During each encounter, you can document screenings, assessments, and interventions.
Within the Screenings/Interventions/Assessments section, click Add item and begin typing to search for the event. You may see a temporary notice “There are no items matching your search” while the search is running. If you do not see the appropriate event, try using additional search terms (e.g. “eye” or “retina").
Once you've selected an item, add the status (Ordered, Not Ordered, Performed or Not performed) and the result of the event. Include the start date of the event, as well as any additional comments, and click Save. This can be edited at any time until the note has been signed.
Specific categories of events will be shared with the PHR, including procedures, diagnostic studies, and interventions. The event title will be passed through to the PHR; however, no comments will be included. In addition, sensitive events (e.g. depression screening) will not be shared via the PHR.
You can view a full list of Screenings, Interventions and Assessments that will be shared with the patient here.
Some of these events are used to calculate clinical quality measures and Meaningful Use criteria. For more information, see How does the 2015 CQM Report work?