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***If you have any IT issues that aren't resolved with information on this page, there are a few resources that you can seek out to help you find a solution.
1) Visit the Information Services & Solutions (ISS) website
at iss.mednet.ucla.edu. You can also visit the DGSOM IT website
at https://dgit.healthsciences.ucla.edu/pages/.
2) Visit IT Connect for in-person assistance!
Location: IT connect is located in the Center for Health
Sciences Building (CHS), in the area west of Cafe Med,
next to the vending machines.
Hours: M-Th (8a-5p), F (8a-3p), closed on holidays/weekends
Website: https://dgit.healthsciences.ucla.edu/pages/itconnect
3) Call ISS Customer Care at (310) 267 - 2273 (CARE) for IT
support 24 hours per day, 7 days per week
Virtual Private Network (VPN) allows for remote access to UCLA Health System information systems from the Internet. Authorized users with an active AD account can connect remotely to MedNet systems and applications. Once downloading a VPN, you can configure your home computers and mobile devices to access CareConnect.
Types of Access
1. Cisco AnyConnect VPN
2. SSL WebVPN Access
As an alternative to the Cisco client, MITS also offers web-based access via a Secure Socket Layer (SSL) WebVPN application. This browser-based VPN software lets you use your web browser to safely connect to Mednet restricted websites from within the browser.
The SSL WebVPN is supported on the following browsers:
Windows 7
Internet Explorer 8.x
Firefox 3.x
Google Chrome 6.0 and 7.0
Windows XP
Internet Explorer 6.x - 8.x Firefox 3.x
Google Chrome 6.0 and 7.0
Windows Vista
Internet Explorer 7.x and 8.x Firefox 3.x
Google Chrome 6.0 and 7.0
Apple: Mac OS X 10.4 - 10.6
Safari 3.x and 4.x
Firefox 3.x
Google Chrome 6.0 and 7.0
Linux
Firefox 3.x
3. Desktop/laptop access
4. Mobile access
Log-In/sign-up
1. Choosing context
Choosing your context can activate different features in the EMR that are helpful to you, depending on the department you're working in.
Below are two images of where you choose your context, either when signing in, or once already signed in:
Here is a list of contexts that you should choose for various services:
2. Signing up for patients
Nursing staff needs to know who intern or resident is covering each patient, so that they can page you with issues. You can do this easily and seemlessly in CareConnect, setting an end time so that you're not paged on your day off. If you aren't signed up for patients, nurses will have to come find you in the workroom or page another provider, which disrupts workflow. Please be diligent about signing up for your patients on a daily basis.
Patient Lists
Creating patient lists is the best way to organize the patients you follow when on different teams. You can also use them to display important information about each patient, including room number, MRN, expiring orders, allergies, etc. For some rotations, using the right categories can be a game-changer for efficiency.
Before you can add any patients to your lists, you must add some columns to a list:
Next, you either add individual patients or add a system list. System lists are ideal because they are typically updated with which patients are currently assigned to that team.
Here are some suggested System Lists (both Units and Primary Team sublists) for various rotations at UCLA and SM.
System Lists -> Primary Team - RR
Silver: Pediatrics - Hospitalists
Gold: Pediatrics - Cardiology + Pediatrics - Nephrology
GI: Pediatrics - Gastroenterology
Heme/Onc: Pediatrics - Hematology/Oncology
Neuro: Pediatrics - Neurology
System Lists -> Units - RR
PICU: 5PICU/PCTU
NICU: 5NICU + 5NOF
Nursery: 5NSY
Delivery room: 5DR
System Lists -> Units - SM OR Primary Team - SM
SMW: 6NW or Pediatrics - Hospitalist
NICU: 2NICI +/- 2NSY
Now, here are some example lists that are useful for some specific rotations.
As the Santa Monica ward senior, knowing if discharge orders are done is useful:
When on call in the NICU, you can see if there are any pending deliveries
Note Writing
Documentation is an incredibly important aspect of being a resident physician. You will spend a large portion of your day completing documentation, including H&Ps, progress notes, transfer notes, and discharge summaries.
The goal should be to complete your documentation in a timely manner, while still making sure that the notes are thorough, accurate, and readable. Here are some tips to do this:
1) Complete your notes during the day, rather than waiting until after signout or after you go home (this is important for your well-being).
2) Daily progress notes are just that: DAILY progress notes, so be careful about copy forwarding! You don't need to include everything that has happened in the past week in a progress note. The notes become unreadable and, in many cases, inaccurate.
3) Use the recommended Note templates for our department. They are dotphrases that have already been shared with you and added to your library under EPIC -> "My SmartPhrases"
History & Physical: .PEDSRESHP
D/C summary: .PEDSRESDC
Progress note: .PEDSRESPN
Transfer summary: .PEDSRESTRANSFER
Transfer accept: .PEDSRESTRANSFERACCEPT
Admissions
It is essential to know how to complete the Admission Navigator. While admission orders can be put in individually, the medication reconciliation must be performed through the navigator. This step essentially requires you to review the patient's home medications, and either hold or order these for the admission. If you do not complete the medication reconciliation, the admission will not be complete and you will be contacted by the bedside nurse, charge nurse and/or pharmacist.
Transfers/Periop
Transfers are similar to admissions in that you should complete the Navigator to ensure a smooth transfer. Anytime your patient comes from another unit (such as the PICU, OR, PACU, or MPU), you will most likely need to complete either the Transfer Navigator or Periop Navigator. Again, the medication reconciliation must be performed through the navigator to complete the MAR Hold. You will know if this is complete by looking at the right-hand bar: an orange bar means incomplete, whereas a green bar means the med rec is complete.
***Troubleshooting tip: If no matter what you try, you can't complete the med rec -> it may be a problem with discontinued medications that have been marked as "given" by the nurse, or orders that have not yet been marked as "given" or "not given". Make sure all orders have been completed by the nurse.
Discharges
Completing a discharge is very similar to completing admissions and transfers, in that it is best to follow the discharge navigator to optimize workflow and prevent errors. You must first complete the discharge medication reconciliation, followed by the discharge order set, to successfully discharge the patient.
Smartlinks
There are 2 new SmartLinks Reports now available in the Sidebar Report area: Common SmartLinks and Common Result Components. The reports show newly created SmartLinks, links to detailed tip sheets, and tips on how to use them to retrieve patient information to make documentation easier.
In the past, it was sometimes difficult to find the SmartLink that contained the information that you needed. The new SmartLinks follow a logical branching naming convention designed to help the clinician choose an appropriate SmartLink. There are new SmartLinks for Medications, Labs, Imaging, Problem List and Diagnosis.
If you do not see a tab for Common SmartLinks or Common Result Components, click on the double arrows in the tool bar of your Sidebar. The reports can also be added through the wrench.
Common SmartLinks sidebar report
The "Common SmartLinks" sidebar report lists some useful SmartLinks to make your documentation more efficient. At the top of the page are 2 comprehensive tipsheets that will explain SmartLinks more fully. At the bottom of the page, you will find additional tipsheets for specific areas, such as medications, labs, and imaging.
Common Result Components sidebar report
This sidebar report is useful for building your own SmartLinks, including SmartLinks for rare labs (i.e. Strongyloides Antibody) that do not have an established SmartLink. This sidebar report contains additional tipsheets, including a master file of the basenames for major lab results, which are required to create your own SmartLinks.
Taking Photos
How to take the photograph (and be HIPAA compliant)
1. Open Epic's HAIKU application on your Smartphone (See #4 in the VPN/Access section above)
2. Select the desired patient
3. Click on the patient's portrait or silhouette placeholder in the top left of the patient's chart
4. Select "Take Clinical Image" (it may ask you for permission to access the camera)
5. Take the photo
6. Give a description of the photo for other users to reference
How to view or add the photograph to the chart
1. Open the patient's chart in CareConnect
2. Go to Chart Review -> Media tab (Here, you can view the clinical image)
3. In a new or existing note, click the "add image" button that looks like a landscape
4. You may select any number of clinical images taken for the patient
PCC Continuity - RedDe Collaborative
In order to improve documentation for both patient safety and medical-legal purposes, we highly recommend the following workflow for lab results that come into your inbox:
1) If the lab result is abnormal and requires some sort of action (such as e-prescribing a medication or placing a referral) - open a telephone encounter so that you can document the diagnosis, your plan of action, and communication with the patient/family all at the same time.
2) If the lab result is normal or mildly abnormal but doesn't require action, please call the family and document as a "result note."
3) Notice below that there is a "route" option that allows you to route the note to the attending that you staffed it with- they should be on the lookout so that they know a result has been taken care of; otherwise after a length of time has passed they will be responsible for notifying the family and/or taking care of the result themselves.
4) Notice also on the bottom right hand side of the screen (blue star above) that if the patient has a parent who signed up as a proxy on myUCLAhealth, you can send them a note directly regarding the lab result at the same time.
5) If the result doesn't belong to you, or if you ordered the lab on someone else's behalf, please feel free to reassign to the appropriate physician.
We recognize that this can be an arduous process that adds more time to your daily work routine, and appreciate all your help with reaching our goal of >99% successful recognition and documentation on abnormal actionable labs. In the spirit of QI, we of course will take into consideration any comments or concerns you have after trying this out for the next few months, and will endeavor to adjust/study/act upon feedback in consecutive cycles to improve the workflow and make everyone's lives easier.
VTE Prophylaxis
VTE prophylaxis is a Core Measure of UCLA Health System policy, and therefore it must be ordered for all pediatric patients > 18 year of age. The entire VTE panel is part of all the admission order sets and the user has to open an order set to access and view the entire VTE panel. However, all the VTE mechanical orders and reasons/ contraindications are accessible and can be ordered separately from the Manage Orders activity, including for pediatric patients. In order to meet the VTE-1 Core Measure you must give the staff enough time to activate, give, or apply the prophylaxis within the time frame of before the end of the day, after the date the “Admission to Inpatient” order is written. We are currently developing a Peds VTE panel. In the meantime, we will continue to use the current VTE order set/panel until this is created. Please enter orders for both mechanical and pharmacologic prophylaxis.
Acceptable mechanial prophylaxis orders:
NUR855: Place and maintain SCD/ alternating leg pressure device (HIGH risk for VTE)
NUR890: Place and maintain anti-embolism stockings
COR112: LOW risk for VTE and mechanical ppx is not needed (i.e. patient is fully ambulatory or the expected discharge is prior to hospital day 2)
COR113: Reason for no mechanical VTE prophylaxis
Acceptable pharmacologic prophylaxis orders:
IP Order COR28: No pharmacologic VTE prophylaxis due to high risk of bleeding (i.e. thrombocytopenia or coagulopathy)
IP Order COR25: Other reason for no pharmacologic VTE prophylaxis
IP Order COR112: LOW risk for VTE and pharmacologic prophylaxis is not needed (i.e. patient is fully ambulatory or the expected discharge is prior to hospital day 2)
Blood Products
There are now easy-to-use order sets for blood products, complete with embedded dosing clarifications and quick orders for follow-up labs. The titles of the order sets are listed here, followed by detailed screenshots that identify the new features of these sets.
"BB Neonate Blood Transfusion (less than 4 months)"
"BB Pediatric Blood Transfusion (greater than 4 months, less than 32 kg)"
Order Preference lists
Order preference lists are an easy way to write groups of common orders, instead of writing each order individually. These are especially helpful on specialized services with common orders, such as GI, Heme/Onc, Neurology, etc. You can continually edit these lists and share them with your colleagues. Below are some PDF documents that explain in detail how to create, edit, and share these lists.
MEDICAL STUDENT ATTESTATIONS
Here are the latest tips for how to attest notes written by medical students. Last updated 07/23/20.
Forwarding Work phones
Since residents now have workphones, in addition to a service phone for some rotations, not to mention your personal phones, we figured it might be a lot to carry at once! Good news -- you have the option of forwarding your phone while on your shift. Please do not forget to stop forwarding once your shift is over.
Here is a handy guide on how to do this (assuming you are forwarding the service phone e.g. Silver Senior to your work iPhone). If you decide to use this feature, I'd love to hear how it's going and if you find it useful.
So the upper R button will activate "Options"
SET UP CALL FORWARD ALL ON PRIMARY LINE
Choose Options > CFwdAll, and enter a target phone number. The icon and the Call Forward All target number display on the screen. (For UCLA numbers, you need to enter "8+1+area code+phone number")
CANCEL CALL FORWARD ALL ON PRIMARY LINE
Choose Options > CFwdAll. The icon and Call Forward All target number clear from the display.
