Accuro EMR 2013.07 Release Notes


Accuro®EMR is the most recent version of Accuro available. The reason for no version number is because Optimed is going to a more regular release schedule to avoid large annual releases. Optimed is now offering regular product releases to all customers. To get the latest release, run your “Update Accuro” at your convenience. Note that once you update one of your computers, all of your computers will need the update run so please coordinate with your clinic. Administrators can lock down updates.

The release notes below are dated. When you apply the update, you will receive all changes since your last update. To find the last date you updated, login to Accuro and click Help > About > Details.

Accuro Release Notes Index by Iteration

Features

Framingham Risk Calculator Changes

The 2012 Canadian Cardiovascular Society standard Framingham Risk Calculator has been adopted as the new default in Accuro. This calculator is called “CVD Risk”. A descriptions “Estimation of 10 year Cardiovascular Disease Risk” has been added and also the reference “Anderson et al. CCS Dyslipidemia Guidelines Update 2012”.

The existing POSP Calculator has been labeled “HCHD Risk”. A descriptions “Estimation of 10 year risk of nonfatal myocardial infarction or coronary death” has been added and also the reference “Genest et al. 2009 Canadian cholesterol guidelines”.
 
The existing Standard Calculator has been labeled “CHD Risk”. A descriptions “Estimation of 10 year Coronary Heart Disease Risk” has been added.

To access the Framingham Risk Calculator click Tools > select Framingham Risk Calculator.> click the Gear button to select an alternative calculator.

Note: Changing the calculator in your version of Accuro switches the calculator for all users.

Faxing From an Open Form

The option to fax from an open form has been added to Accuro (previously users had to save and close the form). To fax an open form click the Fax button in the form (this is next to the print button).

Default Status Bar Label

Users can now select a default label, for the Status bar label. Users can click the Status bar at the bottom of their Accuro window and a window is displayed allowing a patient demographics label to be printed quickly and easily. A new User Preference has been added for this purpose. To access the User Preference click File > select User Preferences > click Labels > click the Status Bar Label droplist and select from the list displayed.

Claim Details and Prescription Windows

An update has been made to the format of these windows so that users can access and edit other windows when these windows are open. Previously these windows would have to be closed before users could edit a different window in Accuro.

Edit Lab Results

Lab results can now be edited from the menu at the top of Accuro without having to search through individual labs in the EMR to locate the appropriate lab. To edit the lab results click Configuration > select Lab Results > type in the name of the test and click Search > select in the list displayed, click Edit > update the result as required and click OK.

Manual Lab Entries

The labs area of the Encounter Notes tab has been enhanced to make it more intuitive and user-friendly. When adding or editing tests the window displayed is clearer to use and easier to complete.

Maintenance and Issue Fixes

Billing:

Aged A/R Subledger Report (ON)

A new Aged Accounts Receivable Subledger report has been added. This report is organized by aging columns for days outstanding from the date that was selected to report for. The days outstanding are grouped into 0-30, 31-60, 61-90, 91-120 and 121+ days. This report is based on submission dates and so billing period (whether enabled or not) have no effect. To access reports from anywhere in Accuro press Ctrl+R.

Default Billing Sub-Procedure Percentages

The Default Sub-Percentage menu option (under the Billing menu) has been updated to include the same percentage options that are available in the Claim window.

Default Claims Sorting

Whilst investigating another issue a developer found the default claims sorting (this is the sorting that is applied when no column headers are selected) was not working correctly. The results displayed appeared to be in random order. An update has been made to ensure that the claims are displayed in the correct order (by date of service, by start time and then by claim ID).

F4 (Quick Patient Appointments View) Menu

When users right-click on an item in the Quick Patient Appointments View window the options displayed have been updated to more closely resemble those available in the Claims area of Accuro.

Printed Statement Enhancements

Enhancements have been made to statements to make them better for clinics. These are as follows:

Searching for Procedure Codes in Manage Procedures (BC)

An update has been made so when users enter a procedure code after a user has started entering three characters, Accuro searches for applicable procedure codes.  To access Manage Procedures click Billing > select Options > click Manage Procedures.

Service Location Indicator and Master Number, Billing (ON)

An update has been made to enable users to set the Service Location Indicator and the Master Number fields.

Documents:

From Field in Documents

An update has been made so users can now edit the “From” field in a document. To edit this field select the EMR icon > click the Virtual Chart tab > right-click on the appropriate document and select Modify > click Document From.

Importing / Exporting Accdocs

Importing or exporting Accdocs is a long task that did not have any indication of how much longer it would take. A progress bar has been added to allow administrative users to see the progress of the import/export. To access Accdocs click Tools > select Admin Tools.

Negative Tiff Handling

Some Tiff images which were imported from other vendors were displaying inversely when viewed in Accuro. This was caused by the images photometric interpretation bit being interpreted backwards. An update has been made to adjust the image viewer to detect this scenario (when it occurs) and return the negative image to its correct format.

Encounter Notes:

Opening a New Encounter Note

If a new encounter note included a styled bookmark in the template the cursor was defaulting to the middle of the page when the note was opened. An update has been released to ensure that the cursor is now at the top left of the note when opened. To access encounter notes select the EMR icon > click the Encounter Notes tab > click the down-arrow in the Clinical Notes section.

Refractive Exam Window

The refractive eye exam window has been updated to follow current UI standards. A new field Prescription Comments has been added and is included on glasses prescriptions that are generated from the refractive exam. The consult letter window spacing has also been changed to meet UI standards (spacing and buttons have been updated). To access the Refractive Exam window select the EMR icon > click the Encounter Notes tab > click the down-arrow in the Clinical Notes section > select form the list displayed.

Saving Notes and Forms

Users were not prompted to save notes or forms if they manually exited Accuro, a session timed out, the screen was locked and users were switched. Accuro has been updated so that either the user is warned and given the option to save or the note/form is automatically saved depending upon the scenario:

To and From Dates in Lab Results Graphing

When graphing lab results in the Lab Results Graphing window. The tooltip and the cursor changing to a finger implied that the “to” and “From” dates should be able to be changed from this window, but they could not. An update has been made so that users can now edit these dates form within the Lab Results Graphing window. To access the Lab Results Graphing window select the EMR icon > click the Encounter Notes tab > the Lab Results Graphing button is located towards the bottom of the window to the right of the Labs section header.

External Communication:

Custom Lab Tests, Welch Allen Labs (ON)

If users use the shortcut (Ctrl+Alt+D) they can select from Physical history or Physical History (Child) in the window displayed. In this window users can add their own custom lab tests and set a default so that the default test is pre-selected each time.

The Lab Test Search window allows searches to be filtered. Add/Remove enables users to add or remove lab tests. When add or edit are selected a new window is opened so users can create or edit a custom lab test.

Note: Only for use with Custom Physical History Tests.

Faxing:

Fax Manager Count Notification

The fax manager count notification has been updated to also include any faxes that have a failed status (e.g. retries exceeded, failed etc.). The fax manager is located in the bottom-left of the Accuro window.

Saving Faxes

If two faxes were saved at exactly the same time by two different users in Accuro it was identified that this could cause an issue where (in theory) the contents of one fax could be sent to another provider. An update has been released to ensure that two faxes cannot be saved at exactly the same time, preventing the potential issue from arising. To access faxes click the Fax link in the bottom-left of the Accuro window.

Forms:

CDM Worksheet Changes (MB)

Mapping functionality has been expanded to include some built in components that are required for CDM Worksheets:
To access CDM Mappings click Configuration > select CDM Mappings.

Fields in Forms

It was possible in forms to add an “Age” constraint field without entering a value or a “Custom Field” with no value and then click Save and OK. No warning was given, but the formula did not save. An update has been made to ensure that constraint values are validated when adding a constraint and also saving the formula field. To access the form editor click Tools > select Form Editor.

Published Forms With Lab Components

When publishing forms with Lab components in them (e.g. query, text input, drop down etc.), are saved with only the Lab Test ID and Lab Result ID.  This works with the publisher's database, but the downloaders of the form did not have the same Lab Test ID and Lab Result ID for the corresponding lab test/result as the publisher. An update has been made to add additional code to ensure that these forms can be downloaded and saved by other users without the lab components creating any issues. To access the Form Editor click Tools > select Form Editor.

Rourke Forms, BORN Program (ON)

The Rourke forms are part of the BORN program in Ontario (Better Outcomes Registry and Networks) for Maternal-Child Primary Care EMR Integration. There are a series of forms that are completed at various stages of pregnancy and child development, these form the BORN program.

Rourke forms are a system that Canadian doctors and other healthcare professionals use for well-baby and well-child visits for infants and children from 1 week to 5 years of age. It includes forms (Guides I to V) for charting the well-baby visits as well as supporting resources for healthcare professionals. The appropriate form should be completed and attached to a child’s EMR. The form should only be added to a patient’s chart once for each visit completed at each stage.

The forms can be downloaded in the Form Editor by clicking Tools > select Form Editor > click the Publish/Download form (block of 8 buttons, second row, second from left). Search for “Rourke” to display all available forms.

New Features Available For Forms (Available for All Forms in All Provinces)

As a result of the introduction of the Rourke forms, the following features have been added to forms and are now available for all forms in all provinces. These are accessed in the form editor (Tools > Form Editor).

Tooltips:  Tooltips can be added to labels, queries and images. To add a tool tip right-click on the appropriate item and click Edit > click the Enable Popup checkbox > click the Edit button > type in the tooltip > click OK.

Triple State Checkboxes: Checkboxes can be added to a form with three states. To add a triple state checkbox:
  1. Right-click on the checkbox on the form and select Edit.
  2. Click the Tri-State checkbox towards the bottom right of the window. The tri state descriptions are now displayed below.
  3. Add descriptions for each of the three states.
  4. Click the State checkbox to display the state the checkbox will be in when the form is opened (you may need to click more than once to get the required state).
Reportable Forms: Forms can now be marked as reportable and fields within a form can be flagged as reportable. The form must be saved as reportable and all the appropriate elements in the form flagged as reportable prior to the form use. To make a form reportable click Tools > select Form Editor > open the form > click the Advanced button (at the bottom of the window to the left of the View button) > select Reportable Form. Once a form is marked as a reportable form individual items on the form can be selected and marked as reportable (right-click on a component on the form and select Edit > the Reportable checkbox is located at the right of the Tag Name field). For more information on Reportable Forms please refer to the Accuro User Guide.

Single Form Per Patient: A form can be configured so that it can only be attached to a patient’s EMR once. To make a single form per patient click Tools > select Form Editor > open the form > click the Advanced button (at the bottom of the window to the left of the View button) > select Singleton Form.

Labels:

Optional Label Printing Module

A new optional Label Printing module has been added to Accuro. If clinics require this module it has to be enabled by Optimed. Once the module is enabled to set up the Label Printing follow the procedure below:
  1. Click File and select User Preferences.
  2. Click the Label button (bottom-left of the User Preferences window).
  3. Click the Ellipses button (three dots) and select the default label printer. The printer paper types are loaded for the printer you selected (plus any custom ones that may have been created if this is not your first time in this module).
  4. Select the Paper from the droplist. (To create a paper type, see the procedure below this one.)
  5. Click the Orientation droplist and select from the list displayed. Some clients find that Reverse Landscape works best for some labels because of the margin settings.
  6. Click Apply and OK to save your settings.
Note: If you create new paper types they can be seen by all users but the actual paper selection and orientation are only set for the current user.


To Create a Paper Type:

  1. Click File and select User Preferences.
  2. Click the Manage button to the right of the Paper dropdown.
  3. Click the Add button.
  4. Type in a name for your paper.
  5. Specify the Height and Width, in inches.
  6. Type in the values for the margins.
  7. Click OK to create.
Printing a Label
  1. Click File and Select Labels.
  2. Select the appropriate label from the list displayed. The Accuro Print Label window is displayed. The image on the right is how the label will look when printed.
  3. Change the Printer, Paper or Orientation in this window if required. These changes are only for the label being printed and do not update User Preferences.
  4. Click the Gear icon if a new paper type needs creating. The Edit paper window is displayed. Create the paper type as detailed in the procedure above. If a paper is created here it will be available for all users.
  5. Click Print to print the label.

Labs:

Labs in the Virtual Chart

An update has been made so that when multiple physicians have labs with the same collection date for the same patient, they can now be separated by Physician in the virtual chart. A system setting has been added to allow users to enable this feature (Users > Manage Security > System Settings > click the General tab > select the Separate Labs in the Virtual Chart by Physician checkbox in the EMR - Encounter Notes section). Previously there was no way of viewing these labs by physician other than ungrouping them. To access the Virtual Chart select the EMR icon > click the Virtual Chart tab

Other:

Activity Log Entries Using Server Time Instead of Computer Time

This issue was identified when a developer investigating another issue found audit log entries that were in the future. An update has been made so when a user logs in the server time is compared to the local computer time. If the time difference is more than 15 minutes (accounting for time zones) then both times are displayed in a warning message.
The computer time (and/ or server time if required) can be changed by clicking the clock at the bottom-right of the computer (or server) window (NOT the Accuro window) > click change Date and Time Settings… > click Change Date and Time. If the time zone is incorrect click Change time zone (correct the time zone and then adjust the date and time if still required).

Note: These instructions may vary depending upon the operating system being used.

CMS 4.1 Update, HRM (ON)

An update has been made to CMS 4.1 to be able to support the binary report format.

Combo Boxes in Accuro

An update has been made to standardize the combo box style used across Accuro 

Default Version of Java

An update has been made to make Java 7 update 25 the default for Accuro and Java 1.7 the preferred Java version for Accuro Web.

Lab Activity Log

The Lab Activity Log did not match up with the time that the files appear in the file queue if a site's database is hosted on servers that are in a different time zone. This caused the time logged in the lab activity log and the time in the file queue to appear separated by a number of hours. An update has been made to ensure that the time is taken from the workstation to ensure the correct time zone is applied.

List Recalls

The list recalls option was not working if the patient had a recall procedure with a lower age set and no recall reminders. An update has been made to ensure that list recalls works work all valid recalls. To access list recalls click Tools > select List Recalls.

Patient Demographics:

Audit Logging / Web Service HCV (ON)

Audit Logging has been created for Ontario HCV Web Service Activity. This includes:

Save Message in Patient Demographics

A client reported that they were being asked to save in Patient Demographics even though they had made no changes. This was caused by the way that Accuro was checking for Patient providers and it was wrongly thinking the provider had changed when a user switched patients. An update has been made so users only see the save message when patient information has changed. To access patient demographics select the Patients icon > click the Demographics tab.

Performance:

Waitlist Requests

When loading requests in the waitlist the full patient record is no longer loaded for each recipient. The waitlist had been loading all patients’ full records and this was using valuable resources and taking time.

Physician:

Adding a New Provider

When a user added a new provider from within the provider search window an error was being generated in the log file. An update has been released to ensure that providers can be added without any errors occurring. To search for a provider press F2.

Prescriptions:

Compliance Package, Prescriptions

 The Print Compliance on the Instructions tab of the prescription writer has been changed from a checkbox to a dropdown. The options available are Blank, Required and Not Required (the default is Blank). If the Blank option is selected then nothing is written on the prescription. If Required or Not Required are selected then this is printed on the prescription. To access the Instructions tab select the EMR icon > click the Encounter Notes tab > in the Active Medications section click to select a medication > click the Instructions tab.

Print Prescription Substitution Information

The prescription window has been updated to have a dropdown for Substitutions (previously it was a checkbox). The default is the same as is selected in user preferences. As long as the blank option is not selected either Substitutions Allowed or Substitutions Not Allowed is printed on the prescription. To access substitutions in user preferences click File > select User Preferences > click Display > click EMR Workflow. To access Medications select the EMR icon > click the Medications tab.

Printing:

Default Printer When Printing Prescriptions (Mac Users Only)

When using a Mac the machine default printer was selected instead of the prescription default printer set in Accuro. An update has been made to ensure that the prescription default printer is always selected.

Reporting:

Billing Period Reports (MB, ON)

The Fee Code Revenue report has been renamed the Fee Code Revenue Summary report.

The Fee Code Adjustment report has been renamed the fee Code Adjustment Summary report.

A new report has been created: Fee Code Summary: The Fee Code Summary report adds in group number filtering (Ontario sites only) and count of fee codes for current periods only (removed YTD). This makes it a lot easier to filter procedures by group #/site/provider/insurer for more detailed analysis.

Billing Period Reports Without Billing Periods (MB, ON)

If a user tried to run a billing period report and billing periods had not been created nothing would happen (and an error was created in the log). An update has been made so that now a message is displayed informing the user that billing periods need to be created before any of the billing period reports can be run. To access reports from anywhere in Accuro press Ctrl+R.

Group Number Functionality on Remittance Summary Report (ON)

Group number functionality has been added to the Remittance Summary report. The change is step 6 allowing users to choose to group by “Provider” or “Group Number, Provider”. Step 7 then allows users to select which Group Numbers to include on the report. To access reports from anywhere in Accuro press Ctrl+R.

Group Numbers, Aged A/R Subledger Report (ON)

The Aged A/R Subledger report has been updated to add group number functionality. Users can now select to group by: Provider or Group Number, Provider. To access reports from anywhere in Accuro press Ctrl+R.

Group Numbers, HST Report (ON)

The HST report has been updated to add group number functionality. Users can now select to group by: Provider or Group Number, Provider. To access reports from anywhere in Accuro press Ctrl+R.

New Rules in Alerts (Query Builder)

To access Alerts (Query Builder) click Reports > select Alerts (Query Builder).<

Patient Appointment History Report

The Patient History Appointment report was truncating the action reason field for cancelled appointments. An update has been made to ensure that they report displays as expected and no fields are truncated. To access reports from anywhere in Accuro press Ctrl+R.

Remittance Summary Report (ON)

The Remittance Summary Report layout has been updated to ensure that the site list in step 5 no longer covers step 6 and part of step 7. To access reports from anywhere in Accuro press Ctrl+R.

Service Code Account Payments Report

The Service Code Accounts Payment report has been updated to allow users to select from private pay and provincial insurers (previously it was private pay only). Users can now also select which providers to run the report on. The service code accounts selection has been tidied up and will no longer allow service accounts to be moved to the included side more than once. A Group By step has been added that includes the options of Service Code Account and Provider, Service Code Account. If Provider, Service Code Account is selected, then the report results are grouped primarily by Provider. To access reports from anywhere in Accuro press Ctrl+R.

Scheduling:

Cut and Paste in Resource Scheduling

When cutting and pasting appointments to a resource with a different provider the appointment provider was not being updated if the provider of the new resource is different form the default provider of the previous resource. An update has been made so the provider is now updated when an appointment is cut and pasted between two different resources. To access resources select the Scheduler icon.

Find Next Appointment (Multiple Booking Slots)

When an appointment was booked in a column and a user selected “find next appointment” appointments for the same time slot but in different columns were not displayed as options. A new system setting (Default to off) has been added, when selected this will enable appointments in the same time slot but in different columns to be displayed. This feature will only work when the system setting is on and the user selects find next appointments for appointment slots with template suggestions. To access this feature in system settings click Users > select Manage Security > click System Settings > click the General tab > at the bottom of the General section is the checkbox “Find Next Appointment includes other booking columns when templates are in use."

Group Appointments in Alerts (Query Builder)

Following recent updates to group appointments functionality, queries in Alerts (Query Builder) has been updates to reflect the group appointments new functionality. Arrive Appointments Constraint can now work with group appointments (in a group appointment each patient can be Arrived individually). To access Alerts (Query Builder) click Reports > select Alerts (Query Builder).

Security:

Bills Created by Macros and Ad-hoc Macros, Audit Logs

Bills created and/or saved using macros and ad-hoc macros are now recorded in the audit logs. To access the audit logs click Users > select Manage Security > click Audit Logs.

Virtual Chart:

Virtual Chart Previewer

With a very specific workflow it was possible to save a chart item that was left open for a previous patient into the chart of the newly selected patient. An update has been made so that if a user changes patients and wants to keep the previous patient’s chart item open, the item that is open is now “detached” and cannot be saved to the new patient’s EMR. To access the Virtual Chart select the EMR icon > click the Virtual Chart tab > double-click a note to open in the viewer. This is a permanent solution to the hotfix that displayed a warning message when chart items were left open and the user was trying to change patients (released in 2013.05).

Waitlist:

Booking Status Linked to Dates

Changes have been made so that when an appointment is booked for a patient (who is on the waitlist) their status on the waitlist progresses and the dates are automatically filled for each appointment booked. Previously booking an appointment would prompt with all the waitlist requests for the patient where the booked date was not assigned and the request status was not booked, cancelled, completed or deceased. To access the waitlist click the Waitlist icon.

Waitlist Request Preferences

When an appointment was made in the scheduler and the patient had an outstanding waitlist request; the table in the Waitlist Request popup window was not remembering the preferences. An update has been made to ensure the table remembers and applies the preferences. To access the preferences in the Waitlist Request popup window select tlohe Scheduler > select the patient (they must have an outstanding waitlist request) > make an appointment > in the Waitlist window displayed click the Gear button > select the preferences > click OK.