3.0.20 Release Notes

January 2021

In release 3.0.20, we're proud to introduce the first phase of a new, unified design system that will improve usability without changing functionality. This release introduces a new look for all headers, tabs, and the patient banner within iKnowMed Generation 2. We've also introduced a number of smaller enhancements to improve existing functionality.

iKnowMed Generation 2 Enhanced Design

As a part of our ongoing effort to modernize iKnowMed Generation 2 across all platforms, this release introduces a new look for all headers, tabs, and the patient banner within the product, including:

New icons for normal messages and critical messages (see callout 1) in the navigation bar.
Rounded patient photos instead of square ones (see callout 2), and patients without a photo will display as a gray icon instead of pink or blue.
Icons for chart alerts now appear next to the patient's name in the banner (see callout 3).
New functionality in the patient banner, such as the ability to see Ht/Wt/BSA units based on your practice preference (see callout 4), new cone icons that allow users to view more information for that field (see callout 5), and a new colorblind-friendly approach to the Pain Scale based on the pain score documentation (see callout 6).
The footer at the bottom of each page has been removed and copyright information can now be viewed on the About page.

Capture Patient COVID-19 Vaccine Status and Bill for Administered COVID-19 Vaccines

Practices can now document a patient's COVID-19 vaccination status in the Clinical Profile, including the option to choose between the Pfizer or Moderna vaccine, where the patient received the vaccine, whether the patient is ineligible to receive the vaccine, or when they received the vaccine. iKnowMed Generation 2

To document a patient's COVID-19 vaccination status:

Go to Clinical Profile > Health Maintenance.
Select ADD IMMUNIZATION (see callout 1).
Choose the vaccine brand (see callouts 2 and 3).
Fill out the Status Date as well as Comment and Date Received, if needed.

NOTE: The Health Maintenance section is used primarily to capture immunizations that were administered elsewhere. Practices will document the administration of vaccines given in the clinic in the nursing MAR.

COVID-19 Vaccine Administration Codes

A new system for administration codes has been put into place for the COVID-19 vaccines. iKnowMed Generation 2 now has logic to determine the first dose and second dose admin codes based on Health Maintenance records and immunization administration within the EHR.

The COVID-19 vaccines come in two doses. The same medication is used for the first dose and the second dose, but the administration codes for the first and the second dose are different.

In this release, we will support the admin codes for Pfizer and Moderna. When the AstraZeneca brand and any subsequent brands of vaccine are approved by the FDA, we will add those administration codes as well.

Below is a table demonstrating the billing codes for Pfizer and Moderna:

Brand	Dose	Medication Code	First Dose Admin Code	Second Dose Admin Code
Pfizer-BioNTech	30 mcg/0.3mL	91300	0001A	0002A
Moderna	100 mcg/0.5mL	91301	0011A	0012A

When administering COVID-19 vaccines, you will notice on the charge capture report that each brand of vaccine has a different administration code and that the first dose and the second dose have different administration codes. iKnowMed Generation 2 determines which code to use based on the following situations:

First Dose Admin Code

Patient has never received the vaccine: the patient does not have a health maintenance record for a COVID-19 vaccine, and they are receiving the COVID-19 vaccine from a practice or location using iKnowMed Generation 2 for the first time in the last 90 days.
Patient has received the vaccine, but it was too far in the past to be considered a second dose: the patient has a health maintenance record for the COVID-19 vaccine, but the date of the vaccine is over 90 days in the past.

Second Dose Admin Code

Patient received their first dose from a practice using iKnowMed Generation 2: the patient does not have a Health Maintenance record for a COVID-19 vaccine, and they are receiving the COVID-19 vaccine from a practice using iKnowMed Generation 2 for the second time in the last 90 days.
Patient received their first dose somewhere else and it has been documented in Health Maintenance: the patient has a health maintenance record for the COVID-19 vaccine, and they are receiving the COVID-19 vaccine from a practice using iKnowMed Generation 2for the first time in the last 90 days.

Mark APP Clinical note as Reviewed by Physician

Some states require that a certain percentage of APP visits be reviewed by physicians and that this tracking is traceable within the EHR. To support this requirement, iKnowMed Generation 2 has added a checkbox in the Note Reviewer selection pop-up to allow APPs to designate they have consulted with a physician for the visit.

For an APP to designate they have consulted with the physician: do the following:

While editing the note in the Documents tab, check the Note Reviewer box or click on the physician name if one is already listed (see callout 1).
In the Clinical Note Review window, select the Needs Review option (see callout 2).
In the Reviewer box, enter the name of the physician to review your note (see callout 3) if a physician is not already selected.
Check the box next to I have consulted with a physician regarding this patient’s care (see callout 4).
SAVE your changes.

Document Patient Smokeless Tobacco and/or Vaping Status

Practices can how document a patient's smokeless and/or vaping-related tobacco use by following these steps:

Go to Clinical Profile > Health Maintenance or use the Smoking Status widget on the Chart Summary.
Select the ADD SMOKING STATUS button.
Choose an option under the Smoking Tobacco section as this is required (see callout 1).
Scroll to the new Smokeless Tobacco and/or Vaping section to document the patient's smoking history (see callouts 2 and 3).
SAVE your changes.

Please note that while these updates have been made to the Health Maintenance page and Smoking Status widget, the macros associated with smoking status in clinical notes templates are not. Those updates will be addressed in a future release.

Admix Queue Includes Drugs with Other Administration Routes

The Worklist Queues > Admix page will now include orders to be administered by intra-catheter, Inhalation, Topical, Feeding Tube, G-Tube, J-Tube, Rectal, and Intra-pyelocalyceally (see callout 1). This gives pharmacists, technicians, and/or nurses a place to provide instructions on how these treatments will be prepared as well as allow them to generate a label for the drugs.

Insurance Updates Require Regimen Reapproval

Prior to this release, when a change to a patient's insurance came through the interface, the Demographics page in iKnowMed Generation 2 reflected the updated information, but the insurance status of the patient's regimen in the Flowsheet and Ins. Auth/Fin. Counseling queue did not always reflect the update. In these cases, the areas continued to show the regimen as insurance approved.

Now, when a patient changes insurance carrier or their current plan expires, the Flowsheet will indicate which regimen days require a new insurance authorization. The Ins. Auth/Fin. Counseling queue will also mark those regimens with a Not obtained status.

Insurance Label Consistently Displays for Orders Requiring Approval

Prior to this release, the orange Insurance label on the Admix and MAR pages only appeared on the row when a new drug was added to the regimen. This could have caused confusion, resulting in a user potentially missing the approval status of a drug and taking an inappropriate action.

Now, the Insurance label will display consistently for all drugs that require insurance approval. This will also include regimen drug orders, individual drug orders added to a regimen, or drug orders outside of a regimen that require insurance authorization.

Verify Insurance Status for Migrated Regimens

In the cycle day window of the Flowsheet, regimens migrated from iKnowMed^SM EHR have been displaying in iKnowMed Generation 2 with the Business Office Approval status of Not Needed, regardless of their insurance status in iKnowMed^SM EHR. This wording was a label and the Not Needed is now replaced with Needs Review.

In addition, a new Migrated Regimen field will be visible in the cycle day window on the Flowsheet (see callout 1).

This field will alert users that they must verify the patient's insurance approval status and will remain in the cycle day window until the patient's regimen is processed through Worklist Queues > Ins. Auth/Fin. Counseling. Please note this applies to all past and future migrated regimens.

Only Group Message Assignee Sees Item in To Do List

When a group message was designated as Request follow up on this message, all members of the group saw the message in their To Do under My Tasks. Even after a user was assigned or accepted responsibility for the message, the message remained visible in all group members' To Do lists.

This issue is now fixed, and once a message is assigned to a user, it will disappear from all others' To Do lists, except for the assignee's.

When the assignee marks that task as complete, depending on their settings to show or not show completed items, it will be removed from their To Do list. The same applies to archived items as well.

Medication Dose Displays Properly on Double-Check

Prior to this release, the display on the double-check did not contain the dose in the bag. This means it did not indicate when the dose in the bag differed from the dose ordered. For example, medication orders split into two bags were displaying as two full orders on the double-check instead of as two orders with the doses halved.

This is now fixed, and users can view the dose ordered as well as the dose in the bag as part of a safety check when doing a double-check.

Attach and Display Lab Results with Attach Documents Permissions

A constraint has been removed that required a user to have Full permissions for both Worklist Queues > Attach Documents and Patient Chart > Results before they could attach labs and have the document display on a patient's Results page. Now, users can complete this task by having just Full permissions to Attach Documents. They are no longer required to also have Full permissions to Results.

Protein Electrophoresis Labs Display in Clinical Notes

It was reported by several practices that the macros #RecentLabResultsTable and #LabSection were not displaying results for Electrophoresis, Protein labs, even when selected from the Flowsheet Category drop down. This is now fixed and Electrophoresis, Protein lab results will display in clinical notes when using these macros.

Generate and Download CCDA Batch for All Patients and All Visits

Prior to this release, practices reported that they were receiving a Failed status when running a CCDA Batch on All Patients and All Visits. This is now fixed, and users can generate and download a CCDA Batch for All Patients and All Visits without issue.

Ability to Discontinue Vaccine Orders

Prior to this release, an erroneous drug-drug interaction alert sometimes appeared in patient charts as the system was including drugs part of a regimen template, but not ultimately saved to the chart in drug-drug interaction checking. This is now fixed, and users will only receive drug-drug interaction alerts for drugs saved to the patient’s chart.

Vital Signs Display Based on Record Date

A patient's vital signs (height, weight, and BSA) will now display on the Flowsheet and SCHEDULED ORDERS report with their recorded date instead of the current date.

Charge Capture Report to Display Correct J Codes

Prior to this release, certain medications that have both J codes and C codes were displaying in the Charge Capture Report with the C code instead of the correct J code. This is now fixed, and you can refresh the Charge Capture Report to have the C code charge removed and replaced with the correct J code for the medication.

EXAMPLE: If your Charge Capture Report shows Daratumumab-Hyaluronidase (Darzalex Faspro) with C9062, refreshing the report will update the charge to reflect J9999 for dates of service in 2020 or J9144 for dates of service in 2021.

EXAMPLE: If your Charge Capture Report shows Sacituzumab Govitecan-hziy with C9066, refreshing the report will update the charge to reflect J9999 for dates of service in 2020 or J9317 for dates of service in 2021.

Audit History Fix on Documents Page

Several practices reported that after accessing a document's AUDIT HISTORY for one patient, the feature would not work for other patients. This is now fixed, and the AUDIT HISTORY will work for all patients' documents.

Patient Transaction Audit Fix

Prior to this release, practices were unable to VIEW the changes made to items in the Patient Transaction Audit. This is now fixed, and the VIEW button will display the window detailing the changes made.

Sign Orders Queue Fix

An issue has been corrected so that electronic prescriptions are not sent back to the Sign Orders queue when the eRx status is updated.