MEDITECH Expanse 2.1 To 2.2: What Will Nurses Think?

Nurses have been the largest users of electronic health records for years and they are no strangers to system upgrades. When a nurse hears about a new upgrade coming many questions come up like: What is going to change? What functionality will I lose? How will this impact my patient care?  

Perhaps you are wondering: How will the migration from MEDITECH Expanse 2.1 to 2.2 impact nurses?

Let me help ease your concerns, because Expanse 2.2 includes an upgraded web version and easier navigation that will help make this transition a more pleasant one. 

So, let’s dive into examples of how navigation becomes easier for nurses, highlight some of the great, new features in 2.2 and offer a few recommendations to help you make the upgrade a smooth transition for them.  

The upgraded web version of 2.2 in the Patient Care System (PCS), Emergency Department Module (EDM) and Surgery (SUR) include a new homepage, improved status boards, trackers and new functionality like a hand off tool customizable by location that helps nurses view information quickly during shift report.    

Home Screen 

Staff will notice the biggest change when they first log into the system because the Home Screen is very different than their 2.1 status board that has buttons and routines listed on the right side of the screen.  

In 2.2, when the nurse logs into their Home Screen, they can quickly view an enhanced status board or tracker packed with patient data.   

What’s to like 

Education tips to help ease the transition 

The first time seeing the home screen can be a bit overwhelming so clear education on the layout of this screen is important. When training staff we recommend breaking up the home screen into four sections:    

• Navigation bar 
• ID Methods/Shortcut tabs 
• Status Board/Tracker 
• Menu/Routine options 

Breaking up the home screen into sections during training helps the end-user have a better understanding of available chart functionality and patient information. It also helps the end-user begin to navigate through the system quicker.   

We also developed a tip sheet that defines each section of the home screen that was shared with staff during training and go live. 

Hand Off Tool 

For years, nurses have been writing their notes on paper and using that for their hand off shift report.  Now, MEDITECH provides an electronic hand off tool that displays patient data on-screen.   

What’s to like 

Patient information at their fingertips.  
Write a note and pull in formatted patient data within the same screen.   
Nursing notes saved in the hand off tool can be useful information when transferring patients to a different location 
Quickly review what information was shared during transfer reports 

Process changes to consider for better adoption 

The biggest challenge we see with facilities is that nurses still tend to do their shift report huddled in a quiet corner or in the nurse’s lounge with no computer because they are using their paper notes.   

If the hand off tool is something your site wants to implement, encourage your nurses to start using the computer as they give report.  

Getting nurses used to having the computer with them during report will promote an easier transition to using the hand off tool. There is also an option that can be added to the status board to display the status of hand-off tool.  

Tracker and Status Board improvements 

You’ll notice several improvements in the web version of the trackers and status boards 

What’s to like 

More space and the ability to see all attached patient data in one view.   
Click to expand view for additional information. Users no longer need to scroll to the bottom of the status board to see additional detail on the highlighted patient like in 2.1. In 2.2, just click to see more. 

Implementation tips: Allow enough time for evaluation and testing 

Carve out some time in your implementation plan to talk with nurses and clinical staff about how they use trackers and status boards. What information is useful or could be? 

• Every tracker and status board need to be updated to the new web version as you implement 2.2. Sites can choose to keep the same information on the trackers/status board, but we recommend taking this time to re-evaluate and determine if information is not being used and if new information should be added.     

• Like 2.1, trackers and status boards can be customized per location. Therefore, taking time to talk with staff at each location will be valuable as you build your new boards. In 2.1, the patient header has a lot of information useful to nurses such as DOB, admission status, code status and account number. Make sure you incorporate this information in your new boards.   

• Heads up: You will need to update all public trackers to the web version. It is imperative that these are built and tested early on using the same computer monitor that will be used during go live.  This will ensure the trackers are working as intended with your monitor resolution.  

Pre-Admission Testing (PAT) Home screen 

This home screen was created with the PAT nurse’s workflow in mind, and it includes the new web functionality for fewer clicks, improved workflow efficiency and enhanced user interface.  

What’s to like 

Manage their patient list directly from their status board and work off the pre-operative review screen.  
View a ton of information about each patient on the interactive split screen and document nurse interactions with the patient. Nurses can document patient calls, schedule PAT appointments, and document information such as lab results and patient history as reviewed.   
The home screen launches the nurse into the surgical assessments where they can pull data into the document from information that the patient entered via the patient portal.  

Implementation tip: Evaluate the benefits for your site 

The PAT home screen is an optional feature that a site can choose to go live with.  We recommend taking serious consideration to review this new functionality early on in your implementation to determine if the new PAT home screen would be beneficial for your site.   

Chart Navigation 

What’s to like 

What I like about the web version of the patient chart in MEDITECH is that it resembles the plastic patient charts with dividers we had on our units years ago. Information is categorized by tabs including diagnostics, nursing, and provider notes. This makes it easy to navigate the chart and can be customized with the use of widgets.   

Widgets bring patient data to the forefront and allow users to update clinical and demographic information on the patient.   

When launching into the chart, the user is taken to the summary page and the reference region which are customized sets of widgets that give the user a lot of information in a one-page view.  

What’s different from 2.1 to 2.2 

• We found that navigating information was a bit of a challenge since data was categorized under different headers. For example, nursing assessments in 2.1 are under Patient Care, but in 2.2, they are now under Nurse/Allied Health.  
• Laboratory and radiology reports which were under different sections in 2.1, are now both under the Diagnostics tab.   

Education tips to help with navigation changes 

Here are a few tips that might help your nurses find patient data, during the move from 2.1 to 2.2: 

• Create an education mapping tool that shows current state and future state: Patient Care data is now under Nurse/Allied health and Microbiology is now under Diagnostics.  There is also a search feature in the chart that can be used to quickly find information.   
• Take time to define the note categories that will display in the nurse/allied health tab. Here you can set up the system to display all of your case management assessments, respiratory assessments and other groups in each of their own categories. This allows the user to find the case management information quickly and prevent having to comb through all assessments. 

Order Screen: Ordering is streamlined 

What’s to like 

Providers and nurses now work from the same ordering screen.   
Searching for medications, labs, and radiology are all in one search option.   
Streamlined ordering. No need to go to three different tabs (new orders, new meds, new sets) to enter orders.  
Users can quickly view current and historical orders from this routine.   
The manage transfer routine is easily accessible, creating a one stop “shop” to transfer patients from location to location.   

Education tip 

Although education is minimal, show nurses the change in functionality and remind staff that order names have not changed. 

Emergency Department (ED) Triage 

What’s to like 

The changes in the ED triage web version brings together all the pertinent patient information staff need for triage.  
The triage nursing assessment does not change, but this new ED Triage routine gives staff the ability to capture patient information such as home medications, pharmacies, allergies, stated complaints, room assignment and patient demographics in one routine.  

Implementation tip: Customize for clinicians 

Prior to go live, sites should take time to review what is being pulled into this routine and how they want to arrange it. MEDITECH has a standard layout built out, but there is also the option to customize it, so take advantage of that! 

Menu Procedure Access (MPA) 

Implementation tips: Allow plenty of time for menu updates and review 

• Your menus must be updated to the web version to use the navigation bar, home menus and chart menus. At this point, everyone, not just nurses, will need their menus updated to the new web version.   
• Many facilities have multiple menus to update, this will take time, so make sure to incorporate enough time for this build in your implementation.   
• This is also a great opportunity to review access and determine if access is appropriate or if there are opportunities to optimize. We recommend that you don’t give users access they don’t need. For instance, if a nurse is not working in oncology, don’t give them the oncology button on the navigation bar. This will reduce confusion at go live. Sometimes less is best. 

Now’s the time to optimize (before you implement Expanse 2.2) 

Something to keep in mind as you go from 2.1 to 2.2 is that there are many features that do not change. So, before you begin your 2.2 implementation, assess your system and determine ways to optimize and improve your current system.  

For instance, nursing assessments and interventions stay the same. Nurses will document on the same screens they did in 2.1. Look at your standards of care, care plans and nursing documentation. What can be optimized or slimmed down? 

What other areas could be affected by the 2.2 update?  

When planning for your implementation, look around your organization and determine what other groups might be affected by the upgrade. In addition to nurses, other users such as your quality team, social workers and chart auditors will need training on some of these new enhancements.   

Nurses and other clinical staff are accustomed to an ever-changing work environment and a new update in the electronic health record is no different. Moving to Expanse 2.2 will be a change but one that will not only improve processes and create efficiencies but will enhance the user experience. 

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