left:  The Data Base stores each of these individually.  Going forward, you will be saving the Impression Preference as three separate sections. 
  5. When adding the Impression Preference Name to the Create Impression Box: Highlight Impression Preference Name in the Box and hold down the Ctrl button and click the letter C to copy to your clipboard.  This makes it easier to paste (holding down the Ctrl button and clicking the letter V) in the Create Preference Box later. This also insures accuracy.
  6. Some Exams will have the same tests:  Foot and Ankle Exams have the same tests, but when you start a visit with the Foot body part, you will have the title Foot Exam on your note.  You will create Normal Foot findings in the Foot Exam and a Normal Ankle findings in the Ankle Exam.

 

Exam Screen Overview 

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1 Save Icon

2 Prior Icon (If you have done this body part exam on this patient before you can pull over all the prior values)

Blue Check Mark Icon (This will be what you will select for Normal Findings to populate in this exam)

4 The drop down arrow has your right normal, left normal and set normal options

Clear All Icon (This will clear all values from exam)

Impression Drop Down (This will show all available impressions for the body part you are working with)

Impression Name (This is the box that shows the impression that you have chosen to populate for the selected patient)

8 Shows the body side you are seeing the patient for, or making the preference on

9 Where you will choose right, left or bilateral body sides

10 Preference Icon ( Lego Man)

11 Drop down that shows Add New, Delete and Map Preference options

12 Help (In Development) 

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When setting preferences or using your body part exam, please pay attention to the areas on the exam that have a value that comments on both body sides.  It will be populated by the last impression or normal value you put in.

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1  When a single arrow is present, you can only make one selection

2  When double arrows are present, you can populate with multiple values

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On the Active and Passive ROM tabs of your Lumbar Exam best Practice is to put these values in specifically per patient. If you do decide to set values in your preferences or normals, please make sure you check every tab when documenting your patient.

Please discuss this with your trainer or Project Manager.

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Set Default is a preset value which can be used to pre populate values on each ROM tab.

 

 

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Every Body Part exam has a Skin tab. If you click Abnormal in the drop down, a pop up screen will appear to document the condition of the skin.

 

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1  The comments tab on every exam can be used for free text documenting, or using dictation software (the character limit is 2500 characters).

2  Any screen that you see a microphone on can be used for Dictation.

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Setting Provider Normal Values 

Edit section

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Select the Blue Checkmark to populate the system Normal values: Bilateral. (Phoenix provides some system Exam and Normal findings to get you started with).  We are going to set your normal findings to make this Blue Checkmark YOUR Normal Lumbar Exam.

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1) Review and populate a normal value on all the tests you would perform on a regular basis. Notice some fields do not have a right and left values. This field crosses right and left to apply to all three options:  Bilateral, Right and Left. If you do not perform any of the test, leave the field blank and the it will not show up on your exam note.

2) Check every field, folder and tab.

3) Check all main tabs across the top of the Exam area.  

4) Screen shots above show every testing area, excluding the Active and Passive ROM tabs.

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1 Go to “Normal” at the top of the screen, and click the small drop down arrow beside it.

2 Select “Set Normal”.  

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You will be prompted “Set Provider Normal?”.  By selecting YES, you have set your normal Lumbar Exam values.

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To refresh and test what you have created, click on the x found at the upper right of the screen, which will exit close the Exam.

Select "No" to Save to patient.  When setting up preferences you do not want to save to the patient.  However, when using your preference on a live patient you would choose "Yes" to save.

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1) Please do a quality check on all of the normal values you have saved. To do so, click on the Blue Check Mark bilateral normal values, and review all fields, tabs and folders.  

2) Click the drop down to use a single body side normal

3) Right or Left values can also be populated independently. Pay attention to the Gait,Posture, Vasc Normal and Neuro Normal findings that populate the same for Bilateral, Right and Left Normal Values. 

Create a New Impression Preference 

 

Start with a Bilateral Impression Preference

Add the Normal values by clicking the Blue Check Mark Normal to populate bilateral normals.

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1 Set side to “bilateral”.

2 Populate the pertinent values for the left and right sides for the Impression Preference you want to save.  

2 Check all fields, folders and tabs. 

4 The recommended Best Practice is to add Range of Motion measurements for each patient and not save as an Impression Preference. You may discuss this with your Project Manager during training.

Custom Fields

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If there is any testing that you do that is not already listed, and would like to add it to the exam, it can be added to an impression in the Custom tab section. There is a 13 character limit in all naming areas.

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To add a new field, click on the small arrow to the right of Custom.  When clicked, you will get this pop up, click on OK

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Name your test in the white box and then click next.

 

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To add all the values you want displayed in the drop down list, type your finding and click Add. Example "Normal" "Positive" and "+1" 

 

 

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1 Select the Preference Icon Drop Down

2 Select Add New to create a New Impression Preference

3 Select Delete to remove an existing Impression Preference

4 Select Map to launch the Protocol Mapper to Map an Impression Preference (Protocol mapping will be explained at the end of this article)

Click Add New (# 2 above).

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1 Name the Impression Preference according to your clinic's Preference Naming convention. Most providers prefer to put a space and their initials at the beginning of the name to bring their preferences to the top of the alphabetical list.  

2 Click "Save"

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You will be asked if you wish to create the new preference, click Yes

To refresh, close the exam by clicking the at the top right corner (under your user name), and click no to save not save to the patient.

Click the Exam icon, and click on Exam

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1 Select Bilateral from the Side Drop Down option

2 Select the Impression Preference name you have created

No Values on the Opposite Side 

Edit section

Saving the Same Impression Preference Values to the Right Side

Use this procedure when the provider does not want any values saved to the opposite side.  Example:  The provider does not typically do an opposite side normal exam.  It is easy to populate the opposite side values by using the drop down by Normal to add the right or left normal. 

1 Select Bilateral from the drop down and Click on Right, so we can make a Right sided Lumbar Sciatica (our example) impression.

2 Remove all Left Side values (checking all folders and tabs)

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1 Click on the drop down arrow next to the Pref Icon ( lego man)

2 Click add new

3. Name the Pref exactly like the bilateral and add right.

 

Close the exam by clicking on the at the top right corner of the screen.

Say no to save changes as during Preference set up you have already saved it to the system, you would choose yes to save it to the patient. 

 

Saving the Same Impression Preference values to the Left Side

Use this procedure when the provider does not want any values saved to the opposite side.  Example:  The provider does not typically do an opposite side normal exam.  It is easy to populate the opposite side values by using the drop down by Normal to add the right or left normal.  Discuss the pros and cons with the provider.  

1 Select Bilateral from the drop down and drop in your preference ( LC Lumbar Sciatica example) then click left on the Preference side.

2 Remove all Right Side values, checking all folders and tabs

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1 Click on the drop down arrow next to the Pref Icon ( lego man)

2 Click add new

3. Name the Pref exactly like the bilateral and add left.

 

 Click the x at the upper right corner to exit out of the exam tab and say no to save changes.

Click “Yes” to save to the patient or “No” to not save changes to the patient (the preference is already saved). Save to patient does not save to the set Normal nor to the Impression Preference.  This saves the values you have entered to the practice patient.  In the event you did not actually save the Normal Values, this protects the values and saves you time from setting them a second time.  

Existing Impression Preferences Edit and Delete 

 

Open the Exam

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1 Select Body Side: bilateral

2 Select Impression Preference from the drop down menu.

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1 Change any values appropriately for this Preference and click on the Pref icon (lego man)  

2 Click Yes to save

You can then go back in and follow the same steps to change the preference you saved under Right and Left.

Delete an Existing Impression Preference 

 

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1 Select Side "Bilateral"

2 Click on Impression Drop Down arrow of the Impression you wish to delete

3 Select drop down arrow by Pref and click on Delete

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Select "Yes" to Delete the Impression Preference Bilateral from the Impression Drop Down

Repeat for Right and Left Individually to remove all 3 parts of the Impression Preference.  

Changing an Impression Preference Name 

Edit section

Always "clear all" on the Exam Screen before any Impression Preference building.

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1 Select Side: Bilateral

2 Select Impression Drop Down

3 Change values as desired

4 Click Add New from the drop down on Pref

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1  Rename 

2  Save  

Exam Mapping 

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Exam mapping is used to link together your Exam with any of the following Protocols: Diagnosis, HPI, Plan, Injection and Procedure. These maps are created after you have preferences in all areas that you are going to link with your  exam. Exam mapping is best to completed after training with your Project Manager.

Map is found in the drop down preference tab of every Body Part Exam

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When you click on Map, it will open up a page where you can create mappings for each Impression that you want to link to other protocols.

1 Lumbar injection is attached to an impression Lumbar Radiculopathy in the above example

2  Diagnosis

3 Injection

 

To create a New Map 

Edit section

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Step One: Your side will come in from the front screen, then select your impression from the dropdown.  Example " Right  kp Plantar Fasciitis"

Step Two: Click on Map in the drop down Pref.

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Step Three: 

1  A new "Impression Mapper" page will open

2  Name your new map by clicking on the pencil and then the green check mark. You will name the map according to what you have mapped.

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Step Four:  You now have a New Map area ready to be created.  

1 Add Protocols you want to map

2 Select your choice for this map

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1 Once you have added the protocols you want to map to this exam impression, they will show on your map. This example is Injection and Diagnosis.

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Step Five: Select your injection preference that has been previously made in your injection workflow tab.

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Step Six: Map your diagnosis (I am mapping my "Lumbar Radiculopathy" diagnosis).  You will need to type in an ICD10 code and select the one linked to the appropriate body part.

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Step Seven: Click on the save button at the upper right side of the screen until you see a green saving flash in the lower right corner. This is your visual indication that your new map has been saved.

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Step Eight: Go back to your Exam tab and your new map will be under the Impression that you saved it under and out to the right. You will notice your impression now has a fly out (arrow) beside it.  When you click on the "map" to populate it to the patient, you will see it in red in the impression box.  

 

Step Nine: When you choose the map it will turn red and everything you mapped will show in the History Tree except your Exam.

 

 

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