Category:Training and User Support
Learning Cerner© PowerNote: On-line Resources for Optimizing Clinical Documentation
- 1 Introduction
- 2 Learning to Use Cerner PowerNote Quickly
- 3 Conclusion
- 4 My Comments
- 5 References
What is Cerner’s PowerNote?
Cerner’s PowerNote is an interactive way of documenting the clinical patient encounter in the electronic medical record. PowerNote provides various templates with structured options as well as unstructured (free text) options. When adding a new PowerNote, Cerner provides the following six options to choose from:
1. Encounter Pathway: List of all available templates. 2. Existing: List of all saved and signed PowerNotes for the selected patient. You can copy a signed note to a new note or finish notes that were saved but not yet signed. 3. Pre-completed: List of pre-completed notes that you can edit for a new visit. 4. Catalog: List of groupings of similar notes. 5. Recent: List of notes that you have used, with the most recent one listed first. 6. Favorites: Encounter Pathway or Pre-completed PowerNotes that are saved as Favorites can be found here.
Structured vs Unstructured Notes OR Why I chose this Topic
Because I was accustomed to dictating patient encounters, when we transitioned to the electronic health record using free text notes seemed the easiest to use to document the patient encounter. However I also understood the importance of using structured data. I needed to understand and learn to use the structured note options as much as possible. So for this project I searched out online resources readily available. This wiki shares some of what I found helpful.
Learning to Use Cerner PowerNote Quickly
YouTube Videos by B. Hota, MD, CMIO, Cook County Health and Hospitals System
- How to do Document Viewing in PowerNote (6:11)
This video focuses on navigating the document viewing window. This is where you can view or create clinical visit notes. The menu allows the user to: 1) add a new note; 2) sign a note; 3) forward a note; 4) modify a note; 5) error out a note; or 6) preview a note.
To create a new note, click Add, choose the Type of note that you want to add (e.g. Liver Clinic Note, Pre-procedure H&P, Admission H&P, etc.), and select template you want to use for your note. Templates are found under the six tabs labeled either 1) Encounter Pathway;2) Existing; 3) Pre-Completed; 4) Catalog; 5) Recent; and 6) Favorites. Descriptions for each of these can be found here.
- How to load templates and pre-populate notes in PowerNote (7:18)
This video explains some of the template options under the Encounter Pathway tab and selection from auto-population dialog box for parts of the note. Within the Encounter Pathway tab you can search for specific templates that already exist.
For example, find the Type field and select “History and Physical”. Then, in the Search field select the “H&P” template. In order to refine the search, it is recommended to choose Contains (not Starts with or Exact Match). This search finds a template labeled “General Admission” Note. When the template type is selected in the bottom box, the Title field above is populated. When you click on “OK” the system will generate a note using template type “H&P”.
The Auto-Populate Document dialog box appears next. This dialog box contains pieces of clinical information (e.g. Allergies, Medications, Problem Lists, etc.) which exist as part of the patient’s record and provides the option for pulling them into the note automatically. This option can be exercised by checking the box next to the item. Click “OK” and the system builds a note.
- PowerNotes: Navigating the PowerNote (11:56)
This video describes how to navigate in the PowerNote as well as how to see the structured options and the final view.
NAVIGATING THE NOTE: There is a Navigation Explorer panel on the left hand side of the PowerNote. Each heading has a “+/- ” symbol to indicate where it can be expanded or collapsed, respectively. Each heading in the Navigation Explorer panel is linked to a bold-faced section heading in the note itself. When an item is selected in the Navigation Explorer panel, that part of the note appears in the Main panel. This works for sub-headings as well as headings.
An alternative to the Navigation Explorer panel is the scroll bar on the far right of the Main panel or you can use the double arrows in the bottom right corner of the screen which allows you to jump through pages in order to scroll through the note faster.
VIEWING and USING THE NOTE STRUCTURE: Each section heading in the note has an element that says <Hide Structure> next to it. If <Hide Structure> is selected, the components of that section are hidden from view and the element changes to <Show Structure>. If parts of the note have been checked those will then be shown on the screen. Another way to hide the structure for the entire note is to press the little button at the top of scroll bar. This button is known as the Display Contributor View button. This button toggles between the structure of the note and how the final note will appear.
Structured components within a section of the note have the most common elements listed shown. However structured components may have the double greater than symbol (>>) following their names if there are additional hidden options. This symbol is a toggle for “showing” or “hiding” these additional options.
Structured elements have choices that when you click once, the item is circled. If you click twice, the item is negated and gets a slash through it, and if you click three times you clear the selection. If you click <Hide Structure> after selecting some of the elements you can see what the final note will look like. This is an alternative to using the Display Contributor View button.
SAVING THE NOTE: Autosaving occurs, but you should check with your system administrator to know how often this occurs. It is a good idea to save frequently.
- How to build and use macros in PowerNote (7:46)
This video describes how the PowerNote is organized as well as how to create and use macros in a PowerNote.
PowerNote is divided into sections with headings that are relevant to the patient encounter e.g. Basic Information, Chief Complaint, History of Present Illness, Review of Systems, Physical Exam, etc. Each section contains structured sub-sections of the patient encounter . Each of these sub-sections has various structured choices or elements to select. Only elements that are checked will be shown in the final note.
Macros can speed up the process of charting. CREATING A MACRO: You can use macros to insert pre-selected items into parts of your current note. For example, you can create a macro for a “ fully negative ROS except HPI”, then save it as a macro by going to heading for that section, right-click, and select “Save Macro As…”, and type a title for your macro.
USING A MACRO: To use a macro, go to the section, click the “M” next to section heading and then choose the macro you want to use. You need to modify the macro selections in your note as appropriate to the visit. If that body system was not asked you can right-click on sub-section heading, choose “Clear” and click “OK”.
- How to create pre-completed notes in PowerNote (7:42)
This video describes how to create and use a pre-completed note. A pre-completed note is a note that has been filled in completely in advance of the visit. When the patient comes this pre-completed note can be loaded and, as appropriate, information can be changed. It is similar to a macro but the difference is that it is the entire note, not just a section of the note. For example you can make a totally negative General H&P pre-completed note type so then when it is needed, you select it, note findings, and clear any sections not done.
In order to save a pre-completed note, go to the Documentation menu item “Save as Precompleted Note” found at the top of the screen, give it a title like “General Admission H&P Negative”, then “Save as New”.
When needed, go to “Add” a new note, select tab labeled Precompleted and then /elect template that you want to use. He suggests free texting HPI and using structured elements for ROS and PE. Modify the note, as appropriate.
- How to enter free text in PowerNote (8:34)
This video describes the two faces of free text, where it can be entered, and how to save free text as a macro. Free text is typing in a narrative which is the same as unstructured information. Dr. Hota notes “There are good things and bad things about free text. The good thing is it really allows the provider to capture the uniqueness of an individual visit. The downside is that information is inaccessible except through manual chart reviews.”
There are two places where free text can be entered. 1) One is in places where “OTHER” is shown as an element. This can be seen at the end of the elements within a sub-section. When this is clicked on, a free text box opens.
2) The second place to enter free text is underneath a “control box” (the outline surrounding that specific section) and you will get a blinking cursor to begin free text entry.
Special Tip: If you are entering free text within the OTHER free text box you must use CONTROL-ENTER to move cursor to a new line, otherwise ENTER will close the text box. OK. This only applies to free text data entry in this free text box.
Any free text entered from the OTHER box can be saved as a macro. Right click on text “Save Macro As”. He uses free text after the control box for HPI and he uses OTHER for ROS.
- How to use auto-text in PowerNote (10:01)
This video describes auto-text including how to create it and how to use it. Auto-text is a tool that allows you to enter in text or templates and then be able to re-use it later.
For example under HPI he free texts “The patient has no current problems. He also has no significant past medical history.” Select all of this text and right-click. Two choices will appear – “Insert Auto-Text” and “Save As Auto-Text”. Select “Save As Auto-Text”. The Manage Auto-Text diaglog box appears. Type a name zzSomeRelevantName. Click “Create” and then “Close”.
Back inside a note in a free text section, type zz, some choices will appear including zzSomeRelevantName. When selected, this text is inserted. This is particularly useful if you are going to use that phrase alot. If you use underlines in the free text sections, you can easily jump from underline to underline by using the F3 button. For example, you have a standard set of 4 questions for every visit like in an anticoagulation clinic.
• Has the patient been following a nutritional recommendations for Coumadin? _ Y _ N • Has the patient been adherent with their Coumadin? _Y _N • Has the patient received antibiotics since the last visit? _Y _N • Has the patient had any bleeding episodes? _Y _N
He recommends saving this text as auto-text so it can be inserted in the HPI box in any note.
He makes note that it is better to use the structured elements if they exist so that the data will be available for reporting.
- How to create basic templates in PowerNote (11:42)
This video shows you how to create a basic template for a General Admission H&P with a negative exam. He uses various features including creating a pre-completed note, macros, auto-text, filling in free text blanks, part of note being able to load that note for future use.
CREATING THE TEMPLATE: He started with a template found under the Encounter Pathway tab, in Type “H&P”. He chose “General Admission H&P”. Under HPI you can type: “ The patient presents with complaints of _. He has had symptoms for _. His past history is significant for problems listed in the problem list. He has additional complaint of _.” Continue completing rest of note. Use macros for Negatives. Then go to menu bar to “Documentation” and select “Save As precompleted note”. Give it a title such as “General Admission H&P – Baseline”. This completes the template.
USING THE TEMPLATE: After selecting “Add a New Note”, go to the PreCompleted tab and select the “General Admission H&P Baseline”. Note is created and you can proceed to complete sections and fill in free text blanks using the F3 key to move from underscore to underscore.
COMPLETING THE NOTE: Go to Diagnosis and Plan. Add diagnosis. He recommends free texting your clinical reasoning/plan under Diagnosis/Orders/OTHER. NOTE: You can also add orders from here. Sign the note.
Indiana University Health PowerNote Learning Resources
This resource provides interactive training modules for learning PowerNote – where you actually go through the actions on the display that you would need to follow. This adds another dimension to the learning process beyond just watching someone do the tasks.
The Cerner company learning website (uCern) provides a variety of training materials. In addition forums are available but you this site requires you have a valid account.
This wiki shared some of the frequently used, publicly available resources on how to use Cerner PowerNote. After a briefly describing PowerNotes, this wiki highlighted Dr Bala Hota’s YouTube video series on how to quickly create and use PowerNotes efficiently and effectively. Topics covered including viewing, navigating, building macros, auto-text, use of free text, as well as the creating and use of templates. Interactive resources created by Indiana University were also noted.
There were surprisingly few publicly available resources for learning about how to use Cerner’s PowerNote. There are many more resources to be found at the uCern site where Cerner provides areas for support, information, as well as forums for collaboration. I found both Dr. Hota’s videos and Indiana University’s interactive learning modules worth every minute of my time. I feel more confident in my ability to optimize the use of structured clinical notes which I understand is important for data analysis, reporting, and the improvement of quality patient care.
1. Doctors Hospital at Renaissance On-line Training Using Cerner PowerNote  Retrieved October 25, 2015.
2. B. Hota: How to do Document Viewing - Video 1  Retrieved October 17, 2015.
3. B. Hota: How to load templates and pre-populate notes in PowerNote - Video 2  Retrieved October 17, 2015.
4. B. Hota: How to build and use macros in PowerNote - Video 3  Retrieved October 17, 2015.
5. B. Hota: How to create pre-completed notes in PowerNote - Video 4  Retrieved October 19, 2015.
6. B. Hota: How to enter free text in PowerNote - Video 5  Retrieved October 19, 2015.
7. B. Hota: How to use auto-text in PowerNote - Video 6  Retrieved October 19, 2015.
8. B. Hota: How to create basic templates in PowerNote – Video 7  Retrieved October 20, 2015.
9. B. Hota: How to create basic templates in PowerNote – Video 8  Retrieved October 20, 2015.
10. University of Indiana’s PowerNote Training Interactive Modules  Retrieved October 25, 2015.
Categories: • Training and User Support Submitted by (E Provost)
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