Changing EHRs?
McKesson EHR Conversion Services

Note must have an identifier unique to a patient and may include other patient information such as name DOB, SSN. Notes will be loaded to specific chart sections based on CATEGORY, if provided in the progress notes data records. Default Chart sections (which can be renamed) are Progress Notes, Past Medical history, Social History, Family History, Consults, Discharge Summary, X-Ray, EKG, Lab Microbiology, Lab Miscellaneous, Pathology, Special Studies. Additional User defined sections may be added. The provided progress notes data records must be free of special characters for RTF, HTML, etc…

Format of Progress Note File
*NEW RECORD**|Patient ID|Title|Date|Doctor Code
Text Line
Text Line
Text Line

Sample format of progress note file
NOTE: Please make sure that no titles are duplicated for a given patient and Date. The note will not load. **NEW RECORD**|111111|PROGRESS NOTE|02/06/2012|MY SMITH, MINNIE P
ACC: 2160
Chart: 2160
02/06/2008

PROGRESS REPORT
PHYSICIAN: Mary Young, M.D.
CHIEF COMPLAINT: None.

HISTORY OF PRESENT ILLNESS: Today the patient presents for routine clinic follow-up.

Overall the patient seems to be doing relatively well.

CURRENT MEDICATIONS: The patient did not bring a list of her medications with her.

ASSESSMENT AND PLAN:
1. Today I have had a long discussion with her. With this, I plan to see the patient again in two months.
2. Social. The patient continues to be followed by hospice.

Mary Young M.D
MY

Electronically Signed by: Mary Young, MD on Saturday, February 16, 2012

**NEW RECORD**|111111| CONSULTATION REQUEST|08/15/2012|MD

HISTORY: Minnie is a 50-year-old lady, who comes in today for evaluation of her left shoulder. The patient has recent weight loss in the past five months. She also has night sweats or chills, and she has constitutional symptoms.

PHYSICAL EXAMINATION: Her physical examination showed she did have pain over the entire shaft of the humerus. There did not appear to be any soft tissue mass in the shoulder, but she did have swelling about the shoulder.

PLAN: We are going to obtain an MRI

Mary Young M.D
MY

PAST MEDICAL HISTORY, SOCIAL HISTORY, FAMILY HISTORY

Patient ID|Date|Test Line

Sample of Past Medical History
11111|08/22/2003| Prostate Cancer.

Sample of Social History
111111|09/25/2003|Lifestyle married 3 children.

Sample of Family History
111111|08/22/2003|Diabetes father
111111|08/22/2003|Hypertension mother sister

Allergies will be loaded to McKesson's EHR if the following is included.
Patient ID|Date allergy was identified| allergy| reaction| type| severity
12345|01/15/06 | PREDNISONE | difficulty breathing | DA | Moderate

Length of the Allergy can only be 35 characters.
Length of the Reaction can only be 40 characters.

Different Values for type
DA – Drug Allergy
FA – Food Allergy
DI – Drug Intolerance
MA - Miscellaneous

Different Values for Severity
Mild
Severe
Moderate

Diagnosis codes can be loaded to McKesson's EHR, if all of the data fields are provided (or assumed constant) in any one of the following lines.

Length of the Diagnosis Name can only be 50 characters.
Length of the Note can only be 100 characters.

• Patient ID|Diagnosis name| date| note| diagnosis code
  12345|headache| 04/01/05| 215.2

• Patient ID|Diagnosis name| date| a free text note (maximum length 100 characters)| a numerical code| the condition's lifecycle status| the provider| the external provider| and an additional code (such as a SNOMED-CT code).
  12345|Headache| 04/01/05 | Mild | 784.0 | Resolved| ABC | AAA| 225064002

• Patient ID|Diagnosis name| the date the problem last occurred| a free text note (maximum length 100 characters)| a numerical code (such as an ICD-9-CM code)| the condition's "lifecycle" status| the provider| the external provider| and an additional code (such as a SNOMED-CT code).
  12345|Headache| 04/25/05 | Mild | 784.0 | Resolved| ABC | AAA| 225064002

• Patient ID|DOS|Diagnosis name| code| Active or Inactive.
  12345|04/25/05|Headache | 784.0 | Inactive

The health maintenance (HM) procedures must be worded exactly as they are on the health maintenance template. They will be translated if a crosswalk is made available. Data for a health maintenance procedure code which is not on any of the patient's health maintenance templates, will be added to the patient's historical health maintenance list.

Length of the Procedure Name can only be 18 characters.

Patient ID|Date of the health maintenance item | procedure names
12345|01/03/02| PAP

Laboratory test names must match test names in McKesson's EHR. They will be translated if a crosswalk is made available. For example HEMATOCRIT or HCT. McKesson's EHR test names cannot exceed 18 characters. Test Results cannot exceed 19 characters.

• PatientID|Date | time | test name | result | units | normal/abnormal | Range
  • date (required)
  • time (optional)
  • test name (required)
  • result (required) numeric or text value.
  • units (optional) of measurement used in the test.
  • Normal/abnormal flag (optional)
  • H = high
  • L = low
  • N = normal
  • C = critical high
  • B = critical low
  • A = abnormal
  • Range (optional) If you enter a range| you must also specify the appropriate flag for the test result.

Major Problems can be loaded to McKesson's EHR, if all of the data fields are provided (or assumed constant) in any one of the following lines.

Length of the Major Problem Name can only be 50 characters.
Length of the Note can only be 100 characters.

• PatientID|Major problem| start date| a note about the problem| code (such as an ICD-9-CM code)
  12345|Diabetes Mellitus Type 2 | 02/02/05 | NIDDM | 250.00

• PatientID|Major problem| start date| a note about the problem| an ICD-9 code| the condition's
  12345|status| the provider| the extended provider| and an additional code (such as a SNOMED-CT code).
  12345|Diabetes Mellitus Type 2 | 02/02/05 | NIDDM | 250.00 | Stable | ABC | AAA | 44054006

• PatientID|Major problem| date the problem last occurred| a note about the problem| an ICD-9 code| the condition's status| the provider| the extended provider| and an additional code (such as a SNOMED-CT code).
  12345|Sinusitis Maxillary | 02/02/05 | Prolonged | 461.0 | Improving | ABC | AAA | 35923002

• PatientID|Major problem| date| ICD-9 code| active or inactive.
  12345|Diabetes | 02/02/05 | 250.0 | active

Other problems can be loaded to McKesson's EHR, if all of the data fields are provided (or assumed constant) in any one of the following lines.

Length of the Other Problem Name can only be 50 characters.
Length of the Note can only be 100 characters.

• PatientID|Other problem name | start date| a note| and an ICD-9 code
  12345|Wrist Pain | 02/02/06

• PatientID|Other problem name | start date| a note| an ICD-9 code| the condition's status| the provider| the external provider| and an additional code (such as a SNOMED-CT code).
  12345|Wrist Sprain | 02/02/06 | From Skateboarding | 842.0 | Improving | ABC | AAA | 70704007

• PatientID|Other problem name | date the problem last occurred| a note| an ICD-9 code| the condition's status| the provider| the external provider| and an additional code (such as a SNOMED-CT code).
  12345|Wrist Sprain | 03/02/06 | From Skateboarding | 842.0 | Resolved | ABC | AAA | 70704007

• PatientID|Other problem name | ICD-9 code| active or inactive.
  12345|Wrist Sprain | 842.0 | Inactive

Procedure codes can be loaded to McKesson's EHR, if all of the data fields are provided (or assumed constant) in any one of the following lines.

Length of the Other Procedure Name can only be 50 characters.
Length of the Note can only be 100 characters.

• PatientID|Procedure name| date| note| code1
  12345|Treadmill test| 04/03/93| Normal| 93019

• PatientID|Procedure | date| note| proc. code1| dx/prob code 1 | dx/prob code 2 | dx/prob code 3 | dx/prob code 4

• PatientID|Procedure name| date| note| proc. code1| modifier1 | modifier2| dx/prob code 1 | dx/prob code 2 | dx/prob code 3 | dx/prob code 4

• PatientID|Procedure name| date| note| proc. code1| rel. dx/prob # | rel. dx/prob code # | rel. dx/prob code # | rel. dx/prob code #

• PatientID|Procedure name| date| note| proc. code1| modifier1 | modifier2|rel. dx/prob # | rel. dx/prob code # | rel. dx/prob code # | rel. dx/prob code #

Due to the variety and complexity different systems store medications, McKesson's EHR will usually display detail as a sig note within the medication, unless the following can be provided consistently throughout all medications.

PatientID|Date | med name | size | take | freq | dur | amount | ref
12345|02/01/93| Amoxicillin| 250 mg| 1| tid| 10| 30| 0

• med name - Medication name, cannot exceed 30 characters

• size - cannot exceed 25 characters

• freq – cannot exceed 25 characters

• extended sig - A line of text with further Sig information (for example| apply lightly to the affected area); it can be left blank

• take - How many to take (for example| 1 or 2); it can be left blank, cannot exceed 10 characters

• dur - Duration in number of days (for example 7| 10). For chronic medications| leave this blank or enter a hyphen. For prn medications| enter prn, cannot exceed 4 characters

• amount - Amount to dispense (for example| 30| 60| or 6 oz.| 1 bottle) and cannot exceed 14 characters

• ref - Number of refills, cannot exceed 3 characters

Vitals must be loaded with the following. To avoid confusion, units should be provided.

PatientID|DOS|Systolic blood pressure| diastolic blood pressure| and pulse. Maximum length is 20 characters.
12345|11/09/10|V1| 120| 80| 80

PatientID|DOS|V2|Temperature| height| and weight. Maximum length is 20 characters.
Height must be converted to inches
Weight in Pounds
Temp in Fahrenheit
12345|11/09/10|V2| T 98.4| Ht. 65 in| Wt. 140lb

OFC and other information. Maximum length is 20 characters.
Head circumference in inches
12345|11/09/10|V3| OFC 44 in| Other 200

Respiratory rate and oximetry measurements. Maximum length is 20 characters
12345|11/09/10|V4| 22 | 100

PATID|DOS|User-defined vital signs name| value| normal or abnormal. Maximum length for the name
field is 30, the result field is 20, and the normal / abnormal value is 1.
12345|11/09/10|V5| Other | Refused | n

PatID|DOS|User-defined vital sign name| value| units| normal or abnormal. Maximum length for the name field is 30, the result field is 20, the normal / abnormal value is 1, and for units is 7 characters.
12345|11/09/10|V6| Left Foot | 31 | cm | n

Orders can be loaded to McKesson's EHR, if all of the data fields are provided (or assumed constant) in any one of the following lines.

Note: If there is a prescription template associated with the order you will receive a warning that a prescription will not be issued. If you choose OK, then the order’s associated prescription will not be issued but the note and order will be saved. If you choose Cancel, then you will be returned to the progress note

• Valid Values for Urgency are:
• STAT
• Routine
• Patient ID|Order Name| date| Urgency| label on extended dialog|text
  12345| CBC | 04/01/05| Routine| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Processor| label on extended dialog|text
  12345| CBC | 04/01/05| Routine| CMH|Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Processor|Dx 1| Dx 2| label on extended dialog|text
  12345| CBC | 04/01/05| Routine| CMH|141.23|123.34| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Processor| Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4| label on extended dialog|text
  12345| Chem Panel | 04/01/05| Stat | CMH| ABC| BBB| CCC| DDD| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Processor| Dx 1| Dx 2|Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4|| label on extended dialog|text
  12345| Chem Panel | 04/01/05| Stat | CMH| 141.23 |123.34 |ABC| BBB| CCC| DDD| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Referring Source ID|Processor| Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4| label on extended dialog|text
  12345| Chem Panel | 04/01/05| Stat | RJH |CMH| ABC| BBB| CCC| DDD| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| Referring Source ID|Processor| Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4| label on extended dialog|text
  12345| Chem Panel | 04/01/05| Stat | RJH |CMH| ABC| BBB| CCC| DDD| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| xx|Processor| Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4 | label on extended dialog|text
  Where xx is the number of days in which the order should be done.
  12345| CBC | 04/01/05| routine | 7|RN1| ABC||||| Reason| R/0 pneumonia

• Patient ID|Order Name| date| Urgency| xx|Processor| Dx 1|Dx 2|Send to PVID1| Send to PVID 2 | Send to PVID 3 | Send to PVID 4| label on extended dialog|text
  Where xx is the number of days in which the order should be done.
  12345| FSH | 04/01/05| routine | 7|RN1| 250.00||ABC||||| Reason| R/0 pneumonia

Organizations with a large number of historical files may find it beneficial to load these to a McKesson EMR as linked files within a patient’s note. When the user clicks on the link, the native browser associated with the file, will open the file. Files must be stored within the network domain, and users must have direct access (no password) to the files. The files may be of any type that the native browser can open, such as Word, Excel, PDF, JPG, or TIF. In order to do so, there will need to be an ACSII index of the files containing:

• Image File name (unique and without spaces in the name)
• Date of Service or Date of business (that the image refers to)
• External Patient ID (numeric or alphanumeric)
• Patient First and Last Name (avoid compound names if possible)
• Document Type (category or chart section)
• Document Title (if possible, to help distinguish this document among others in the same category)

Sample File
P:\ppart\ OldImages\14.pdf|10/27/2003|11111|MARY SMITH|A4 Conversion|Registration Forms/Insurance Cards