3.0.24 Release Notes

September 2021

In iKnowMed Generation 2 version 3.0.24, we introduce updates around Health Maintenance, Demographics, Chart Alerts, and a number of fixes improving the overall user experience.

Can Add Chaperone To Visit

Practices can now add a chaperone note to a patient’s chart when one was present during an exam, as requested. To add chaperone information:

Go to a patient’s Clinical Profile and select the Health Maintenance page.
Under Counseling & Education, click the ADD PATIENT SERVICE button.
In the modal window, users can add the Date of the exam and any other information, such as the name of the chaperone, in the Notes box (see image below).

Any chaperone information saved in this window will appear on under the Counseling & Education section, as well as on the clinical profile report.

APP Supervisor Selection

Some states in US require APPs to include a supervising physician on prescriptions. The system has been enhanced to allow an APP to designate a specific physician, who must be eRx registered and EPCS registered, for controlled drugs. APPs requiring a supervising physician are designated by the checkbox for Use Supervising Physician for prescribing (defaults to patient attending) in the user’s profile (see callout 1).

In the search box for Supervisor, enter enough characters to find the correct physician and SAVE your selection (see callout 2).

Now when entering a prescription, the chosen physician is displayed as the Supervisor (see callout 3). If no physician is chosen, the patient’s attending is displayed as the supervisor.

If there is more than one attending, or if the chosen physician is displayed, a different attending can be chosen as supervisor from the dropdown. Selecting Other (see callout 4) opens a search box to choose a different supervisor (eRx and EPCS registered).

Similarly, when responding to Renewal Requests in the eRx Message Queue, approving a renewal requires the selection of a supervising physician (see callout 5).

When a non-prescriber is writing a prescription on behalf of an APP, the supervisor defaults in the same way and is required to be used, or an alternative chosen.

Chart Alert to Block Auto-Release Results for At-Risk Patients

This chart alert will hold results from the patient portal, after the upcoming auto-release feature is implemented. Once the auto-release feature is implemented, patients without this chart alert will have their results released automatically to the patient portal.

Practices and providers should determine their policies for exempting a patient and adding this chart alert. Whenever the chart alert is added to the patient, details should be added to document the reason for the patient's exemption from the 21st Century Cures Act.

Currently, this chart alert does not affect the release of lab results. We have released this chart alert prior to the auto-release feature to allow practices time to determine which patients, if any, should be exempt from the upcoming auto-release feature.

To add this chart alert to a patient:

Go to the patient’s Clinical Profile and click on the Chart Alerts tab.
Click on the ADD ALERT button.
Under the Alert Type, select the new Do not release results until reviewed alert (see callout 1).
The options, Display icon for this alert and Display on dashboard Visit List, will automatically be checked (see callouts 2 and 3).
SAVE your changes.
The icon for this alert will appear as a rectangle with a padlock on the patient’s chart and the visit list (see callout 4).

COVID-19 Third Dose Admin Code

iKnowMed Generation 2 will now support third dose administration billing for both the Pfizer and Moderna COVID-19 vaccines.

The workflow for documenting vaccines has not changed. On-site vaccines are tracked in the MAR, and off-site administrations are tracked in Clinical Profile > Health Maintenance.

The system infers which shot the patient is receiving based on the brand, the number of vaccines given, and any Health Maintenance records for a COVID-19 vaccine marked as given Elsewhere.

The logic for determining the First Shot, Second Shot, and Third Shot is listed below. The administration codes which will be produced by Charge Capture are also listed for each shot and brand.

First Shot

Patient is receiving the COVID-19 vaccine for the first time in their medical record, and there is no entry in their Health Maintenance record to show that the patient has received a shot Elsewhere.

Second Shot

Patient is receiving the COVID-19 vaccine medication for the second time in MAR.

Patient is receiving the COVID-19 vaccine medication in the MAR, and there is an entry in their Health Maintenance record with comment Elsewhere to show that the patient has received their first shot off-site.

Third Shot

Patient is receiving the COVID-19 vaccine medication for the third time in the MAR.

Patient is receiving their second COVID-19 vaccine medication in the MAR, and the patient has one entry in their Health Maintenance record with comment Elsewhere to show that the patient has received one shot off-site.

Patient is receiving the COVID-19 vaccine medication in the MAR, and the patient has two entries in their Health Maintenance record with comment Elsewhere to show that the patient has previously received two shots off-site.

	Pfizer Admin Code	Moderna Admin Code
First Shot	0001A	0011A
Second Shot	0002A	0012A
Third Shot	0003A	0013A

Preserve Hospice Data for VBC

Several practices requested the ability to see patients’ hospice status in their chart, even after death. Now, the patient’s Demographics page will show the progression as the patient’s status goes from hospice (with date and notes) to deceased (with date, notes, and other details) as shown in the image below.

Perform Date on All Orders in Orders Queue

Prior to this release, the projected Perform Date only appeared for lab orders in the Orders Queue. Now, the projected Perform Date shows for all orders, except medication and regimens, and corresponds with the date of the order in the Flowsheet (see callout 1).

Just as with lab orders, the Perform Date for orders with super fuzzy order dates, such as Next Available, will be highlighted in yellow (see callout 2). Having access to this information in the worklist may improve the efficiency for those working the queue.

Restore Chronological Order of Trended Labs from G1 to G2

Patient charts converted from iKnowMed EHR to iKnowMed Generation 2 were not showing dates in the proper order for labs, results, and vital signs in the Audit History. This is now fixed, and the Audit History will display items in reverse date order as expected.

Authorization Queue Improvements

The logic in the Ins. Auth/Fin. Counseling queue has been enhanced to respond more appropriately to interface updates to a patient’s insurance, such as the addition of a new policy or removal or change to an existing policy.

We realize that the logic used in this area is complex and is further complicated by the fact that for a given patient, multiple insurers might be valid at the same time, and that the insurer(s) may change in the middle of a regimen.

The goal of this revised functionality, as shown below, is to archive/invalidate prior insurance approvals more appropriately. We plan to continue to refine the rules and logic used as we learn more about the most common use cases.

NOTE: The diagram below does not cover all scenarios.

In this release, the following general principals were applied:

Changes to existing insurance (the insurance matches on patient name, insurance ID, and policy number):
1. If the update sent does not include an expiration date, the system will not archive prior approvals.
2. If the update sent includes a future expiration date, the system will archive prior approvals where the treatment date is after the updated insurance expiration date.
3. If the update sent includes a past expiration date:
  1. The system will archive prior approvals where the treatment date is in the future and after the updated insurance expiration date.
  2. The system will not archive prior approvals where the treatment date is in the past.
New insurance added (insurance does not match existing insurance):
1. If the new insurance sent does not include an expiration date, the system will archive prior approvals from the effective date of the new insurance forward.
2. If the new insurance sent has an expiration date that is today or in the future, the system will archive prior approvals where the treatment date is in the future.
3. If the new insurance sent has a past expiration date (this a retroactive update):
  1. The system will not archive prior approvals where the treatment date is in the past.
  2. The system will not inactivate the existing insurance that has an effective date beyond the expiration date of the retroactive update sent. The system will not archive prior approvals from the past or future. If there is ambiguity due to overlapping or unspecified effective or expiration dates on the existing insurance, the system will archive the approvals from the date that the interface update message was sent forward. The prior insurance will however remain active and thus available for use.

Framework in Preparation for Carequality Integration

Progress continues to be made as we prepare for implementing Carequality.

With the 3.0.24 release, users may see a new Carequality section in Practice Preferences explaining the purpose of Carequality and noting whether enrollment has been setup for your practice and patients (see image below).

Please note that these Carequality preferences cannot be changed by your practice at this time. This is a work-in-progress, and communication will be sent when the functionality is available for general use.

Set Practice Limit on Open Charts

Practices can now limit the number of charts users are permitted have open at one time to reduce the risk of entering orders or documentation into the wrong chart.

To set this limit at the practice level:

Go to Admin > Practice Preferences.
Under the Field Defaults section, set the Max Allowed Open Charts option to the desired limit (see callout 1).
SAVE your changes.

Unified Sign Queue Auto-checks Orders

Prior to this release, signing long patient orders in the Unified Sign Queue required users to scroll to the very end of the order before items were marked as reviewed. Now, these longer orders will be auto checked as they are being reviewed by users scrolling through the orders, making it easier to sign and submit.

View Demographics Permission Change

The 3.0.24 release includes security updates to help protect practices and patients, including increased security around user permissions. Users will now need Demographics permissions (view or full) to access patient information.

If your permissions reflect any of the examples below, and you are unable to access patient information as expected, please contact your practice administrator to have your permissions updated:

Users with Clinical Profile permissions now need Demographics permissions (view or full) to continue accessing patient charts.
Users with New Patient permissions now need Demographics permissions (view or full) to preserve their ability to create new patient charts.
Users with the Patient Search dashboard widget now need Demographics permissions (view or full) to continue using the widget to search for patients.

Admixture Carry Forward by Roles

When an admixture is saved and the user selects the option to apply the admix plan to future days, the information for Pharmacist, Pharmacy, and Mixed By now carries forward to the future days.

Fixed False Patient Matching Error Message in the Message Center

Prior to this release, users viewing their Sent messages in Message Center > External Messages would see a false Not yet matched error message next to the patient's name. This is now fixed, and users will no longer see this error.

Fixed Message Center to Only Display Active Patient Charts

An issue that allowed both active and merged patient charts to be visible in the Message Center has been corrected. Users will now only see the active chart when working in the Message Center.

Fixed Treatment Plans to Prevent Notes from Clearing in Unfinished Chart

Some users reported that Treatment Plans created through Decision Tools were causing the Notes column in Unfinished Charting to clear without an electronically signed clinical note being present. This is now fixed, and Treatment Plans created by the resource for the appointment will no longer count as completed notes in Unfinished Charting.

Fixed Incorrect Date Order in Audit History for Converted Charts

Fixed Clinical Note Template Permissions

We fixed an issue in the system did not always acknowledge users’ Manage > Clinical Note Template permission when working on patient notes. Now, users without Manage > Clinical Note Template permission will no longer see the SAVE AS A NEW TEMPLATE option as expected, keeping your note templates organized and secure.

Fixed Scheduler to Allow the Setup of Ad Hoc Appointments

An issue preventing some iKnowMed Generation 2 Scheduler users from scheduling appointments by selecting a day and time from the patient chart has now been corrected.

Fixed Incorrect Application of Z51.11 and Z51.12 to E/M Charges

Prior to this release, when E/M charges were added to the same charge capture report as chemo charges, diagnosis codes Z51.11 or Z51.12 were automatically applied to both the E/M and infusion charges. This issue is now resolved, and the Z codes will only be applied to chemotherapy and immunotherapy charges.

Fixed Incorrect Billing Units on some Infusion Charges

Prior to this release, some time-based infusion charges were incorrectly rounded up, causing the charge capture report to reflect an extra billing unit. This issue is now resolved.

Fixed Dispense and Waste Mismatch

Prior to this release, some charge capture reports contained the correct Dispensed and Wasted (D/W) amounts, but when the charges were sent to the practice management system, the D/W amounts no longer matched the charge capture report. This issue is now resolved.

Removed Blank from Patient Status Drop Down

Prior to this release, there was a blank in the Patient Status column of Demographics. When selected, this would cause a chart to be marked as Merged in the background. This has been fixed, and the blank is no longer present in the drop down.