EHR Ability Overview
- Dylan Nigh
- Tim Carpenter
The EHR Ability is used to create and manage Electronic Health Record forms that can be utilized by providers and patients alike. Here, you can review filled out patient forms and create/edit templates to be used to generate new patient forms.
The benefit of using EHR forms is the interoperability that is built into the form. The MacPractice Suite will allow the office to use a form across several platforms - on the patient portal with online registration, the iPad using the Clipboard application for patients and the iEHR application for clinicians, and on the desktop using the EHR ability.
This article covers the interface of the EHR Ability, and how to manage patient forms. This article doesn't cover building EHR Templates, but you can read more about that topic in our Building Templates article.
Clinical Summary
The Clinical Summary node is the default view when entering the EHR Ability. After selecting a patient, the user will be presented with the Clinical Summary. This node will display the entire history of the patient's account. MacPractice will group all related items into a colored bubble or box known as a clinical widget. Each item in the patient's summary has a link to the corresponding document or item within MacPractice. Simply click a blue link to be taken to that corresponding record. The Clinical Summary view in EHR will differ slightly from the Clinical Ability, in that, you are not able to add new records to the Clinical Summary view in EHR, but only able to view existing records.
The clinical summary also has a filter at the top of the screen. This filter allows the user to show only the relevant information during a time period. Use the popup box to select a predefined date, or enter in a customized time frame using the Start Date and End Date fields.
The 3-dot icon 
This view is fundamentally the same as present in the Clinical Ability (or Clinical Tab in the Patient Ability in older builds of MacPractice). You can read more about the Clinical Ability here.
Incidents
The Incidents node allows you to view any specific incidents created on the patient's account. This view essentially filters down the information already present in the Clinical Summary to the specific details which only apply to the selected incident.
When needed, a new incident can easily be created within the EHR ability by selecting + Add New Incident. This incident will also be present in other areas of MacPractice, such as in the Ledger.
The incident details will be shown at the top of the main window, where you can set the Incident Name, Date, and a Referral Source. You can also check the First Encounter checkbox if this is your first interaction with this patient.
If an arrow appears to the left of the incident folder when it is selected, this means there are records associated with this incident. Click this arrow to expand the folder contents in order to access the patient forms associated with the incident.
The Incident can also be exported using direct messaging or uploaded to the patient portal if desired.
Creating Patient Forms
To create patient forms in the EHR ability, refer to the following steps:
Go to EHR
Select a patient if you haven’t already
Select an incident from the “INCIDENTS” section of the Sidebar on the left
Click the Green Plus button
Select a template from the Template Selection Window that pops up
Click Create
Data Pulling
At the bottom of the Template Selection Window, there are two checkboxes which allow you to control what data is carried forward from previously filled out forms.
These data pulling preferences apply to the MacPractice user (the user you are logged into MacPractice as), and once set, will not change unless changed by the user. Each MacPractice user can set their own preferred data pulling preferences.
Allow Sections to Pull Data Forward: When checked, this option will place a blue header across each Form Section, as shown here:
This prompt shows the form title of the previous form data is being pulled from, the user who created that form and the date it was last updated. If you want to use the previously entered form's data, you can click the Pull Data button to populate this field with that previous information. Clicking Cancel will pull no data and the section will be blank and ready for new input.
Auto-Commit Pulled Data: If this checkbox and the "Allow Sections to Pull Data Forward" is checked, this will automatically pull the most recent data into the section's respective fields as if the Pull Data button had been pressed for each section.
Data that is pulled in from a previous record can be edited, added to, or overwritten on the new form. Editing data on the new from will not affect the data of the previous forms. Each patient form is its own entity.
For sections set to “Never Pull Data”, no data will pull for those sections regardless of what you have checked above. Setting the default pulling behavior for each section will be covered below.
Manual Data Pulling
Data can also be pulled manually in each from section. This is done from the down-facing arrow icon 
By Selecting a past record in the Data Pull window, you can see a preview of the data as it exists on those previous records. Clicking “Pull Data” will pull the selected data into the form. After pulling in this data, it can be edited as needed. Clicking “Cancel” will exit out of the window without pulling anything.
In the example above, the user will have the option to pull from any previous record that contains the Subjective section - in this case, past SOAP Notes. If this Subjective section exists on any other forms, such as an Exam form, the data from those forms would also be available to pull.
It is crucial to grasp this concept, since this is the mechanism on which data pulling operates. In order to pull data from one form to another, the same section must be present on each template. Using the example above, If you are trying to pull data from the Subjective section on the SOAP Note, to a Subjective section on an Exam form, the same Subjective section must be used on both the SOAP Note template and the Exam template. If the SOAP Note contains its own Subjective section and the Exam form contains a different Subjective section, data cannot pull between the two, even if the two Subjective sections are identical in content.
In the example above, you will also observe a dropdown labeled “When creating a new form, automatically pull...” This dropdown determines the default behavior for the data that will be automatically pulled into this section. The three options within this dropdown are as follows:
Data Saved Today - retrieves any data that was previously entered into this section on the same day.
Most Recent Data - retrieves the most recent data that was previously entered into this section any time in the past (recommended).
Nothing - this section is always kept blank and never pulls any previous data (recommended for any sections the patient might sign or consent to something).
Regardless of the default setting used above, the option to manually pull any data is always available.
Certain sections will not have the down-facing arrow icon in the top-right corner. This is the case for certain “Preconfigured” (or “Codified”) sections, such as Medications and Allergies, since these sections automatically populate this data from the Clinical ability.
If a section has a blue down-facing arrow 
Viewing and Editing Patient Forms
Selecting an EHR Form in an Incident in the sidebar will bring up an active patient form. On the left, a Table of Contents pane contains all of the sections that make up this new form, with a Go To button to the right of each listed Section, which you can click to quickly navigate to that section.
In the center of this header, you can see a toggle and a lock icon. This toggle will either display the “Current Form Updated” with the last date and time the from was saved or will state “Not yet updated” if this is a new form and nothing has been saved yet. If the toggle is clicked, you can switch between the different views of the form. These views are defined as follows:
Current Form View (shows most recent updated date and time) - This is the default view (referred to as the “Form Side”) and is the active view of the form where data is entered.
Current Narrative - This switches the view to the printable view (referred to as the Narrative Side) and represents the final complete record (if no further editing is done).
Snapshot (date and time) - This shows the data as it was at the listed date and time. A snapshot is created each time the from is edited and saved.
Once a patient form is completed and no further edits are needed, you can click the padlock icon 
Click “Lock” to lock the form, or Cancel to leave the form open. After locking, the open padlock icon 
A locked form cannot be unlocked. If an error is identified on a locked form, the user must create a new form, pull forward all relevant data from the locked form and make the necessary edits on the new form. The erroneous locked form will then need to be archived.
Form View
The Form View (aka - “Form Side”) refers to the interactive side of the form and allows the user to enter data into each section that comprises the form. This data, when entered, will be formatted into a print-friendly form in the Narrative View, or an easily readable EHR Form on our iEHR app for iPads. For some Sections, you can add data by clicking into fields, or by clicking specific hyperlinks (elements that show blue) within the form itself.
You'll note that in the upper right hand corner of each section, there are either 1 or 2 additional buttons available. We have already covered the down-facing arrow icon in the Manual Data Pulling section above. The purpose of the Gear icon is detailed below.
The purpose of the Gear icon is to offer options that help manage the data in each section of a patient form. When the Gear icon is selected, a popover menu will appear with three options. These three options are defined as follows:
Include on Narrative Checkbox: This checkbox allows the user to control which section’s data will display on the narrative, or not. This checkbox is checked by default, meaning, by default all sections will show on the narrative as long as they are interacted with. Unchecking this box will hide that sections’s data from the narrative. This will only apply to this specific section on this specific patient form. There is no way to default this option to unchecked for subsequent patient forms.
Add Annotation: When clicked, this button will allow you to add an annotation to the end of this Section that will appear on the Narrative and the Form View. This is useful if you want to elaborate further on a particular entry or if details are needed and there is no readily available space to add this information. The Annotation will be printed in blue, and will list the MacPractice User's name and the date which the Annotation was made.
Note that annotations cannot be added to a form after it is locked.
Clear Section: This button will clear any previously made entry in this Section, effectively resetting it. This is useful if you pull in old data that no longer pertains to the patient and would like to start with a blank section. Sometimes, it may be useful to pull in old data just to reference it, but then reset the section in order to enter new data.
After editing any fields, you can save with the keyboard shortcut Command S or by using the edit menu's Save Record option, as shown in the screenshot below. The Command+S and Save Record save processes are the same throughout the MacPractice software.
You can easily see if a record contains unsaved data by the dot that appears in the red (exit) window management button in the top-left corner of every window.
After saving a record, this dot will disappear.
Narrative View
The Narrative View is the printer-friendly version of the EHR form. It displays the entered form data and will be what is viewable when the form is locked. Even if locked, you can still toggle through the narratives of previously saved Snapshots of the form.
You can also use the Search Field in the upper right to search for particular terms or words.
You can print off a copy of the form by pressing Command-P on your keyboard, or by navigating to the File Menu and selecting Print. You'll need to be on the Narrative View in order to print a form. From the resulting window, you can either select a printer and click Print, or you can use the PDF menu to save a PDF copy of the form.
Locking Forms
Once a patient form is completed and no further edits are needed, you can click the padlock icon
When you click the open padlock icon to lock the form, you will see the following prompt:
Click “Lock” to lock the form, or Cancel to leave the form open. After locking, the open padlock icon
A locked form cannot be unlocked. If an error is identified on a locked form, the user must create a new form, pull forward all relevant data from the locked form and make the necessary edits on the new form. The erroneous locked form will then need to be archived by selecting it and clicking the red minus button at the top of the sidebar.
Once a form is locked, you'll see the header bar note that the form is locked, and the date, time and the user that locked the form. You will also notice a padlock icon in the form icon in the sidebar and will also see this in the Clinical ability.
Patient Portal and Assigning Forms
The Patient Portal node contains all EHR Templates that you have assigned to the Patient via the Patient Portal. This feature requires that you have Online Registration and EHR Forms purchased on your license, in addition to having a Patient Portal set up. Visit this website to see if the appropriate abilities are active on the office serial number.
Notes
The Notes section contains the Notes Template node, which you can read about here.
Template Library and Shared Templates
Shared Templates are free-to-use templates that can be installed by users and are customizable or ready to use, depending on individual needs. These templates may be a means for new EHR users to learn the ability or a way to get started using the EHR ability quickly. These forms have been created by the MacPractice EHR department, and are worth reviewing to see if they meet your needs. Forms can be installed and updated through this node.
To access the Shared Template Library:
Go to the EHR ability
In the Sidebar, to the left, find and select the Shared Templates node.
In the center column you'll be presented with a list of available Shared Templates, and the date a template was most recently updated by the MacPractice EMR Staff. You can use the Specialties dropdown to select the specialty for your office and see if there are any templates of this type available. You can also use the Search bar to search for a specific type of form. Keep in mind that there aren't templates available for every specialty, but you can contact MacPractice to have us build custom forms specific to your practice (recommended).
Select a template that you may be interested in. In the pane to the right you can preview and interact with the template to see if it is a good fit before installing it.
To install the template, click the Install button in the bottom-right corner of the screen. After the template is installed you can find it in the Templates folder in the Sidebar to the left, and the sections associated with this template can be found in the Sections folder.
When a template is selected in the left column, a summary and preview will be displayed in the right column.
The Summary Tab contains a list of all the Sections that make up this particular form. Below this list, there'll also be an entry indicating whether the form is available for use in the Clipboard iPad app, or not. Only patient-facing forms would be used on the Clipboard app. Staff and provider-facing forms will be used from the iEHR app on the iPad. All forms, including shared forms, can be used in iEHR.
The Preview Tab allows you to get a glimpse at how the form is laid out. Sections that are a "codified section" won't be fully displayed here in the Preview, meaning that those sections are built to contain standardized information that interface with other areas of MacPractice.
Once a template has been installed, a green checkbox will be displayed on the form icon in the list of forms and the “Install” button will change to “Uninstall”. If the user chooses to uninstall the template it will be removed from the Templates folder and will no longer be selectable in the Template Selections Window. Any patient forms created before uninstalling the template will still be available under each respective patient account. In other words, uninstalling the template does not remove patient forms created with that template. The same is true if a template is archived directly from the Templates folder. Patient forms are only removed from the patient account if the patient form itself is archived. Archived templates and patient forms can always be retrieved, if needed. Patient forms can only be archived, never deleted. Templates can only be deleted if they have not already been used to create a patient form.
If a new version of an existing template is uploaded to the Shared Library, the “Install” button will instead display “Update”. The “Update” term will only appear if the template is already installed and there is an updated version available.