CIS Tutorial

INTRODUCTION TO MSK
CLINICAL INFORMATION
SYSTEMS
FOR PEDIATRIC RESIDENTS

INTRODUCTION TO MSK CLINICAL
INFORMATION SYSTEMS
• Entering CIS
• Results
• Orders – Reviewing
• Orders – Entering
• Hand Off
• MAR
• E-Medical Record
• Pharmacy Profile

ENTERING MSK
CLINICAL INFORMATION
SYSTEMS

You will always start from this
screen with the MSK logo. To log
into HIS (Healthcare Information
System), go to the Start menu and
choose Clinical Applications, and
then Healthcare Information
System

.

This light blue screen will open.
Choose Clinical Information System.
This is the system for orders,
results, and MAR. You can also use
it to find old chart information on
your patients, as well as accessing
the PACS radiology viewer.

You will also notice that helpful references are
available from this screen, such as the MSK
Phone Directory, Lexi-Comp and UpToDate.

Once you enter CIS, you need to select a
patient. To look up a patient not currently
admitted to M9, select the Find Patient
Icon. Enter the patient’s name in the pop-
up box to search.

Or, you can select the Identification tab
and enter the patient’s MRN, then
select the Search button. Once the
patient’s name appears, double click to
bring up a list of their visits. You can
select any visit to open the chart.

Patient

Nicekid

PATIENT, NICEKID

Once the patient’s name appears under
the Search Results, double click to bring
Results
up a list of their visits.

.

Patient

Select any visit and click OK to enter the
patient’s chart.

.

If your patient is admitted to the Peds
If your patient is admitted to the Peds
Floor, set the Current List drop-down to
Floor, set the Current List drop-down to
“M09 Admitted.” This will display all of the
“M09 Admitted.” This will display all of the
patients currently on M9. Double click on
patients currently on M9. Double click on
your patient’s name to open their chart
your patient’s name to open their chart
(patients’ names and MRNs are hidden in this screen
(patients’ names and MRNs are hidden in this screen
for HIPAA compliance, but appear next to their room
for HIPAA compliance, but appear next to their room
number).
number).

.

When you open the patient’s chart,
you will notice a row of tabs along
the top; you can use these to change
the screen you are viewing within
the same chart. Here, results is
selected.

Defaults are set so that when you
open the patient’s chart, you will
go immediately to a Results screen
which looks like this one. In this
view, lab results are chronological,
with the most recent results at the
top of the screen.

These results are in the Report by Order Display
Format, which is useful for looking up daily or
most recent labs, but less helpful for comparing
values or looking for trends. In this view, all
labs are displayed in chronologic order, with the
most recent results at the top of the screen.

To view only selected types of
results, such as Microbiology
or Radiology, use the drop-
Radiology
down menu under Result
Selection to highlight the type
of result you wish to view.

Make sure to click Show Pending
so all received specimens are
displayed; if this box is not
checked, only specimens with
results will be shown.

When a result has a [+] sign,
clicking on the highlighted
result will bring up more
information.

Results will display as shown,
and can be copied and pasted
or printed out.

To compare results, select
Trend View in the Display
Format box.

You can select an individual result
and display a graph by highlighting
the desired result and clicking the
button next to Graph.

The Summary view in Display Format allows
you to view all of the tests which have been
done; clicking on the red and green flag icons
opens the desired result. You can also
highlight an entire row (test) or column
(date) to see all of those results.

To narrow results to see only
more recent values, change
the Since field to the specific
time frame.

Selecting the Orders tab will
display all orders placed for
the patient.

In this default view, all orders are shown,
whether they are active or not, and orders are
organized by when they were placed, with the
most recent orders at the top of the screen.

Use the Status/Priority drop-
down box to change the status of
orders listed; for most situations,
it is helpful to set this to Active to
avoid long lists of previous orders.

When you change this setting,
your new setting will be
retained for other patients until
you change it again.

Use the Display Format drop-
down box to change how orders
are grouped; for most situations, it
is helpful to set this to By
Department to show the same
type of orders together (Nursing
orders in one section, Pharmacy
orders in one section, etc).

To begin entering orders, choose
either one of the order entry icons
in the upper left hand corner of
the screen.

Clicking either icon will bring you to
this order entry screen. There are
several different ways to enter
orders. The best way is generally to
choose from the drop-down menus
on the left-hand side of the screen.

Orders can be found under the PED-INPATIENT tab.
Most of the time, residents working on the Green
Team will select .Oncology; residents on the Blue
Team will select .BMT for order set options.

In this example, to enter lab orders, the AM Lab
Order Set is chosen by clicking on the selection in
the drop-down. Once the order set is highlighted
in the large box, it can be double-clicked, and it
will open to allow details to be entered.

Once the order set opens, simply click to check
the boxes next to the orders you would like to
choose. Once you have selected all of the orders
you want, click on OK at the bottom of the
screen.

In most cases, you will receive warnings; this is
warnings
the system alerting you to fields which must be
filled in before the order can be submitted.
Simply highlight and select the first order with a
warning to complete the required information.

Any field with a * is a required field. In this case,
you must fill in the date you would like the test
done. You can click on the calendar icon and it will
expand. In addition, Special Instructions is a free-
text box where you can enter further comments.

Use the drop-down calendar to select the date on
which you would like the test to be performed.

Only fields with * are
mandatory. Other fields are
defaulted or may be left
blank; however, you must
make sure that the defaults
or blanks are what you
want for the patient.

In this example, you may wish to change the priority from
“Per Requested Date” (Routine) to “STAT”; for medications,
you might want to set a stop date, or other parameters.

You will be prompted to enter your CIS
password in the pop-up box; once you do
this and click OK, the order will be entered!

Patient, Nicekid
123456789

Notice that the patient’s name appears on both the
Submit Order button and the Password Required pop-up.
This is a patient safety measure to help ensure that the
order you are submitting is for the correct patient.
Always double-check these reminders!

Patient, NiceKid

In some cases, you may want to
browse available orders instead of
using an order set. Under PED –
INPATIENT, click the [+] buttons to
expand categories until you reach the
order you want; for example, click [+]
next to Diet to see all diets that can be
ordered, and double click on the one
you want for your patient.

You can also quickly change orders when you are in
the order viewing screen. Highlight the order you
are interested in and then right-click to bring up a
menu of options. You can easily discontinue an
order, reorder a discontinued order, or discontinue
and reorder a current order. Don’t worry, you will
have a chance to modify the current order; this is
great for daily IV fluids!

The hand-off tab allows you to keep updated
information about each patient in an easily printed,
easily referenced format.

Nicekid is a 4 y/o boy with Stage IV Neuroblastoma diagnosed in 6/07; s/p initial
treatment with CAV x 5 cycles, thoracoabdominal resection completed without
complication 8/12/07. Continues on CAV, but repeated episodes of F&N without
positive cultures. Significant malnutrition, now on home TPN.

The Oncological History box allows text to be
entered about the patient which will remain
throughout the admission, and for all future
admissions; it can be changed at any time, and
should be updated to provide a BRIEF overview of
their evolving “big picture.”

The History of Present Illness tab is used to enter
the problem list by SYSTEMS, and the patient’s
Nicekid is a 4 y/o boy with Stage IV Neuroblastoma diagnosed in 6/07; s/p initial
treatment with CAV x 5 cycles, thoracoabdominal resection completed without
current status and problems. This should be
complication 8/12/07. Continues on CAV, but repeated episodes of F&N without
positive cultures. Significant malnutrition, nowIt does TPN. carry over from one
regularly updated. on home not
admission to the next.

Nicekid is now admitted with nausea and vomiting x 3 days at home, decr UOP, no
fevers. Abd mildly distended, no pain, AXR, CT neg for obstrxn. NPO, NGT to
gravity.
-Low BPs O/N – follow, no boluses if MS normal, BPs >80s/45s
-LE weakness: PT/OT following – FALL precautions!
-Needs full dental exam when current illness resolved
-Small, superficial ulcer on L scapula – RNs placing duoderm; monitor

Changing the Selection from Onc Hx/HPI to To Do List
will allow you to enter a check list of items to follow
up. This should also be updated regularly, both on
rounds, and at signout at the end of the day.

To add a new item to the To-Do list, simply choose
the Add button at the bottom of the screen, and
then free-text in the pop-up New Task box. Click
box
OK, and your task will be added to the list.

Schedule next pentamidine dose

Once you are viewing patients within your patient list,
you can print your Hand Off List from any screen in the
Hand Off tab. Select the Reports button at the bottom
of the screen. You will be asked if you want to forward
your pager. What a silly question – just say no!

You may choose a report on all of the patients on
your list, or only a single patient; the report that
prints will include all of the information you have
put into the Hand Off section, as well as the
current list of all ordered medications and doses.

MEDICATION ADMINISTRATION
RECORD (MAR)

To access the MAR, choose the rainbow colored
icon along the top of the screen and click to open.

The Patient Info tab provides patient demographic information such as
home address, emergency contact information, etc.

Surgery Events provides information about
all past surgeries at MSK for the patient.

The Hand-Off tab is used by clinicians to “hand off” patient
information.

The Historical Chemo tab provides Chemo information for patients
before 9/13/2003.

For all chemo information after this date, go to Tools and
select Pharmacy Profile.
Profile

To link to the Electronic Medical Record, go to Tools and select Go to E-
Medical Records.
Records

To Electronic Medical Record is opened for the patient selected in CIS. This is
the patient’s entire chart, all in optical scan. For Progress Notes, open
Assessments by clicking on the [+] to the left of the green folder.

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