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Amazing Charts Help

Getting Started
Welcome to Amazing Charts. This manual will provide you with the information you need to use Amazing Charts effectively and efficiently. After installing Amazing Charts on your computers, we recommend you review, briefly, the "How Do I..." chapters as well as watch our online tutorials. In addition to these items, we also provide a number of other amazing resources that will have you getting the most out of Amazing Charts in short order and can be used to supplement your Amazing Charts education and make understanding this program painless. These include:

An up-to-date listing of the most common issues that Amazing Charts has discovered and their solutions. The Amazing Charts Users' Bulletin Board (get information from and/or assist other Amazing Charts users) in this Live Training - either remotely where we can easily log into your computer from our offices in Rhode Island (included in
our standard pricing), or we can even come out to your practice (though 99% of practices using Amazing Charts have not required onsite training). Coming to your office costs money, of course, and the price to have us come to help set up and train your office is listed on our website. Click here to set up a live training session. Our staff regularly attends medical conventions across the country, and we are happy to assist you at our boot. Click here for a list of our upcoming conferences. The annual Amazing Charts Users' Convention is designed to teach users of all levels on the basics and advanced aspects of Amazing Charts. ACUC is also where you assist us in determining what new features or program improvements are needed, and where our development schedule is defined - and it is a great place to meet and get to know other Amazing Charts clients. uncensored forum.

Welcome!
Welcome to the Amazing Charts Help Manual.

Amazing Charts was developed to provide a powerful option for physicians who just can't get over the ludicrous cost and complexity of current medical software. Our goal is simple: create software that is easy to use, affordable, and makes practicing medicine easier and better. If you can't find what you are looking for, check out our website (AmazingCharts.com) where we keep information up to date. To get help regarding various screens and functions while using Amazing Charts, click the F1 key. This will open our context-sensitive Help, and can save you a bunch of time figuring out how and why Amazing Charts works the way it does. You can also watch movie tutorials of Amazing Charts in action. Tutorials are regularly updated as we add new and enhanced features and spending a few minutes watching these before getting started will rapidly bring you up-to-speed with all we have to offer. Other great sources of help include the Amazing Charts Bulletin Board and our website. The first step is to install Amazing Charts on your main computer. We've designed the program so that you don't need to know the details of how or where the program resides. It just works, and that is a major reason we are one of the fastest growing EHRs on the market. That said, many geeks want to know more, so for those who wish to know the details, check out our Technophiles section. Finally, if you have not yet done so, be sure to review our End User License Agreement (EULA) since, by installing and/or using Amazing Charts or any of our services, you are agreeing to the terms of the EULA. You can probably guess how we feel about lawyers and contracts, but as you also know there are a lot of morons out there - and we must insist that you are not one of them. The EULA basically says that you understand that Amazing Charts is provided for you "as is" and there are no guarantees it will work. While we strive to keep it working well, supported, affordable, and conforming to any requirements that the government or other parties feel are necessary to make your practice more difficult - there is no guarantee that this is the case or will continue to be the case. Trust us, if you dare - as thousands already do - but if you need the legal guarantees before using certain software or services, you can pay the tens of thousands of dollars our competitors charge and use somewhere else for your EHR needs.

(We'll still be here when you realize their program costs much more yet provides you much less - and still has a more onerous contract that likely requires you commit to years of payments with no recourse if you find it just doesn't work for you.)

An Overview
When you first run and install the AmazingChartsInstaller program, Amazing Charts is unpacked and placed into a folder called Amazing Charts. Where Amazing Charts Is Installed This Amazing Charts folder is located (providing you used the default location when installing) in your programs folder located on your computer's main hard drive (usually C:\Program Files\Amazing Charts). A shortcut to the program can be found by clicking on your Window's Start button, selecting the All Programs option, then the Amazing Charts folder, and finally Amazing Charts. You can also start Amazing Charts by clicking on the Amazing Charts shortcut icon automatically placed on your desktop during installation. Amazing Charts Associated Programs Amazing Charts includes a number of utilities that can help with various - less commonly required procedures. For example, the Amazing Utilities utility is an included program that can be used to help sort out issues related to database connections, speed issues, and cleaning up old backup versions when your hard drive is running out of space. Other utilities include the Amazing Backup utility, which as its name implies, automatically prepares backups of all the critical Amazing Charts data, Backup Restore Utility, which can restore the backups made by the Backup utility, and a few others we'll look at later. Your Patient & Practice Data Amazing Charts uses Microsoft's SQL Server databases to store all the practice and clinical data generated. These databases (with extension .mdf) are located in the Amazing Charts directory on your main computer. By default, the folder is placed on the C drive in the Programs directory (i.e., C:\Program Files\Amazing Charts). While there are also codes.mdf meds.mdf present as well, both of these databases are static and have their data regularly updated. Only the AmazingCharts.mdf (and its associated log file, .ldf), the Imported Items directory, and the _Data01 directory contain your patient and practice data. Thus, these are the items that the Amazing Charts Backup utility backs-up. You never want to delete or mess with this items, as they contain nearly everything you put into Amazing Charts, including your practice data, user info, patient demographics, notes, meds, and essentially everything else that you would hate to lose. Data Protection & OffSite Backup In the interest of data protection, Amazing Charts offers an easy way to backup your critical data at regular intervals, encrypted, securely, and without much hassle. The Amazing Backup Utility saves all your crucial practice data and notes in a Backup folder in the Amazing Charts folder, and can be configured to backup to one or more other hard drives as well. In addition, we offer the OffSite Backup service that will also send your critical data to a location other than your office, and provides a quick and easy back-up source if ever there is a catastrophe (e.g., fire, vandalism, hurricane, etc.). This is essentially an insurance policy to ensure all your critical data is available soon after you experience an office calamity and is described here. Always Improving Amazing Charts is an ever-improving tool to help you run your medical practice. It is constantly updated and enhanced with both the government and payor mandates that are continually instituted and changed, as well as the new requirements of our users. Through the program and our annual Amazing Charts Users' Conference, our clients tell us what needs to be added or changed, and the priority with which this is to be done. If you don't like how Amazing Charts works today - you can play an active role in helping morph Amazing Charts into what you need to get your job done. This is done by submitting your feedback directly through our software as well as attending our annual Amazing Charts Users' Conference where development priorities and changes are decided upon by our users.

End User License Agreement (EULA)

The End User License Agreement

This agreement will change from time to time. The most up to date version is always available at www.amazingcharts.com/EULA.pdf

SOFTWARE & SERVICES END USER LICENSE AGREEMENT (EULA) The Core Concepts In line with the different way in which we provide our software and services, we (AmazingCharts.com, Inc.) are providing to you (the person(s) using our software or services) an easy-to-understand (and we hope, reasonable) End User License Agreement (EULA). We've summarized the take-home-messages you must understand if you wish to use our products or services.
1.Who

can use Amazing Charts? We provide software and services for medical professionals wishing to use our products and who understand the risks, benefits, and limitations of our products as described in this EULA and on our websites. If you are a lawyer, third-party insurer employee, patient, drug-seeker, or anybody else not planning on using the software to generate clinical records in a professional health-care setting, you may NOT download, try, or use our software without written permission from us. use Amazing Charts at your own risk! We are providing you this product at a significantly discounted cost, and as such we are not liable for any problems that may arise as a result of using our software or services. This program and its associated services are provided as is. That means that there could be (albeit unlikely) serious programming errors that may result in lost or erroneous data, computer or network problems, or other issues which may interrupt or impact your ability to get your work done correctly or get paid. You use our products and services at your own risk! (Of course, since word-of-mouth is the reason we are so popular, we certainly will use reasonable commercial efforts to solve any problems you experience.) Behavior. AmazingCharts.com encourages open discussion of issues and concerns regarding our software (and our company behavior) on our website at www.amazingcharts.com/board. In fact, we consider constructive criticism an invaluable means of improving our software and services. That said, users who act in a manner that is detrimental to our ability to provide software and services to clients equally, or those whose actions are at odds with the well-being of our company will not be allowed to continue to use our software or services. Examples of such unacceptable behavior include users who don't pay the licensing fees, users who behave in a manner that our staff finds to be inappropriate or threatening, users who post comments about Amazing Charts or related services that are false, and users using our products in a manner other than which they are intended. Treat us as you would like to be treated, and we'll do the same. current pricing for our software and services is clearly published on our website and we do not charge hidden fees. Users who purchase services that have a recurring charge (e.g., our guardian angel support & maintenance service, Offsite Backup service, etc.) have the opportunity to

2.You

3.Expected

4.Cost. The

have their credit card automatically rebilled for these charges. Since automatic rebilling saves us time and energy, users who pay via credit card will have the price for those services locked-in to the current price paid, until such time as the credit card expires or until we have to manually adjust or alter the credit card information. This locked-in price is offered solely as a courtesy, is subject to change at any time, and does not apply to invoicing or any other payment methods that requires us to spend time (and money) collecting payment.
5.What

if you don't abide by this EULA? We have the right to turn off our software and services after sending you notice of your breach. That said, we certainly will try to amicably resolve any disputes before we revoke the right to use our software and services. Even if your license is revoked, you maintain the right to export patient demographics and notes through the Administration section of the program. The clinical data in Amazing Charts is your data, not ours even if you've treated us badly and we have revoked your license. if we don't abide by this EULA? You have the right to stop using our products and to stop paying us any recurring charges at any time. You may also sue us (in the state courts of Rhode Island) if you feel we didn't abide by this agreement.

6.What

Okay, now the informaton wriien in a manner which allows lawyers to deal with the details of the a ovev Terms and Conditions By downloading and/or using Amazing Charts, or any of the applications, services, programs, installers, utilities, contained files, databases, or integrated third-party products (herein collectively referred to as the Program), or by using any services offered by AmazingCharts.com, Inc., you agree that you have read, understood, agree to, and will abide by, all terms of this Agreement. We recommend you read this Agreement completely as you are agreeing to the terms of this agreement as well as agreeing to our online user agreement when you download, install, or use any portion of the Program or related Amazing Charts services. You agree that this Program and associated services is intended to serve as a rapidly accessible, concise initial resource and not as a complete reference resource. It does not include information concerning every therapeutic agent, diagnosis, laboratory or diagnostic test or procedure available. The product is clinically oriented and is intended to be used only by medically licensed providers who are physicians and/or other competent and duly authorized/licensed healthcare professionals who will rely on their own discretion and judgment in medical diagnosis and treatment. Neither Amazing Charts, nor related interfaced third party providers, directly or indirectly practice medicine or dispense medical services and, as such, assume no liability for data or function contained in this Program or services, or its use. You assume full responsibility for the appropriate use of medical information contained in the product and agree to hold AmazingCharts.com, Inc., and its third party providers harmless from any and all claims or actions arising from your use of the product. Trial Period Amazing Charts software and services are intended for active Healthcare Practitioners and their employed staff only. Persons not intending to evaluate Amazing Charts for use in their own medical practice (e.g., patients, laymen, attorneys, insurance companies, or any of their agents) who wish to download the Software must first receive written permission from AmazingCharts.com, Inc. and pay an upfront license fee of 10 times the then stated license fee for the Software. FOR THESE PERSONS, NO TRIAL PERIOD IS PERMITTED AND LICENSING IS ONLY PROVIDED AFTER PAYMENT AND BACKGROUND VERIFICATION. Non-healthcare person who download the Software or use it before receiving a written license and authority from Amazing Charts AND paying the aforementioned license fee will be subject to legal liability, and will be prosecuted to the full extent of the law. By agreeing to the terms of this Agreement, users who are evaluating the Amazing Charts software for their medically-related healthcare practice, may download and use the Program for an initial trial period of

approximately 80 days. The downloaded Program includes a time limit mechanism to prevent it from operating after a period of approximately 80 days from when it is installed on a computer. The Program MAY NOT provide reminders that operation will imminently cease. If you wish to use the Program beyond the initial trial period, you agree to pay the currently stated license fees. All Fees are non-refundable. Upon payment, you will receive a registration code (Registraton ode) that must be entered into the Program to allow it to continue to operate. Continuing Use Beyond The Trial Period At regular intervals, the downloaded program will connect to the Amazing Charts servers via an Internet connection and automatically verify current services and verify that the client is in Good Standing (see description below). Without this intermittent verification, the licensed Program may cease to operate. Use of Amazing Charts without an Internet connection will limit the ability of the program to automatically verify itself and may require additional user intervention (i.e., calling into Amazing Charts to obtain a validation code required to continue to use the program). Amazing Charts includes information that must be regularly updated to reflect the current standards-of-care of medicine and that addresses identified programming errors in earlier versions of our software and services. Thus users are strongly advised to subscribe to our Update & Support services which provide the means to ensure Amazing Charts software and services are up-to-date. Although users are not required to subscribe to this service, failing to do so means that the Amazing Charts software, services, third-party interfaces, and databases will contain outdated and/or erroneous information which may put the user at increased risk of errors and potential loss or corruption of their data from programming errors fixed in subsequent updates. Users who do not subscribe to our Update & Support service do so at their own risk and agree to hold AmazingCharts.com, Inc. harmless for any claims arising from such use of outdated software, services, third-party interfaces, medication, codes, and other databases. Good Standing AmazingCharts.com, Inc. provides software and services for medical professionals wishing to use our products and who understand the risks, benefits, and limitations of our products as described herein and on our websites. In addition, AmazingCharts.com, Inc. encourages open discussion of issues and concerns regarding our software (or company behavior) at www.amazingcharts.com/board. In fact, constructive criticism is considered a critical means for improving our software and services and is not considered to be inappropriate. That said, users who act in a manner that is deemed by AmazingCharts.com, Inc. to be detrimental to the ability of AmazingCharts.com, Inc. to provide software and services to all clients equally, or those whose actions are detrimental to the continuing well-being of the company will be considered to NOT be in Good Standing, and may have their license to use our software and services revoked. Examples of such unacceptable behavior include users who don't pay the required licensing fees, users who behave in a manner that our staff finds to be inappropriate or threatening, users who post comments about Amazing Charts or related services that are false, and users who use our software or services in a manner other than which they are intended. Users acting in a way deemed to be inappropriate will be notified that their behavior or action is considered disruptive and an attempt to correct such behavior shall be encouraged. If such disruptive behavior persists, AmazingCharts.com, Inc. may terminate this license as described in the Termination section below. Patient-Related Data Through the use of the Amazing Charts program, patient demographics and clinical encounter notes are generated and stored in Amazing Charts. Much of this data is retrievable by you WITHOUT HAVING TO NOTIFY OR PAY ADDITIONAL FEES TO AmazingCharts.com, Inc. To retrieve this data, you may log into the

Administration window of Amazing Charts and select the Import/Export tab, and then export the data in a number of different formats. Optional Services In addition to the Programs, AmazingCharts.com, Inc. is also offering certain maintenance and support, data backup, electronic prescribing, billing services to its licensees, and other possible services (Services). These Services are described, and may be purchased on the AmazingCharts.com Inc. Web site. The terms of this Agreement will apply to the Services, in addition to any specific terms and conditions set forth on the Web site and/or agreements made regarding such services. Service Fees You agree to pay AmazingCharts.com, Inc.'s current service charges for any Services you chose to use. These service fees, which are subject to change, are posted on the Web site at AmazingCharts.com. Changes in service fees will be notified to you by posting on the Amazing Charts website. You agree that AmazingCharts.com, Inc. may bill you for the Service fees as posted on the Web site. Should AmazingCharts.com, Inc. raise the charge for these Services, you agree to be billed at the new rate, and that these fees will be recurring in nature and charged to you unless you notify AmazingCharts.com, Inc. that you want to terminate a Service at least two weeks prior to billing. Service fees are non-refundable. As a courtesy to users who subscribe to our services and allow their credit card to be automatically rebilled, the price for such services will e locked-in at the inital price paid untl such tme as their credit card expires or requires manual intervention by us to alter credit card information. This locked-in price is provided as a courtesy only, is not guaranteed, can be revoked at any time, and does not apply clients who pay by check, requires invoicing, or those who require their credit card information to be adjusted. Support Support for Amazing Charts is NOT included with the Program. Any support provided, whether purchased or not, is done at the sole discretion of AmazingCharts.com, Inc. and is covered by this EULA, including the No Warranty and Limitation of Liability sections below. No Warranty THE PROGRAM AND SERVICES ARE PROVIDED "AS IS." AMAZINGCHARTS.COM, INC. DOES NOT MAKE ANY WARRANTIES OR REPRESENTATIONS, EXPRESSED OR IMPLIED, CONCERNING THE MERCHANTABILITY, QUALITY, NON-INFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE OF THE PROGRAM OR SERVICES. YOU ASSUME ALL RISK OF USE. NO WARRANTY IS GIVEN THAT THE PROGRAM OR SERVICE WILL BE ERROR-FREE, FREE OF VIRUSES, OR THAT IT WILL NOT ADVERSELY AFFECT YOUR COMPUTER OR OTHER PROGRAMS ON YOUR COMPUTER. AMAZINGCHARTS.COM, INC. DOES NOT WARRANT THAT THE FUNCTIONS CONTAINED IN THE PROGRAM OR SERVICES WILL MEET YOUR REQUIREMENTS OR THAT THE OPERATION OF THE PROGRAMS OR SERVICES WILL BE UNINTERRUPTED. Limitation of Liability AMAZINGCHARTS.COM, INC. SHALL NOT BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY DIRECT, SPECIAL, INDIRECT, CONSEQUENTIAL OR INCIDENTAL DAMAGES INCURRED ARISING OUT OF THE USE OR THE INABILITY TO USE THE PROGRAM OR SERVICES, OR OUT OF DATA PRODUCED BY THE PROGRAM, ANY LOSS OF DATA, OR ARISING FROM ANY BREACH OF A REPRESENTATION OR WARRANTY, OR FOR ANY CLAIM BY ANY THIRD PARTY, REGARDLESS OF THE TYPE OF CLAIM OR THE NATURE OF THE CAUSE OF ACTION, EVEN IF AMAZINGCHARTS.COM, INC. HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE OR LOSS. AMAZINGCHARTS.COM, INC.'S MAXIMUM LIABILITY FOR ANY REASON WILL BE TO REFUND THE AMOUNT YOU PAID TO IT IN THE TWELVE MONTH PERIOD PRECEDING THE DATE OF THE CAUSE OF ACTION GIVING RISE TO THE CLAIM CONCERNED. THE FOREGOING LIMITATION OF LIABILITY IS AN AGREED ALLOCATION OF RISK THAT IS REFLECTED IN THE FEES FOR WHICH AMAZING CHARTS SOFTWARE, SERVICES, SITE AND/OR CONTENT IS MADE AVAILABLE BY AMAZINGCHARTS.COM, INC., WITHOUT WHICH THE AVAILABILITY AND/OR PRICE OF WHICH WOULD NECESSARILY DIFFER FROM THOSE OFFERED BY AMAZINGCHARTS.COM, INC.

Confidentiality onfdental lnformaton means any informaton (without regard to the medium on which such information may be recorded, whether written, visual, audio, graphic, computerized or otherwise) concerning or relating to your property, business affairs and patients and specifically includes data transmitted from your computer(s) to AmazingCharts.com, Inc.'s servers. Confidential Information shall be held in confidence by AmazingCharts.com, Inc. and shall be used only for the purposes provided for in this Agreement. AmazingCharts.com, Inc. shall use the same degree of care to safeguard your Confidential Information as it utilizes to safeguard its own Confidential Information. The terms of this provision shall apply to AmazingCharts.com, Inc.'s confidential information which comes into your possession. AMAZINGCHARTS.COM, INC. WILL KEEP YOUR CLINICAL DATA (including, but not limited to, medical care, prescribing habits, and other patient-care data in your medical records), CONFIDENTIAL. AmazingCharts.com, Inc. WILL NOT sell, trade, transmit, or provide any clinical information to insurers, pharmaceutical companies, attorneys, governmental agencies, or any other third-party except with your expressed permission. AmazingCharts.com, Inc. requires all its employees to review, understand, agree with, and comply with HIPAA regulations (described below). The confidentiality of any and all clinical records is mandated at all times. AmazingCharts.com, Inc. may comply with any subpoena or similar order related to data on its server, provided that AmazingCharts.com, Inc. notifies you promptly upon receipt thereof, unless such notice is prohibited by law. AmazingCharts.com, Inc. WILL NOT USE AD-WARE, SPY-WARE, or other mechanisms that may compromise confidentiality of records or intentionally damage the integrity of the medical records or content on your computer. HIPAA Requirements AmazingCharts.com, Inc. will use its reasonable efforts to comply with the Health Insurance Portability and Accountability Act of 1996, as codified at 42 U.S.C. 1320d (HlPAA) and any current and future regulations promulgated there under including without limitation the federal privacy regulations contained in 45 C.F.R. Parts 160 and 164 (the Federal Security Regulatons), the federal security standards contained in 45 C.F.R. Part 142 (Federal Security Regulatons), and the federal standards for electronic transactions contained in 45 C.F.R. Parts 160 and 162, all collectvely referred to herein as HlPAA reeuirements. AmazingCharts.com, Inc. agrees not to use or further disclose any Protected Health Information (as defined in 45 C.F.R. Section 164.501) or Individually Identifiable Health Information (as defined in 42 U.S.C. Section 1320d), other than as permitted by HIPAA Requirements and terms of this Agreement. AmazingCharts.com, Inc. will make its internal practices, books, and records relating to the use and disclosure of Protected Health Information available to the Secretary of Health and Human Services to the extent required for determining compliance with the Federal Privacy Regulations. Property This Program and all related materials are the copyrighted property of AmazingCharts.com, Inc. Except as noted below, the Program and all intellectual property rights therein are owned by AmazingCharts.com Inc. You are authorized to use the Program for your own internal use. You are prohibited from selling, leasing, or licensing the Program or any portion thereof to any unauthorized party, or using it to process the work of any other party. You are prohibited from creating derivative works based on the Program without written permission from AmazingCharts.com, Inc. You are prohibited from disassembling or reverse engineering the Program, or removing any copyright notice from it. You may only make copies of the Program for backup or archival purposes. It is your responsibility to ensure that anyone who has authorized access to the Program complies with the provisions of this Agreement. The CPT five-digit codes and descriptions are the copyrighted property of the American Medical Association (AMA) and are subject to the restrictions set forth in the previous paragraph. The CPT codes are licensed to

AmazingCharts.com, Inc and continued use within the program is dependent upon continuing contractual relations with the American Medical Association. You may not use the Program, or any of the Medications, ICD, or CPT information contained therein in any public electronic bulletin board, or public computer based information system (including the Internet and World Wide Web). Export Controls You acknowledge that the Program contains 128-bit, and higher, encryption algorithms and may be subject to restrictions and controls imposed under the export control laws and regulations of the jurisdiction in which you are using the Program and may not be exported, acquired, shipped, transferred or re-exported, directly or indirectly, to (i) any country or region prohibited under such laws and regulations or (ii) any end user who has been prohibited from participating in the export transaction under such laws or regulations. In particular, the Program is subject to regulations respecting export permits and prohibitions on export under the laws of the United States and Canada. Termination Once you purchase the license registration key, this License is automatically renewed in perpetuity on the first day of each year until terminated. This License will automatically terminate if you fail to comply with any term of this agreement, and you must cease to use the Program after notice. In addition to automatic termination for breach of this agreement, Amazing Charts may terminate your license and ability to use our software and services if you are found NOT to be in Good Standing (as described in the Good Standing section above). AmazingCharts.com, Inc. has the ability to terminate access to most of the features of the Amazing Charts software and services. Even if this access is turned off, however, you will still maintain the ability to export your patient demographics and notes (see Patient-Related Data section above). Other than terminating access to parts of the Amazing Charts software or services, after notice to you that you are in breach of this Agreement, AmazingCharts.com, Inc. WILL NOT DELIBERATELY DISABLE, TAMPER, or CRIPPLE YOUR COMPUTER or otherwise hamper your ability to use non-Amazing Charts software or services. You may terminate this License at any time by sending mail to AmazingCharts.com, Inc. at the address on our website or via email to us, explaining your situation and why you are terminating the License. (Be sure to export your patient-related data as described in the Patient-Related Data section before terminating your license.) Upon termination of the License for any reason, you agree that you will immediately delete all copies of the Program from your computers and cease using Amazing Charts or any associated services. You agree that by terminating your license, you are authorizing AmazingCharts.com, Inc. to immediately delete any and all backup files, billing information, and any other data you have provided us. Miscellaneous If you violate any terms of this Agreement, AmazingCharts.com, Inc. may immediately terminate your license to the Program and any services provided by AmazingCharts.com, Inc. or third-party providers. All fees are non-refundable. (Refer to the Termination section above for more information.) This Agreement is nontransferable, nonexclusive, and only within the United States and its territories. This Agreement shall be governed in accordance with the laws of the State of Rhode Island, excluding its conflicts of laws principles. Any action by you against AmazingCharts.com, Inc. shall be brought in the state courts of Rhode Island. In the event that a provision of this Agreement is determined to violate any law or is unenforceable, the remainder of this Agreement shall remain in full force and effect.

No failure or delay on the part of AmazingCharts.com, Inc. in exercising any right hereunder will operate as a waiver of, or impair, any such right, or any other right of AmazingCharts.com, Inc. Provision of an updated version of Amazing Charts CPT database and information at AmazingCharts.com is dependent upon continuing contractual relations with the American Medical Association. This license is updated from time to time and the most up-to-date version is posted at www.amazingcharts.com/EULA.pdf. Providing you agree to abide by the latest version of this license as posted at the link above, the End Users License Agreement will be considered to automatically renew on the first day of the year (January 1) in perpetuity until terminated by you or AmazingCharts.com in accordance with the Termination section above. (EULA Version Date: 06/03/09)

Installing & Uninstalling Amazing Charts


If you're reading this, then you've probably already run the initial installation program and know how easy it was to do so. In case you haven't though, or if you ran into trouble, here's the details on how to install Amazing Charts on your computer: 1. Download the AmazingChartsInstallerX.exe (where X is the version number of the current release, e.g., AmazingChartsInstaller6.exe) from our website, and save it to your desktop (or better yet, a shared directory on your computer so you can then get it and install it on your other computers later without having to keep re-downloading the large file). A couple more things to note before continuing to Step 2:

o While Amazing Charts is designed and primarily tested to run on Windows XP, Vista, and

Windows 7 PC computers, many people also run it without issues on their Small Business Servers, Macintosh computers (running Bootcamp, VMware, Parallels, or VirtualPC), and even Linux boxes. It can run on processor chips made by Intel or AMD. More specific hardware requirements are listed here. The vast majority of standard off-the-shelf PCs today have these recommended configurations by default.

o Amazing Charts, like essentially all Window's programs, requires DLLS and OCX files that are

located in the Window's folder, in the Common folder, in the Amazing Charts folder, and scattered about in various arcane places as dark and dingy as Bill Gates' colon. Happily, we spend a lot of development time ensuring our installer can successfully determine which additional files you'll need to run Amazing Charts, and automatically install them without overwriting any files you already have (and without bothering you with the details). Of course, anybody running Microsoft Windows knows that isn't always the case, and a seemingly harmless installation can lead to hours of frustration with lost and overwritten files. Therefore, we strongly recommend you become familiar with the restore function of your Windows operating systems (found in the Windows control panel) as experiencing DLL Hell is just that.

2. Double-click the AmazingChartsInstaller.exe and follow the prompts one by one: these should be self-explanatory - though we walk through each step here. We recommend using the default settings to minimize future complexity and make troubleshooting easier. One of the more common tech support issues we encounter are problems introduced when an IT consultant who "knows how best to do things," starts changing the default setup and putting Amazing Charts or its associated files where they don't belong. IT consultants, while often quite knowledgeable, have a bad habit of basing decisions on their prior anecdotal experiences rather than what is recommended by our developers as best practices related to an EHR. Visit our website to find IT consultants who we are confident can do a good job for those who aren't comfortable installing and setting up Amazing Charts by themselves. We can also come to you (for an additional fee) and set up and train your staff. 3. Because Amazing Charts uses a professional grade (and thus easily scalable) database called SQL Server (Express Edition), setting this up tends to require a bit of caressing. Rest assured, we've built in automated features to allow you to set up Amazing Charts without needing a dedicated IT consultant or database administrator. These steps are described here. 4. Once installed and configured (meaning Amazing Charts has been able to connect to the SQL Server as described here), there will be just one more step before you're ready to start enjoying all Amazing Charts has to offer. This is getting Amazing Charts and its associated databases and files recognized

as valid applications on the security-conscious Window's Operating Systems (7, Vista, XP SP3) machines. These steps are described here. 5. The rest is as easy as adding a test patient and then using this patient to see exactly how intuitive and easy Amazing Charts can be. Most of our users can get Amazing Charts installed, patients added, and writing notes within an hour of deciding to do so. Amazing Charts can run on one or many (networked) computers. Networking Amazing Charts requires that the computers are linked together, and the Amazing Charts folder is shared on the "main" computer. The "main" computer will act like your server, whether or not it truly is a server. For more information on networking, click here. Technophiles who wish to understand the inner-working of Amazing Charts and its associated files can review this data here. CONFLICTS AND ISSUES WITH INSTALLATION Known conflicts with various antivirus, intrusion detection, and malware eradication software, as well as issues that have occurred in association with various operating systems and end user hardware and software configurations, are addressed and regularly updated and posted on our website at www.amazingcharts.com/help. While the installation process usually occurs without a hitch, there are a number of problems that can occur from time to time.

Antivirus, intrusion detection, malware eradication, and firewalls are the most common issues encountered when
installing Amazing Charts. Amazing Charts has been tested with default configurations of Norton Anti-Virus, McAfee Anti-Virus, Lavasoft's Ad-Aware and Spybot Search and Destroy software and no issues have been encountered to date. We have, however, occasionally encountered some users who had difficulty installing the program if using one or more of the following applications: o Norton (e.g., Norton 360, Avast, Malewarebytes, Webroot , and Windows User Access Control (UAC). Certain settings of these, and potentially other, antivirus/intrusion detection software may impair the ability of the program to install or be run successfully. Users are advised to disable these applications before installing Amazing Charts. In addition, due to the nature of scanning software and their inherent slowing of system operations, it is recommended when a full system scan is warranted, it be performed during off-peak hours.

o Amazing Charts recommends full system scans be performed regularly (e.g., weekly). It is recommended
that the Anti-Virus software installed on a user's server exclude the Amazing Charts applications and the SQL Server databases (located by default at C:\Program Files\Amazing Charts).

An updated list of the most common issues is located at www.amazingcharts.com/help (and, more specifically, If the files listed above have been disabled or turned-off, and if you've checked our online updated information, and
errors still occur, try restarting the computer and attempting to install Amazing charts as this often succeeds. If you still have difficulties, contact us at www.amazingcharts.com/help for assistance. For example, usually, when SQL Server is first used on all supported Microsoft operating systems, a window will automatically pop open asking if the user wishes to allow/unblock the firewall to allow the Amazing Charts instance to run. You should allow Amazing Charts to access SQL Server, or the program will not function. Sometimes, however, the firewall or intrusion-detection software block occurs silently and in the background (based on the configuration of the user's program). Thus, the programs listed above, and other programs which will be added to our list on our Help site, should be disabled or uninstalled before installing Amazing Charts. A known issue occurs during the initial configuration on Microsoft Vista, right-clicking on the application and setting the program to Run As Administrator is often required. A pop-up window in Amazing Charts instructs the user on how this is accomplished (the window is shown below). here).

Run as administrator warning Window that opens automatically if Amazing Charts finds it does not have the required permissions to run correctly. Finally, Amazing Charts has its own built-in Virtual IT Person that can help walk through unblocking the firewall as well as setting up the initial configuration settings that Amazing Charts needs to interact with SQL Server. This Virtual IT Person prompts the user to sequentially solve the various steps needed to allow the program to access the database. These steps include: unblocking any firewalls, finding and defining one open port (61067 to 61087) for the MSSQL$AMAZINGCHARTS instance, starting the SQL Server service, and then testing to ensure the database can be queried and written to, proving the above steps were successful. Issues encountered during this sequence are provided in a subsequent window, which provides suggestions for remedying the problem.

The Virtual IT Database Administrator Window which automatically opens to help configure Amazing Charts on the server.

Running the Installer


Before Amazing Charts can be used, there are a number of prerequisite files that must be installed. These include the .Net framework and the SQL Server database, which stores and maintains all of your precious practice data. Which prerequisites are installed (and where they are put) depends on whether the computer you are on is to be the main computer (by definition, the computer where the databases are stored), or just one of the computers that is used to access the databases (e.g, a computer in one of your exam rooms or at the front desk of the office). Thus, after you first start the AmazingChartsInstaller, you'll be asked whether the computer you are currently using will be the main computer.

1. We recommend you first install Amazing Charts on your main computer (e.g., the computer in your office, a server, etc.), and complete the initial configuration process. Known installation issues are discussed here.

Amazing Charts Database Setup Window which opens upon starting the Amazing Charts Installer. 2. After installing Amazing Charts on your main computer, walk through the Setup Assistant steps and be sure the program runs on your main computer. 3. Once complete, you can install Amazing Charts on other computers on the network. As you do this, you should select the "No, this isn't the main computer..." on the screen that will come up automatically as the installation proceeds. The difference between the options is whether or not to install a SQL Server database. On computers that won't be acting as the main computer, you don't need SQL Server as it takes up space and system resources (though you could install it on every computer if you so desired). Thus the "Yes..." and the "Sort of..." options install SQL Server. The "No..." option does not. 4. If you chose one of the versions that install SQL Server, the Amazing Charts Installer will first install the files needed to run SQL Server, and then install SQL Server. Usually this will occur without you needing to do anything, though you may have to accept Microsoft's End User License Agreement at some point.

The Amazing Charts Installer can automatically install SQL Server if that option is selected. Installation of the prerequisite files (Microsoft Windows Installer, the .Net framework, +/- SQL Server) takes about 5 to 10 minutes to complete. Once these prerequisite files are installed, other required Amazing Charts files will be installed. After completing installation of these prerequisite programs, you'll be asked to configure your practice information.

SQL Server and the .Net Framework


Microsoft SQL Server (Express Edition), which we'll refer to as SQL Server, is a robust and scalable database that stores your practice and clinical data. The Amazing Charts windows you use to enter and review this data are simply a conduit between you and the databases.

The benefit of this database is its ability to be scaled to a much larger level, able to run practices with 10, 100, and even thousands of users. The reason we chose this database is because Microsoft permits us to distribute this fully-functional and robust database without charging a per-seat license cost so common with most databases. The catch is that the database that is provided with Amazing Charts has a 4 GB size limit (which is actually fairly difficult for a 1-5 doc practice to reach), can only access 1 CPU (though can be used on computers with any number of CPUs), and can access up to 1 MB of the RAM on the computer. For larger practices, we can assist you in upgrading your SQL Server Express version to

the full SQL Server version (although Microsoft requires you purchase "seats" to use their full SQL Server version). Amazing Charts also requires the Microsoft .Net framework, which is a library of various tiny programs that allow Amazing Charts to harness the full power of the computer, network, and Internet. If your computer doesn't have the correct version of the .Net framework, the Amazing Charts Installation program will automatically load it. (To install the .Net framework and SQL Server requires a specific version of the Microsoft Windows Installer (MSI) program. While most current off-the-shelf computers have this preinstalled, if your computer doesn't, the Amazing Charts Installer will automatically install this program as well.

Problems Installing Amazing Charts


While the installation process usually occurs without a hitch, there are a number of problems that can occur from time to time.

Antivirus, intrusion detection, malware eradication, and firewalls are the most common issues encountered when
installing Amazing Charts. Amazing Charts has been tested with default configurations of Norton Anti-Virus, McAfee Anti-Virus, Lavasoft's Ad-Aware and Spybot Search and Destroy software and no issues have been encountered to date. We have, however, occasionally encountered some users who had difficulty installing the program if using one or more of the following applications: o Norton (e.g., Norton 360, Avast, Malewarebytes, Webroot, and Windows User Access Control (UAC). Certain settings of these, and potentially other, antivirus/intrusion detection software may impair the ability of the program to install or be run successfully. Users are advised to disable these applications before installing Amazing Charts. In addition, due to the nature of scanning software and their inherent slowing of system operations, it is recommended when a full system scan is warranted, it be performed during off-peak hours.

o Amazing Charts recommends full system scans be performed at least once a week. It is recommended that
the Anti-Virus software installed on a user's server exclude the Amazing Charts applications and the SQL Server databases (located at C:\Program Files\Amazing Charts).

An updated list of the most common issues is located at www.amazingcharts.com/help (and, more specifically, If the files listed above have been disabled or turned-off, and if you've checked our online updated information, and
errors still occur, try restarting the computer and attempting to install Amazing charts as this often succeeds. If you still have difficulties, contact us at www.amazingcharts.com/help for assistance. Program Compatibility Assistant Warning Message Windows Vista will sometimes warn that "this program might not have installed correctly." here).

The Program Compatibility Assistant Warning Not to worry, this is a Microsoft Vista bug related to the way Amazing Charts installs Microsoft SQL Server. You can click

the "This program installed correctly option," and then continue.

Uninstalling Amazing Charts


While we hope you never read this, but if you do want to remove Amazing Charts from your system, it's quite easy. Just follow the steps below: 1. In your Window's control panel, select Amazing Charts and chose the Uninstall option. This will remove the vast majority of the files, dlls, and databases Amazing Charts initially installed. This step won't, however, remove your practice and patient-containing data (as a way to prevent accidental deletion). 2. Next, in the same Window's control panel, you'll see ACPrerequisites. Select and remove this (this program automatically installed the SQL Server and other prerequisite files such as the .Net framework) 3. To completely remove Amazing Charts - and all your patient and practice data - you'll need to browse to your Programs directory on the computer (usually at C:\Program Files\Amazing Charts or C:\Program Files (x86)\Amazing Charts) and manually delete the Amazing Charts folder by right-clicking on the Amazing Charts folder, and clicking Delete. Once you do this, all your practice and clinical data is deleted permanently, so only do this step you are sure you have your clinical data backed-up elsewhere. Performing a backup that will contain all the practice and clinical information is critical, and the steps to do this correctly are discussed here.
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Amazing Charts Setup Assistant


With newer Windows operating systems, security measures have been implemented to ensure an unauthorized program isn't running. Thus, the first time you run Amazing Charts on a computer (and whenever you update your Amazing Charts to a new version), you need to run Amazing Charts "As an administrator" by right-clicking on the Amazing Charts program icon found within the Amazing Charts directory. While this sounds like a pain, we've built a tool that will automatically open that directory for you and tell you what to do. The one caveat is that you need to close the instruction window before restarting Amazing Charts or it will say that the program is already running.

Running Amazing Charts The First Time Requires Starting The Program From Within the Amazing Charts Directory Once you've completed installation and run Amazing Charts as an Administrator as described above, the Amazing Charts Setup Assistant will walk you through the initial set up process, after which you'll be ready to go. The Setup Assistant will step you through the following:

Find your Amazing Charts Database Enter your Practice Information Enter a reseller/distributor code (if a reseller or distributor helped you get Amazing Charts running) Set an Admin password Add Users Add Schedules Import an initial list of patient demographics (from another software's export) Verify your practice (to allow prescription writing)

Once you have completed the setup process, the next step will be to Add your first patient.

Locate the Amazing Charts Database


The Amazing Charts Setup Assistant will walk you through the important steps in getting Amazing Charts up and running. The most important step is telling the Amazing Charts Setup Assistant where the Amazing Charts databases are located.

Your practice's data is stored in the AmazingCharts.mdf on your "main" computer (this can be a dedicated server, or just another computer on your network). This is the SQL Server database, and is actually comprised of a few necessary files, including the AmazingCharts.mdf (Microsoft data file) and AmazingCharts.ldf (log data file). If you're running Amazing Charts on one computer only, these files are likely sitting in the same folder as the Amazing Charts.exe application. For those running Amazing Charts on one computer, click the: Yes, this is currently the 'main' computer... Don't worry, you'll be able to change these settings later if you start to use this on your office network. (Click here to see how to Reset The Path to the main database.) Similarly, if you are setting up the main computer on a network, also click the Yes option. For those running Amazing Charts on a network (i.e., you're setting up one of the other computers in your office that will run Amazing Charts) - or if you have not installed Amazing Charts according to the default settings, and thus installed the Amazing Charts database files in a folder outside of the folder where the Amazing Charts.exe application is located - you need to locate the Amazing Charts database. To make this easier, Amazing Charts has the Amazing Charts.xml configuration file, which holds information on where the SQL Server database files are located. Once you make the choice above, the next step is to locate this Amazing Charts.xml

AmazingCharts.xml
Amazing Charts uses the AmazingCharts.xml file (the "configuration file") to store the location of your database. This is done by locating the AmazingCharts.xml configuration file on the main computer. If you are currently on your main computer, simply click the Open button to continue. If, however, the main databases are not on the current computer (i.e., you are in the process of setting up one of the other computers on your network), you'll need to find the AmazingCharts.xml file by browsing across your network to the correct location and then select the file that says "AmazingCharts" (as shown below). Then click the Open button.

The AmazingCharts.xml File That Tells All Amazing Charts Programs On Your Network Where, Exactly, The Main Database Resides. Once you select the AmazingCharts.xml configuration file, you'll be asked to enter the practice information, this is the next step in configuring Amazing Charts. If you have a database that has already been set up and you are just resetting the path to a database, Amazing Charts will simply start at this point. The AmazingCharts.xml configuration file (which, by default, doesn't display the .xml extension) contains information that Amazing Charts uses each time it starts up. (More information on the various files and what they do is here.)

The AmazingCharts.xml configuration file

Practice Information Window

Entering Your Practice Information Window After you locate the AmazingCharts.xml file, the Setup Assistant will ask you to enter your practice information. The information you enter will appear at the top of most reports (e.g., prescriptions, patient notes, problem lists, etc), so enter the data correctly. Your registration code is tied to the Practice Name field so enter your Practice Name correctly or Amazing Charts won't work correctly when you register after your trial period. A street address, city, state, and zipcode are all required fields. The Practice EIN (Employer ID Number), also known as the practice's Tax ID isn't required, but will be used if you use Amazing Charts to do billing. This number will be put on CMS1500 forms and your exportable billing data for each encounter. Similarly, a practice NPI isn't required either. If all providers in a practice function under one Tax ID number or one facility NPI, then you enter them. You can also enter individual provider's Tax ID and NPI for each user in the systems (discussed here). Most of the data you are entering during these steps is editable, if you need to, from within the Admin section of Amazing Charts. Once you've entered the data, click the button to continue.

Setting the Administrator Password


The Setup Assistant asks you to set the Admin (aka the Administrator) password. Like any password, picking something that is obvious (e.g., your last name or birthdate) is rather stupid, and defeats the purpose of passwords.

The Admin username and password is reserved for the person ultimately responsible for the program. The Admin will have access to all the practice preferences, users, user passwords, scheduling, and templates, and should be, if not the owner of the practice, one of the brighter of your employees, and the person with the most to lose if Amazing Charts gets messed up. While the Admin doesn't have to be the most computer savvy (since Amazing Charts is designed to be intuitive even for the computer illiterate), he or she shouldn't be a moron since they'll be able to mess with Amazing Charts settings and potentially cause problems, including overwriting the database when using the Backup Restore Utility.

The Administrator has the power to add and delete users, add and delete schedules, export all patient and practice data, and change practice information. Keep in mind that the Admin username and password will only be used to access Admin-level areas of Amazing Charts. The Admin usually will also have a regular username and password that they use on a daily basis when doing their charting and other activities. In other words, if you are a physician in solo practice, you will log in as the "Admin" from time to time when adjusting preferences or doing database maintenance. On a much more regular basis, however, you will log in with your regular username (e.g., your first name) when you are doing most of your Amazing Charts work (e.g., documenting notes, etc). Once you've entered the data, click the button to continue.

Adding A User
After setting your Admin password, the Setup Assistant asks you to enter user information. Users are those working in the office who will be using Amazing Charts. This includes providers and support staff, including nursing, secretarial, etc. We recommend you enter your own information first, and then the other users. Every different person should have their own user log in, so that Amazing Charts can keep track of who did what and when. If folks share a log in account, that defeats the purpose - and since only providers (docs, mid-levels, and others who are in charge of the patient care) require a license, there is no limit to the number of individuals you can add as distinct users.

The Add A User Window During Initial Setup Enter the user information in the fields provided. Confirm that the user's name is spelled and capitalized correctly as you go. This is made simple by looking just below the "This is how the user's name will appear" line. The name will be updated as you move from field to field. The fields with red headers are the only ones required. You must pick a "degree" from the list for everybody, even if they haven't finished high school. If the "degree" you want doesn't appear in the list, you can type your own entry. For non-providers, and other folk without an actual degree, type in their job description. For example, in the case of a secretary, you would add "Secretary" or "Administrative Assistant" or "Receptionist" or something like that. For non-providers, the degree doesn't appear in printouts. Assuming this user is you, and you are a physician or other provider that can write prescriptions, be sure to enter your correct DEA # and license information. The DEA # can be printed on your prescriptions when needed (as is often required when prescribing certain controlled substances). For non-prescribers, you can leave this information blank. If you are going to use Amazing Charts to do billing (now, or in the future), you should provide the provider's EIN or Tax ID if that provider will be billing under their own Tax ID and not under the practice's

Tax ID. Most of the time, you can leave this as the "Use the practice EIN." Now pick a username (the default is the user's first name, and will already appear in the box) and a password. Like any password, picking something that is obvious (e.g., the user's last name or birthdate) is rather stupid, and defeats the purpose of passwords. Users can change their passwords at will, and will be reminded of this every three months, to maintain security. Users change their password in the "My Preferences" section found under the "View" menubar (View | My Preferences). Finally, pick a Security Level (Level of Access). This is pretty self-explanatory. In the current version, all users will have access to the medical records, but we are working on hiding some patient data for upcoming versions, so set the security correctly now.

Now click the . Providing you didn't make any obvious errors, you will get confirmation that the user was added successfully. After filling the fields Press button a confirmation dialog box will be displayed as shown.

Press the Yes button if you want to add another user now (e.g., your staff's information, one by one) or press the No button if you don't want to add new user. You can always ADD, REMOVE, OR EDIT users in the Admin section.

Adding A Schedule
As our name doesn't imply, Amazing Charts includes the ability to schedule. You can add a schedule for any provider-level user at any time through the menubar at View | Administrator Options. If you like, you can add a provider schedule now during the initial setup.

The Add A Schedule Window Within The Amazing Charts Setup Process 1. To do this start by selecting a provider from the pull down list. (Only those with a security level set to "Provider" can have a schedule, so only these users names appear.) 2. Next pick the Start Date that you want the user's schedule to begin. When you click the button on the right of the text field (the thing that has three "..." buttons in it), a calendar pops up. Click on the day you want this user's schedule to begin. 3. Now pick an end data by clicking on the three dot thingy in the End Date field. The default time period is two years. While you can set this longer, if you have more than one schedule set, you will see a slow-down in the performance of the scheduler. We suggest you update the user's schedule

every 6 to 9 months, adding an additional 6 to 9 months. 4. Now pick the Start Time for each day listed. Each day must have some value, whether it be a time or "Off". The scheduler will automatically fill in an eight hour day, with an hour lunch break occurring three hours after the start time. You can adjust these times as needed. If you don't want a break, pick "Off" in the break field, and appointments will go from start to end times without a gap. 5. Now click the Add Schedule button, and the slots are set up (this takes a bit of time depending on how many appointments are set up - give it a minute or two and don't stop the process before you get the confirmation message that it is complete). Caveats

By default, appointments are 15 minutes in length - but you will be able to adjust the appointment
duration in the Administrator section after the schedule is setup. Overbooking can be done at any time by your secretary (or yourself), without having to add more slots. (This is discussed in the Scheduling section.) Once all days are finished, check your times once more since this is a pain to fix later (e.g., to change one day of the week required rebuilding the entire schedule for that user - although patient visits won't be deleted). As with most data you are entering during the setup process, you can add/edit and remove schedules in the Admin section of the program.

Add A Reseller
Amazing Charts has a number of distributors with whom we have a contractual agreement that provides them money back if they are responsible for your use of Amazing Charts. If a distributor is responsible for your use of Amazing Charts, enter their Reseller Code before continuing (usually the distributor is the person setting up the program for you, so they enter their own code here).

This is the only opportunity there is to enter a reseller code. The reseller code is provided by Amazing Charts to the contracted Distributor/Reseller.

Verify Your Practice for Prescription Writing Clicking the Import Patients button will end the Amazing Charts Setup Assistant and open the Amazing Importer
application. To use the prescription writing feature requires us to ensure we know who you are and are able to contact you and confirm your right to write prescriptions. You have the opportunity to verify yourself after your complete the installation process, so you don't have to do this part now. If you wish to submit your practice (and your prescribing information) now, click the Verify Practice button. Otherwise, you'll be asked to walk through the verification process later when attempting to use the Prescription Writer window.

Import Existing Patients From Your Practice Management And Verify Yourself For Prescription Writing Abilities During The Setup Process

Importing Patients
THE AMAZING IMPORT UTILITY IS PRIMARILY FOR USE DURING THE INITIAL SETUP OF AMAZING CHARTS! If you have problems doing the import, contact us as we will help get the data in so you can try Amazing Charts with your real patients. For importing of patient data after you have already set up Amazing Charts, see Interfaces. While importing patient demographics is easy with Amazing Charts, it is crucial that it be done correctly. Erroneously saved data will lead to problems later, and may cause the program to crash or save future data incorrectly, so please read and follow the instructions closely. To import patient information, you will need to have a delimited text (.CSV) or Microsoft excel file (.XLS) that has all the information. Usually this is exported or outputted from your current billing, scheduling, or EHR program (sometimes you need to call that program's vendor to have them explain how to do this). The import file must be correctly delimited or you won't see your data. This is the most common problem people have when trying to import data. To run the importer, first click on the blue "Step 1. Open File To Import" icon and find the text or excel file you wish to import. All the delimited data should automatically be placed into columns. If this does not occur, check to be sure your file is Saved as CSV type. First, browse for the file containing the data you wish to import.

If you are having troubles getting the data to appear correctly after selecting the file to import, try first importing your file into Excel, then save it as a CSV file. To do this, import your data into Excel and then under the "File" menu heading, click "Save As..." A new window will open, you "Save as Type: CSV (Comma Delimited) (*.csv)". If you get a message that some formatting will be lost, click YES or OK.

Looking at the data in the columns, you should be able to tell which column represents the first name, last name, middle name, birthdate, etc. The minimum amount of information required to run the importer is the patient's first name, last name, and birthdate. To the left of these columns is a long list of COLUMN NAMES. Now for the part you don't want to mess up... Select the COLUMN NAME and drag and drop it to the top of the correct column (e.g., drag the First COLUMN to the top of the column that looks to have all your patient's first names in it (as shown below). Repeat this procedure until all the data you want to import has a column header. (Any columns without headers won't be imported.)

Below are the available column headers representing various demographic fields. Only those in red are required. ChartID Salutation First Middle Last Suffix Gender This is the unique ID number that your current system uses (it won't be the patient's ID number in Amazing Chart). How that patient likes to be addressed (e.g., Mr., Mrs., Dr., etc). This is the patient's first name (e.g., John, Bill, Sally, etc). This field is required. This is the patient's middle name or first initial of middle name. This is the patient's last name (e.g., Smith, Jones, Doe, etc). This field is required. This is any suffix that the patient has (e.g., Jr., Sr., III). This is the gender of the patient and should be either "M" for male or "F" for female. Other valid entries are Male, Man, Female, or Woman. Numeric entries are not valid and should be changed prior to trying to import the data. This field is required, but you can run it without the value, and enter it later. This is the patient's date-of-birth. This field is required. This is the patient's social security number in the form 123-45-6789. This is the patient's street address (e.g., 123 Hunterbot St., Apt 2A). This is the patient's city (e.g., Boston). This is the patient's state (e.g., MA) and needs to be in the 2 letter standard format. This is the patient's zip code (e.g., 02134 or 02134-5678). This is the patient's telephone number (e.g., (617) 555-4999). This is the patient's work phone number (e.g., (617) 555-5000). This field is for the patient's cell phone or fax number. The format is (617) 555-5001, if they happen to have one. This is the patient's email address (e.g., John@aol.com). Upcoming versions of Amazing Charts will allow patients to receive correspondence to their email address. This is the name of the patient's employer (e.g., Sears, Inc). A patient's school name could also be placed in this field.

BirthDate SS PatientAddress City State Zip Phone WorkPhone Fax or Cell Phone Email

EmployerName

EmergencyContac This is the name of the patient's emergency contact (e.g., a spouse or parent). tName EmergencyContac This is the telephone number of the patient's emergency contact (e.g., (617) tPhone 555-1234) SpouseName This is the name of the patient's spouse or significant other, if applicable.

InsuredPlanName InsuredIDNo InsuredName

This is the name of the patient's primary insurance carrier (e.g., Blue Cross/Blue Shield, United, USHealthcare, etc). This is the patient's insurance identification (ID) number for their primary insurance. This is the name of the person whose name is on the insurance card. In most cases, this is the patient themselves, but sometimes this will be the patient's parent or spouse. This is the Group Number for the primary insurance This is the dollar amount the patient is required to pay at each visit (e.g., 10.00). This is the name of the patient's secondary insurance carrier (e.g., Blue Cross/Blue Shield, United, USHealthcare, etc), if applicable. This is the patient's insurance identification (ID) number for their secondary insurance. This is the name of the person whose name is on the secondary insurance card. In most cases, this is the patient themselves, but sometimes this will be the patient's parent or spouse. This is the group number of the secondary insurance. This is the dollar amount the patient is required to pay at each visit (e.g., 10.00) as it applies to their secondary insurance. You can put any miscellaneous comments here. This is the date of birth for the subscriber of the primary insurance This is the primary insurance address (line 1). This is the primary insurance address (line 2). This is the primary insurance city. This is the primary insurance state. This is the primary insurance zipcode. This is the primary insurance telephone number. This is the date of birth for the subscriber of the secondary insurance. This is the secondary insurance address (line 1). This is the secondary insurance address (line 2). This is the secondary insurance telephone number. This is a miscellaneous field in which to enter some data you wish to track on the patient demographic window. This is the patient's marital status (S=Single, M=Married, O=Other).

InsuredGroupNo Copay InsuredPlanName 2 InsuredIDNo2 InsuredName2

InsuredGroupNo2 Copay2 Comments InsuredsDOB InsAddL1 InsAddL2 InsAddCity InsAddState InsAddLZip InsAddPhone Insureds2DOB Ins2AddL1 Ins2AddL2 Ins2AddPhone Miscellaneous1 MaritalStatus

If there was an error, or you selected the wrong column, you can go back and run the importer again. If you get a "Data Conversion Error" than there is a problem with some of your data (e.g., there is a missing lastname, firstname, or birthdate). Open your text file and be sure these three fields have data. This is a very common problem as often there are empty rows scattered throughout the list of patients. These empty rows will trigger an error, and must be removed. If you run into a number of errors, and retry to import a few times, once you have it working, we recommend you restart with a blank AmazingCharts.mdb. We recommend you contact our support technicians for help with this.

Running the Installer (on networked computers)


Once you've installed and configured Amazing Charts on your main computer AND you've shared the Amazing Charts folder on that computer, you can run the AmazingChartsInstaller on the other computers on your network so they can use the program as well. When you start the AmazingChartsInstaller on a computer other than the main computer, select the No, this isn't the main computer... option as shown below.

The installer will still install any required prerequisite files (such as the .Net framework) as well as the other files needed by Amazing Charts to run. If you plan on using the computer to take with you off site (e.g., it is a laptop you plan on bringing away from the practice), select the Sort of... option. This choice will also install SQL Server as this will be needed when the laptop is acting as the main computer when off site. Once the installation is complete, start Amazing Charts (either by clicking the desktop icon, or via the Windows Start menu. The Amazing Charts Setup Assistant will open, since the program must know where the databases are located to function.

Select the No, I need to browse... option and then find the AmazingCharts configuration file as shown below. You'll only need to do this process once.

If you can't find the AmazingCharts.xml file shown above on the main computer, it may be that you've not set up sharing correctly (you need to share the Amazing Charts directory on the main computer as described here). If you can't get to your network at all, then the computer likely isn't connected to your practice's network. See Connection Issues.

Running Amazing Charts (the first time)


Background One of the reasons SQL Server is such a robust and powerful database is its stability. Instead of Amazing Charts connecting directly to the database file (.mdf), all data is first passed to a log file (.ldf) where the instructions on what data to put into the database is first checked to be sure it won't damage the database, and is then written to the database. The engine that controls this access and stability is called SQL Server, and works like a mini-computer of its own. This SQL Server mini-computer "listens" for instructions through one of the ports on your computer (usually port 61607, though will use another port if needed) and it does the heavy work involved with tracking the log data and writing/reading it to the database file. Because of this, Windows needs to be sure this SQL Server "server within a computer" is authorized to run on your computer and isn't a malicious program doing bad things to (e.g., hacking) your computer or network. Thus, by default, the built-in Windows Firewall (and other firewall programs like McAfee and Norton Utilities) block Amazing Charts access to SQL Server unless you Unblock and allow Amazing Charts to connect. Once you tell your firewall software that Amazing Charts is an authorized program, and is authorized to use SQL Server, all will be well. Usually, when SQL Server is first used, a window will automatically pop open asking if you want to unblock and allow the program to run. Sometimes, though, it isn't that easy to unblock, or the firewall block occurs silently based on the configuration of your firewall program. Instructions on manually unblocking your firewall in these instances is here. Amazing Charts has it's own built-in virtual IT person that can help walk through unblocking the firewall as well as setting up the initial configuration settings that Amazing Charts needs to interact with SQL Server. Thus, the first time you run Amazing Charts requires a few extra steps you won't need after this initial set up process.

These include: 1. 2. 3. 4. Running Amazing Charts as an administrator. Unblocking your firewall to allow Amazing Charts to access SQL Server. Knowing which port SQL Server will use to transfer data to/from the Amazing Charts program. Turning on the SQL Server Service (a mini-program that runs in the background and "listens" at the port above).

On the main computer (the one you should set up first and that houses the Amazing Charts databases), the virtual IT person will do all these steps for you.

Vista UAC (User Access Control)


One of the reasons that Windows 7 was called "Vista done right," was because of issues like this where Vista caused many more steps to install software. (Windows 7 has improved on these annoying steps.) Vista's User Access Control (UAC) is a program that Windows uses to ensure what is running on the computer is authorized by the user (and isn't a virus or other unauthorized program that may have been started without permission). Once you tell Vista to allow a program you won't have to re-allow it each time it starts.

User Access Control: Select Allow to let Amazing Charts run.

Run as administrator
Even if you are logged into Windows as a user with administrator permissions, Vista and Windows 7 will still require a few more steps to initially run the Amazing Charts program. During this initial configuration of Amazing Charts and during the initial use of associate Amazing Charts utility programs (such as the Amazing Backup Utility, Amazing Utilities, SQL Migration Utility, etc.), you may see a window telling you to run the program as an Administrator.

To do this, you need to find the actual .exe (executable) program on your computer. While Amazing Charts puts
various shortcuts to the program on your desktop and in the Window's Start menus, the actual Amazing Charts program is located in the Amazing Charts folder (which, during the initial Amazing Charts installation is placed on your C: drive, in the Programs Folder, by default - specifically C:\Program Files\Amazing Charts\Amazing Charts.exe).

If Amazing Charts hasn't automatically opened this folder for you, go to the Start menu on your Windows desktop,
click the My Computer option, then open the Local Disk C: option, then the Program Files folder.

If you see a warning that files and directories are hidden, click the option to show these files.

Then open the Amazing Charts folder, and RIGHT-CLICK on the Amazing Charts program (or whatever program you're trying to run) and select the Run as administrator option. (Be sure to close Quit the Amazing Chars Setup window below before trying to Right-Click and run the program as an administrator or you will get an error message saying that Amazing Charts is already running.)

Starting Amazing Charts For The First Time Requires You To Run As Administrator

Firewalls
Firewalls protect your computer from malicious (and non-malicious) programs. Due to the myriad of malware found on the Internet today, most computers come with a software firewall set to block most access to/from the Internet. Windows Vista and XP have a built-in firewall that will prevent most non-Microsoft programs (including Amazing Charts) from getting or giving information over the computer's connections.

Windows Security Alert on Vista: Select Unblock to allow Amazing Charts to function. In other words, if the firewall is not told to allow Amazing Charts to do its thing, Amazing Charts can't run correctly. Sometimes this isn't a big deal (for example, when Amazing Charts wants to go online and check if there is an updated version available). Other times, it can prevent Amazing Charts from working at all (for example, when the firewall blocks Amazing Charts from connecting to the SQL Server database. By default, most Windows computers are set to alert you when the firewall blocks a connection. For Amazing Charts to work correctly, you should always select ALLOW or UNBLOCK if asked about whether Amazing Charts should be free to do its thing.

Windows Security Alert on XP: Select Unblock to allow Amazing Charts to function correctly. In addition to the built-in Windows firewall, many computers have other software firewalls installed or included as part of an anti-virus program. Norton, McAfee, and Zone Alarm are common examples that will block Amazing Charts from doing some of its tasks. While many of these will pop open a window alerting you when it is blocking Amazing Charts and providing you an opportunity to allow Amazing Charts to function correctly, sometimes these programs are set to silently block, and you'll need to go into the program's configuration area and set it to allow Amazing Charts processes. If you have trouble configuring your firewall to allow Amazing Charts to work correctly, contact our technical support for assistance.

Amazing Charts Virtual IT Person

Because the initial configuration of SQL Server requires quite a bit of fine-tuning. Amazing Charts includes a virtual IT person who will help configure certain settings (without trying to tell you why you need a new server). Clicking Step 1 will start the process, and our virtual IT assistant will automatically move from one step to the next requiring you only to click "Continue." Using this utility usually allows Amazing Charts to configure SQL Server without much difficulty. (If not, you can always contact us here.) Once configured, Amazing Charts should run without needing to use the virtual IT assistant except if, for some reason, the SQL server port or database files are changed.

The Amazing Charts Virtual IT Assistant Assists With Fine-Tuning Of The SQL Server Database To go through the steps to configure SQL Server require you to have Administrative permissions on that computer. 1. 2. 3. 4. Running Amazing Charts as an administrator. Unblocking your firewall to allow Amazing Charts to access SQL Server. Knowing which port SQL Server will use to transfer data to/from the Amazing Charts program. Turning on the SQL Server Service (a mini-program that runs in the background and "listens" at the port above).

Once you've completed these steps, Amazing Charts should start correctly and you'll be taken to the Login Screen.

Logging Into Amazing Charts


To log into Amazing Charts requires that you have a username and password. If you have not received one, contact your practice's administrator (or the person who set up Amazing Charts). Select your username in the top field, then enter your password. Click Log In. Multiple attempts at hacking the system will cause Amazing Charts to quit.

Press button to log into Amazing Charts. When you log in, the main Amazing Charts Desktop window will open.

Our lawyers also want us to remind you that: Use of Amazing Charts means that you have read, understood, and agreed to the user license. They also note that you can read the find print by clicking the statement on the Log In screen, which will open the full End User License Agreement.

Networking Amazing Charts


There are three key steps to understand if you want more than one computer to run Amazing Charts (e.g., as in most offices with multiple computers and staff). 1. Install Amazing Charts on the main computer. First chose which computer will be your "main" computer in the office, and install Amazing Charts on main computer by running the AmazingChartsInstaller. We recommend you use the default settings as you walk through the installation. 2. Share the Amazing Charts directory on the main computer to allow full read and writing permissions. Sharing can be done by Right-Clicking on the Amazing Charts folder on the main computer. The steps to share the Amazing Charts folder vary depending on the operating system you are using and are discussed below.

o Sharing on a computer running Windows XP o Sharing on a computer running Vista (or Small Business Server, etc). o Sharing on a computer running Windows 7
3. Install Amazing Charts on the other computers on your network. For other computers on the network to connect to Amazing Charts, a working network must be in place. Most networks (e.g., a peer-to-peer setup, a client-server arrangement, or some other network where all the computers are connected to a router or dedicated server) will work without problem. An easy way to be sure a computer is on the network and configured correctly is to simply open a web browser and type in google.com or some other website address. If you can get to the web page on the Internet, that computer is likely networked correctly.

Sharing Amazing Charts (on XP)


If you plan to use Amazing Charts on more than one computer in your office, you must have a network and make the database accessible to all the computers on the network. This is how to do that: Make the main directory accessible by SHARING it. The Amazing Charts directory must be shared so that all the other computers on your network can read (and write) to the Amazing Charts database files. o But first you need to find the directory on the computer. If you used our default settings during the installation process, the Amazing Charts directory will likely be located in the Program Files folder on the C Drive (C:\Program Files\Amazing Charts). Go to the Amazing Charts folder (aka directory) and RIGHT-CLICK on the Amazing Charts directory select the Sharing and Security option in the window that opens after you right-click on the folder. (If you don't see the Sharing and Security option, you likely need to go the Windows control panel and set the computer up to allow sharing.)

Right-Click on the Amazing Charts Directory and select Sharing and Security.

Now turn sharing on in the Amazing Charts Properties window, with full read/write access and no
password protection (i.e., check off both boxes: Share this folder on the network and Allow network users to change my files.)

Sharing A Directory In Windows XP You'll get a warning issue about the name length since Windows 95, 98 and ME computers can only recognize files with fewer than 12 letters. Modern computer running XP, Vista, 7, or other modern OS (operating system) have no problem reading the Amazing Charts name, so you can ignore this message when you click Apply. If you are using Window's Vista, 7, or other more secure operating systems, you'll need to specify

permissions for your users. This is discussed here. Finally, after you install and run Amazing Charts on the other computers on the network, you'll be able to browse to the AmazingCharts.xml configuration file and the program should work correctly. (Don't worry, Amazing Charts will walk you through exactly what you need to do.) Keep in mind that best security practices doesn't necessarily support doing this in instances where there are guest accounts or you have a large network that might have untrusted users. These instructions are for the small practice where all users of the computers are trusted employees who will have an account in Amazing Charts. If this is not your case, you should contact an IT person who likely set up your network as they may recommend a different configuration or may have developed subgroups that have different permissions on the network.

Sharing Amazing Charts (on Vista)


If you plan to use Amazing Charts on more than one computer in your office, you must have a network and make the database accessible to all the computers on the network. This is how to do that: Make the main directory accessible by SHARING it. The Amazing Charts directory must be shared so that all the other computers on your network can read (and write) to the Amazing Charts database files. o But first you need to find the directory on the computer. If you used our default settings during the installation process, the Amazing Charts directory will likely be located in the Program Files folder on the C Drive (C:\Program Files\Amazing Charts). Go to the Amazing Charts folder (aka directory) and RIGHT-CLICK on the Amazing Charts directory select the Share... option in the window that opens after you right-click on the folder. (If you don't see the Share... option, you likely need to go the Windows control panel and set the computer to allow sharing.)

Right-Click on the Amazing Charts Directory and select Share...

Once the Share window opens, click the Advanced Sharing option.

The Advanced Sharing Window Where Permissions Are Set In the Advanced Sharing window, click the Share this folder option (1), and then be sure to allow for the number of computers/users that may connect to Amazing Charts at one time (2). The default is set to 10 users, although if you had 10 computers in your office, and each one had a few user accounts that might be running Amazing Charts concurrently, you should increase this number to cover all of those concurrent users. Then click the Permissions button (3) as users must be able to write to the database for Amazing Charts to function correctly.

The Permissions Window For The Amazing Charts Directory

In the Permissions for Amazing Charts, check the Full Control button (which will automatically check
all the open boxes) for everybody. Click OK and the Amazing Charts folder should be configured correctly. Finally, after you install and run Amazing Charts on the other computers on the network, you'll be able to browse to the AmazingCharts.xml configuration file and the program should work correctly. (Don't worry, Amazing Charts will walk you through exactly what you need to do.) Keep in mind that best security practices doesn't support doing this in instances where there are guest accounts or you have a large network that might have untrusted users. These instructions are for the small practice where all users of the computers are trusted employees who will have an account in Amazing Charts. If this is not your case, you should contact an IT person who likely set up your network as they may recommend a different configuration or may have developed subgroups that have different permissions on the network.

Sharing Amazing Charts (on 7)


If you plan to use Amazing Charts on more than one computer in your office, you must have a network and make the database accessible to all the computers on the network. This is how to do that: Make the main directory accessible by SHARING it. The Amazing Charts directory must be shared so that all the other computers on your network can read (and write) to the Amazing Charts database files. o But first you need to find the directory on the computer. If you used our default settings during the installation process, the Amazing Charts directory will likely be located in the Program Files folder on the C Drive (C:\Program Files\Amazing Charts), or if you are using a 64 bit machine it will be at (Local Disk C:\Program Files (x86)\Amazing Charts). RIGHT-CLICK on the Amazing Charts directory - select the Share with | Advanced sharing... option in the window that opens after you right-click on the folder. (If you don't see this option, you likely need to go the Windows control panel and set the computer to allow sharing.)

Right-Click on the Amazing Charts Directory and select Share with | Advanced sharing...

Once the Share window opens, click the Advanced Sharing option.

The Advanced Sharing Window Where Permissions Are Set In the Advanced Sharing window, click the Share this folder option (1), and then be sure to allow for the number of computers/users that may connect to Amazing Charts at one time (2). The default is set to 10 users, although if you had 10 computers in your office, and each one had a few user accounts that might be running Amazing Charts concurrently, you should increase this number to cover all of those concurrent users. Then click the Permissions button (3) as users must be able to write to the database for Amazing Charts to function correctly.

The Permissions Window For The Amazing Charts Directory

In the Permissions for Amazing Charts, check the Full Control button (which will automatically check
all the open boxes) for everybody. Click OK and the Amazing Charts folder should be configured correctly. Finally, after you install and run Amazing Charts on the other computers on the network, you'll be able to browse to the AmazingCharts.xml configuration file and the program should work correctly. (Don't worry, Amazing Charts will walk you through exactly what you need to do.) Keep in mind that best security practices doesn't support doing this in instances where there are guest accounts or you have a large network that might have untrusted users. These instructions are for the small practice where all users of the computers are trusted employees who will have an account in Amazing Charts. If this is not your case, you should contact an IT person who likely set up your network as they may recommend a different configuration or may have developed subgroups that have different permissions on the network.

Getting Help
Amazing Charts includes an extensive Help manual (you're looking at it), which is updated with each new release. If you are within the Amazing Charts program, clicking the F1 key will bring you to context-specific help regarding the window you are currently using (though if it doesn't, please let us know and we'll fix it for the next version.) Subscribers to our Guardian Angel Support & Maintenance service (as well as those in their free trial) can also get live help at any time. You can connect with our Help Desk from within Amazing Charts by selecting the Help menu | Get Live Support. (Click here for more information on Guardian Angel Support & Maintenance.)

This will bring you to the web page, http://www.amazingcharts.com/help. Through this link you can
immediately initiate an online chat session that will allow us to log into your computer and troubleshoot various issues. If you are not online, or you prefer to call, you can reach us at toll-free at (866) 382-5932. You can also email us at help@amazingcharts.com. We also have an active community of users who post and discuss various issues or problems they have encountered. A solution to your problems may well be here.

Get Live Support Under The Help Menu Within Amazing Charts

How Do I...
The "How Do I..." chapters explain the basic steps which you'll frequently perform using Amazing Charts (e.g., How
Do I...Prescribe A Medication). You can also use the search tab to quickly find information on a specific topic (e.g., Meaningful Use). Bullet points with interspersed images (worth a thousand words) are used to summarize salient points, and help you quickly find the answer to your question. For additional help resources, click here.

Get Help
Amazing Charts includes an extensive Help manual (you're looking at it), which is updated with each new release and posted online at www.amazingcharts.com/help. If you are within the Amazing Charts program, clicking the F1 key will bring you to context-specific help regarding the window you are currently using (though if it doesn't, please let us know and we'll fix it for the next version.) Subscribers to our Guardian Angel Support & Maintenance service (as well as those in their free trial) can also get live help at any time. You can connect with our Help Desk from within Amazing Charts by selecting the Help menu | Get Live Support. (Click here for more information on Guardian Angel Support & Maintenance.)

This will bring you to the web page, http://www.amazingcharts.com/help. Through this link you can
immediately initiate an online chat session that will allow us to log into your computer and troubleshoot various issues. If you are not online, or you prefer to call, you can reach us at toll-free at (866) 382-5932. You can also email us at help@amazingcharts.com. We also have an active community of users who post and discuss various issues or problems they have encountered. A solution to your problems may well be here.

Get Live Support Under The Help Menu Within Amazing Charts

Log Into Amazing Charts


Amazing Charts must be installed on the computer to use the software. If you've not yet done so, run the AmazingChartsInstaller program to install all the necessary files.

Once installed, click on the Amazing Charts icon on the desktop to start Amazing Charts (or use the Window's Start menu | All Programs | Amazing Charts).

Click (Or Double-Click) The Amazing Charts Shortcut On Your Desktop To Start Amazing Charts

The Startup (Splash) Screen Initially, the Splash screen will appear as the Amazing Charts programs checks itself and the databases, and optimizes various processes to run smoothly. Upon successfully connecting to SQL Server and verifying that everything is working correctly, the Log In window will appear. Enter your username and password here to log into Amazing Charts. If your username doesn't appear in the Username field, click the arrow and select the correct username. (You can also type ADMIN into the Username box and log directly into the Admin section.)

The Amazing Charts Log In Window

Lock Amazing Charts


You can quickly log out of the Amazing Charts program by clicking CTRL-L, or selecting the option from the File |
Logout menubar.

Another way to lock access to Amazing Charts, but not log out per se (e.g., when walking out of an exam room, when
you know you'll be back shortly), is to click the Windows Key + L (the Windows key is located between the Fn and the Alt keys). This should activate your Window's screen saver. To function properly, you must set up your Window's screen saver and have the password protection option set. o If you are using Windows XP, you must set the screen saver option to: On resume, display Windows screen.

Lock Down Amazing Charts


You can log out of the Amazing Charts program by clicking CTRL + L, or selecting the option from the File |
Logout Menu bar. You can also click the Red X at the top of the Amazing Charts window to log out, although this is not the recommended approach.

Another way to lock access to Amazing Charts, but not log out per se (e.g., when walking out of an exam room, when
you know you'll be back shortly), is to click the Windows Key + L (the Windows key is located between the Fn and the Alt keys). This should activate your Window's screen saver. To function properly, you must set up your Window's screen saver and have the password protection option set. o If you are using Windows XP, you must set the screen saver option to: On resume, display Windows screen.

Add A Patient
Adding a patient is usually done in the Patient Demographic Window (though one can also import patients from an external data source or using the Amazing Importer, which can be run during the initial Amazing Charts Setup).

To manually add a patient, click on the Rolodex card just below the Patient List, or use the menubar:
File | Add New Patient. You can also quickly open the Add New Patient window without using the mouse at all by clicking Ctrl+N. For a list of other quick shortcuts, click here.

The Rolodex Button On The Main Desktop Opens The Demographics Window Where A New User Can Be Added

Once the Enter New Patient Demographics window is open, you can add the desired information. Only the fields in red are required (DOB, Gender, Lastname, Firstname). Everything else is optional,
but the more information you add the better the notes and reports will appear, and the more Amazing Charts features will be available to use. The Meaningful Use Wizard color-codes various fields that you should make a habit of documenting. More info on Meaningful Use is here. Once you've entered a few patients' data, the pull down lists under City, State, Insurance, etc. will become populated with your prior entries. Using these to select the entry will help minimize different spellings which will improve future searches and database queries. Instruct your staff to use the pull down menus whenever possible.

New Patient Demographics Window With Color-Coded Fields Required For Meaningful Use

Add A Patient Photo


Patient photographs can be taken with a digital camera or an inexpensive webcam. Any camera will do, and we suggest you buy a cheap one. Keep the cam, usually connected via a USB port near the front desk computer (presumably where the patient checks-in). Follow the steps below to add a patient's picture: 1. Using the camera, ask permission, then take the patient's head shot. 2. Using the software that comes with the camera, save a JPG or GIF version of the picture (this can usually be automated in the software's preferences section). Since the image is stored in the Amazing Charts database. Keep the resolution low and strive to have a file size under 100 Kb (Kilobytes). Failing to keep the file small will eventually make backing up your databases a problem when you have many patients. 3. Pictures should be 2 inches by 2 inches, since this is all that will appear in the Patient Pic window. The picture will be stretched to this size, so it may appear distorted if you image is not square. 4. To attach the photo to the chart, select the patient from the patient list, and then click the Rolodex image on the taskbar to open their demographic window. Click the Add Pic button (see arrow below), and browse to the patient's picture. The image will automatically be set to fit the 2x2 window. 5. To remove or change a patient photo, click on the Add Pic button and select a different photo.

Click The Add Pic Button And Browse To The Patient Picture That You've Taken With Your USB Camera

Inactivate A Patient
Patients can be inactivated in Amazing Charts by checking the Inactivate Patient option on their demographic window. Select, or enter, the reason you are inactivating them from the drop down box. Patients can be reactivated by unchecking this box. Inactivated patients (and any notes or other information) is not deleted from the database - that would be like throwing away a medical record. In an future version we will provide the means to remove patients (and other information) that was erroneously entered, but for now inactivate these patients.

Include The Reason Why You The Patient Is Being Made Inactive You can also inactivate a patient from the Patient List by selecting the option in the taskbar as show below.

Click The Make Patient Inactive Option To Inactivate The Patient

Schedule An Appointment
Scheduling is done in the scheduling area of the Amazing Charts Desktop. o If you aren't seeing the schedule, click the Schedule navigation button located on the
Amazing Charts Desktop.

The Schedule Button On The Amazing Charts Desktop

To be able to schedule a patient appointment, there must be a schedule already set up in Amazing
Charts.

If you've not already set up a provider schedule during the initial installation of Amazing Charts,
schedules can be set up through the Administrator section (see Setting Up a Provider Schedule). To Schedule a patient: 1. Browse to the day on which you wish to book the patient by using the Calendar control located on the left lower side of the Amazing Charts Desktop window. (In the example below, Saturday May 13th has been selected as the day the appointment is to be scheduled.) 2. To book the patient appointment, select (highlight) the patient in the Patient List on the Amazing Charts Desktop. (In the example below, the patient William Saffire, has been selected.) 3. Now drag and drop the patient onto the desired time slot. (In the example below, we are dragging Mr. Saffire's name and dropping him into the 11:15 AM time slot with the Provider named Diana.) You can also schedule without drag and drop by (1) selecting the patient, (2) selecting the day in the calendar control, (3) clicking the Book Appointment button, which will open the Schedule Detail Window.

o To remove an appointment, see Remove A Scheduled Appointments.

Scheduling A Patient Is Done By Selecting The Patient And Dragging Their Name Onto The Desired Time Slot 4. When you drop the patient onto the schedule, the Schedule Detail window will open. Here you can set any parameters you wish to change from the default settings. 5. Click the Book Appointment button to complete the scheduling process.

Use the Schedule Detail Window To Change Any Of The Default Settings

Remove A Scheduled Appointment


To remove or edit an appointment that has been scheduled:
1. Select the desired patient within the schedule 2. Click one of the options (edit, reschedule, or remove) as shown in the red outline in the image below. Edit Appt option allows you to change the information for the appointment (e.g., Appointment Type, Duration, etc). Reschedule option allows you to browse to a different day and/or time and/or provider. Select the new choice to move the patient to the new slot. Remove Appt option will delete the appointment from the schedule.

To Change Or Remove A Scheduled Patient, Select Them On The Schedule Then Click The Option

Whenever an appointment is changed, the provider with whom the appointment was initially
scheduled can be notified of the change (as it is a good idea to always document canceled, removed, or rescheduled appointments). Upon making a change, a window will open to allow this notification.

The Document A Changed Appointment Window Allows All Schedule Changes To Be Recorded To The Patient's Chart

Clicking the Notify Selected Provider button will result in a message being sent to the provider's To find and remove a previously scheduled appointment for a specific patient, see Finding A
Scheduled Appointments. Inbox, from where it can be saved as a Scheduling Addendum to the patient's chart.

Pull A Patient Chart

Patient charts are pulled from the purple-colored frame on the Amazing Charts Desktop (the Patient
List). Enter the patient's last name into the Lastname text box and a listing of all names beginning with these letters will appear. Click on the desired name and then click the yellow folder on the taskbar to open the patient's chart. The patient's most recent encounter will open. o You can also double-click on the name to pull their chart and open the most recent encounter (aka the last note).

Use The Patient List To Pull A Patient's Chart

Alternately, you can Right-Click on the patient in the list (shown below), which will give you show
you the most common tasks usually performed.

For Common Action Such As Pulling A Chart, Right-Click On The Patient Name And Select From The List

Pull A Patient Summary


The Patient Summary Window can also be opened from the patient list.
1. Enter the patient's last name into the Lastname text box and a listing of all names beginning with these letters will appear. 2. Click on the desired name and then click on the down arrow by the yellow folder. 3. Select the "Pull Summary Sheet" option to open the chart looking at the summary.

Open Any Section Of The Patient Chart From The Patient List

Alternately, you can Right-Click on the patient in the list (shown below), which will show you the
most common tasks.

For Common Action Such As Pulling A Chart, Right-Click On The Patient Name And Select From The List

Document An Encounter
To document an encounter, first pull or open the patient's chart. The Most Recent Encounter tab is where you document the current visit. The entire note is visible on
this one window. If the patient has a previously saved encounter in the system, the chart's text boxes will contain the information from this most recent encounter. This facilitates follow-up of issues discussed previously and minimizes duplication of previously entered information - since much of the findings from prior visits will likely be unchanged (e.g., PMH, SH, FH, etc).

The Most Recent Encounter Section of The Patient Chart Is The "Stepping Off" Point From Where You Can Document The Current Visit

If you wish to start from a prior visit other than the most recent, use the drop-down Past Encounter
list located on the upper left side of the chart (see red box below).

You Can Use Any Prior Visit As The "Stepping Off" Point For The Current Visit

You can choose to overwrite the current CC, HPI, and ROS by clicking the Overwrite all fields
option. Selecting the default value Keep existing cc, hpi & ros prevents overwriting of information added by the nurse already. This is helpful if a nurse has entered today's CC, HPI, and/or ROS and then forwarded the chart to you.

If There Is New Information In The Chart, Use The Keep Existing CC, HPI & ROS Option To Avoid Overwriting This Information

Once you have selected which visit you want to use as a starting point, document the encounter Information can be documented by a number of inputs, including: o typing on the keyboard, o using templates, o or using another input device, such as dictating or Voice Recognition (e.g., using
third-party software like Dragon Dictate) into the appropriate text boxes.

o or by using handwriting-recognition (e.g., on a tablet PC). No matter how you enter the information, the data currently being written will not change Your documentation will not be saved to the chart until you click the Sign Chart button. If you are not ready to sign-off and save the current information permanently, you can click the
Forward Chart button and send your newly added information to yourself or another user for review and/or completion at a later time (see Forward A Chart). The Forward Chart and Sign Chart buttons are located on the bottom right of the window as shown below. previously signed-off (saved) notes.

Forward Charts That You Are Not Yet Ready To Sign-Off

Change The Date Of A Note


You can alter the date and time of the encounter you are documenting by clicking the Alter Date
button at the top of the Most Recent Encounter window within the patient's chart. This will change the date/time from the default, which is "now." We recommend that if you do change the date, you document within the note (e.g., in the first line of the HPI) that this is a late entry actually documented <<time/date>>.

Once signed, a note cannot be changed or altered.

Enter A Patient's Medications


Documenting medications can be a bit more confusing that it would seem. This is because patients arrive with a list of their current medications, and often leave a visit with one or more of these being changed.

The Current Medication List on the left side of the patient's Most Recent Encounter (aka the current
note), is where the list of medications the patient was taking when they arrived at the office should be recorded. Most commonly, this is done by the nursing staff when "rooming" the patient. To open the Current Medication List, double-click in the Current Medications text box within the Most Recent Encounter as shown below. This will open the Current Medications search and entry box.

Double-Click In The Current Medications Textbox To Document The Medications The Patient Is Taking Before They Are Altered By The Provide

Current Medication List Where Staff Can Record What Medications The Patient Is Taking Before They May Be Altered By The Provider During The Current Visit

To add a medication that the patient reports taking, type into the Med Name field on the right side of
the window then click Save Changes.

Type The Medication Name And Select The Correct Choice.

Once Saved, The Selected Medication Will Be Added To The Patient's Current Medication List But Without Being Prescribed By The Provider

To edit a medication (e.g., the patient tells you they are taking it differently than it is documented),
first select the medication from the Current Med List (left side of the window) and record the details on the right side of the Current Medication List window then click save and close. To remove or inactivate a medication, open the Current Medications List window and check no longer taking this medication," then save and close.

Select the Patient Is Not Longer Taking This Medication (And Provide The Reason Why), when Inactivating A Medication

When finished click the Close button at the top right aspect of the window, and the updated
medication list will automatically be placed into the Current Medications textbox in the Most Recent Encounter window.

The Current Medications Window On The Left Side Of The Most Recent Encounter Window Should Contain The Current Medications Before The Current Visit.

By entering medications in this manner, you are able to document the medications the patient was
. taking before the current visit. Often this list will no longer reflect their current medication regimen once the provider has made any alterations (which appears under the Plan). The Current Medications Window, by default, populates with all the meds recorded during the prior visit, so when the patient returns for the next visit, the list will show not only what was added by the nursing staff, but also any prescriptions written during the prior encounter

Attach A Picture
Within the patient's chart, there are a few places where images and other items can be added. o The patient's picture is on the Demographics window of the chart. o Miscellaneous items can go in the Imported Items window. o Images of lesions and other issues pertaining to the current visit belong in the Most Recent

Encounter window where one documents the current visit. You can drag and drop or browse for digital images, movies, or other files that you want to become part of the patient's medical record, and more specifically to the current visit. These items are placed in the Physical Exam area, under the Picture tab.

Images Can Be Put Into The Current Patient Visit Within The Physical Exam Area of the Most Recent Encounter Window

Once you browse or drop an image into the chart, you'll be asked to describe the image. Your
description will be placed below the image.

Briefly Describe What The Image Represents (e.g., rash on upper body).

Images Can Be Placed Into The Current Visit And Get Stored With The Specific Encounter

Currently you can enter up to two images per encounter (although we plan to add more in the
future). Images can be printed out in some printed reports (i.e., detailed note format). See Printing A Note for more information on printing images attached to notes.

Add A Diagnosis To The Note


One of the benefits of Amazing Charts is the ability to rapidly find the correct ICD code for the diagnosis, which makes billing a breeze. It is best practices to always select a diagnosis from the formal list, so the associated code is added to the chart in the Assessment field. This is critical if you are doing any billing with Amazing Charts where an ICD code is needed. If the patient already has the diagnosis on their Problem List, simply select it from the list to place it into the Assessment textbox (as shown below).

Select A Diagnosis From the Drop-Down Problem List Of Existing Active Patient Diagnoses

The Selected Diagnosis Will Be Automatically Placed In The Assessment Window And Added To The Patients Active Problem List (Providing It Is Not Already There)

To find a diagnosis not already set as an active diagnosis for the patient, start typing it into the
Diagnosis list on the right side of the Most Recent Encounter window.

Type Into The Diagnosis Field To Rapidly Find A Diagnosis

o The diagnoses are listed formally (as defined by the World Health Organization) and this can o o o

make it sometimes difficult to find exactly what you are looking for. Diagnoses highlighted in green are considered "complete ICD9 codes" and have a much lower rate of denials by insurance companies. (Yellow highlighted diagnoses are considered "incomplete" and often result in a denial when submitted for reimbursement.) If you can't find the correct diagnosis, it is likely called something else (e.g., Otitis Media is officially "Acute Otitis Media"). Click the Search Dx (ICD9) button to open the Search Diagnosis Database window where you have advanced options to find the diagnosis for which you are looking. Once you find the diagnosis, you can click the Edit Code button on the bottom left of the Search Diagnosis Database window, and rename it to something that will be easier for you in the future (e.g., OM instead of Acute Otitis Media). Best practices for editing diagnoses is too rename it what you want, but leave the official diagnosis as well (e.g., OM/Acute Otitis Media).

The Search Diagnosis Database Window Provides More Options To Find That Elusive Diagnosis

Although the included list of diagnoses is regularly updated and contains ALL diagnoses recognized by
payors, if you want to add a new diagnosis you can do that by clicking the Add Code button in the Search Diagnosis Database window. If a patient does not have an active diagnosis, you may document this by using the No Active Diagnosis check box. Documenting one or more diagnoses, or lack thereof, is a requirement for Meaningful Use.

Use The E&M Coding Assistant


Amazing Charts includes a Evaluation & Management (E&M) Coding Helper that is accessible from the patient chart (under the Most Recent Encounter tab | Know | E&M Coding Guidance) as well as from the Sign-Off window. The helper can assist you in selecting the correct CPT code based on what has been documented.

Access The E&M Coding Assistant Under the KNOW Menu or From The Sign-Off Window In Amazing Charts

Once opened, follow the steps to calculate the recommended E&M code. You can tie more deeply tie the E&M Coding Helper to your templates by adding a delimiter (e.g., >)
to your templates. For example, if you add a decimeter to every distinct bulleted item within your review of systems template, the E&M Coding Helper can tally and calculate the numbers for you. The E&M Coding Helper will recommend Your Likely Code based on the input within the window. At the bottom of the E&M Coding Helper window will be instructions on what additional documentation could bring you to a higher CPT level. The E&M Coding Helper should always be used for guidance, and is not a substitute for understanding how to best code your notes.

The E&M Coding Assistant Window Should Be Used for Guidance Only

Use Spellcheck
Spell check can be run from the menubar | Edit | Spelling within the patient chart and letter writer. o Alternately, you may use the F7 key on your keyboard to initiate spellcheck.

You can set spell checking to automatically run before signing a note or printing a letter through the My Preferences window.

Order Tests
Amazing Charts has the ability to generate, track, and reconcile orders - an important aspect of Meaningful Use. You can write an order from within the patient's chart by clicking the Write Orders button o Alternately, you can right-click on the patient's name in the Patient List found on the Amazing Charts o

Desktop, and then select the Write Order option (i.e., when writing an order for a patient that is not currently being seen). You can also click the Write Orders button from within a message (i.e., an order is being written based on information from a phone call or message) by clicking on the Write Orders button within the message (on the Amazing Charts Desktop).

Usually Orders Are Written By Clicking The Write Orders button In The patients Most Recent Encounter Window

Orders can be automatically sent to specific staff or printed directly from this window. To write an order:
1. Select the specific ICD Diagnosis code(s) that apply for the reason the order is being done. 2. Select the tab for the type of order you are writing (e.g., Nursing, Imaging, Referrals, etc.) Order templates that you have written or used in prior versions of Amazing Charts (V4 and earlier) are found under the Other tab.

Orders Are Classified Under Various Tabs 3. Select to whom the order is to be sent. Once you select the specific provider or group (e.g., Front Desk), this setting will automatically appear the next time you select the order type tab but can be changed as needed (red arrow in image below). 4. Although each order can have different ICD Diagnosis codes associated with it, you must select the ICD code(s) before checking the specific order check box (red arrow in image below). 5. Click the specific order(s) from the list (red arrow in image below), or click the Quick Add button to write a new one that is not on the list. You can set up and preconfigure your order templates in the Admin section of Amazing Charts 6. Add any additional Comments you want documented with the order (e.g., rule out infiltrate) in the Comments column. 7. Check the selected order to add it to the Order Queue. 8. Once you have completed the orders from one or more tabs using the steps above, click the Send Orders button to have the orders sent to the specified user or group.

The Steps To Write And Send An Order To A Staff Member

As You Select Orders, They Are Added To The Order Queue

You can review the details of the orders that you have selected by Right-Clicking on the order name in the Order
Queue list as shown below.

Right-Click On Queued Orders To Review Details Or Remove The Order From The List

An Example Of The Order Details Quick Add An Order

To quickly add an order that is not in the list, click on Quick Add button and a window will pop open into which you
can type the name of the order (e.g.,TdaP). Click OK to place the new order into the list. To add, edit, or remove orders on a larger scale, as well as set up order groups, use the Order Sets button in the Admin window.

Click The Quick Add Button To Add Orders Not In The List. Edit And Update The Full List Of Orders In The Admin Section Of Amazing Charts

To complete the order process you must save them (or send them, which also saves them automatically). Click the Save (without sending) or Send Orders button to save the selected orders.

Click One Of The Buttons Highlighted To Complete The Ordering Process

The orders that have been selected will automatically be documented in the plan section of the current visit (if you
have come to Orders window from the patient note).

Orders Are Automatically Documented To the Note (And Can Also Be Reviewed In The Order Reconciliation Window)

Review, Reconcile, And Track Orders Once ordered, orders can be accessed by your staff in the Orders Reconciliation window. Access the Order Reconciliation Window from the Amazing Charts Desktop under the View menubar | Orders option.

You Can Review Orders At Any Time On The Amazing Charts Desktop Window Under the View Menu

Within the Order Reconciliation Window, you can review orders for a specific patient, orders on all patients, or all Orders can be additionally filtered by Type (e.g., Nursing, Imaging, etc.). In the example below, all orders that have
been sent to Nursing are shown. providers' orders.

The Order Reconciliation Window Is Where Pending Orders Can Be Reviewed, Tracked, And Reconciled

Orders need to be reconciled to show they have been completed, or if not - why not. This is done in the Order Reconciliation Window. Here are the most common steps through which orders are processed:
1. An order is initially ordered by the provider as described here. 2. If an order requisition wasn't simply printed and given to the patient by the provider, the order will have been sent to a person or group within the practice who is now responsible to see that the order is completed. 3. Many orders (e.g., referrals, laboratory tests sent out, imaging studies) undergo a two step process of (a) getting the order requisition to the place where the order will be completed, and (b) getting back the results. The order must be sent out, after which the order is said to have results pending. The order results (or lack thereof if the patient doesn't get the order done) must get back to the practice - and these results must be reconciled (aka attached) to the original order. Amazing Charts has interfaces to many lab, radiology, and other companies so the order results can automatically be transmitted to the practice. Click here for information on our interfaces. 4. From the Order Reconciliation window, a requisition can be printed by the staff member to whom the order was assigned (as shown below

The Nursing Staff Can Click The Print Req Button To Generate The Requisition That Will Be Given To The Patient Or Sent To The Testing Facility 5. The staff member needs to update the order status as shown below.

The Nurse Should Document That The Requisition Was Given To The Patient (1), Then Select That Results Are Pending (2), Then Update The Order (3)

For example, if there is an order that is to be sent out (e.g., a lab or study) the results will be pending until they are
received back at the office. To document this, select the specific order from the order grid at the top of the window, then document a comment (or the result if known) in the space provided. o You can right-click to use templates in this field to avoid having to rewrite commonly used phrases such as "Req provided to patient. Told patient to contact us if they have any trouble getting it completed." This will update the order status and remove it from the nursing to-do list, but the order remains incomplete since results are pending. "Results Pending" orders can be reviewed by selecting the Results Pending option.

Select The Results Pending Option To Find All Orders That Meet This Criteria

The final step in the order process is reconciliation. Reconciling Orders The final step in the process of documenting orders (to comply with Meaningful Use and other medicolegal best The reason for this multi-step order process is to ensure that orders are completed, or if not, that they are adequately When the results get back to the practice (e.g., through a direct interface, fax, or letter), this fact should be
documented in the Results (comments) field and the results should be reconciled to the specific order that was generated to have the test done. To do this, follow the steps below: 1. Pull the orders with Results Pending via the drop-down menu on the Order Reconciliation window. followed-up upon. practices) is to reconcile the order to the completed study result.

2. Select the order which is to be reconciled by clicking the Find Imported Items (not yet reconciled)

3. In the window that opens, double-click on imported item result for the order.

4. Click the Update Order button to complete the reconciliation process.

Since it is common that nursing or other staff is doing the order reconciliation, a message regarding the results or
status of the order should be sent to the ordering provider. If results are placed in the Results (comments) text box, when the non-provider clicks the Update Order button with the order status set to Completed, a message window will open to allow this information to be sent to the ordering provider.

Document An Immunization Or Vaccination


Immunizations and Injections Immunizations, shots, and injections are all documented in the Health Maintenance section of Amazing Charts.

To document one or more immunizations, click the HM: Immunization & Shots tab. If the patient has had prior injections previously documented in Amazing Charts, they will be populated in the Prior
Injections area at the bottom of this screen. o If you have migrated from an older version of Amazing Charts, an additional tab to migrate the existing immunizations will be shown.

Document Immunizations Under The HM: Immunization & Shots Tab On The Health Maintenance Details Window

To document a vaccination, begin to enter the name of the vaccine in the generic name window. Amazing Charts includes a complete list of the various vaccination available. Select from appropriate vaccine name and manufacturer depending on which item you use within your office. Enter the site of the injection on the patient, the volume injected, the route, etc. o To document a vaccine or injection given elsewhere, click the 'Injection given elsewhere' check box. To provide a Vaccine Information Sheet (VIS) to the patient, click the Get Vaccine Info Sheets (VIS)' button. This will bring you directly to CDC's website where the most up to date version of the VIS is made available. o Save VISs and other frequently used documents to the computer, then save them to the Practice Documents window. o Practice Documents can also be imported into a patient's chart (e.g., if you want to save a copy of the VIS given to the patient for medicolegal reasons).

Access Vaccine Information Sheets (VIS) From Within The Health Maintenance Details Window | HM: Immunizations & Shots Tab

Click the Vaccine Schedule' button to access an Immunization schedule, categorized by age group.

When you are done recording the immunization, click the Save' button, or click the Save/Close' button to exit the
window.

Injections & Other Shots


Vaccines are documented in the Health Maintenance module. To document administration of a non-health maintenance injection (e.g., Vitamin B-12 shot), click on the Injections
(non-HM) tab in the Health Maintenance window. Within the Injections: Non-HM tab, enter the date the injection was given, the name of the injection, the route, etc. You may also record an injection given elsewhere by clicking the check box next to Check here if recording an injection given elsewhere.' When you are done recording an injection, click the Save' button, or click the Save/Close' button to exit the screen. o To enter another injection without closing the window, click the Add New' button after you've clicked the Save' button.

Record Injections That Are Not Vaccines In Health Maintenance | Injections: Non-HM tab Located In The Patient's Health Maintenance Details Window

Forward A Chart
Data entered into the patient's encounter can be forwarded to yourself or to another user. Common office flow is for a nurse or medical assistant to enter vital signs and other patient data and
then forward the chart to the provider. To forward a chart, click the Forward Chart button at the bottom of the chart. The provider can then pull the chart from their inbox, and document the encounter. If a provider is not ready to sign off on a note, they can forward the chart back to themselves for completion at a later time (or at a different computer on the network). In this situation, the provider will select their own name from the Forward Chart window. A provider can also use the hot keys CTRL+S to quickly forward a chart to yourself (i.e., save it to your inbox to retrieve later).

Click The Forward Chart To Send The Chart To Another Person In The Practice (Or To Your Own Inbox To Finish Later)

After clicking the Forward Chart button, a window opens where the desired recipient of the forwarded
chart is selected and a message regarding the forwarded chart can be optionally added.

Select The User To Whom You Wish To Forward The Current Chart

Clicking the Send Chart button sends it to the Inbox of the recipient. Forwarded charts remain in
the user's Inbox until deleted.

Pull A Forwarded Chart To pull or open a chart that has been forwarded to you, you first must have your email Inbox This is done by clicking on the Message button on the Amazing Charts Desktop. Your message frame
will appear with all messages in your Inbox. displayed.

Forwarded charts in your inbox are listed as "CHART: PATIENT NAME (Birthdate)". Any message that Double-click the message and you'll open the chart. o Alternately, you can select the desired message and click the Pull Chart button. When pulling a chart, you are given the option of deleting the forwarded chart once pulled. Answering
"NO" to this question lets you keep the forwarded chart in your Inbox for use later. You would do this at times where you just wanted to glance over a forwarded chart, but were not yet ready to document the encounter. was included when the chart was forwarded is displayed in the Message box.

Save A Note
You can permanently save the information to the patient's note by clicking the Sign-Off button. Clicking the Sign-Off button will open the Signature window that will allow you to select the CPT codes and other billing information applicable to this visit. Once you Sign-Off, the note can no longer be edited or removed and becomes part of the patient's permanent record. Because you may not be ready to Sign-Off a note during or immediately following a visit, there are three other options that can occur. o If you do sign-off a note but realize there is an error or missing information, you can Add An Addendum to the note.

Click the Sign-Off Button To Open The Code/Sign Encounter Window And Permanently Save The Information

1. You can save the chart to your inbox by clicking CTRL-S (or select the File menu | your message inbox)), which will save the chart to your Inbox, presumably to complete o Saving the chart to your inbox is different than Signing-Off; the documented the note is not permanently saved until somebody goes through the Sign-Off

Save Chart (to later. information in process.

2. You can forward the chart to somebody else in your practice by clicking the Forward Chart button. o Forwarding the chart to yourself is the exact same result as saving the chart to your inbox. o Forwarding the chart is different than Signing-Off; the documented information in the note is not permanently saved until somebody goes through the Sign-Off process. 3. You can close the chart without saving by clicking the red X at the top of the window. (Although it is unclear why you would want to do this as it simply will result in losing any information that has been entered.)

o If you do close the chart by accident, or your computer crashed while you were documenting,
you may be able to resurrect the note.

Sign & Code An Encounter Click the Sign-Off button at the bottom of the Most Recent Encounter window to begin the Sign-Off
process. o In addition to Signing-Off on a note, which permanently saves the note to the database and prevents any subsequent changes or edits, there are also a few ways to temporarily save a note when you are not ready to sign-off. Information on these other options is here.

Click the Sign-Off Button To Open The Code/Sign Encounter Window

The Code/Sign Encounter window is designed to allow you to quickly find the most appropriate CPT
code(s) to allow billing and reimbursement. The window has a number of Procedural (CPT) code tabs as well as a few tools to help you select the most appropriate CPT billing code, including: o the Top Ten CPT by Diagnosis tab that shows the most common CPT codes used based on the ICD code(s) selected. o the Quick Codes tab that shows the most common codes in the office setting and automatically calculates the correct code based on the patient's age. o the Search CPT tab that provides a complete database of all CPT codes as distributed by the American Medical Association (and for which we pay royalties to the AMA). o Tools on this window include the E&M Coding Helper that can assist in helping you find the appropriate code based on details of the encounter, and o the Meaningful Use Wizard that allows real-time analysis of what Meaningful Use criteria has (or has not) been documented in the current encounter.

It is important that you have at least one diagnosis in the current encounter for the Code/Sign
window to function correctly. Selecting a diagnosis is discussed here.

The Code/Sign Encounter Window Has Everything You Need To Appropriately Code The Current Encounter Including the Top Ten By Diagnosis tab

The Quick Codes Tab Provides Common Codes Used In The Outpatient Setting And Automatically Determines The correct Code Based On Age When Required

The Search CPTs Tab Contains A Complete List of Codes As Defined By The AMA

When you select one of the CPT codes (i.e., double-click the CPT code), it is automatically populated
in the CPT and Associate ICD-9 grid.

Double-Click The CPT Code Will Place It In the CPT and Associate ICD-9 Code Grid

The Associated ICD-9 Diagnoses code will align in the order which it appears in the Most Recent Update the Medical Decision Making and Place of Service as needed.
Encounter Assessment textbox in the note you are completing.

Add a billing comment if necessary.

Change the price or number of units as needed. Add one or more modifiers as required for your specialty. Confirm the ICD codes are considered "complete" to minimize the risk of billing denials. Codes that are
highlighted yellow are not considered complete and should be avoided. Codes highlighted in green are considered complete by most third-party insurers. When you click on the highlighted code, a list of Alternate Codes will appear

Incomplete ICD-9 Codes Are Highlighted In Yellow

To change from one code to another, double-click on the preferred code in the Alternate Codes list.

Double-Click On Another Code To Replace The Selected ICD

Once you are ready to permanently sign-off on the note, click the Sign It button. Although the contents of the note can't be altered after signing, the billing codes can. To sign the note without a CPT and/or ICD code, just click the button without selecting any codes.

When You Are Ready To Permanently Sign The Note Click The Sign It Button

Amazing Charts will verify the data, check to be sure there are no obvious mistakes (e.g., half a
blood pressure), and save the note to the SQL Server database. An electronic superbill will be automatically generated based on the codes selected.

The Note Is Saved To The Database (Signed-Off)

Print A Note
The Print Encounter/Send Letter window is designed to allow you to print any saved encounter,
message, or addendum on a specific patient. You can also use it to compose a letter pertaining to a saved encounter, message, or addendum. Most commonly, it is used after Signing-Off a patient note. By default the Print Encounter/Send Letter window automatically opens to allow you to print the note (e.g., you wish to have a paper record as well) or compose a letter to the referring or consultant provider. o You can turn off the automatic opening of this window by checking the box at the bottom that says "Do not automatically open this window..." The Print Encounters window is also accessible from the Amazing Charts Desktop by right-clicking on the desired patient and then selecting the Print Notes & Letters option.

Access The Print Note & Letters Window From Within The Patient Chart Or From The Amazing Charts Desktop (As Shown After Right-Clicking On The Selected Patient)

To print a note, first select which of the patient's notes you wish to print (1. Select Note) You can select a standard format for the printed note using the drop down list (2. Select Header for

You can access the Letter Writer from this window. The selected note will be used within the letter
as desired. Click Print Preview to review the note, or simply have it printed to the default printer (saving a few clicks).

Printed Note), or type your own verbiage into the field.

The Print Encounters/Letter Writer Window

Select the Print Preview option to review the note before printing, but also if you wish to save the
note in another type of file format (e.g., text, html, etc.)

The Print Preview Window Also Allows You To Save The Report In Various Other Formats (Red Box Area)

CoSign Notes
Amazing Charts has a the ability to require certain providers (those set to High level of access in the
Admin section) to have their note co-signed (e.g., mid-level providers, medical students).

Select The High Level Of Access To Require Notes To Be Sent To A Supervising Provider For

Sign-Off

Users who have been set up with a supervising provider, and require co-signing will automatically
have their signed notes forwarded to the supervising provider. The notes will appear in the supervising provider's Inbox with the subject, "Co-Sign: Patient Name"

Notes Waiting For Co-Signature Are Found In The Supervising Provider's Inbox With Subject "Co-Sign"

The supervisor will be able to review the note, add a signature and comment, and even be able to
reply to the mid-level provider/student with comments that are not part of the medical record.

The Co-Sign Window Opened By Double-Clicking On The Co-Sign Message In The Supervising Provider's Inbox

The Co-Sign Window allows the supervising provider to efficiently review multiple notes requiring
co-signature. o Mousing over a cell will show a pop-up with the rest of the documented information. You can also click the Pull Chart button to open the full patient note. o The Comment field allows the supervising provider to add a comment which will be added to the chart (e.g., Reviewed and agree with plan). o The Yellow Feedback field allows the supervising provider to add feedback to the mid-level provider that is not saved with the chart (the information is sent as a message to the mid-level provider). o Check the CoSign checkbox to select the item(s) you wish to co-sign, and then click Co-Sign Selected Items to save your co-signature +/- your comment, to the patient's note.

Resurrect A Lost Note


Amazing Charts has an note resurrection tool that will automatically attempt to repopulate any note
that was lost if you computer crashed (or was shut off) while documenting.

The Resurrect Last Note Window Will Automatically Open If An Encounter Was Being Documented At The Time Of A System Failure

Resurrection should happen automatically, but if it doesn't, you may still be able to manually retrieve
the information in the LastNoteBackUp.txt file. This file located in the Amazing Charts directory on the computer on which you are working. o By default this location would be C:\Program Files \Amazing Charts or on 64-bit computers C:\Program Files (x86)\Amazing Charts. o Open the Amazing Charts folder on the current computer and locate the LastNoteBackUp.txt, then double-click it to open it.

The LastNoteBackUp.txt Text File Is Located Within The Amazing Charts Directory On The Computer You're Working On

The LastNoteBackUp.txt file contain the text from the last note you were working on. You can copy and paste this information back into a note. For more info, see "I accidentally quit before saving a note!"

The LastNoteBackUp.txt Text File Contains Each Of The Fields From The Last Note You Were Working On

Prescribe A Medication
Only Amazing Charts users who have a valid license from the DEA and their state to write
prescriptions may use the Prescription Writer. In order to use ePrescribing within Amazing Charts you must submit your credentials for verification, and be a current subscriber to our Guardian Angel Maintenance & Support service.

The Amazing Charts Prescription Writer Window (With ePrescribing Functionality Turned On) Accessing The Prescription Writer The prescription writer can be accessed from the patient's Most Recent Encounter, Summary Sheet, or by

right-clicking on a selected patient within the Patient List.

Click The Write Scripts Button To Access The Prescription Writer From The Patient Note Or...

Click The Edit/Refill Button To Access The Prescription Writer From The Patient Summary Sheet Or...

Right-Click The Selected Patient On The Amazing Charts Desktop And Select Medication & ePrescribing Writing A New Prescription To write a new prescription, begin typing in the textbox by the Rx. Medications from our database of meds that match what you are typing will be shown.

As You Type Into The Rx Area, Medications Matching Your Text Will Be Displayed.

Select the correct medication and dose from the list of options as only codified medications can be checked for If you are unable to find a matching medication, you can type free text into the field, but it will not be checked against
allergies or the patient's other medications for interactions. o This is especially useful if writing a prescription for exercise or other non-medicine "prescriptions." o If a prescription is not eligible for electronic transmission, for example you have entered free text or not included the required information, a warning will display at the bottom of the Rx window. interactions.

Use the Amazing Charts Quick Script Writer button to open the Quick Script Writer tool that allows you to
quickly select from common entries for prescriptions in regards to how many to take, route, frequency, refills, notes, etc. Then complete the prescription by clicking on the Prepare Script button. o To turn off the Quick Script Writer, uncheck the box marked "Open Quick Script Writer automatically," which is checked (ON) by default.

The Quick Script Writer Lets You Point And Click To Select How A Medicine Is To Be Prescribed

o Alternately, you can manually enter how a medicine is to be prescribed using the textboxes and drop down
list.

Once complete, click the Prepare Script button to move the prescription to the Pending Medications list. o If ePrescribing is active, the medication will be checked for drug/drug and drug/allergy interactions, and these
will appear in the Interactions area. To add another medication, repeat the process above. To renew a prescription, select it from the Current Medication list and then click the 1. Prepare Script button followed by the 2. Prescribe button. o Within the Current Medications box users have the options to view Active, Inactive, or All medications through the drop down list. By default the list initially shows only the patient's current (Active) medications. To renew all prescriptions, click the Refill All button at the bottom of the Current Medication area. This will prepare new prescriptions for all active medications with the same sig, dispense amount, and refills as it was last prescribed.

When you are ready to print (or electronically transmit) the prescription(s), click the Prescribe button which will open

the prescription review window.

The Prescription Review Window & Print/Transmit Window

Click the Preview Prescription button to view the prescription before printing, or print the prescription(s) directly to the You can change the prescription format as required by your state through the Admin window. If your state requires secure paper for prescriptions, you can order it here.
Renewing A Prescription To renew a previously prescribed medication, select the medication from the Current Medications box on the left and the Prescription Writer will fill in the information based on how it was last prescribed. Click the Prepare Script button like you would with any other prescriptions. For electronic renewals of prescriptions sent by the pharmacy, see here. default printer by clicking the other button.

Verify Yourself
Because not everybody is as honest as you, Amazing Charts must verify that we know who you are and how to reach
you before you can use our Prescription Writer. Verification provides us with information about your Amazing Charts installation and other user and computer information. Providing erroneous information is illegal, and we do cooperate with law enforcement agencies if we believe you are not somebody licensed to write prescriptions. Do not submit for verification if you are not authorized to write prescriptions in your locale, as your information will be provided to law enforcement and you will be prosecuted to the full extent of the law. (It has already happened and will happen again.)

Click the Verify Practice Button (Or Link) And Follow The Instructions

We must have the exact name of your practice for the verification to function. Copy (CTRL-C on the keyboard) your practice name.

The Practice Name In Your Amazing Charts Database Must Match What You Submit For Features To Be Unlocked

Paste the practice name (CTRL-V on the keyboard) into the Practice Name field on the verification form and enter the
additional information requested.

Paste Your Practice Name And Complete The Other Information To Unlock Restricted Features

You will receive via email a verification number. Be sure that your spam blocker allows email from amazingcharts.com
and amazingcharts.net. Enter the verification code from the email by copying it (CTRL-C) and then pasting it (CTRL-V) into the window that has automatically opened.

Paste Your Verification Code In The Space Provided

Amazing Charts will go online and confirm the code before restricted features, such as prescription writing, is
unlocked.

There is an additional process required to activate electronic prescribing (ePrescribing), which is described here.

Edit A Medication
To modify a current medication, first select it from the Current Medication list. The medication will appear in the Rx window and can be adjusted as required. Whenever possible, select a matching (codified) medication from the drop-down list so interaction
checking can occur if ePrescribing functionality is on.

Remove A Medication
To inactivate a medication from the patient's Active medication list, select the medication and then click the
Inactivate button found below the Medication list in the Prescription Writer window. o Alternately, as shown below, you can right click on the specific medication and select the Inactivate option. This will open a box where you should document the reason you are inactivating the medicine (e.g., caused leg swelling).

Document The Exact Reason The Medication Is Being Inactivated

If a medication was entered by mistake, and never actually prescribed, you can delete the medication by
right-clicking on the erroneously entry, and clicking the Delete Med option.

An Incorrect Dose Was Accidentally Selected. To Remove (Delete) This Erroneous Entry, Right-Click On The Incorrect Medication And Select Remove

Review The Prescription History


To quickly review how a medication was last prescribed, simply hold your mouse over the medication and a window
will pop open and display this information.

For a more in-depth prescription history, right-click on the medicine in question from the patient's medication list and
select History from the list that appears. Right-Click On The Prescription And Select History To Open The More Detailed Prescription History Window

The Prescription History window shows the prescription history of the highlighted medication.

The Prescription History Window Provides Information Such As How Many Days Ago A Medication Was Prescribed.

For historical information on prescriptions transmitted electronically, click the ePrescribing menu at the top of the
Prescription Writer and select the Transaction Status Page, which will open the Electronic Transaction window.

Review Electronic Transactions


You can review electronic transactions, including the renewal history for patients. This is helpful since all too frequently a pharmacy will tell a patient that they did not receive the renewal or prescription
from the doctor's office. The transaction status window provides details on the transaction and can be used to figure out why the pharmacy has reported this (usually it is because they didn't check their computer to see that an electronic prescription came in). To review information on all electronic transmission for the practice, click the Prescription Status window accessible under the E-prescribing menu at the top of the Amazing Charts Desktop window.

Obtain The Status For All Prescription Transactions For The Practice

To review the transmission history for a specific patient, select the ePrescribing menu from within the patient's
Prescription Writer window.

Obtain The Status For Prescription Transactions For An Individual Patient

The Prescription Transactions window will allow you to see the information regarding prescriptions that were You can sort the columns to view status by the different headings such as Date Sent, Patient, Drug, etc. You can also use the Status drop down menu at the top of the Transactions window to filter the results. Prescriptions will be listed with a status of Queued, OK, Verified, or Failed - revealing the current status of the
prescription transmission. transmitted electronically.

The Transaction Window Showing Information On Prescription Disposition

You can also review a report of electronic transmissions from New Crop (our ePrescribing backend engine) by clicking
on the End of Day Reports menu item at the top of the Prescription Writer window. You can select a range of dates to display all electronic prescriptions transmitted within the time period.

Set My State Prescription Format


As prescription requirements change, we continue to modify our default prescription format as well as add additional The default prescription format has a number of security features required by many states, including micro line print
and ensuring dispense number and refill amounts aren't altered. (Descriptions of the various security features are found on the prescription's footer section.) formats required by various states.

The Prescription Format In The Admin Section

Some states require their own prescription format (+/- security paper) for paper prescriptions. You can set your state's format in the Admin window. If your state has a format that we don't currently support, please let us know and we will add it. ePrescribing that is accepted in all states for non-scheduled medications (and we are told by Surescripts and the DEA that our clients will be able to prescribe scheduled medications soon).

Order Secure Prescription Paper


Secure (copy-resistant and watermarked) paper can be purchased online. We also support secure thermal printed prescriptions. Set the prescription format in the Admin section.

Use Electronic Prescribing


You can activate ePrescribing functionality in the Interfaces area within the Admin window. Once active, additional options are visible in the Prescription Writer and Prescription Review windows. Whenever the Prescription Writer window is opened (assuming the practice has ePrescribing turned on), Amazing
Charts will automatically check for Drug/Drug and Drug/Allergy interactions for the patient's active medications. These features are on the left side of the Prescription Writer window. Automatic interaction checking can be disabled (e.g., if the speed of checking is problematic) in the user preferences window. o An active Internet connection is required for ePrescribing functionality such as interaction checking and transmission of electronic prescriptions through the Surescripts network. If your connection isn't working correctly, Amazing Charts will alert you.

o Patient's allergies will be listed in the upper left in red, and any interactions found will be listed in the
Interactions box in the bottom left corner.

o Any medicine listed in red denotes that an interaction was found. o You can also update the patient's known allergies by clicking within the Current Allergies
section.ePrescribing functionality requires an active subscription to our Guardian Angel Support & Maintenance service so interactions and pharmacies can be updated regularly.

The Prescription Writer Window

In addition to interaction checking, ePrescribing also allows electronic transmission of prescriptions via the
Surescripts network. To transmit prescriptions electronically, select the pharmacy to which the prescription should be sent. By default, the patient's address as documented in their demographics will be used to locate pharmacies nearby the patient's home. You can override this selection by entering another zipcode or city. The pharmacy list is updated regularly and automatically.

The Prescription Review Window With List Of Pharmacies

Renew Prescriptions Electronically


Renewal Set Up & Settings ePrescribing functionality, available for providers with our Guardian Angel Support & Maintenance service, allows renewal requests sent from the pharmacy to be refilled. Before using the Prescription Renewals screen, set the notification settings to match your practice's needs. o You can access these Settings from the E-Prescribing menu located on the Amazing Charts Desktop.

Either Configure Your ePrescribing Renewal Settings Through The ePrescribing Menu On The Main Amazing Charts Desktop,

o There is also a link to the Prescription Preferences window located at the bottom of the Pending Renewals
screen

Or Configure Your ePrescribing Renewal Settings By Clicking The Link At The Bottom Of The Renewals Screen

The Prescription Preferences window allows you to set various features regarding ePrescribing and renewal
notification settings.

The Prescription Preferences Window

You can disable to the interaction checking using the first two options. o If you disable both options you will receive a warning informing you that these options are

The third checkbox will remove the practice name from printed prescriptions. The fourth checkbox will turn off drug/allergy checking in the allergy window found on the Most Recent Encounter
screen and the Summary Sheet. The Drug Interaction Filter allows you to set what types of interaction notifications you receive. Checking the Send message for each renewal request checkbox will place a notification in the prescribing provider's inbox each time a new renewal has been received. Checking the Enable pop-up alerts for ePrescribing issues checkbox will add an additional pop-up message when preparing a prescription or entering patient information alerting you if there is any reason a prescription is not eligible for electronic prescribing. The next checkbox will highlight an unmatched sig in red lettering on the Pending Renewals screen when checked off. It will not list the entire renewal request in yellow or list it as a denial by default as the sig verbiage does not need to be completely matched in order to accept a renewal. Providers can also use the drop down menu to assign another user within Amazing Charts to receive their renewal requests if they do not want to receive them directly. There is an Administrative Settings button on this screen that will allow you to access the Electronic Prescribing Administrative functions by entering your admin password.

necessary to meet Meaningful Use' standards.

Accessing Renewals Coming From Pharmacies You can determine how many renewals are currently waiting to be completed on the Amazing Charts Desktop window.

The Current Number Of Renewals Pending Is Displayed On The Amazing Charts Desktop

Although Amazing Charts checks every 15 minutes for renewals, this number will refresh only when returning to this
window (e.g., when closing a patient chart). The total number of renewals for the practice will also be displayed in parentheses. You can open the renewal window under the E-Prescribing menu item (see image at top of this page) You can also click on the renewal number (the red area in the above image) to rapidly open the Renewal screen. Once the Pending Renewals screen is open you will see the list of prescriptions awaiting renewal.

The Prescription Renewal Window. Each Renewal Must Either Be Accepted Or Denied. Areas In Red Or Yellow Require Clarification.

The renewal window shows the list of prescriptions requiring action. Surescripts requires that renewals be completed within 48 hours, or they may suspend your account. Prescriptions that are highlighted yellow indicate information the pharmacy (i.e., the renewal request) does not
exactly match the information within Amazing Charts (e.g., can't match the specific patient, medication name, dose, sig, etc.) o The specific information that doesn't match will be highlighted in red. Prescriptions that appear in white have automatically been matched to a specific patient and medication from their current medication list. o Matched prescriptions (in white) that have Accept in red indicate that the prescription was matched, but the Sig was not matched. The most common mismatch occurs because the renewal request from the pharmacy has a sig that was adjusted to make it easier for the patient to understand (e.g., 1 PO QD prescribed is returned as 1 tablet by mouth daily). Select Accept or Deny to either allow the renewal or refuse it.

You Must Accept Or Deny Each Renewal Reconciling Renewal Requests Unmatched information (other than the Sig) must be matched in order to proceed and renew the medication. You can match the information by double-clicking on the patient name or by right-clicking on the renewal in question.

Renewals Must Be Matched Before You Can Transmit Them

The Match The Patient window is designed to match the incoming patient information. Only the patient and medication information that the pharmacy originally sent is returned to
the pharmacy when you Accept the renewal. In other words, matching the patient to another person or matching to an updated medication in the patient medication list will not alter the renewal request that was sent. o If the renewal request doesn't match correctly, DENY the renewal and then prescribe the correct medication. o You need to Deny and write a new prescription in these instances because changes DO NOT get transmitted back to the pharmacy due to Surescripts limitations. The pharmacy simply receives confirmation that their request was Accepted or Denied (and additional refills authorized). o Since this is a confusing issue, let's reiterate: Surescripts only allows the patient, medication, dose, and sig that was originally sent from the pharmacy to be Accepted for renewal or Denied. Changes and matching is done solely to ensure your Amazing Charts database has matching information. Your changes or updated matching information is NOT sent back to the pharmacy.

Match The Renewal Request To The Patient In Amazing Charts. If The Patient Does Not Match, Deny The Renewal And Write A New Prescription That Is Correct

Once you have matched the renewal to the correct patient the row will appear white on the renewal screen and the The same match process can be performed for the medication.
action will be set to Accept.

Once Matched, The Renewal Action Will Change To Accept Automatically

Once you have a matched renewal or all renewals, you can choose to Accept or Deny the renewal. Accepting renewals will send the prescription back to the pharmacy it was sent from using the same patient name, If you are selecting to Deny a renewal you must either choose one of the predefined Deny Reasons or type in your
own. You cannot send a denial without a Deny Reason or Comment (again, a Surescripts requirements). If the dosage or instructions need to be modified you need to right-click on a renewal request and then select to Deny and write a new prescription. Once the new prescription has been sent you will be returned to Renewal Request page and that renewal will no longer be listed in the request queue. medication, and dose. Only the number of refills and Comments can be altered.

If You Don't Agree With The Patient Or Prescription, You Need To Deny And Write A New Prescription Since Matching Only Serves To Attach The Renewal To Information Within Your Existing Patient Chart

The only fields that can be edited and returned to the pharmacy are the Number of Refills, Comments, and the Deny The Number of Refills and the Deny Reason can be filled in by using the drop down arrows and selecting from one of
the predefined entries or by typing in text. To enter text in the Comments section just click inside the comments box and you free type whatever you would like sent back to the pharmacy. Reason.

Fields That Can Be Adjusted And Returned To The Pharmacy Through The Renewals Window

Let My Staff Prescribe On My Behalf


Staff Prescribing Before a staff member can handle prescriptions on a provider's behalf, they must have proper permissions set in their User Account within the Administrative window. o From the edit users window you will need to click on the Edit an Existing User option located in the light purple menu to the left of the screen. o Once you have selected to Edit an Existing User you must select the staff member you wish to enable prescribing rights for by using the drop down arrow (to the right of the Pick A User) to Edit box located near the top of the users window.

o Once you have selected the staff member you would like to enable prescribing for, you must check off the
box marked as Allow user to prescribe located near the bottom of the users window and then select a provider to prescribe for. Then click Save Info. You can change the provider later, when writing a prescription.

Once a staff member is authorized, they can access the Prescription Writer in the same manner as their provider. Upon completing a prescription as ordered by the prescribing provider, and clicking the Prescribe button on the
Prescription Writer window, the Prescription Review screen will open. Within this window, the authorized staff member should select the provider for whom they are preparing the prescription in the Prescribe on behalf of drop down menu, which is now visible. o If the Prescribe on behalf of menu is not enabled, the staff member is not correctly configured in the Admin section | User Account information area. Prescriptions printed (or transmitted) in this manner will be printed (or sent) with the selected provider's information.

Authorized Staff Can Prescribe And Refill Medications As Ordered By The Prescribing Provider By Selecting The Provider From The Prescribe On Behalf Of Menu

Document A Phone Message


To document a phone message, click the Message button on the Amazing Charts Desktop. Your
message inbox will be visible on the right side of the screen.

The Message Button Opens Your Mailboxes Select the patient that the message is regarding from the Patient List. Drag and drop the patient's name from the Patient List into the message window. o Alternately, you can select the patient (e.g., click on their name) in the Patient List and then click the Attach button on a message.)

Drag And Drop The Patient From The Patient List To The Message Window Document the phone call in the message area. As with most text boxes in Amazing Charts, you can Right-Click in the message text box to access your templates of the most commonly used information that is documented. Select the Amazing Charts user to whom you want the phone message sent and click Send. o If you simply wish to save the patient's phone call without sending information to another Amazing Charts user, click the Save To Chart button.

Review A Saved Message


Select the patient in the patient list and select the Pull Visit History option. o Alternately, you can always just double-click on the patient , which opens the Most Recent
Encounter by default, and then click the Past Encounters tab.

The Visit History Section Of The Patient Chart Contains Messages, Prior Notes, Addenda, Etc.

This will open the Past Encounters tab for the selected patient. From here you can view and print all
encounters, messages and addenda.

The Past Encounter Tab Within The Patient Chart Contains All Notes, Messages, Addenda, Etc.

Document An Addendum
The Addendum Window is used to document miscellaneous aspects of the doctor-patient relationship
that are not documented in the usual visit process or the usual phone call process. Common examples for the Addendum are missed or canceled appointment information, procedure notes that are not documented during the usual visit. The Addendum is also useful when you need to add more information to a note that has already been signed-off. To access the Addendum window, right-click on the patient name from the patient list and choose Add Chart Addendum.

Access The Addendum Window By Right-Clicking On The Patient In The Patient List

Addendums can also be opened and saved when in a patient chart under the File menu | Addendum.

When Within A Patient Chart, Access The Addendum Window Under The File Menu

This will open the Addendum window. Like most text boxes in Amazing Charts, right-clicking in the text area allows use of your Addendum
templates.

The Addendum Window, Also Known As The Miscellaneous Entry Window

After creating your addendum, you have two options to save the information: o Save/Append To A Signed Note allows you to save the information to a note that has

previously been signed-off (e.g., you forgot some information that you feel is important to be in that note or to document that erroneous information was accidentally documented). Choose an encounter from the list in box 2 and review how your addendum will appear within the note in box 3. When finished click 4. Save.

Option #1: Add Your Addendum To A Previously Signed Note

You can also save the addendum as a standalone note (e.g., procedure note). This option allows you
to manually generate a Superbill as well.

Option #2: Add Your Addendum As A Standalone Note (And Have The Option To Generate A Superbill)

Previously documented addendums are viewable under the patient's Past Encounter tab.

Know What Has Happened Since The Last Visit (Interim Alerts)
When pulling a patient chart, the Interim Information Alert window will show you what phone
messages and/or addenda have been saved since the last encounter. This is a helpful reminder as to what has happened with this patient since they were last seen (e.g., missed or canceled appointments, refill requests, etc.)

The Interim Information Window Will Let You Know What Has Transpired Since The Last Encounter Turning Off And On Interim Information Alerts The Interim Information Alert window can be turned on and off under user preferences. By default it is on.

User Preferences Are Adjustable Under The Edit Menu On The Amazing Charts Desktop

Turn Off (Or On) Interim Information Alerts In The General Settings Of The User Preferences Window

Use Templates
Templates are useful when you wish to document the same (or similar) information repeatedly. For
example, many paragraphs, sentences and phrases are used regularly and repeatedly (e.g., as in the common physical exam: "Well-nourished, well-developed, in no acute distress.") Right-Clicking in most textboxes in Amazing Charts opens the template window containing information commonly used within the specific textbox. The purpose of templates is to avoid having to re-enter the same data over and over again. Given that much of the data entered into patient notes is similar, templates allow rapid enter of text, which you can then modify as needed for the specific individual. To access templates, Right-Click within the text box where you wish to place a template. In the example below, the patient is being seen for low back pain. Since we regularly document this type of neurological exam, we right-click in the Physical Exam text box to use a template.

Right-Click Within A Text Box To Open Templates Related To The Specific Template

After right-clicking in a text box, the template window will open. Select one or more template to use, then click the Move To Chart button to move the template text
into the text box from whence you came. o Alternately, you can double-click on a template to rapidly place it back into the text box from whence you came.

The Template Window Showing Personal Templates, Practice-Wide Templates, And Various Other Options Related To Your Templates

The template window contains "Personal Templates." These are templates that have come with
Amazing Charts, or that you have added or edited. Only you have access to templates in this area. The Practice-Wide Templates are templates that have come with Amazing Charts, or that you or another user in your practice has added or edited. These shared templates can be used by any user in the practice.

Add/Edit A Template
A template has three main components: the Template Name, the Template Text, and the Template
Location. o Template Name: This is a brief name that will remind you what the template is about. o Template Text: This is the text that actually is placed in the text field. o Template Location: This is the specific text box in Amazing Charts where this template text will be placed. If you have documented information that you commonly use, and wish to save this as a template, hold the ALT key down while you Right-Click. This will allow you to rapidly save the specific text as a new template.

ALT Key + Right-Click Will Let You Rapidly Save A New Template

To complete the new template, enter the desired name for the template (red box in the image above)
and click the Save Template button. The next time you open your templates, you'll see this newly added template alphabetized in your Personal Templates. o To add a template so all users in the practice can use it, see Sharing A Template. You can edit existing templates under the Edit menu | My Preferences | Templates, which opens the Add/Edit Templates Window.

Add/Edit/Delete Templates Through The Edit | My Preferences | Templates Menu

The Add/Edit Template Window contains all templates. Follow the instructions within the window to add, edit, delete, or share one or more templates. Templates can also be exported and/or imported from other Amazing Charts practices using the
Import/Export buttons.

The Add/Edit Template Window

Share Templates
Templates can be shared so that any Amazing Charts user can have access to them. o By the way, templates can also be shared between different Amazing Charts Practices. See Shared templates are found in the Practice-Wide Templates frame in the Template window. To share a template, open the Add/Edit Template Window by selecting Templates under the Edit
menubar. Sharing Templates Online for additional information.

Share Templates Through The Edit | My Preferences | Templates Menu, Which Will Open The Add/Edit Template Window

Find the template you wish to share and check the Shared box. Then click the Save Changes button.

Check The Shared Checkbox To Allow All Users Access To A Template.

The template will now be shared with all Amazing Charts users. When a user open the template
window, shared templates will appear in the right frame of the template window (Practice-Wide Templates).

Shared Templates Are Found In The Practice-Wide Templates Frame In The Template Window.

Import A Template
In addition to sharing templates between users in your own practice, you can import templates from
our online community by opening the template window, and clicking the Import Template button.

Import Templates Through The Edit | My Preferences | Templates Menu, Which Will Open The Add/Edit Template Window

Templates can also be shared with the larger Amazing Charts community via our online bulletin board. You can select and export templates which will be uploaded to the Amazing Charts User Template Similarly, and you can download and save templates from the repository using the Share Templates
buttons. Repository

The Amazing Charts Template Repository Has Templates That Other Users Have Decided To Share With The Amazing Charts Community

To import a template from the repository, select the Import A Template | from Amazing Charts
Website option and click the import button.

To Obtain A Template From The Repository, Click The Import button

When you click the Import button, you'll be directed to our online user repository. Select a desired template by clicking the download button. Save the xml-formatted file to your computer's desktop (so you can find it for the next step) by
selecting the Save File option.

Select The Save File Option

Save The File To Your Desktop (Keeping The Default Name) So You Can Find It Easily For The Next Step

After download is complete, you may have to close the Download Complete window or download The Select file to import window will automatically open.
notifier (depending on which internet browser you use)

Double-Click The Downloaded XML File To Import Into Amazing Charts

After selecting and opening (or double-clicking) the file, the Save A Template window will open. Edit the template name and template text as desired, then click the Save Template button. The
template will appear in your Personal Templates list.

Edit The Imported Template As You Deem Appropriate Before Saving

You can also export templates by selecting the Export Templates option. To do so, select the template you wish to export from the Add/Edit Template Window, then follow
the steps to upload it to Amazing Charts User Template Repository.

Import An Item
Importing lab and radiology directly into Amazing Charts is discussed here. You can import files (e.g., paper that has been scanned, faxes, etc.) into a patient chart via a
number of different mechanisms. These include: o Browsing to the item on your computer by clicking the Import New button. o Controlling your TWAIN-compliant scanner to scan in paper items by clicking the Import New Button. o Dragging and dropping an item from your computer into the left window.

Import Items Into A Patient Chart Via Various Methods

Imported items are placed into the patient's Imported Item tab within their chart.

Imported Items Are Stored In The Imported Items Tab Within The Patient Record

When you select an item in the left frame, it will appear in the right frame or in its own application You can further classify the type of import in the left frame of the Imported Items window. Click here
to learn how. (depending on the file type).

Set Up A Lab Interface (Or Other Interface)


Before you can import lab, radiology, and other electronic data directly into Amazing Charts, these interfaces must
first be turned on and configured in the Administrative section. Once configured and set up, labs (and other electronic interfaces) can be imported. To import electronic labs through one or more of your interfaces, click on File | Import/Export | Labs or CTRL+Ins:

A progress bar will appear

There might be instances that a patient's name or DOB is incorrect in your results. If this happens you have two
options: 1. You select the existing patient in your drop down list and select OK. 2. You also have the option to select Add to add a new patient to the Amazing Charts database. Do not select Add unless you are certain that there are no patients with that name and date of birth as this will cause duplication of a patient's charts.

The lab is now a part of the patient chart and can be viewed in Imported Items. The provider will also get a lab sign-off
message in their Inbox. o Please note: if it is the provider themselves importing the item, a sign-off message will not be sent to the provider.

To sign-off on an imported item, the provider should double-click the message which will open the sign-off window to
allow signing-off. You can also sign-off all pending items (without review, and thus not recommended) using the batch sign-off tool in the Administration window.

You can enter a comment or use any of the options provided before Signing-off on the item.

Edit An Imported Item


Right-clicking on an imported item in the left frame of the Imported Items window will allow you to
open an editor window.

Right-Click On The Item Whose Envelope You Wish To Edit

You can change the item type by either selecting a new one from the drop down list or by typing in a
custom name. You can edit the Date, Subject, and/or Comments. When finished, click Edit It and your updates will be saved.

The Imported Item's Directory As Well As The Envelope Information Can Be Edited

The Imported Item Is Now Under A New Directory Name

Signoff All Unsigned Items


The bulk sign-off ability has been included for practices that still receive paper documents that have
already been signed-off before being scanned into the system. We do not recommend signing-off items that have not already been reviewed by a provider due to the risk of including something in a patient's medical record that has not been adequately reviewed or addressed. If you wish to signoff on all unsigned Imported Items at one time (batch signoff), you can do so in the Administrative Options window. This prevents you from having to pull each chart with imported items that require sign-off. Batch sign-off can only be performed on the main computer that houses the Amazing Charts database. The batch sign-off operation can not be undone, so it may be a good idea to run the Amazing Backup Utility before running the batch sign-off in case of problems.

Sign-Off Multiple Imported Items Under The Tools Menu In The Admin Window

When you select the signoff option, a series of dialog boxes will step you through the process. You will need to click
Yes' to proceed or No' to cancel.

Walk Through The Various Steps To Sign-Off All Unsigned Imported Items

Select whether or not you would like to include Lad and Radiology results.

Be Careful When Signing-Off Items As You Are Medicolegally Responsible For The Information In Your Patients' Chart

Batch Sign-Off Has Completed

Control A Twain Scanner


Amazing Charts can control scanners that support TWAIN drivers. (These drivers can be found with either
the install disk that came with your scanner or from the manufacture's website.) In the patient's Imported Items window, click the Import New button and select the Import Directly From Your Scanner option.

You Can Control And Import Directly From A TWAIN-Compliant Scanner

To begin, set the default scanner that you wish to control (be sure it is attached or networked to
the computer you are using). Next, select how you wish to import the data (single or multiple pages and in which format you want the item stored). We recommend files be saved as PDF documents if you do not plan to saving the original paper file, as PDF files appear to be more acceptable from a medicolegal perspective. The smaller the size of the file being imported, the easier backing up your data will be over time as you add more patients and more imported items. o We recommend you open your PDF program (e.g., Adobe) and set the option to scan at the lowest resolution that allows you to adequately review the document (e.g., 72 dpi). Saving files as bitmaps (BMP) or tiffs (TIF) will result in large file size and may ultimately lead to difficulties with the time it takes to backup your files.

Scanner Controller Window

Once scanned, follow the steps to complete your importing.

Repair Imported Items Missing Links


You can run the Imported Items missing link (repair) utility from within the Administrative section of Amazing
Charts.

Find Patients Meeting Specific Criteria & Generate Reports


Find Individual Patients The easiest way to find a specific patient is to search by ID or name in the Patient List on the Amazing Charts

Desktop. Advance Practice Analysis And Reporting For more advanced analysis of your entire patient panel and to further filter patients by criteria, open the Report window by clicking on the Reports button on the Amazing Charts Desktop.

Access Advanced Reporting & Database Analysis By Clicking the Reports Button

Once clicked, the Advanced Search & Reporting window will open.

Search For Patients


Advance Practice Analysis And Reporting For advanced analysis of your entire patient panel by various criteria (e.g., all patients with diabetes that have an A1C > 7 ), open the Report window by clicking on the Reports button on the Amazing Charts Desktop.

Access Advanced Reporting & Database Analysis By Clicking the Reports Button

The Amazing Charts Report Window For Detailed Analysis of Your Practice As A Whole

Quickly pull all patients in the practice that meet commonly requested criteria (e.g., patients with a specific
diagnosis) using the Common Searches that are pre-configured in Amazing Charts. o Select the desired query and enter the specific parameter(s) when asked.

Use A Pre-Configured Search Query To Quickly Generate A List (And Report) Of Patients Who Meet Certain Characteristics Ad Hoc Queries And Advanced Reporting You can add additional criteria and generate your own database search queries by adding one or more specific criteria to your query. First, select the Category (e.g., Demographics), then a specific Field within the category (e.g. Gender), then an Operator (e.g., equal to) then a Value (Female). Then click the Add Criteria to Query button, which will place the criteria in the Query Criteria grid. You can add any number of criteria, one after the other, following the steps above. You can additionally set the search criteria to be either "And" or "Or" (e.g., All patients in the practice that are female AND have a diagnosis of Osteoporosis)

Add Each Criteria One By One To Build A Custom Query Of Your Amazing Charts Database

Once satisfied that your query reflects what you wish to pull from the database, click the Run Report button.

Click The Run Report Button To Search Your Database For Records Matching Your Query Criteria

The results appear in the Query Results grid. You can pull individual patient charts by double-clicking on any of the rows or Right-Click on a patient to open other You can further adjust the information in the Query Results using the buttons at the bottom, including options to hide You can generate various reports (e.g., with patient's de-identified), and printing and exporting options (e.g., to excel
or other spreadsheet application). You can print or export the information to various file types by clicking the Print or Export button, respectively. You can generate a Blind Carbon Copy (BCC) email to all patients pulled by your query (email addresses are saved in patient demographics) and/or generate a mail merge file. or show specific column name. common options.

Saving Custom Queries If you created a custom report and would like to save it so you don't have to manually re-enter all the criteria in the future, click the Save This button and give the report a name. Saved Queries can be modified and then re-saved as well as deleted using the respective buttons. When making modifications to a saved query choose Save Query As to create a new query based on those changes. Saved Queries appear in the Saved Queries drop down list.

Save The Queries You Plan To Run Regularly To Avoid Having To Reselect All The Individual Criteria

Send A Practice Newsletter


To generate a newsletter to all patients (one per unique address), click the Reports button on the Amazing Charts
Desktop to access the Advanced Search & Reporting window.

Access Advanced Reporting By Clicking the Reports Button

Using the Common Searches menu, select the Newsletter option you wish to use.

Use The Pre-Configured Search Queries (Common Searches) To Generate Newsletter Addresses And BCC Email Blasts

Create A Mass Email Blast


To create an email blast, open the Reports window.

After selecting the desired criteria and running your report (as described here), choose Select All and then the Mail
Email option.

Type (or copy & paste) your email content in the space provided. Click the Email button or one of the other options to generate a mail merge file.

Chose A Password
Amazing Charts can be customized by adjusting preferences. Preferences for the practice as a whole are found in the Admin window. Preferences for individual users are found on the Amazing Charts Desktop under the Edit | My Preferences menu.

User Preferences Are Accessed In The Amazing Charts Desktop Window Under The Edit | My Preferences Menu

Change A Password
Passwords are the critical line of defense in protecting the precious Amazing Charts patient identifiable data. Using commonly guess-able passwords is just plain stupid. Passwords, like ones date of birth, last name, repeat of one's username, or other obvious choice, should be avoided. A strong password is one that is difficult for others to determine by guessing or by using automated programs (programs, for example, that will run through every word in a dictionary).

A good and strong password is one that:

Contains at least seven, but not more than 16 characters; and, Combines three of the four different character types: uppercase letters (A, B, C...), lowercase letters (a, b, c...),
numerals (1, 2, 3...), symbols (~, !, @, #, $, +, ?, etc); and, You can remember it...

To create a strong password that is easy for you to remember but hard for somebody else to determine, try one of these techniques: 1. Merge two or more words, and combine the words with numbers and symbols. For example, Walk[My]Dog, Champions=2005. 2. Abbreviate a phrase you'll remember. For example, the phrase I ride my bike 5 miles each Saturday could become the password Irmb5meS. 3. Drop all vowels from a favorite saying, and then add numbers or symbols. For example: Walk three dogs could become the password Wlk3Dgs. To change your login user password, open the Change Password menu option under Edit | My Preferences | Change Password.

Follow the directions, entering your existing password, and then your new password - repeated a second time to be sure there were no typos.

Amazing Charts will check your password strength; get in the habit of picking a strong password!

Do Billing
There are many ways to use Amazing Charts to complete patient billing and basic practice management activities. As you save notes in Amazing Charts, an electronic superbill containing the E&M coding you assign is automatically

generated. At day's end (or whenever you wish to do so), these data can be printed, exported, tallied, etc. You can access the various billing options through the billing section of the menubar on the Amazing Charts desktop. There are a number of methods through which Amazing Charts can be used for practice management: Using Amazing Charts alone as a practice management System Amazing Charts currently has the ability to print invoices, CMS-1500 forms, and record monies obtained from patients and third party payors. In addition, we are currently developing our practice management suite to allow more advanced features such as billing reports of A/R, collection reports, eligibility, and direct clearing-house connectivity. These features are expected in our next major release. Using Amazing Charts Billing Service for your practice management Another method for performing your practice management needs is to use a billing service that has contracted with Amazing Charts to perform various services at a significantly discounted price. At the end of the day, after your staff has entered the various copay and other patient information, all the practice superbills automatically generated as you signed notes, can be uploaded to a third-party billing company with which Amazing Charts has an agreement. This agreement states that the billing fee will be a flat percentage of practice collections with no hidden fees or charges (e.g., stamp fees, invoicing fees, etc). Click here for more information on this service. Using X-Link middle-ware software to link to your practice management program Amazing Charts has an interface to X-Link which can be turned on in the interfaces window within Administrative section of Amazing Charts. X-Link is a middle-ware program which runs on the computer and intermittently accepts data from your practice management program (e.g., Medisoft, Lytec) and imports it into Amazing Charts. At the same time, it accepts the electronic superbills generated automatically by Amazing Charts when you sign an encounter, and exports this data to your practice management program. In addition to purchasing our X-Link interface, you must also own a copy of X-Link for this to function. More information on X-Link is here. Using a direct interface (via HL7) to a third-party practice management program Amazing Charts has built interfaces directly with a number of practice management programs which allow their demographic data to be imported automatically into Amazing Charts while exporting your electronic superbill data (generated as you sign notes) to your practice management program for submission and billing. In addition to our interface to your practice management program, you must also own a license to the practice management program you wish to use. More information on available interfaces is here.

Facilities
Facilities and Places of Service (PoS) such as your office, are configured in the Administrative window under the
File menu. Once configured, you may select these as needed for billing. The Place of Service (PoS) is selected in the Sign & Code window where the Superbill for an encounter is generated.

Use the drop down menu to find the correct location where the encounter took place.

You can also select the location from the Account Information tab within the patient chart.

And when creating a manual Superbill.

Add A Modifier (or Two)


You can add one or more modifiers by clicking the drop-down within the CPT and Associate ICD-9 grid

Click The Drop-Down List To Select A Modifier

Multiple Modifiers Can Be Added

Print A Daily Batch


You can print a batch of reports by clicking the File | Print Daily Batch option on the Amazing Charts Desktop. You can then select the specified batch you wish to print from the various options.

Lookup Codes

Codes can be looked up via the ICD-9 and CPT code window. This is accessible from the patient's chart (Most Recent Encounter, Summary Sheet) as well as from the main Amazing Charts Desktop (under the View | Codes options). Clicking the F12 key when on the Desktop will also open this window.

Add ICD (Diagnosis) Codes


Amazing Charts includes a full ICD-9 and CPT database, and is updated regularly as part of the Guardian Angel Support & Maintenance program. You can also add your own unique codes by opening the Lookup Code window and then selecting the Edit Codes menu option.

Edit ICDs
Amazing Charts includes a full ICD-9 and CPT database, and is updated regularly as part of the Guardian Angel Support & Maintenance program. You can also add your own unique codes by opening the Lookup Code window and then selecting the Edit Codes menu option.

Add CPT
Amazing Charts includes a full ICD-9 and CPT database, and is updated regularly as part of the Guardian Angel Support & Maintenance program. You can also add your own unique codes by opening the Lookup Code window and then selecting the Edit Codes menu option.

Edit CPTs
Amazing Charts includes a full ICD-9 and CPT database, and is updated regularly as part of the Guardian Angel Support & Maintenance program. Y You can also add your own unique codes by opening the Lookup Code window and then selecting the Edit Codes menu option.

Do Offsite Backup
Amazing Charts is designed to prevent corruption or loss of data already accepted into the system in the event of a system or hard drive failure. Amazing Charts understands that data protection is of the utmost importance to our clients. As such we do our utmost to prevent data loss, even in the event of computer, system, or user failure. There are many types of threats that can corrupt data: power outages and surges, hardware failure, virus or malware, system failure, and software issues. Ensuring your computers have Uninterruptable Power Supplies (UPS), surge protectors, and that computers are kept away from dust, contaminants and humidity, and that you use an updated antivirus system and firewall, are the first steps you should take to ensure your data is protected. Amazing Charts has other built-in protection measures to minimize the impact of a system failure. The first is the use of SQL Server as our backend database. SQL server constantly sends data to the database

as distinct transactions and is built to be fault-tolerant. In the event of a failure, only the current unsaved documentation is lost. Amazing Charts also has the ability to save patient encounters as you are documenting (but before saving the note to the database. In the even of a power failure or computer shut down, Amazing charts "holds" this data and will alert the user upon re-logging in that a note may have been lost and providing the opportunity to resurrect the note.

Resurrect Last Note window that pops up if a patient encounter was being documented at the time the system shut down.

Despite these protection methods, there is absolutely no substitute for regular (at least
daily) backups of your Amazing Charts database and the other information within your Amazing Charts directory on the main computer. Thus, included with Amazing Charts is the Amazing Charts Backup Utility, the Amazing Backup Automator, and the Backup Restore Utility. The configuration and use of these is designed to minimize the technical complexity to encourage their use (see images below). Movie demonstrations at www.amazingcharts.com/demo are also available and show the steps needed to automate backup and restore your Amazing Charts data in the event of a system, hard drive, or other unexpected failure.

The Amazing Charts Backup Utility can be configured to automatically create a backup of your current database state, including all information stored to that point. This can be set to run at regular intervals. Backups are saved to an encrypted backup file housed in the Backup directory within the Amazing Charts directory, and can also be configured to save these backup files (with the extension .enc) to three other locations of your choosing. Amazing Charts recommends backup be performed daily. the date and time of your last successful backup is displayed on the Amazing Charts desktop whenever a user logs in. To further ensure you remember to regularly backup Amazing Charts, a message will alert you upon login if a backup has not been successfully performed recently.

Users should backup regularly and at a time of minimal activity as the backup process may slow down the system on which it is running. Before or after normal work hours is usually ideal. As your practice data grows, so too does the time it will take to complete the backup (and uploading) of your backup file. You can continue working while the data is being backed up +/- uploaded. Should a system failure occur, you can use the Backup Restore Utility and use your most recent backup to restore the system to full functionality. The restored system will contain all practice and patient data to the point-in-time the backup was generated. Backed up data can be saved locally (on the same hard drive or a backup drive), on a removable storage device or media (and taken off-site), or uploaded to our secure OffSite Backup (OSBU) servers.

The Amazing Charts Backup Utility Window opened from within the Amazing Charts Administration Window, via the Windows Start Menu under Amazing Charts, or from the Amazing Charts directory. OffSite Backup To minimize the risk of user error when backing up the required files in the Amazing Charts directory, we recommend the use of our OffSite Backup (OSBU) service. We intentionally keep the cost of this service at an affordable level to encourage its use. If you chose to perform your own backup, you can use your own removable media (with nightly relocation to an off-site safe location) to prevent data loss due to issues on host computer as there is not much worse than losing your practice or patient information. While other off-site backup services (e.g., Mozy, Carbonite) may be cheaper, there is no guarantee that the backed up data is stored in a way that ensures it is recoverable - and a number of users have found (the hard way) that their backup using one of these online services did not completely back up their SQL Server database or other necessary files within the main Amazing Charts directory. The Amazing Charts Offsite Backup service is an affordable insurance policy designed to allow the regular uploading of your precious Amazing Charts database and imported items to secure servers located away from your own practice. Information and the ability to purchase this service is available here. Your Amazing Charts databases will be backed up, and then encrypted to a CCHIT and HIPAA-compliant level. If you subscribe to our service, and have checked off the "Step 3" option, your encrypted data will be uploaded over an encrypted network to our secure servers (click here for more information). By default, Amazing Charts backup files are stored in the Backup directory in the Amazing Charts folder on the main computer (or server). You should also set one or more additional backup locations NOT on the main computer (in case the hard drive fails). This is done under the Advanced Settings button on the Backup Utility. Prior and outdated backups can be removed automatically by using Amazing Utilities. Whether or not you chose to use our service, the Amazing Charts OffSite Backup Utility is included with Amazing Charts and available for your use. Advanced Backup Features

Click the Advanced Settings button to access additional options, including backing up to more than one location and
sending a confirmation message. Additional backup settings are in the Admin window.

Restore an Amazing Charts Backup


The Amazing Charts Backup Restore Utility is designed to simply restore your Amazing Charts system from the
backup file generated by the Amazing Charts Backup Utility. Access to the Backup Restore Utility is in the Amazing Charts directory (run the Backup Restore Utility). We recommend you contact Amazing Charts technical support for assistance and guidance if you need to restore Amazing Charts.

The Backup Restore Utility (found in the Amazing Charts directory) provides the means to restore and Amazing Charts backup file (with extension .enc).

Click the Restore Database button, browse to the correct file, and run. The utility has some
idiot-proofing to alert you if you are about to overwrite an existing database with patients, and if you chose to proceed, will require the Administrator password.

Write A Letter
The Letter Writer window allows you to use templates to write a letter. Letters can be sent to patients, consultants or referring providers, or anybody else for that matter. If you are writing a letter regarding a patient. Right click on the desired patient in the Patient List on the Amazing Charts Desktop, and select the Print Notes/Consultant Letters option.

The Print Window will open. Select the person to whom you want the letter sent in the Letter Writer section of this window, then click the Compose Letter button.

In the Letter Writer window, you can use templates to rapidly document commonly repeating information. You can include a prior encounter attached to the note, include parts of the encounter within the text of the letter, and/or include an

attached patient demographic report.

When you click the Print/Fax button, you'll be given the option to also save the report to the patient's Imported Items window. We recommend you do so. If you don't actually print the file, the item won't be saved.

The Report window will open, where you can review the information before printing or faxing the letter. Click the box at the top left to select the printer or fax machine you wish to write to.

To print the report, select the printer and click the Print Button.

To send the report as a fax, select the Windows Fax instead of the printer (you need to have a fax on the computer for this

to function), and then click the Print button. The Fax wizard will automatically start.

Add Users
Amazing Charts users are added (and edited) in the Admin section of Amazing Charts, under the User Account New users can be added to the system by selecting the Add User option, and then entering the user's information. To edit an existing user, click the Edit User option, select the user you wish to edit from the drop down list, and
change the information you wish to edit. button.

Inactivate A User
Amazing Charts users are added (and edited) in the Admin section of Amazing Charts, under the User Account button.

Add A Signature
You can import a user's signature into Amazing Charts by either scanning or having the user sign in a paint or other illustration program and saving it as an image file (e.g., gif, jpg, bmp, etc). (A free paint program comes with Microsoft Windows and is found in the Start | All Programs | Accessories folder. It is called Paint.) To import this image file of your signature, go into the Admin section of Amazing Charts and select the User Account button. Click the Browse button under the user for whom you are adding the signature, and browse to the image file. The space provided is the amount of room available for the signature on various reports in Amazing Charts (e.g., prescriptions, letters), so the complete image of the signature should fit in the space provided to avoid having it cut off on the reports. If a user has a signature added, it will appear on all letters and default prescription formats.

Add or Edit A Schedule


Schedules are added or edited and modified in the Admin | Schedule section. Once in the Scheduling window, click the option to Set Provider Schedule, select the provider whose schedule you wish to

add or change, and then set up their time schedule and date range for this schedule. The schedule you add will REPLACE any slots the selected provider already has. Although the selected provider's schedule will be overwritten, if there are any patients already booked, they will remain in the schedule and are not deleted. (Since having patients show up for scheduled appointments that you don't know about is rather unpleasant.) To delete a provider's schedule, select them and set their schedule to "Off" for each day.

Turn On An Interface
Interfaces are configured in the Administrative Options window.

Reset The Path


There are a few ways to reset the path so you can browse to a different database (via the AmazingCharts.xml configuration file). That said, other than taking a computer off site or changing the main computer, there really shouldn't be a reason to do this. Don't try this unless you know what you're doing and why you're doing it. The Right-Click Technique. When first starting up Amazing Charts, if you Right-Click on the white area of the log in screen, you'll be given an option to reset the paths.

Click the Yes button, and then restart Amazing Charts and you'll be given the opportunity to browse to the AmazingCharts.xml configuration file. The Admin Option Technique There is a button in the Admin window to reset the paths. Log into the Admin window under View | Administrative options, and click this button. When you restart Amazing Charts, you'll be asked to find the AmazingCharts.xml file. The Amazing Utilities Technique If you are unable to start Amazing Charts (and thus can't reach the log in screen or Administration window), you can open Amazing Utilities and click the Reset Paths button on the lower aspect of the screen. (To get to Amazing Utilities, click the Window's Start Menu | All Programs | Amazing Charts and select Amazing Utilities.)

Export Information From Amazing Charts


You can export your entire patient list and all patient demographic information through the Administrative options section. Select the Import/Export tab and then click the Export Patient Demographics button. The resulting delimited text file will appear in your Amazing Charts folder on the local computer, and will be named, AmazingCharts<<type of item exported>>.xls.

You can export a list of all unique household addresses (e.g., for a practice newsletter or mailing list), your practice Rolodex data, your patient demographics, and all patient encounters. You can also export select patients from Amazing Charts using the Advanced Search window.

Export A Continuity of Card Document (CCD)


The CCD (Continuity of Care Document) is a standardized format of patient data which can be
exchanged with third-parties (e.g., other physicians using other EHR systems). The export file is in a standard XML format. You can also print a human readable form of the CCD.

Export A Continuity of Care Record (CCR)


The CCR (Continuity of Care Record) is a standardized format of patient data which can be
exchanged with third-parties (e.g., other physicians using other EHR systems). The export file is in standard XML format. You can also print a human readable form of the CCR. Export a CCR by selecting a patient from within the patient list. Click on the drop down menu to the right of the Print icon, select Print Continuity of Care Record (CCR).

Once the print preview window comes up, click on the export button found on the top left corner of each page. A new
window will pop up asking the specific location where you will like the file to be exported to. Select the path you want to save it to, name the file, and click on save.

Buy Amazing Charts


We want you to buy Amazing Charts only after you've had a chance to try it out and see if it will
work for you. After the trial period, a window will automatically open and will walk you through the steps to purchase the program. The window that opens will give you approximately a two week warning that the program will soon be locked-down, so when you see the window, it's time to pay. If you decide you want Amazing Charts before the trial period ends, you can purchase it by going to the Help menu on the Amazing Charts Desktop, select About Amazing Charts, then click the Register button.

The Registration Window will open and provide step by step directions. Follow the directions and be sure to enter your practice name exactly as it appears, or the
registration code you receive from us will not work.

Report A Bug
Bug identification and reporting is built into Amazing Charts. Our goal, as is yours, is to have an error-free experience, and we review submitted bugs and fix issues that arise, often for the next release. Intense Debugging By default, Amazing Charts is set to record, but not alert you to, minor issues. You can turn on (and off) advanced and detailed debugging in the About Amazing Charts window under the Help menubar. In addition to recording errors that occur, Amazing Charts will ask you to report any errors to us so we can learn about and fix these problems. If you don't have an always-on Internet connection, this can be annoying. You can turn on and off the automatic bug reporting in the Admin | Maintenance section. Error Reports The error window provides information to help determine why the error was encountered and provides a means to submit errors to Amazing Charts. All errors are saved to an error.log file (located in the default Windows Temp folder) and all prior errors since the last error report was submitted are included in the current report. Submitted error reports have a standard format that includes the error overview information and the error details listed below: Error Overview Date of error submission Practice name and registration number Description of error (if provided by user submitting the error) Seriousness of error (decided by user submitting the error) Other comments (provided by the user submitting the error) Current version of Amazing Charts running at the time of submission Location of the Amazing Charts directory on the computer submitting the error (AmazingCharts.exe path). Location of the Amazing Charts database (network path to the Amazing Charts database) Computer Operating System(OS) details, including which service pack and OS version is being run) Computer processor information (including the amount of physical memory used by the Amazing Charts process) The logged-in user's name, date/time, time zone, practice telephone, and email address of the user submitting the error report. Error Details (more than one error may be submitted with the error report)

Date and time the error actually occurred (this may be different than the date/time the error was submitted) Version being used when the error occurred Username (ID) of the user experiencing the error The active window being displayed at the time of the error and the active control within the window The programming module being run at the time of the error, along with the line number in the code where the error
occurred Details and id number of the error An example of a submitted error report is shown below (with client identification data removed - XXXX) Date: 2009-03-20 Practice Name: XXXX Neurology (XXXXXXXXXXXXX/8XXX17-0-270YACU-1) Description: opening a chart Seriousness: CRITICAL Other Comments: Current Version 4.0.60 EXE Path: C:\\Program Files\\Amazing Charts DB Path: \\\\XXSERVER\\Amazing Charts\\AmazingCharts.mdf Platform: Microsoft Windows Vista Business (Microsoft Windows NT 6.0.6001 Service Pack 1) Processors: 1 (Physical memory for entire process: 154050560) Uploaded by XXXXX XXXX, MD (Mar 20, 2009 Fri 10:27 AM) Central Standard Time Practice Phone Number: (XXX)XXX-XXXX 03/20/09 10:26:49 AM Version 4.0.60 User: XXXXX Active Form: frmSchedule Active Control: dblistPatients Value: 7983 Source: frmChart:LoadIllustrations Line: 50 Error: (53) File not found Upon submission, you will be directed to a regularly updated (and searchable) web page where known issues and solutions (or work-arounds) are posted. Submitted error are automatically categorized by version and severity and then reviewed by a quality assurance, tech support, or developer personnel and are handled as follows: Unknown the user is contacted for more information such as to retrieve a copy of their database and/or system configuration to allow for replication and determination of the underlying cause. Known/Unsolved the user is contacted for more information such as to retrieve a copy of their database and/or system configuration to allow for replication and determination of the underlying cause. Users are regularly informed if their error remains in this category. Known/Solution in Development the user is alerted that the solution is in development and the estimated time to release. Known/Solved the user is alerted to that the solution is available.

Update Amazing Charts


Amazing Charts will automatically check for available updates every two weeks. You can turn this feature on and off in the Admin | Maintenance section. (You will need an Internet connection for this to work.) If an updated version is available, you will be redirected to the portal through which you can download the update. Updates consist of one or two required files. The first is the latest AmazingChartsInstaller program that will update the various As Amazing Charts adds and improves features, various database changes occur. The Database Tuner is a utility that can alter your database safely and in a manner that allows existing users to upgrade their system. If you install an updated version of Amazing Charts without running the Database Tuner, you'll get an alert message.

Clicking yes will bring you to our website where you can log in and immediately download the Database Tuner, required to upgrade your database to the latest version - click here to go there now. (You must be a subscriber of our Maintenance service to retrieve the current database tuner.)

Check For Updates


By default, Amazing Charts will check for available updates every 15 days. o If you are using a beta version, Amazing Charts will automatically check for an update every 2 To manually check for an updated version, click the Help menu on the Amazing Charts Desktop
window and select "Check for Updated Version." Amazing Charts will check your version number against the latest version listed on our website, and inform you whether you have the most up-to-date version, or if a newer version is available. days.

Know if I have the most up-to-date version


By default, Amazing Charts will check for available updates every 15 days. o If you are using a beta version, Amazing Charts will automatically check for an update every 2 To manually check for an updated version, click the Help menu on the Amazing Charts Desktop
window and select "Check for Updated Version." Amazing Charts will check your version number against the latest version listed on our website, and inform you whether you have the most up-to-date version, or if a newer version is available. days.

Upgrade From V3
While these instructions may look long and complicated, they are not. We have just detailed every step needed, even though many of the steps are obvious (e.g., click the "Next" button). Just follow the directions and you'll be using the latest version in no time! Updates should always be completed on your main computer (or server) first. Always backup Amazing Charts before updating (just in case...)

Make A Backup: although Amazing Charts automatically makes a backup of your critical files before updating, it is wise to make your own copy of your Amazing Charts database and Imported Items directory before upgrading. Follow the steps below to make a copy of the critical patient and practice data stored in your Access databases and Imported Items directory.

Browse to the Amazing Charts folder by double clicking on the Computer icon on your desktop, or under the Windows Start menu. (this must be done on your Main computer or the files won't have your actual patient/practice data). Find the folder that holds the Amazing Charts database. By default, Amazing Charts puts all the critical files in the C Drive (C:)\Program Files\Amazing Charts directory as shown below.

Double-click to open the Amazing Charts folder and select the Access database files shown below. To select multiple files at the same time, first click the AmazingCharts, file then while holding down the CTRL key, click on the other files: AmazingMeds billing, codes, import, schedule, and the ImportItems folder. Once they're all highlighted, right click your mouse and select copy (as shown below).

: Now create a new folder on your computer's desktop into which we'll paste the items that you have just copied. To create a folder, right click on your desktop, select New | Folder.

You will now have the ability to name the New Folder if you like (in this case we've renamed this back up folder, AMZBU).

To paste the files, double-click on the folder you've just created, then right click and select the Paste option as shown below.

Once you see all the files pasted into your folder, your backup is complete. The image below shows you the files you should now have copied to the backup folder on your desktop. You are now ready to update to the latest version.

Download The Installer: On the Main Computer login to www.amazingcharts.net/ac and enter your email address and password to log into your account. Click on Click here to download your updates link.

Now follow the steps as outlined in step by step order. Click on Click here to download the Amazing Charts installer on you main computer.

A prompt will appear with the option to Run, Save, or Cancel the file. Select the Save option.

We recommend you save the file to your Desktop so it will be easy to find.

Once the download is complete, you'll see the AmazingChartsInstaller5.exe on the desktop.

. Run The Installer: run the Amazing Charts Installer on your "main" computer. If your main computer (the one you should be doing this on) is running Windows 7 or Vista, you should Right-Click on the AmazingChartsInstaller5.exe and select "Run as administrator." For other versions of windows, simply double-clicking the installer will do just fine.

A security warning may appear. Click the Run option to allow the installation to begin.

The Amazing Charts Installation Wizard will now take over and help walk you through the installation.(Depending on the speed and memory on your computer, this process can take a number of minutes.)

The first step is to unpack the various files you'll need during the installation. Let the process go through, even though it may appear that nothing is happening. Wait...

Once the ACPrerequisites is complete, the Amazing Charts Setup Assistant window will appear. Your main computer requires Microsoft SQL Server (Express version), our new robust backend database (into which all your old Access database info will be migrated in a few minutes). Answer the questions and our installer will put everything where it should be.

Various windows will pop up to let you know what is going on. In some instances you'll need to click a button to allow the various files to be correctly installed. Don't abort the process midway through as Windows doesn't take kindly to this and will likely get you back by requiring a lot of manual configuration by our support team later on.

Once SQL Server installation is complete, the Amazing Charts V6.0 Installation will continue to walk you through the process. Click on "Next," and follow the steps.

Our End User License Agreement (EULA) will appear. We strongly encourage you actually read this, as you are agreeing to the terms when you install or use our program and services. If you agree to abide by the terms of the EULA, select the "I accept..." choice to continue. (If you are not comfortable with any part of our EULA, please select "I do not accept..." This will stop the installation. The EULA is discussed on our user board, and you should feel free to post your concerns for public debate. If you agree to the terms of the EULA, a destination folder prompt will appear. It's important that you select the correct database location - in other words the correct directory where your main databases reside (i.e., the directory you did the backup from in Step 1). In this example, and by default, the location is: C:\program files\Amazing Charts. If your database is located on a different drive, click on "Browse" and find the correct folder. Once you locate your main Amazing Charts directory, select the Anyone who uses this computer" option and then click on "Next:"

Amazing Charts will now install various files necessary to use the program. You will see various messages indicating which files are being installed and enhanced. Do not cancel this process.

Once the installation is complete, a window will appear. Click on "Finish."

Start up Amazing Charts: Double click on the Amazing Charts icon on your desktop. The Amazing Charts setup Assistant will appear, click on Next and answer the step by step questions.

Again, you should first set up Amazing Charts on the main computer. So select "Yes." If you are installing this on other computers and not your main one (since you've already completed the install on your main computer), then you can select "No," and then browse to the main computer.

For Amazing Charts to know where the main database is, it must read information in a file called AmazingCharts.xml. If the correct directory does not appear automatically, you'll need to browse for it. Once found, select the file and click Open.

Amazing Charts will start up and attach to your new database.

Migrate your existing data. In order to continue to use your data from our prior version, you need to migrate this information from Access to Microsoft SQL Sever. We, of course, have built a tool that should make this simple. Click on Yes to start the built-in Amazing Charts Migration Utility.

The Database Conversion Utility will appear, click on Start. This process can take quite some time (e.g., possibly an hour or longer) depending on your existing database size.

Be patient. Don't stop the process prematurely!

Once the Database Conversion Utility is complete, click on OK

You have successfully updated Amazing Charts and migrated your old data into our new database. Double-click on the Amazing Charts icon to begin using the new version. If using a Vista computer, you may be directed to right-click on the real Amazing Charts.exe file in the Amazing Charts folder the first time you run Amazing Charts. That folder will open automatically along with instructions on what to do. Upgrade your other computers. You now need to update all the non-main computers (we refer to them as the "locals," or "remote" computers. We suggest that you copy the AmazingChartsinstaller6.exe from your Desktop to your Main Amazing Charts folder. That way, you can browse from each of your local computers to the shared main folder and run the installer from there. (On the local computers, you will not need to install SQL or migrate the databases, so this will take a lot less time.) To update your local computers, browse to the AmazingChartsinstaller5.exe which, as recommended above, is likely in your main Amazing Charts directory on the main computer. Other alternatives to get the installer would be: Put the AmazingChartsInstaller.exe into a shared or public folder accessible from any computer on your network. Download the installer from our website (takes more time).

On Windows Vista and Windows 7, instead of just double-clicking on the installer to run it, we recommend you right-click and select Run as Administrator.

Open File - Security Warning may appear, click on Run.

As before, the Amazing Charts Installation Wizard will take it from here.

Once the required files are unpacked, the Amazing Charts Database Setup will appear. This time, since you are on a local (i.e., not the "main" computer), select: No, this isn't the main computer, and thus does not need to have Microsoft SQL installed. Click on Continue (If, on the other hand, this is a laptop that you may be taking offsite to use Amazing Charts and returning to the office to synchronize, you will need to click on Sort of option, which will install the SQL Server database for when you do take the computer off site.

Amazing Charts V6.0 Installation Wizard will appear. Click on next.

Again, the End User License Agreement will appear. Given that you've already read it and agreed when installing the program on the main computer, we presume you'll agree again.

Most likely your non-main computers you have used the default setting for the Amazing Charts files. If not, browse to the correct directory.

Amazing Charts will now complete the installation. You will see various messages indicating what is being installed where. Again, do not cancel this process.

A window will appear once the installation has successfully completed. Click on Finish.

Now start up Amazing Charts on the computer by double-clicking the Amazing Charts icon on your desktop. On Windows Vista machines, you may have to run Amazing Charts as an administrator the first time you attempt to start it. If this is required, Amazing Charts will open the correct directory and tell you what to do. You only need to do this once on the computer. The Amazing Charts setup Assistant will appear, click on Next.

You now need to find the Amazing Charts databases located on the "main" Amazing Charts computer onto which you've already installed and set up Amazing Charts. To do this, click the "No..." option, then browse across your network to the

shared directory that holds the AmazingCharts.xml file.

Browse to your main computer (or server) where you installed Amazing Charts in step 2, and double click on AmazingCharts.xml file.

Amazing Charts should start. If not, click the following link for assistance: http://amazingcharts.com/support/help-me-now/ Now run these steps (page 15 Upgrade your other computers) on each of your other computers, and you're good to go!

Upgrading Amazing Charts


Upgrading Amazing Charts from Microsoft Access to Microsoft SQL Server requires the SQL Server Migration utility. (This only applies to clients upgrading from versions prior to V4.)

The utility should automatically start when first running the SQL Server version of Amazing Charts, though one can decide not to migrate data initially and then migrate later by manually running the SQL Migration utility. (By browsing to the Amazing Charts directory on the main computer and right-clicking on the SQL Migration Utility and selecting Run as administrator.) The SQL Migration Utility is designed to run once and will move the data from the AmazingCharts.mdb, billing.mdb, codes.mdb and other Access databases into the AmazingCharts.mdf. (Only the AmazingCharts.mdf database in the SQL Server version has data that is changed.) In most cases the program will run without issues, though if there are data in the existing databases that isn't correctly formatted an error window may open or be reported. For mild errors related to erroneous dates found during migration, notification will occur within the main window.

These errors are automatically fixed by replacing the incorrect date with 1/1/1800 (which can be searched later and updated with the correct date). Unanticipated errors will generate a pop up window with a description of the error. In most cases it is okay to select the Ignore option when an error window opens. (At the end of the migration you'll have the opportunity to print out the errors found which will help us solve any issues that arise if the updated version doesn't function correctly.)

An error involving the 'AuditTrail' table. It is okay to Ignore most errors. While it is okay to ignore errors related to the AuditTrail table (even if you get a lot of these), as shown above, it is NOT okay to ignore errors related to the Demographics table or SOAP tables as you'll lose patients and notes. If you see these

errors, please contact us to help before continuing.

Upgrade From V4
While these instructions may look long and complicated, they are not. We have just detailed every step needed, even though many of the steps are obvious (e.g., click the "Next" button). Just follow the directions and you'll be using V6 in no time! Updates should always be completed on your main computer (or server) first. Always backup Amazing Charts before updating (just in case...)

Make A Backup: although Amazing Charts automatically makes a backup of your critical files before updating, it is wise to make your own copy of your Amazing Charts database and Imported Items directory before upgrading. Follow the steps below to make a copy of the critical patient and practice data stored in your Access databases and Imported Items directory. Use the Amazing Charts Backup Utility to make a backup before upgrading. The backup utility can be accessed in one of two ways: Click on Windows Start button | All Programs | Amazing Charts | Amazing Backup (as shown in the picture below); or, From within the Amazing Charts Admin window click on the View menu | Admin Options | Offsite Backup.

When the Amazing Charts Backup Utility starts up, click the Backup Now button, which will make an encrypted backup of all your data.

We recommend that, after backing up Amazing Charts, you run the Amazing Utilities tool to optimize your database. Like the way you accessed the Backup Utility, you can start Amazing Utilities either from the Amazing Charts folder in the Windows Start menu, or from the Admin window within Amazing Charts. (The image below shows the first technique.)

Once Amazing Utilities starts, click the Optimize Databases button.

Once all processes are complete, click on Finish.

Now Quit Amazing Utilities, as shown below.

Download The Installer: On the Main Computer login to www.amazingcharts.net/ac and enter your email address and password to log into your account. Click on Click here to download your updates link.

Now follow the steps as outlined in step by step order. Click on Click here to download the Amazing Charts installer on you main computer.

A prompt will appear with the option to Run, Save, or Cancel the file. Select the Save option.

We recommend you save the file to your Desktop so it will be easy to find.

Once the download is complete, you'll see the AmazingChartsInstaller6.exe on the desktop.

Run The Installer: run the Amazing Charts Installer on your "main" computer. If your main computer (the one you should be doing this on) is running Windows 7 or Vista, you should Right-Click on the AmazingChartsInstaller6.exe and select "Run as administrator." For other versions of windows, simply double-clicking the installer will do just fine.

A security warning may appear. Click the Run option to allow the installation to begin.

The Amazing Charts Installation Wizard will now take over and help walk you through the installation.(Depending on the speed and memory on your computer, this process can take a number of minutes.)

The first step is to unpack the various files you'll need during the installation. Let the process go through, even though it may appear that nothing is happening. Wait...

Once the ACPrerequisites is complete, the Amazing Charts Setup Assistant window will appear. Your main computer requires Microsoft SQL Server (Express version), our new robust backend database (into which all your old Access database info will be migrated in a few minutes). Answer the questions and our installer will put everything where it should be.

Various windows will pop up to let you know what is going on. In some instances you'll need to click a button to allow the various files to be correctly installed. Don't abort the process midway through as Windows doesn't take kindly to this and will likely get you back by requiring a lot of manual configuration by our support team later on.

Once SQL Server installation is complete, the Amazing Charts V6.0 Installation will continue to walk you through the process. Click on "Next," and follow the steps.

Our End User License Agreement (EULA) will appear. We strongly encourage you actually read this, as you are agreeing to the terms when you install or use our program and services. If you agree to abide by the terms of the EULA, select the "I accept..." choice to continue. (If you are not comfortable with any part of our EULA, please select "I do not accept..." This will stop the installation. The EULA is discussed on our user board, and you should feel free to post your concerns for public debate. If you agree to the terms of the EULA, a destination folder prompt will appear. It's important that you select the correct database location - in other words the correct directory where your main databases reside (i.e., the directory you did the backup from in Step 1). In this example, and by default, the location is: C:\program files\Amazing Charts. If your database is located on a different drive, click on "Browse" and find the correct folder. Once you locate your main Amazing Charts directory, select the Anyone who uses this computer" option and then click on "Next."

Amazing Charts will now install various files necessary to use the program. You will see various messages indicating which files are being installed and enhanced. Do not cancel this process.

Once the installation is complete, a window will appear. Click on "Finish."

Start up Amazing Charts: Double click on the Amazing Charts icon on your desktop. The Amazing Charts setup Assistant will appear, click on Next and answer the step by step questions.

Again, you should first set up Amazing Charts on the main computer. So select "Yes." If you are installing this on other computers and not your main one (since you've already completed the install on your main computer), then you can select "No," and then browse to the main computer.

For Amazing Charts to know where the main database is, it must read information in a file called AmazingCharts.xml. If the correct directory does not appear automatically, you'll need to browse for it. Once found, select the file and click "Open."

Amazing Charts will start up and attach to your new database.

You may be asked to run the Database Tuner. The link to the tuner is available here. You can usually run the tuner without saving it to your computer.

Click Run the Tuner, which will update and migrate your V4 or V5 data into V6.

Click the OK button once the tuner is done. Do not stop the tuner while it is running - even if it appears to have frozen. Give it time!

Upgrade your other computers. You now need to update all the non-main computers (we refer to them as the "locals," or "remote" computers. We suggest that you copy the AmazingChartsinstaller6.exe from your Desktop to your Main Amazing Charts folder. That way, you can browse from each of your local computers to the shared main folder and run the installer from there. (On the local computers, you will not need to install SQL or migrate the databases, so this will take a lot less time.) To update your local computers, browse to the AmazingChartsinstaller6.exe which, as recommended above, is likely in your main Amazing Charts directory on the main computer. Other alternatives to get the installer would be: Put the AmazingChartsInstaller.exe into a shared or public folder accessible from any computer on your network. Download the installer from our website (takes more time).

On Windows Vista and Windows 7, instead of just double-clicking on the installer to run it, we recommend you right-click and select Run as Administrator.

An "Open File - Security Warning" may appear, click on Run.

As before, the Amazing Charts Installation Wizard will take it from here.

Once the required files are unpacked, the Amazing Charts Database Setup will appear. This time, since you are on a local (i.e., not the "main" computer), select: No, this isn't the main computer, and thus does not need to have Microsoft SQL installed. Click on Continue (If, on the other hand, this is a laptop that you may be taking offsite to use Amazing Charts and returning to the office to synchronize, you will need to click on Sort of option, which will install the SQL Server database for when you do take the computer off site.

Amazing Charts V6.0 Installation Wizard will appear. Click on next.

Again, the End User License Agreement will appear. Given that you've already read it and agreed when installing the program on the main computer, we presume you'll agree again.

Most likely your non-main computers you have used the default setting for the Amazing Charts files. If not, browse to the correct directory.

Amazing Charts will now complete the installation. You will see various messages indicating what is being installed where. Again, do not cancel this process.

A window will appear once the installation has successfully completed. Click on Finish.

Now start up Amazing Charts on the computer by double-clicking the Amazing Charts icon on your desktop. On Windows Vista machines, you may have to run Amazing Charts as an administrator the first time you attempt to start it. If this is required, Amazing Charts will open the correct directory and tell you what to do. You only need to do this once on the computer. The Amazing Charts setup Assistant will appear, click on Next.

You now need to find the Amazing Charts databases located on the "main" Amazing Charts computer onto which you've already installed and set up Amazing Charts. To do this, click the "No..." option, then browse across your network to the shared directory that holds the AmazingCharts.xml file.

Browse to your main computer (or server) where you installed Amazing Charts in step 2, and double click on AmazingCharts.xml file.

Amazing Charts should start. If not, click the following link for assistance: http://amazingcharts.com/support/help-me-now/

Now run these steps (page 13 Upgrade your other computers) on each of your other computers, and you're good to go!

Migrate Vaccines From Versions Prior to V5


If you have upgraded to the latest version of Amazing Charts from a version earlier than V5, and the Database Tuner
was unable to completely migrate your prior data, you may have patients in your database that have injections that were not codified at the time they were documented. If the patient has injections that are not codified, a tab call Migration will be visible in the patient's Health Maintenance Details window.

The Migration Tab Will Be Visible When Injections Have Been Recorded That Should Be Codified

To codify the vaccine stored while using a prior version of Amazing Charts, select the Old (non-codified) injection and
then match it to the correct New (codified) injection by selecting the appropriate choice on the list.

o Click on the drop down arrow to see the available choices. o If the selected item is not a vaccination, select the Other Injection - NOT AN IMMUNIZATION' option. o If you are unsure of the manufacturer, click the Vaccine Manufacturer Information' button to look up this
information on the Institute For Vaccine Safety website.

Match Your Old (Uncodified) Entry To The New (Codified) Vaccine

Once you are done codifying the injections, click the Migrate This Patient Only' button. You will receive a confirmation message stating that this is not reversible.

Migrating Vaccines From Older Versions Of Amazing Charts

You may also choose to migrate all outstanding non-codified injections for all patients. To do this, click the Migrate All Patients' Vaccines' button. This will launch a Vaccine Migration utility. This option is also accessible from the Administrative advanced
options window.

Upgrade From V5
While these instructions may look long and complicated, they are not. We have just detailed every step needed, even though many of the steps are obvious (e.g., click the "Next" button). Just follow the directions and you'll be using V6 in no time! Updates should always be completed on your main computer (or server) first. Always backup Amazing Charts before updating (just in case...)

Make A Backup: although Amazing Charts automatically makes a backup of your critical files before updating, it is wise to make your own copy of your Amazing Charts database and Imported Items directory before upgrading. Follow the steps below to make a copy of the critical patient and practice data stored in your Access databases and Imported Items directory.

Use the Amazing Charts Backup Utility to make a backup before upgrading. The backup utility can be accessed in one of two ways: Click on Windows Start button | All Programs | Amazing Charts | Amazing Backup (as shown in the picture below); or, From within the Amazing Charts Admin window click on the View menu | Admin Options | Offsite Backup.

When the Amazing Charts Backup Utility starts up, click the Backup Now button, which will make an encrypted backup of all your data.

We recommend that, after backing up Amazing Charts, you run the Amazing Utilities tool to optimize your database. Like the way you accessed the Backup Utility, you can start Amazing Utilities either from the Amazing Charts folder in the Windows Start menu, or from the Admin window within Amazing Charts. (The image below shows the first technique.)

Once Amazing Utilities starts, click the Optimize Databases button.

Once all processes are complete, click on Finish.

Now Quit Amazing Utilities, as shown below.

Download The Installer: On the Main Computer login to www.amazingcharts.net/ac and enter your email address and password to log into your account. Click on Click here to download your updates link.

Now follow the steps as outlined in step by step order. Click on Click here to download the Amazing Charts installer on you main computer.

A prompt will appear with the option to Run, Save, or Cancel the file. Select the Save option.

We recommend you save the file to your Desktop so it will be easy to find.

Once the download is complete, you'll see the AmazingChartsInstaller6.exe on the desktop.

Run The Installer: run the Amazing Charts Installer on your "main" computer. If your main computer (the one you should be doing this on) is running Windows 7 or Vista, you should Right-Click on the AmazingChartsInstaller6.exe and select "Run as administrator." For other versions of windows, simply double-clicking the installer will do just fine.

A security warning may appear. Click the Run option to allow the installation to begin.

The Amazing Charts Installation Wizard will now take over and help walk you through the installation.(Depending on the speed and memory on your computer, this process can take a number of minutes.)

The first step is to unpack the various files you'll need during the installation. Let the process go through, even though it may appear that nothing is happening. Wait...

Once the ACPrerequisites is complete, the Amazing Charts Setup Assistant window will appear. Your main computer requires Microsoft SQL Server (Express version), our new robust backend database (into which all your old Access database info will be migrated in a few minutes). Answer the questions and our installer will put everything where it should be.

Various windows will pop up to let you know what is going on. In some instances you'll need to click a button to allow the various files to be correctly installed. Don't abort the process midway through as Windows doesn't take kindly to this and will likely get you back by requiring a lot of manual configuration by our support team later on.

Once SQL Server installation is complete, the Amazing Charts V6.0 Installation will continue to walk you through the process. Click on "Next," and follow the steps.

Our End User License Agreement (EULA) will appear. We strongly encourage you actually read this, as you are agreeing to the terms when you install or use our program and services. If you agree to abide by the terms of the EULA, select the "I accept..." choice to continue. (If you are not comfortable with any part of our EULA, please select "I do not accept..." This will stop the installation. The EULA is discussed on our user board, and you should feel free to post your concerns

for public debate. If you agree to the terms of the EULA, a destination folder prompt will appear. It's important that you select the correct database location - in other words the correct directory where your main databases reside (i.e., the directory you did the backup from in Step 1). In this example, and by default, the location is: C:\program files\Amazing Charts. If your database is located on a different drive, click on "Browse" and find the correct folder. Once you locate your main Amazing Charts directory, select the Anyone who uses this computer" option and then click on "Next."

Amazing Charts will now install various files necessary to use the program. You will see various messages indicating which files are being installed and enhanced. Do not cancel this process.

Once the installation is complete, a window will appear. Click on "Finish."

Start up Amazing Charts: Double click on the Amazing Charts icon on your desktop. The Amazing Charts setup Assistant will appear, click on Next and answer the step by step questions.

Again, you should first set up Amazing Charts on the main computer. So select "Yes." If you are installing this on other computers and not your main one (since you've already completed the install on your main computer), then you can select "No," and then browse to the main computer.

For Amazing Charts to know where the main database is, it must read information in a file called AmazingCharts.xml. If the correct directory does not appear automatically, you'll need to browse for it. Once found, select the file and click "Open."

Amazing Charts will start up and attach to your new database.

You may be asked to run the Database Tuner. The link to the tuner is available here. You can usually run the tuner without saving it to your computer.

Click Run the Tuner, which will update and migrate your V4 or V5 data into V6.

Click the OK button once the tuner is done. Do not stop the tuner while it is running - even if it appears to have frozen. Give it time!

Upgrade your other computers. You now need to update all the non-main computers (we refer to them as the "locals," or "remote" computers. We suggest that you copy the AmazingChartsinstaller6.exe from your Desktop to your Main Amazing Charts folder. That way, you can browse from each of your local computers to the shared main folder and run the installer from there. (On the local computers, you will not need to install SQL or migrate the databases, so this will take a lot less time.) To update your local computers, browse to the AmazingChartsinstaller6.exe which, as recommended above, is likely in your main Amazing Charts directory on the main computer. Other alternatives to get the installer would be: Put the AmazingChartsInstaller.exe into a shared or public folder accessible from any computer on your network. Download the installer from our website (takes more time).

On Windows Vista and Windows 7, instead of just double-clicking on the installer to run it, we recommend you right-click and select Run as Administrator.

An "Open File - Security Warning" may appear, click on Run.

As before, the Amazing Charts Installation Wizard will take it from here.

Once the required files are unpacked, the Amazing Charts Database Setup will appear. This time, since you are on a local (i.e., not the "main" computer), select: No, this isn't the main computer, and thus does not need to have Microsoft SQL installed. Click on Continue (If, on the other hand, this is a laptop that you may be taking offsite to use Amazing Charts and returning to the office to synchronize, you will need to click on Sort of option, which will install the SQL Server database for when you do take the computer off site.

Amazing Charts V6.0 Installation Wizard will appear. Click on next.

Again, the End User License Agreement will appear. Given that you've already read it and agreed when installing the program on the main computer, we presume you'll agree again.

Most likely your non-main computers you have used the default setting for the Amazing Charts files. If not, browse to the correct directory.

Amazing Charts will now complete the installation. You will see various messages indicating what is being installed where. Again, do not cancel this process.

A window will appear once the installation has successfully completed. Click on Finish.

Now start up Amazing Charts on the computer by double-clicking the Amazing Charts icon on your desktop. On Windows Vista machines, you may have to run Amazing Charts as an administrator the first time you attempt to start it. If this is required, Amazing Charts will open the correct directory and tell you what to do. You only need to do this once on the computer. The Amazing Charts setup Assistant will appear, click on Next.

You now need to find the Amazing Charts databases located on the "main" Amazing Charts computer onto which you've already installed and set up Amazing Charts. To do this, click the "No..." option, then browse across your network to the shared directory that holds the AmazingCharts.xml file.

Browse to your main computer (or server) where you installed Amazing Charts in step 2, and double click on AmazingCharts.xml file.

Amazing Charts should start. If not, click the following link for assistance: http://amazingcharts.com/support/help-me-now/

Now run these steps (page 13 Upgrade your other computers) on each of your other computers, and you're good to go!

Learn More
There is always more to learn, and we are continually adding features, updating documentation, and adding movie tutorials. For all the latest information, come to our website at www.amazingcharts.com where we have, among other things, links to the following resources:

The Amazing Charts Users' Bulletin Board (get information from and/or assist other Amazing Charts users). Live Training - either remotely where we log into your computer from our offices in Rhode Island (free) or we can even
come out to your practice (though 99% of practices using Amazing Charts never needed onsite training. Coming to you costs money, of course. These prices are listed on our website.). Click here to set up a live training session. Brief demos at medical conventions across the country (Click here for a list of our upcoming conferences.) The annual Amazing Charts Users' Convention (get together with other like-minded users for frank discussion, version and company planning, and just a good time).

Graph Vital Signs


You can graph the patient's vital signs automatically by clicking the Graph button on the Physical Both saved vital sign information from prior visits, as well as the current unsaved vitals are
automatically plotted when the button is clicked. Exam area of the patient's chart.

Plot Growth Curves


You can plot growth curves automatically by clicking the Graph button on the Physical Exam area of
the patient's chart. Both saved information from prior visits, as well as the current unsaved information is automatically plotted when the button is clicked.

Add A Directive
Directives and alerts are entered on the patient's Summary Sheet or from within the patient's demographic window.

Print A Chart
Amazing Charts can print out an entire patient chart (aka the Formal Health Record).

You can configure what components of the chart to include by default through the Admin window. To print the chart, first select a patient from the Patient List on the Amazing Charts Desktop
window. o Right click the name, and then select Print Formal Health Record, by left clicking. o The Release Of Records window will pop up as it is required by HIPAA that you record to whom the patient's information is being released. o Fill out the information, hit save, then the Print Formal Health Record window will open.

Right-Click On A Patient In The Patient List To Print Their Entire Chart (AKA The Formal Health Record)

Fill out the information as required by HIPAA.

You can manually change what information is to be included by selecting the desired checkbox. Once you have made your selections click the Print' or 'Preview' button. o You can configure the default settings in the Admin window

You can also print the Formal Health Record from the patient's Summary Sheet within the patient's
chart.

Click The Formal Health Record To Print The Patient's Entire Medical Record

Recommend Improvements
Amazing Charts adds the features and recommendations that our user's need. To submit your recommendations, click the Help menu bar on the Amazing Charts Desktop and select
Recommend Improvements. After entering your recommendations, click the submit button to upload this information to our development team.

Know
Amazing Charts includes a connection to an online knowledge base of evidenced-based medicine and commonly used forms. This knowledge base is available under the menu on the Amazing Charts Desktop window | Know option.

Use the Audit Log


The Audit Log contains information on all activities occurring within Amazing Charts. Through the Log you can see who has accessed which charts and performed what activities within
the program. The Audit Log is accessible within Administrative window.

Use The Tracked Data Module


Tracked Data items are data that you wish to track over time, such as recurrent studies (e.g., Tracked Data is accessed in the patient's the Summary Sheet within a patient's chart. To alter or add new default item types, access the Define Tracked Data Headings in the admin
window. endoscopy, stress tests, certain labs), and/or lab data not imported through a direct lab interface.

Connect To Health Information Exchanges (HIEs)


You can quickly access any Health Information Exchanges (HIEs) or Regional Health Information Access to these HIEs is in the Imported Items window of the patient chart. To access the Imported
Items section of the chart, right-click on the patient name in the patient list on the Amazing Charts Desktop. Organizations (RHIOs) preconfigured in the Admin window.

Open The Imported Items Section Of The Patient Chart From The Patient List On The Amazing Charts Desktop

Click the HIE/RHIO button located on the top left of the Imported Items window and the HIE/RHIO
Window will open.

Directly Access Your Local HIE Through Amazing Charts

Reset The Path To Your Database


There are a three ways to reset the path to your main Amazing Charts database, which will allow you That said, other than taking a computer off site or changing the main computer, there really shouldn't
be any reason to do this. In other words, don't try this unless you know what you're doing and why you're doing it. to browse to a different Amazing Charts database (via the AmazingCharts.xml configuration file).

The Right-Click Technique When first starting up Amazing Charts, if you Right-Click on the white area of the log in screen, you'll be given an option to reset the paths. Click the Yes button, and then restart Amazing Charts and you'll be given the opportunity to browse to the AmazingCharts.xml configuration file.

The Administrative Option Technique There is an option in the Admin window to reset the paths. Log into the Admin window under View | Administrative options, and click on File and select Reset Database Connection (locate a different main database). The next window that pops up will ask you if you really want to reset the path, click on Yes. When you restart Amazing Charts, you'll be asked to find the AmazingCharts.xml file.

The Amazing Utilities Technique If you are unable to start Amazing Charts (and thus can't reach the log in screen or Administration window), you can open Amazing Utilities and click the Reset Paths button on the lower aspect of the screen. (To get to Amazing Utilities, click the Window's Start Menu | All Programs | Amazing Charts and select Amazing Utilities.) Once in the Amazing Utilities window, click on the Reset Paths and reset the path.

Use The Health Maintenance (Decision Support) Module


Amazing Charts includes United States Preventative Services Task Force (USPSTF), CDC, and other decision
support pertaining to evidenced-based health maintenance recommendations. Decision Support to ensure that these health maintenance recommendations are addresses is a fundamental aspect of achieving Meaningful Use Since these are regularly changing based on the latest evidence, Amazing Charts can automatically remind you of the recommended screening or procedure that should be undertaken to practice the best evidenced-based medicine. These can be customized on a per patient basis and/or a practice-wide basis.

Immunizations and vaccinations are documented within the Health Maintenance Details window under the HM:
Immunizations & Shots tab. Non-health maintenance injections (e.g, depo-provera) are documented within the Health Maintenance Details window under the Injections: Non-HM tab.

o Edit specific patient decision support rules here. o Configure and edit practice-wide decision support rules in the Admin section.

Access A Patient's Health Maintenance Status You can access a patient's Health Maintenance status by clicking on the Decision Support button, located on the Most Recent Encounter window within the patient's chart. o There is also a list of due and overdue health maintenance recommendations in the plan area of the chart, under the Health Maintenance tab.

You can also access this information on the Summary Sheet within the patient's chart under the Decision Support &
Injections section.

You can also access this information within the Most Recent (current) Encounter, under the Plan textbox by clicking
the Decision Support tab (and this can be automatically set to appear when there are Health Maintenance recommendations that are currently due).

Using Amazing Charts Health Maintenance Health maintenance recommendations are based on a patient's specific characteristics. For example, since there is much evidence supporting the screening of patients for hypertension, this recommendation will appear on all patients that meet the age criteria for this USPSTF recommendation. Certain risk factors (e.g., people with diabetes) will trigger additional health maintenance recommendations. Risk factors related to diagnoses are automatically added when specific diagnosis codes are added. Some risk factors are not associated with a diagnosis (e.g., people at risk for osteoporosis). Similarly, some patients have not had a diagnosis or condition formally documented within Amazing Charts. In these instances, you need to manually select the various risk factors that apply, since having one or more of these risk factors effects the health maintenance reminders that will be recommended. To add risk factors for a patient, click on the Risk Factors button within the patient's Most Recent Encounter.

Click The Risk Factors Button To Select The Conditions That Influence Which Health Maintenance Recommendations Are Advised

The Risk Factor window will open when the Risk Factors button is clicked.

The Risk Factor Window Where Various Conditions Can Be Added

Select the risk factors that apply to the patient. Click the Analyze' button to trigger the Health Maintenance recommendations. Click Save' when you are done. Clicking on the Decision Support button will bring up new recommendations for the patient.

The Decision Support Health Maintenance Window Showing All Recommendations That Should Be Performed Based On The Patient's Risk Factors And Other Demographics And Conditions

Double-click a health maintenance recommendations to open a window where details of the recommendation are
displayed, and where you can order or document that the recommendation has been followed.

The Health Maintenance Detail Window Where The Specific Recommendation Is Detailed

Once documented, the specific recommendation will no longer appear in the list of health maintenance
recommendations that are due for this patient, until such time as it becomes recommended again (e.g., annual influenza vaccination) o You may need to click on the Refresh button to update the list. You can review the health maintenance recommendations that have been completed within the patient's Summary Sheet tab in their chart. Click on the Complete' tab under the Decision Support & Injections area to view those health recommendation guidelines that have been documented.

Review Health Maintenance Recommendations That Have Been Completed In The Summary Sheet Of The Patient's Chart

If you've documented the health maintenance while documenting a patient encounter, the information is also saved
within the Plan section of the note.

Health Maintenance That Is Documented During An Encounter Is Also Recorded In The Plan Section Of The Note

Edit An Individual Patient's Health Maintenance Rule


To edit rules for a specific patient go to the Summary Sheet for the patient and click the Edit Rule button. o To view rules that are already in place click the Enlarge button. o Rules can also be edited for the Entire Practice from here as well, as described here.

Click The Edit Rule Button To Adjust An Individual Patient's Decision Support Rule

In The Custom Rule Window, you can select the rule you want to edit and change rule parameters, such as age and When you are done editing, the Save' button to save your changes.
frequency.

Customize Decision Support Rules For An Individual Patient In The Custom Rules Window

Do Meaningful Use
Meaningful Use has been designed by government agencies and various stakeholders (e.g., technology consultants,
insurance companies, etc). As a result, figuring it out is a complex mess that we've distilled to as simple a process as possible. Anybody with experience submitting billing information to third-party payors understands how something that should be relatively easy can be made so difficult - and Meaningful Use is no different. To accomplish this Herculean task, we designed the Meaningful Use Wizard (patent pending). The goal of Amazing Charts is to make achieving "Meaningful Use" as painless as possible. Amazing Charts V6 (and higher) has been ONC-ATCB Certified as a complete EHR and is thus eligible to be used to achieve Meaningful Use, as defined by the Office of the National Coordinator (ONC) within the department of Health and Human Services (HHS). Click here to see an overview of what Meaningful Use is all about. There are four distinct categories that make up Meaningful Use: Core items, Menu items, Core Clinical Quality Measures, and Alternative Clinical Quality Measures. The ONC defines how many from each of these category must be passed in order to achieve Meaningful Use, as well as what defines "passing." The Meaningful Use Wizard is a tool that combines a number of processes that will encourage, remind, and prompt you to collect the information that the government deems as proof that you are using your EHR meaningfully. Of course this definition is arbitrary (and will change), and some of the requirements are downright silly - so don't get frustrated with us for trying to collect certain data (you can read our perspective on Meaningful Use at the link above). You can run all aspects of the Meaningful Use Wizard at any time; none of the information will be formally submitted until such time as you confirm that you are ready - so feel free to use, play, and try the various components of the Wizard.

The Meaningful Use Wizard is composed of four major components, further described by clicking on the following
links: 1. 2. 3. 4. Automatic color-coding of necessary fields The checkpoint dashboard The report writer The submission assistant

More details regarding the specific requirements and instructions to register regis for the incentive program are on the
CMS EHR Incentives Program website.

Use Color-Coding Of Required Meaningful Use Data


The first component of the Meaningful Use Wizard is to automatically highlight all fields within the current window that While you only need to show that a certain percentage of patients have this information documented, though this Fields that are highlighted in an aqua color should be documented whenever possible. o You can change the color of the field within the User Preferences window.
percentage will increase over time as the ONC further defines subsequent stages of Meaningful Use. need to be documented for Meaningful Use recognition.

Fields Required For Meaningful Use are Aqua-Colored In Each Window

Holding the cursor (mouse) over the color-coded Meaningful Use field will open more information on how this
information translates into Meaningful Use.

More Information On The Meaningful Use Requirement When Holding The Cursor Over The Highlighted Field Meaningful Use Queries In The Report Window Several Meaningful Use Searches have been built into the reporting window for ease of access. The shortcut can be accessed from the main menu as seen below. On the right hand of the menu, you will find one of several shortcuts to the Meaningful Use Wizard.

Use The Checkpoint Dashboard


Another component of the Amazing Charts Meaningful Use Wizard is the Meaningful Use Checkpoint dashboard. The Checkpoint shows how you are doing in your quest to achieve Meaningful Use on a patient by patient basis. Clicking on the Meaningful Use Wizard button will open the Checkpoint dashboard where you can track both the
current visit's status as well as your overall progress in meeting the Meaningful Use requirements. This real-time analysis tool is accessible from a number of places, including the patient's chart.

Access The Meaningful Use Wizard's Real-Time Checkpoint By Clicking The Wizard Button Found In The Patient Chart

By default, when the Meaningful Use Checkpoint dashboard is opened, it shows how you are currently doing in terms
of documenting Meaningful Use criteria for this specific patient. Each of the core and menu elements are listed, along with their real-time status based on the documentation within the current encounter.

The Meaningful Use Checkpoint Showing The Current Meaningful Use Status For This Patient's Current Visit

Each core and menu measure item will have its current status listed. This provides information on whether or not it
has been completed, whether it is applicable (N/A), or whether it is completed by attestation. To review your current overall status with regard to Meaningful use (i.e., your current status for all patients seen by the provider), select the period of time to review (3 months, 6 months, or 1 year) and then click the Get Overall Results button. The overall % column will be calculated and then displayed. It show the status for all patients during the selected time period. o Since all patient information must be tallied for this to occur, we do not automatically populate this information. Instead you need to click the Get Overall Results button which will trigger the Meaningful Use Wizard to collate and calculate all patient data to figure out your overall status based on the selected time period. This may take a some time to complete since all patients seen during the specified time period have to be tallied.

Click The Get Overall Results Button To Calculate Your Current Overall Status For The Specified Time Period.

The Goal column within the Meaningful Use Checkpoint dashboard shows the minimum required percentage of your
patients that must meet the criteria in order to achieve Meaningful Use based on the current Meaningful Use stage (e.g., Stage I). The ONC will add Stage II and Stage III (in 2013 and 2015, respectively) and in addition to new measures, the goal percentages are expected to increase - so it is a good idea to strive not just for the required goal, but for 100%. To figure out what, exactly, is being measured and how it is calculated, click the information button (or double-click the specific row). Upon doing so, the Meaningful Use Wizard will open a window that summarizes the objective of the measure and provide other salient information.

Detailed Information On Each Measure Is Found By Double-Clicking The Specific Row

Use The Meaningful Use Report Writer


The Meaningful Use Wizard Report Writer is accessible in the Reports window in Amazing Charts. Access the Report Writer through the Amazing Charts Desktop window. o It is also accessible from the Meaningful Use Checkpoint dashboard.

The Report Button Through Which The Meaningful Use Wizard Report Writer Can Be Accessed

The Meaningful Use Wizard's Report Writer can provide you detailed information on each of the Core, Menu, and CQM
items that make up Meaningful Use. An Internet connection is required to review these details as they are updated from time to time and the most up to date version is presented, even if you are using an older version of Amazing Charts.

The Meaningful Use Wizard Report Writer Window

Although it contains quite a bit of information, the Meaningful Use Wizard's Report Writer window is designed to walk
you through all the complexities of figuring out what you need to report on, and how to do it. You can run this tool at any time. Data will not be submitted or finalized.

Stepping Through The Meaningful Use Wizard Report Writer The first step is to select which CMS program you are working towards. Information on who is eligible for each of the programs (Medicare or Medicaid) is here.

Select which CMS program, the provider, and the reporting period, and then click the Run Report button.
Select Which Program, Which Provider, And What Reporting Period You Wish To Analyze

The Amazing Charts Wizard will analyze the information and advise you as to what additional information is required.

A Pop-Up Provides More Information On What Is Required

For example, the message above explains that in addition to all the Core elements, you must also select at least 5
reports from the Menu elements, and one of these needs to be the Immunization Registry measure or the Syndromic surveillance measure. At least three Continuing Quality Measures (CQM) will also be required. Meaningful Use divides the required information that must be reported into four distinct categories: Core items, Menu items, Core Clinical Quality Measures, and Alternative Clinical Quality Measures. For Stage I, here's what is required: o Core Items (All 15 are required.) o Menu Items (Five of 10 are required.) o Core Clinical Quality Measures (Three are required and they provide three additional alternate core measures in case your practice cannot do all of the three core.) o Alternate Clinical Quality Measures. (Three more are required from this list.) Each of these categories is represented as a tab in the Meaningful Use Wizard. Each of the items is found under their respective tab, and clicking on an individual item will show the details, as well as how these can be documented within Amazing Charts. o As Criteria are highlighted, the window to the right displays information regarding the specific reporting Criteria listing you have chosen, including the Objective, Measure, Exclusion, Attestation Requirements, and other instructions on how to complete each function within Amazing Charts.

On the Core Items tab, all 15 Core items are required and will remain checked. On the menu tab, you will need to select five Menu items. (Don't worry if you make a mistake, the Wizard will let you
know which items are required, and nothing is finalized or submitted at this point of the process.)

o FYI: at least one of the last two Menu items, Menu 9: Immunization Registries Data Submission or Menu 10:
Syndromic Surveillance Data Submission must be selected. If one of these items is not selected you will receive a pop up message.

Clinical Quality Measures (CQMs) are a Core requirement. But as there are many choices, the Amazing Charts
Meaningful Use Wizard has separated them into two tabs. o The CQM Core tab has the CQM Core and Alternate Core, with the Core items always checked. o Like the main Core items, the CQM Core items cannot be unchecked. o If you need to replace a Core with one of the Alternate Core (because you have no patients that meet the Core criteria), you can select an Alternate Core from the list.

The CQM Alternate tab holds all the additional CQMs. Similar to the Menu items, you can manually check and
uncheck any items in the list. Choose at least three CQM Alternate criteria.

The Meaningful Use Wizard keeps track of what is required, and will alert you if you try to run the report writer without

certain required information.

Once you have made your reporting selections click the Run Report button. The Meaningful Use Wizard will tally and calculate the data and display the results. Keep in mind: o This process may take a few minutes depending on the size of the practice and time frame selected. o This report is specific to the provider and the time frame selected. o Each provider's report will be unique based upon the patient's he/she has seen during the reporting period. o You will either Pass or Fail (P/F) each criteria based on the percentage of patients who meet the requirement. o Criteria that you have met (Passed) will be labeled with a green check mark. o Those that you do not meet (Fail) will be labeled with a red X. o Criteria that require attestation will have a red X until such time as you click the Click To Attest link, which
will open a window to confirm that you are attesting to performing the required action.

o You can run the report as often as you like and click any buttons and links at any time as
nothing is submitted until you access the Submission Assistant.

Once the report has been generated you can choose to filter your results as well as print the entire report or export
the CQM section.

The Help button links to a page with some helpful information about Meaningful Use, and the Submission Info button
has information on the process for receiving reimbursement.

Use The Meaningful Use Submission Assistant


The Submission Assistant will assist you in compiling the required reports and submitting them correctly. The submission process will vary based on whether you are submitting for the Medicare reimbursements or the
Medicaid reimbursements. The submission assistant is currently in final development and will be available by the time you are ready to submit your information (e.g., at least 90 days after starting to use Amazing Charts V6 or higher).

Access A Patient's PHR


Before you can access a PHR, it has to be configured in the Administrative Options window. To upload to a PHR, select the PHR export button located on the patient's Summary Sheet, under the Reports &
Resources section.

Select the location of the export, then click the Settings' button. From the PHR Configuration screen, select the PHR
you wish to use, and then click the Add' button.

You may add multiple PHRs if you wish. When finished choosing the PHRs, click the export button to finish.

Amazing Charts Desktop

The Desktop

The Amazing Charts Desktop is the main area of the program from where you will check your schedule, pull charts, send intra-office messages, etc. At the upper left-hand side there is the purple patient list area, in which are the three main navigation buttons: Schedule, Messages, and Search. Each button will bring you to a specific area in Amazing Charts. The Schedule view is shown above, and to return to this view, one would click the Schedule button. Clicking the Messages button reveals the users message Inbox. Clicking the Search button, opens the Advanced Search window.

Just below the main buttons is the Patient List area. Once patients have been added to the system (see Adding A Patient), all patient information can be pulled by typing in the first letter(s) of the last name, first name, and/or the patient's ID number.

When a patient is selected (highlighted) the Amazing Charts user can do any number of things. Most of these are done by clicking on the bar just below the highlighted patient - also known as the Amazing Charts Taskbar.

The Taskbar
The taskbar, located on the Amazing Charts Desktop, just below the Patient List, facilities common activities and is designed to allow rapid access to all pertinent patient information.

Once a patient is selected (highlighted), clicking on the taskbar will allow you to quickly access various Amazing Charts features. Starting on the left, the Rolodex will open the patient demographic window. In this window you can add or edit patient demographics. Clicking the down arrow next to each taskbar image provides additional options. The yellow chart represents the patient's medical records. Clicking here brings up the Last Progress Note (which is usually used as the basis for entering the current encounter data). If you click on the down arrow next to the yellow chart, you are given the option of pulling the patient's Last Note, Summary sheet, and other options. The printer button brings up a list of options, which are fairly self-explanatory. The binoculars allow you to search for prior or future appointments for the selected patient. The critical sign allows you to note when an appointment has not be kept (DNKA), or using the down arrow allows you to quickly make the patient inactive without having to first pull their demographics to do so.

Patient List
The purple Patient list is located in the upper left corner of the Amazing Charts Desktop. Here you can quickly find look up all patient's in the practice.

As you begin to type the patient's last name in the Lastname text box, all patients matching this spelling will quickly come up. Select the desired patient, and use the task bar to perform various functions. Below, the letter "S" has been entered, and all patients whose last name starts with this letter now appear. In the example below, the patient, "William Saffire" has been selected. Right-mouse clicking on the select patient will show a pop-up window (circled below) with the most common functions and allow quick selection of any of these common tasks. Double-clicking on the selected patient will open the Patient Chart.

The Patients

Demographics
Patient information is accessed and adjusted through the demographics section. You can access the demographics section by using the taskbar to open a chart, or by clicking on the
Demographics tab while in a patient's chart, as shown below.

In the Demographics page, most of the fields are self-explanatory. The drop-down menus for items such as CITY, STATE, INSURANCE PLAN NAME, etc., contain all the
entries that have been added previously. o These drop-down menus will not contain any items until at least one patient is saved. This helps prevent one user from entering the same information differently for different patients, which will cause problems when using advanced search capabilities. o If there are misspellings or errors within these fields, click here to learn how to fix it.

To add a patient photo, click the ADD PIC button (see Adding Patient Photos). The yellow NOTES area is for miscellaneous information on this patient. This information will pop-up
when the patient is pulled from the desktop as a reminder. This can be helpful for unpaid balances or multiple missed appointments when the patient is calling to book another appointment. Entering other data such as RECORD RELEASED TO or HOW DID PATIENT FIND US, can be helpful for practice analysis, this information will allow you to "check-up" your overall practice. Clicking the INACTIVATE Chart button will stop this patient from being listed in the Active Patient list in the taskbar, but will not delete the patient or their notes, from the database. o For medicolegal reasons, there is no way to delete a patient or their notes. A drop-down list appears when you click the INACTIVATE button, and data saved here will also be used in future Amazing Charts version as part of the practice check-up described above. To save your changes, you must click the UPDATE INFO button.

Summary Sheet
The Summary Sheet located in the patients chart is broken down into six categories as listed below: Problem List A way to track problems by either showing active problems, inactive active problems and/or all problems associated with the patient. In this field you can: Add Problems Inactivate Problems Delete Problems

Medication List - Tracks history of the Medication & Dosage including Sig. for active, inactive and/or all medications the patient has been prescribed. This field also allows the provider to Add / Edit / Refill Medications. Injections - Injections can be Added, Deleted and Printed from this field. Information entered on the Add Immunization window includes: Patients Name, DOB, ID Number and Age in the across the top information bar of the window. Date of Injection Name of Injection Body Side of Injection Volume Route Lot Number Manufacturer Injection Expiration Date NOTE: The fields in the injection window will store information entered in each category allowing for a list of common populated information for the conveniences of less data entry. Alerts & Directives Field is used to document patients Advanced Directives & Alerts dependant on certain situations. The following are fields contained with in the Add window: Type Advanced Directive or Alert Name Comments Level Normal or High (Levels set to High will pop up when chart is pulled) Import Document to Patient Chart Save NOTE: When the Alert or Directive is saved the there is a History field that populates the individual entering information including the date for tracking purposes. There is also a field that populates the By and Date which is the individual who enters the data as well. Tracked Data This field allows the tracking of Data on a patient dependant on the practice / specialty. The Data can be added for tracking by going into the Administrative Options field. Examples of Tracked Data would be: Cholesterol / Value / Date Blood Pressure / Value / Date Stats: There are presently four stats that are tracked for in Amazing Charts, they include: Notes DNKA Messages Addenda

Injections
To add new Immunization Click button the Add Injection window will appear. After entering the information required, click the Save button to continue.

Medications
Medications are listed on the summary sheet. Meds can be added/inactivated, etc, by double-clicking on the Medication area. This will open the Prescription window where data can be changed.

Tracked Data
To add Data Click Add Data button Track Data screen will be displayed. Enter your own item to be tracked, or select an item from drop down list, enter the value of an item in next field enter date and press Add Data button data will be saved. Click Save Changes button the record will be added in Tracked Data Block.

Most Recent Encounter


Click here for information on the Most Recent Encounter (i.e., the current note).

Imported Items
To view imported items open a patients chart and select the imported items tab.

There are a few different ways to import items into Amazing Charts. o One way is to already have the document scanned into your computer and saved in a folder.

Then you will need to click on the import item button and in the resultant window, click the Import New | Import Files | Browse for Items button and browse to your scanned document and select the item (shown below).

After doing this you will need to enter the date of items date (Amazing Charts defaults to the current date), item type, item subject and any additional comments. While on this screen you will notice that there is a button that allows deletion of the original item when done ( Delete originals after importing) and a button that allows you to close the window without importing (close window).

Once you are satisfied with your selection, click the import items button. Another window will appear and will ask you if you are done importing items. If you hit yes the window will close but if you hit no, you may continue to import additional items.

o Alternately, you can just drag and drop a selected item into the left side of the Imported

Items window, rather then going through the steps of clicking Browse... as outlined above.

o Another way to import items is to select the import new button and then choose import

directly from scanner. By doing this a window will open up that will allow you to set your scan options and control your scanner.

You can sort and organize your imported items by selecting and moving items from one category to
another, and/or edit categories by editing the imported item (by right clicking with your mouse on any of the imported items you are able to edit information). If you have Midmark hardware and it is connected to the current computer you may control the Midmark software and directly import items such as Electrocardiograms, Holter recordings, and spirometry, directly into the patient's chart. This is done by clicking on the import new button and then selecting Midmark followed by the specific type of hardware that is attached to your computer. After doing this Amazing Charts will open up the Midmark software within the patients chart so that results can be directly imported into the chart.

Imported items can be viewed by date or alphabetical order depending on which option you select.

Account Information
The Account Information window allows the documenting of CPT codes per visit. Bills can be manually added in this section.

Add A Manual Superbill


When creating your own super bill, make sure that the patient is not seeing the Doctor, and is only going to be seeing the Nurse or Medical Assistant, or some unsupervised visit. Start off by highlighting the patient's name on the main screen and select billing at the top of the menu. In the drop down menu click on Pull Bills By Patient, this option will bring you to the last encounter created.

On this new page, about a of the way down, select the drop down arrow and select Create a New Superbill. You will be directed to a new screen.

Follow the directions at the top, make sure that the proper Place, Doctor and Date are correct (steps 1 3). Under Step 4, type the Chief Complaint. Select the proper CPT codes under Step 5, and double check that all the charges are correct. To edit the charges, put the arrow in the box of the price, delete it out, and put the new charge. Once you finished entering all your codes, click on Save Superbill. *Note 2 boxes will pop up after the price change, asking if this will be a permanent change or a onetime change.

Pulling Bills You can pull this bill up two ways: Highlight the person's name and choose pull patient bill by name. Once, that comes up you can then print it. Or, you can pull the pull patients bills by date highlight the one you want and print it also.

Print An Invoice
Start off by highlighting the patient's name on the main screen and select billing at the top of the menu. In the drop down menu click on Pull Bills By Patient, this option will bring you to the last encounter created.

About a of the way down select the drop down menu and choose the Invoice you want to print. On the right hand side of this page, select print this invoice only or all invoices

Print A CMS 1500


Start off by highlighting the patient's name on the main screen and select billing at the top of the menu. In the drop down menu click on Pull Bills By Patient, this option will bring you to the last encounter created.

About a of the way down the super bill there is a drop down arrow, you want the one to the left, you then need to drop the menu and choose the Invoice you want to print. On the right hand side of this page, select the CMS 1500 button.

Once the CMS 1500 is open, select Print Form.

Scheduling

Booking An Appointment
Scheduling is done in the scheduling area of the Amazing Charts Desktop. If you aren't seeing the schedule, click the Schedule navigation button. To be able to schedule a patient appointment, there must be a schedule already set up. If you've not already set up during the initial installation of Amazing Charts, schedules can be setup through the Administrator section (see Setting Up a Provider Schedule). 1. Browse to the daily schedule you wish to book by using the Calendar control located on the left side of the Amazing Charts Desktop. In the example below, Saturday May 13th has been selected as the day the appointment is to be scheduled. 2. To actually book the patient appointment, select (highlight) the patient in the Patient List on the Amazing Charts Desktop. In the picture, the patient William Saffire, is selected. 3. Now just drag and drop the patient onto the desired time slot. In this example, we are dragging Mr. Saffire's name and dropping him into the 11:15 AM time slot with the Provider named Dianna.

4. The schedule detail window will open. Set any parameters you wish to change from the default settings, and click the Book Appointment button (red arrow below).

To remove an appointment, see Remove A Scheduled Appointments. Another way, without having to drag and drop: To Schedule Visit select the Patient to whom you want the Schedule visit and press button as shown in Fig.

The Schedule visit Patient will be appearing in Patient list as shown in Fig.

Choose the Scheduling date from the given Calendar as shown in Fig.

Select Provider name from drop down list and press

for Appointment.

Finding A Scheduled Appointment


The binoculars on the taskbar will search the appointment book for any previously scheduled appointments for a patient. First select the desired patient in the Patient List, then click the binocular button in the taskbar. A list of all appointments scheduled will be shown. To delete a previously scheduled appointment, select the desired appointment from the Scheduled Appointment list and then click the "Remove Appt" button.

Common And Advanced Reporting

Search & Reporting


Reports sections of Amazing Charts will give any user the capability of doing in depth search reports for all active or Searches can be categorized based on specific criteria requested by the user. On the top left corner of the window
there is a short cut to the most common searches that can be used practice wide as seen below: inactive patients in the practice.

For more in depth searches, the built in manual search provides a wide variety of categories to be selected. An
unlimited number of criteria can be added to each query and each can be saved as a commonly used query under Save This Query As.

Running Reports: Once the Criteria are selected, clicking on the Run Report will create a full Query Report. At the bottom of the results there are options to Select All, Print or Export the results.

Practice Rolodex

Using The Practice Rolodex


The Practice Rolodex allows you to save information for contacts your office may need to have on hand for referrals, You can open the rolodex right from the Amazing Charts main screen by clicking on the Rolodex icon located below
the patient list. consultants, patient letters, or any other business contacts.

Once the Rolodex is open you can choose from the contacts you have entered by using the drop down list under the
Select a Contact from the List heading or you can choose to add a new contact. The drop down list can also be filtered using the Category options.

To add a new contact click the Add New button and enter in the contact's information. The only fields that are
required are the Last Name, First Name, Specialty, and Provider Type. The Provider Type must be selected from the drop down menu but you may type in the Specialty as you would like it to appear. You may also delete an entry by selecting it from the drop down menu and then clicking the Delete button.

Once all the information has been entered, click the Save button to complete the entry. Once the entry has been saved, you will be able to look up the new contact using the drop down list. You may also print or export any Rolodex entry using the Print button to the left of the Save button. Once you have entered or updated your contacts you will then be able to use the entries to compose letters and document referrals. To use a Rolodex entry in a letter you can right-click on any patient in your patient list and select Print Notes & Letters.

The Print Encounters/Send Letter window will open and you can select a contact to address the letter to as well as
filter the list by the type of contact.

The same letter window will also open automatically after signing off on the Code/Sign Encounter screen and the
contacts are available for selection there as well. You can also use the Rolodex entries to list a referral or consultant contact in any patient's demographics to note the patient was referred to or referred from a certain contact. You can do this by going into the patient's Demographics and clicking on the Referrals & Consultants tab in the middle of the page and Clicking the Add button. You can then choose the contact to list for the referral from the drop down list and specify it by the date range or number of visits, as well as add any comments you would like included.

Meaningful Use (MU)


Our goal when creating this ONC-ATCB certified version was to make meeting 'Meaningful Use' as painless as
possible. To accomplish this Herculean task we developed the Amazing Charts Meaningful Use Wizard, the steps of which are described here.

Meaningful Use was designed with the goal of improved patient care and decreased medical costs through more efficient communication, central storage of information, and fewer errors. To this end, the CMS and ONC developed criteria that EHRs need to meet to be considered Fully Certified EHRs' and that doctors need to meet to be using their EHR meaningfully'. These primarily consist of new fields to collect data (race, ethnicity, smoking status), improved electronic communication (ePrescribing, interoperability between doctors' offices via standard CCD/CCR exports, and giving patient access to their records), and reporting structures to collect and send this information into CMS. All reports are based upon patients seen during the reporting period. You are not required to update all of your patient records with the required data. There are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met, including: 15 required core objectives 5 menu set objectives that may be chosen from a list of ten from the menu tab. One of the core objectives is called CQM (clinical quality measures). These refer to another set of numerator/denominator reports. The meaningful use wizard breaks this CQM objective out into two more tabs because Clinical Quality Measures is represented by many reports in one measure. Refer to the section on Clinical Quality Measures for more detail. Core and Menu objectives have goals needed to meet them (i.e. 40% of prescriptions must go electronically). CQMs do now have goals to meet. They are evidenced based guidelines to follow to improve patient care These are described here and on the CMS Incentive Program website.

Stage I Meaningful Use Details


Core 1: Computerized Provider Order Entry (CPOE) for Medications HOW TO DO THIS IN AC: In the Write Scripts screen, select a medication from the medications grid (below where you start to type in the drug's name) to select codified medication. Medications that are free text entries (not from the grid) do not qualify. Amazing Charts will automatically check the Takes No Meds box when there are no medications in the patient's list. Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Any EP who writes fewer than 100 prescriptions during the EHR reporting period NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator that have at least one medication order entered using CPOE. EXCLUSION: EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 30 percent in order for an EP to meet this measure.

Measure

Exclusion Attestation Requirements

Core 2: Drug Interaction Checks HOW TO DO THIS IN AC: Drug Interaction Checks are turned on by default in Amazing Charts and need to remain on during the entire reporting period. There are two options for checking Drug Interactions, Automatically check for interactions when first loading medications page' and automatically recheck for interactions when adding or editing medications' and at least one of these options must remain enabled. You will attest to this when submitting your documentation Objective Implement drug-drug and drug-allergy interaction checks. Measure The Eligible Provider (EP) has enabled this functionality for the entire EHR reporting period. Exclusion No exclusion. Attestation YES / NO Requirements Eligible professionals (EPs) must attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure.

Core 3: Maintain Problem List HOW TO DO THIS IN AC: Diagnoses can be entered into a patient's chart in Most Recent Encounters or Summary Sheet. We have added a new checkbox on both screens to enter No Active Diagnoses as structured data. This box is checked on all new patients entered and when checked, will inactivate any existing diagnoses. Also, this box will check automatically when a self-limiting diagnosis has elapsed and there are no more active diagnoses. On the Summary Sheet the checkbox is underneath the Diagnosis section in the upper left hand corner of the screen. In Most Recent Encounters, the checkbox is next to the Diagnoses box. Objective Maintain an up-to-date problem list of current and active diagnoses. Measure More than 80% of all unique patients seen by the Eligible Provider (EP) have at least one entry or an indication that no problems are known for the patient recorded as structured data. Exclusion No exclusion. Attestation NUMERATOR / DENOMINATOR Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. The resulting percentage (Numerator Denominator) must be more than 80 percent in order for an EP to meet this measure. Core 4: Generate and Transmit Permissible Prescriptions Electronically HOW TO DO THIS IN AC: To meet these criteria, prescriptions need to be send via the ePrescribing network; prescriptions sent by electronic fax do not qualify. When writing a prescription, selecting Transmit will automatically send the prescription electronically if allowed. There are 3 primary reasons a prescription will be faxed instead of electronically prescribed; medication issue (currently Scheduled drugs can only be faxed), pharmacy issue (some pharmacies do not accept electronic prescriptions), information issues (certain patient and provider data is required). Pharmacies that do not accept electronic prescriptions are highlighted in yellow for easier identification and there are alerts on the Write Scripts page about any data issues. Objective Measure Exclusion Attestation Requirements Transmit eligible prescriptions electronically More than 40% of all permissible prescriptions written by the Eligible Provider (EP) are transmitted electronically using certified EHR technology. Any EP who writes fewer than 100 prescriptions during the EHR reporting period is excluded. NUMERATOR / DENOMINATOR / EXCLUSION The resulting percentage (Numerator Denominator) must be more than 40 percent in order for an EP to meet this measure.

Core 5: Active Medication List HOW TO DO THIS IN AC: Patient's must either have a medication on their medication list or have selected that they have "Takes No Medications". Medications can be entered in 2 ways, through the Current Medications box or on the Write Scripts screen. If a patient has no medications, we will automatically enable the Takes No Medications box. Objective Measure Maintain active medication list. More than 80 percent of all unique patients seen by the Eligible Provider (EP) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. No exclusion. NUMERATOR / DENOMINATOR DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medications) recorded as structured data in their medication list. The resulting percentage (Numerator Denominator) must be more than 80 percent in order for an EP to meet this measure.

Exclusion Attestation Requirements

Core 6: Medication Allergy List HOW TO DO THIS IN AC: Patients must have either an active allergy or structured data that they have No Known Allergies. This data can be entered by accessing the Allergies screen from the patient's Most Recent Encounter, Summary Sheet or Write Meds pages. Selecting A' button will open the allergy window where allergies can be recorded. Objective Measure Maintain active medication allergy list. More than 80 percent of all unique patients seen by the Eligible Provider (EP) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. No exclusion. NUMERATOR / DENOMINATOR DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list. The resulting percentage (Numerator Denominator) must be more than 80 percent in order for an EP to meet this measure. Core 7: Record Demographics HOW TO DO THIS IN AC: Language Preference, Race, and Ethnicity must all be entered on a patient to meet these criteria. These are found in patient Demographics in the Miscellaneous Info tab in the middle section on the screen. Select the appropriate categories from the drop down menus . Objective Record all of the following demographics: (A) Preferred language (B) Gender (C) Race (D) Ethnicity (E) Date of birth Measure More than 50 percent of all unique patients seen by the Eligible Provider (EP) have demographics recorded as structured data. Exclusion No exclusion. Attestation NUMERATOR / DENOMINATOR Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.

Exclusion Attestation Requirements

NUMERATOR: Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. Core 8: Record Vital Signs HOW TO DO THIS IN AC: Vitals signs are recorded in the Most Recent Encounter and saved when the encounter is signed. Height, weight, and blood pressure are required on a patient during the reporting period. BMI is automatically calculated when height and weight are entered for a single visit. Objective Record and chart changes in the following vital signs: (A) Height (B) Weight (C) Blood pressure (D) Calculate and display body mass index (BMI) (E) Plot and display growth charts for children 2-20 years, including BMI For more than 50 percent of all unique patients age 2 and over seen by the Eligible Provider (EP), height, weight, and blood pressure are recorded as structured data. Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients age 2 or over seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structured data. EXCLUSION: An EP who sees no patients 2 years or older would be excluded from this requirement. Additionally, an EP who believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure.

Measure Exclusion

Attestation Requirements

Core 9: Record Smoking Status HOW TO DO THIS IN AC: In the Most Recent Encounter, the Tobacco drop down field is just above Social History. There are 6 options to choose from: Current Every Day Smoker, Current Some Day Smoker, Smoker-current status unknown, Former Smoker, Never Smoker, and Unknown if ever smoked. Selecting an option here will automatically populate the information in the Social History box and in Health Risk Factors. Adding one of the 2 options in Health Risk Factors (Current smoker, Former smoker) will also auto populate the information in the Tobacco drop down. Objective Measure Exclusion Attestation Requirements Record smoking status for patients 13 years old or older. More than 50 percent of all unique patients 13 years old or older seen by the Eligible Provider (EP) have smoking status recorded as structured data. Any EP who sees no patients 13 years or older. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients age 13 or older seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data. EXCLUSION: An EP who sees no patients 13 years or older would be excluded from this requirement. EPs must enter 0' in the Exclusion box to attest to exclusion from this requirement.

The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. Core 10: Clinical Quality Measures (CQMs) HOW TO DO THIS IN AC: See individual CQMs in CQM Tabs for more information Objective Report ambulatory clinical quality measures to CMS. Measure Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS. Exclusion No exclusion. Attestation YES / NO Requirements Eligible professionals (EPs) must attest YES to reporting to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS to meet the measure.

Core 11: Clinical Decision Support Rule HOW TO DO THIS IN AC: Amazing Charts pre-populates decision support with USPSTF (United States Preventive Services Task Force) rules and risk factors. To add new decision support rules, go to Administrative Options and select the Set Health Maintenance button. From here you can add or edit existing rules. Once a rule has been created, choose the Additional Settings tab and select the Edit Conditions button at the bottom. Select conditions to add to the rule. If you select more than 1 criterion in a category, you can decide whether to include All, At least one, or None of that category by double clicking on the Category Name. Any patient that meets the selected criteria will have the rule appear in their decision support due box. Objective Measure Exclusion Attestation Requirements Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Implement one clinical decision support rule. No exclusion. YES / NO Eligible professionals (EPs) must attest YES to having implemented one clinical decision support rule for the length of the reporting period to meet the measure.

Core 12: Electronic Copy of Health Information HOW TO DO THIS IN AC: Exporting an electronic copy of health information (CCD) for the patient, can be done on the Summary Sheet. In the Export box in Reports & Resources section of the Summary Sheet, select the Clinical Summary button. This will export an electronic copy of the clinical summary to be given to the patient. Objective Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of patients of the EP who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period. NUMERATOR: Number of patients in the denominator who receive an electronic copy of their electronic health information within three business days. EXCLUSION: An EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement. EPs must enter 0' in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 50

Measure Exclusion Attestation Requirements

percent in order for an EP to meet this measure. Core 13: Clinical Summaries HOW TO DO THIS IN AC: To print a clinical summary from an encounter, select the Print Instructions (Summary) button in the Plan section of the Chart. This will add the CCD (the clinical summary) to the printed instructions. From the Summary Sheet, select the Clinical Summary button from the Print section of Reports & Resources. Objective Measure Exclusion Attestation Requirements Provide clinical summaries for patients for each office visit. Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Any EP who has no office visits during the EHR reporting period. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients seen by the EP for an office visit during the EHR reporting period. NUMERATOR: Number of patients in the denominator who are provided a clinical summary of their visit within three business days. EXCLUSION: EPs who have no office visits during the EHR reporting period would be excluded from this requirement. EPs must enter 0' in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure.

Core 14: Electronic Exchange of Clinical Information HOW TO DO THIS IN AC: To exchanging clinical information with authorized entities select CCD from the Export section of Reports & Resources on the Summary Sheet (this may also be done from anywhere you can export a CCD). On the HIPAA form make sure to select Exchange Clinical Information in the Reason drop down Objective Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. No exclusion. YES / NO Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information during the EHR reporting period to meet this measure.

Measure Exclusion Attestation Requirements

Core 15: Protect Electronic Health Information HOW TO DO THIS IN AC: This step requires an internal audit by the practice to make sure adequate security precautions are in place. These features include, but are not limited to, protecting wireless networks with a strong password, authenticating users and maintaining secure user passwords, and encrypting all PHI. Amazing Charts help you do this in 2 ways. In Administrator Options go to User Configuration (Security) to configure advanced security options. In Amazing Utilities, in the Advance menu is an option for Encryption. Here you may encrypt or decrypt files. Files can only be decrypted on a computer with Amazing Charts installed and the correct password entered. Objective Measure Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

Exclusion Attestation Requirements

No exclusion. YES / NO Eligible professionals (EPs) must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure.

Menu 1: Drug Formulary Checks HOW TO DO THIS IN AC: On the Write Scripts screen, select the Check Formulary Eligibility menu. If this patient is eligible for formulary checking another screen will open where the drug name can be entered to check formulary. Once this has been done successfully once, Amazing Charts attests that this criterion has been met. Objective Measure Exclusion Attestation Requirements Implement drug formulary checks. The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Any EP who writes fewer than 100 prescriptions during the EHR reporting period. YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having enabled this functionality and having had access to at least one internal or external formulary for the entire EHR reporting period to meet this measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this objective and associated measure. EPs must enter 0' in the Exclusion box to attest to exclusion from this requirement.

Menu 2: Clinical Lab Test Results HOW TO DO THIS IN AC: Any labs that are imported as structured data via one of our lab interfaces are automatically counted toward this criteria. Lab data that is brought into Amazing Charts in any other way (scanned, faxed, etc) count against the criteria (add to the denominator but not the numerator). Tracked data do not have any effect on this measure. Objective Measure Incorporate clinical lab test results into EHR as structured data. More than 40 percent of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number. NUMERATOR: Number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data. EXCLUSION: If an EP orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 40

Exclusion Attestation Requirements

percent in order for an EP to meet this measure.

Menu 3: Patient Lists HOW TO DO THIS IN AC: From the Main Screen select Reports. Run 2 searches that include Demographics, Diagnoses, Medications, and/or Laboratory data. Then attest to this criteria on the Meaningful Use Wizard. Objective Measure Exclusion Attestation Requirements Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one report listing patients of the EP with a specific condition. No exclusion. YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having generated at least one report listing patients of the EP with a specific condition to meet this measure.

Menu 4: Patient Reminders HOW TO DO THIS IN AC: From the main Amazing Charts window select Reports, and then select the highlighted Meaningful Use Searches menu. Then choose whether to search on patients <=5yo or >=65yo. You will be given an option to filter by contact preference. Selecting All will include patients with and without a contact preference. Then you will need to add at least one more criteria from Demographics, Diagnoses, Medications, or Laboratory Data. Amazing Charts will automatically count how many patients were returned in the search and compare with the total number of patients in that age range who were seen during the reporting period. Objective Measure Exclusion Attestation Requirements Send reminders to patients per patient preference for preventive/follow-up care. More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients 65 years old or older or 5 years older or younger. NUMERATOR: Number of patients in the denominator who were sent the appropriate reminder. EXCLUSION: If an EP has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology that EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 20 percent in order for an EP to meet this measure.

Menu 5: Patient Electronic Access HOW TO DO THIS IN AC: Patient's can gain electronic access to the personal health information (PHI) through Personal Health Records (PHR). To export a CCD (the format recognized by most PHRs), go to the Reports & Resources section of the Summary Sheet and select PHR. On the next screen, select the Settings button to activate or inactivate PHRs for that patient. Once saved, PHRs can be exported anywhere on your computer and then manually uploaded to the PHR (the process for this upload differs between PHRs)

Objective

Measure

Exclusion

Attestation Requirements

Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withhold certain information. Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information online. EXCLUSION: If an EP neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period, they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be at least 10 percent in order for an EP to meet this measure.

Menu 6: Patient-Specific Educational Resources HOW TO DO THIS IN AC: When patient-specific education is provided to the patient, simply check the Patient Education checkbox above the Plan section of Most Recent Encounters. Objective Measure Exclusion Attestation Requirements Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources. No exclusion. NUMERATOR / DENOMINATOR DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who are provided patient-specific education resources. The resulting percentage (Numerator Denominator) must be more than 10 percent in order for an EP to meet this measure.

Menu 7: Medication Reconciliation HOW TO DO THIS IN AC: To record that a patient was transferred into, or back to your practice, double click in the Current Medications box in Most Recent Encounters. Check the Transfer of Care box and select Save. If you reconciled the patient's medications (compared the list of the patient's current medications to their medication list from the transferring institution), check the Medications Reconciled box and select Save. Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Measure The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Exclusion An EP who was not the recipient of any transitions of care during the EHR reporting period.

Attestation Requirements

NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. NUMERATOR: Number of transitions of care in the denominator where medication reconciliation was performed. EXCLUSION: If an EP was not on the receiving end of any transition of care during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure.

Menu 8: Transition of Care Summary HOW TO DO THIS IN AC: To export a Transition of Care Summary, go to the Reports & Resources section of the Summary Sheet and select CCD. In the Reason drop down on the HIPAA form, choose Patient Transitions. Continue through the steps and export the CCD. Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. NUMERATOR / DENOMINATOR / EXCLUSION DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of care record was provided. EXCLUSION: If an EP does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period then they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure.

Measure

Exclusion Attestation Requirements

Menu 9: Immunization Registries Data Submission HOW TO DO THIS IN AC: In order to export vaccines, you must first set up a state immunization registry interface. Open Administrative Options and select the Interfaces button. In the Vaccine Registries section, select your state. If you state isn't listed, select the Meaningful Use Immunization Registry. Follow the steps on the screen. If you select the Meaningful Use registry, skip Step 1 - Sign up. Once your registry is active you can begin exporting. To export vaccines, go to the File menu from the main Amazing Charts page and select Import/Export --> Export to State Registry and follow the instructions. Once you have exported to your selected registry, Amazing Charts automatically attests that you have completed this criteria. Objective Measure Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically).

Exclusion Attestation Requirements

An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test was successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically) to meet this measure. EXCLUSION: If an EP does not perform immunizations during the EHR reporting period, or if there is no immunization registry that has the capacity to receive the information electronically, then the EP would be excluded from this requirement. EPs must select NO next to the appropriate exclusion(s), then click the APPLY button in order to attest to the exclusion(s).

Menu 10: Syndromic Surveillance Data Submission HOW TO DO THIS IN AC: To export data to a public health registry you must enable the public health interface. Open Administrative Options and select the Interfaces button. Under Public Health Registries select your state. If you don't see your state choose the Meaningful Use Public Health Registry (MUPHR) and follow the instructions on the sign up screen. If you selected the MUPHR, skip Step 1 - Sign up. To export syndromic surveillance information go to the appropriate patient's Summary Sheet and from the File menu choose Export --> Export to State Public Health Registry. Follow the steps to export this information. Upon completing the export, Amazing Charts will automatically attest that you have completed this criteria. Objective Measure Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically). An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically. YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology's capacity to submit electronic syndromic surveillance data to public health agencies and follow up submission if the test was successful (unless none of the public health agencies to which the EP submits such information has the capacity to receive the information electronically) to meet this measure. EXCLUSION: If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period or if no public health agency that has the capacity to receive the information electronically, then the EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.

Exclusion

Attestation Requirements

Clinical Quality Measures (CQMs) Eligible professionals (EP) must report from the table of clinical quality measures which includes, 3 Core, 3 Alternate Core, and up to 38 additional CQMs. Core CQMs - EPs must report on 3 required core CQMs. If the denominator of one or more of the required core measures is 0, then EPs are required to report results from one of the three alternate core measures. One alternate core measure must be selected for each required core CQM that has a numerator of zero. EPs also must select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a '0' denominator provided the EP does not have an applicable population. In sum, EPs must report on 6 total CQM measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures. A maximum of 9 measures would be reported if the EP needed to attest to the 3 required core, the three alternate core, and the 3 additional measures.

What this means is that if you can meet all 3 Core CQMs (i.e. you have patients that are in those categories), you only need to have the 3 Core CQMs and 3 Alternate CQMs (no need to worry about the Alternate Core CQMs). If you do not have patients that can meet a Core CQM (i.e. a pediatric practice wouldn't have any patients who could meet the Adult Weight Screening Criteria), than for each Core CQM you can't do, you need to select 1 Alternate Core CQM. If you don't have patients that meet any of the Core CQMs, then you would select all of the Alternate Core CQMs (this is the case where you would have 9 measures - 3 Core CQMs, which you can't meet; 3 Alternate Core CQMs; and 3 Alternate CQMs). No matter what you do with Core and Alternate Core CQMs, you still need to select 3 CQMs from the Alternate CQMs tab. Remember CQMs have no Pass/Fail percentage. These can be used to help you follow goals for you patient's that are evidenced based. CORE CQMs NQF 0013 - Hypertension: Blood Pressure Measurement HOW TO DO THIS IN AC: This screening can only be met in patients with hypertension aged 18 years and older who have had at least 2 visits during the reporting period. In Most Recent Encounters enter the patient's blood pressure and sign the encounter. Measure Developer Description 0013 AMA Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded. Effective management of blood pressure in patients with hypertension can help prevent cardiovascular events, including myocardial infarction, stroke, and the development of heart failure. Treating SBP and DBP to targets that are <140/90 mm Hg is associated with a decrease in CVD risk complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mm Hg. (JNC VII, 2004).

Rationale

Clinical Recommendation

NQF 0028 - Preventative Care and Screening Measure Pair: (a) Tobacco Use Assessment & (b) Tobacco Cessation Intervention HOW TO DO THIS IN AC: This screening can only be met in patients aged 18 years and older who have had at least 2 outpatient visits (or 1 preventive care visit) during the reporting period. This criteria has 2 parts 0028a (Tobacco Assessment) and 0028b (Tobacco Counseling) Part 1 (Tobacco Assessment) of this criteria is met by entering smoking status in the Tobacco drop down above Social History in Most Recent Encounters and signing the encounter. Part 2 (Tobacco Counseling) of this criteria can be met in Decision Support or Medications. In Decision Support, double click on "Counseling to Prevent Tobacco Use and Tobacco-Caused Disease in Adults", enter the appropriate comments and Save. In Current Medications or Write Scripts screens add a medically indicated smoking cessation medication. Measure Developer Description 0028a, 0028b AMA Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months (0028a). Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention (0028b) Tobacco use is one of the leading causes of many preventable diseases; however, not all individuals are screened for tobacco use. The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products. (A Recommendation) (USPSTF, 2003).

Rationale Clinical Recommendation

NQF 0421 - Adult Weight Screening and Follow-Up HOW TO DO THIS IN AC: This screening can only be met in patients 18 years and older who have had at least 1 visit during the reporting period. This criteria has 2 parts based upon the age of the patient, 0421a (Patients aged 65 years and older) and 0421b (Patients aged 18-64 years). To meet this

criteria enter a height and weight (BMI will be automatically calculated) in the vitals area of Most Recent Encounters and sign the encounter. If the BMI is abnormal (<22 or >30) you will need to enter an ICD9 code indicating diet was discussed (V65.3), after medically appropriate discussion. Measure Developer Description 0421 QIP Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented. Of the Medicare population, 37 percent are overweight, and 18 percent are obese. Between 1991 and 1998, the prevalence of obesity among persons age 60-69 increased by 45 percent (American Obesity Association). According to a 1998 survey, only 52 percent of adults age 50 or older reported being asked during routine medical check-ups about physical activity or exercise. The likelihood of being asked about exercise during a routine check-up declined with age (Center for the Advancement of Health, 2004). Elderly patients with unintentional weight loss are at higher risk for infection, depression and death. In one study it was found that a BMI of less than 22 kg per m2 in women and less than 23.5 in men is associated with increased mortality. In another study it was found that the optimal BMI in the elderly is 24 to 29 kg per m2. (Huffman, G. B., Evaluation and Treatment of Unintentional Weight Loss in the Elderly, American Family Physician, 2002 Feb, 4:640-650.) Clinical The USPSTF (2009) recommends that clinicians screen all adult patients for obesity Recommendation and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. (Level of Evidence = B, USPSTF). The clinical guideline for obesity recommends assessment of BMI at each encounter (National Heart, Lung and Blood Institute). Management of Obesity indicates that the body mass index should be calculated at least annually for screening and as needed for management (The Institute for Clinical Systems Improvement's 2009 Guideline for Prevention and Management of Obesity). Validated measure of nutrition status serves as an indicator of over-nourishment and under-nourishment. Nutrition Screening Initiative: Nutrition Interventions Manual for Professionals Caring for Older Americans, 2002 (Co-sponsored by American Dietetic Association (ADA), AAFP and National Council on Aging, Inc.). The NSI-suggested BMI range is 22-27 (values outside this range indicate overweight or underweight for elderly) Nutrition Screening Initiative: Nutrition Interventions Manual for Professionals Caring for Older Americans, 2002 (Co-sponsored by American Dietetic Association (ADA), AAFP and National Council on Aging, Inc.). ALTERNATE CORE CQMs NQF 0024 - Weight Assessment and Counseling for Children and Adolescents HOW TO DO THIS IN AC: This screening can only be met in children aged 2-16 years who have had at least 1 visit during the reporting period. This criteria has 3 parts, based upon age of patient: 0024a (2-16 years), 0024b (2-10 years), 0024c (11-16 years). It also has 3 numerators for each part: Numerator 1 (BMI), Numerator 2 (Nutrition Counseling), and Numerator 3 (Physical Activity Counseling). You will only need to worry about the numerators as we automatically sort out the aged based parts. Numerator 1 (BMI): Enter height and weight in the vitals area of Most Recent Encounters (BMI is automatically calculated) and sign the encounter. Numerator 2 (Nutrition Counseling): This can be met in Decision Support or with an ICD9 code. In Decision Support, double click on "Behavioral Counseling in Primary Care to Promote a Healthy Diet in General Population", enter the appropriate comments and Save. Or you may enter the ICD9 code V65.3 (Dietary Surveillance and Counseling) in patient's Most Recent Encounters or Summary Sheet Numerator 3 (Physical Activity Counseling): This can be met in Decision Support or with an ICD9 code. In Decision Support, double click on "Behavioral Counseling in Primary Care to Promote Physical Activity", enter the appropriate comments and Save. Or you may enter the ICD9 code V65.41 (Exercise Counseling) in patient's Most Recent Encounters or Summary Sheet

Rationale

Measure Developer Description

0024 NCQA The percentage of patients 2-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. Rationale This measure assesses the percentage of age appropriate patients who had an outpatient visit with a PCP or OB/GYN and who had evidence of a BMI percentile assessment, counseling for nutrition or counseling for physical activity. The prevalence of overweight and obesity has increased sharply for children over the last 30 years: from 5.0% to 13.9% for those aged 25 years; from 6.5% to 18.8% for those aged 611 years; and from 5.0% to 17.4% for those aged 1219 years. This increasing prevalence has had significant economic ramifications, with economic costs correlated to obesity and related comorbidities estimated at over $70 billion, or 7% of the national health care budget. To address this problem and its long term implications effectively, promotion of routine physical activity and healthy eating and lifestyle changes are essential (CDC 2007). This measure is important in efforts to improve long term health outcomes and quality of life. Clinical U.S. Preventive Services Task Force (USPSTF): I Recommendation. Insufficient Recommendation evidence to recommend for or against screening for overweight in children and adolescents reflects the paucity of strong evidence of the effectiveness of interventions for this problem in the clinical setting. The American Academy of Pediatrics (AAP): The child's height, weight and percentiles for age should be determined at the start of the physical examination. Because obesity is strongly linked to hypertension, BMI should be calculated from the height and weight, and the BMI percentile should be calculated. Poor growth may indicate an underlying chronic illness. The American Medical Association (AMA), Health Resources and Services Administration (HRSA), and Centers for Disease Control and Prevention (CDC): The Expert Committee recommends that physicians and allied healthcare providers perform, at a minimum, a yearly assessment of weight status in all children, and that this assessment include calculation of height, weight (measured appropriately), and body mass index (BMI) for age and plotting of those measures on standard growth charts. The American Academy of Pediatrics and the American College of Clinical Endocrinology (ACCE): The AAP and the ACCE recommend and encourage pediatric providers to screen children for obesity using BMI; examine overweight children for obesity related diseases; initiate weight management practices to improve diet and physical activity habits; and increase frequency of visits to reinforce behavior changes. The Centers for Disease Control and Prevention (CDC): The CDC recommends using the percentile BMI for age and gender as the most appropriate and easily available method to screen for childhood overweight or at risk for overweight. BMI is calculated by dividing the weight in kilograms by the height in meters squared. Age and gender norms for BMI are readily accessible. BMI correlates with adiposity and with complications of childhood overweight such as hypercholesterolemia, hypertension and later development of cardiovascular disease. Although more precise measures of lean body mass and body fat such as dual x-ray absorptiometry (DEXA) may be appropriate for clinical studies, BMI norms are particularly helpful for screening in busy office practices and for population assessment. NQF 0041 - Preventive Care and Screening: Influenza Immunization for Patients >= 50 Years Old HOW TO DO THIS IN AC: This screening can only be met in patients aged 50 years and older who have had at least 2 outpatient visits or 1 preventive care visit during the reporting period. To meet this criteria give the influenza vaccination (if medically indicated) in the "HM: Immunizations and Shots" tab of Decision Support. Measure Developer Description 0041 AMA Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

Rationale

Clinical Recommendation

Influenza vaccination has shown to decrease hospitalizations for influenza, especially for those with risk factors, however annual influenza vaccination rates remain low. Annual influenza immunization is recommended for all groups who are at increased risk for complications from influenza including persons aged 50 years. (CDC, USPSTF)

NQF 0038 - Childhood Immunization Status HOW TO DO THIS IN AC: This screening can only be met in children aged 2-16 years who have had at least 1 visit during the reporting period. This criteria has 12 parts, based upon which vaccinations were given: 1-DTaP, 2-IPV, 3-MMR, 4-Hib, 5-Hepatitis B, 6-Varicella, 7-Pneumococcal, 8-Hepatits A, 9-Rotovirus, 10-Influenza, 11-DTaP, IPV, MMR, Hib, Hepatitis B, and Varicella, 12-DTaP, IPV, MMR, Hib, Hepatitis B, Varicella, and Pneumococcal. To meet any and all parts of this criteria, enter the medically appropriate vaccinations in the "HM: Immunizations and Shots" tab of Decision Support. Measure Developer Description 0038 NCQA The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. Rationale This measure monitors the appropriate and timely use of vaccines for children prior to their second birthday. Pediatric vaccines are responsible for preventing 10.5 million diseases per birth cohort in the U.S. and are a cost effective preventive measure. For every dollar spent on immunizations, as many as $29 can be saved in direct and indirect costs. With the development and use of vaccines, the prevalence of some infectious diseases has dramatically reduced; since the beginning of the 20th century, there has been a 99% decline in vaccine preventable disease morbidity. Despite the established guidelines and well known benefits of vaccination, however, in 2007, 22.5% of children 1935 months of age had not received the recommended immunizations. General clinical consensus notes that if immunization practices ceased, most infectious diseases currently prevented by vaccinations would reemerge as serious health threats. This measure facilitates efforts toward infectious disease prevention among a vulnerable subgroup of the population. Clinical Current CDC/ACIP Guidelines recommend infants and toddlers receive the Hepatitis B Recommendation series, four DTaP vaccinations, four HiB vaccinations, three IPV vaccinations, one MMR vaccination, four pneumococcal conjugate vaccinations, and one varicella vaccination. Some combination products on the market include both the DTaP and HiB vaccines and should only be administered three times. In these cases, children receive three HiB vaccinations instead of the four mentioned above. The recommendation is to receive these vaccinations between birth and 18 months of age. The current HEDIS specifications allow a grace period by measuring compliance with these recommendations between birth and age two. CQM ALTERNATE You always need to select 3 CQMs from the Alternate CQMs tab. Remember CQMs have no Pass/Fail percentage. These can be used to help you follow goals for you patient's that are evidenced based. NQF 0018 - Controlling High Blood Pressure HOW TO DO THIS IN AC: This screening can only be met in patients with hypertension aged 18-84 years who have had at least 1 visit during the reporting period. To meet this criteria, the patient's most recent blood pressure, entered in the vitals section of Most Recent Encounter, must have a systolic less than 140 mmHg AND a diastolic less than 90 mmHg.

Measure Developer

0018 NCQA

Description

The percentage of patients 18 85 years of age who had a diagnosis of hypertension and who's BP was adequately controlled during the measurement year. Rationale This measure assesses the percentage of patients demonstrating adequate control of systolic and diastolic blood pressure levels. Over 50 million Americans warrant treatment for high blood pressure, according to the NHANES survey (JNC 7 2003). Financially, hypertension and associated disorders and heath complications, such as coronary heart disease and congestive heart failure, cost the U.S. economy more than $100 billion each year. The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen adults 18 and older for high blood pressure (2007). This guideline is further endorsed by research studies and clinical trials that have demonstrated decline in costly health outcomes as a direct result of improved blood pressure control. This measure is important in efforts to promote blood pressure control and improve quality of life. Clinical The U.S. Preventive Services Task Force (USPSTF) recommends screening for high Recommendation blood pressure in adults age 18 years and older. This is a grade A recommendation JNC 7: Treating SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in CVD complications. NQF 0027 - Smoking and Tobacco Use Cessation, Medical Assistance HOW TO DO THIS IN AC: This screening can only be met in patients aged 18 years or older who have had at least 1 visit during the reporting period. This criteria has 2 parts: 0027a (Smoking Status) and 0027b (Tobacco Counseling). Part 1 (Smoking Status): In Most Recent Encounters, enter current smoking status in the drop down above Social History. Part 2 (Smoking Counseling): In Decision Support on the first tab (Health Maintenance Due) double click "Counseling to Prevent Tobacco Use and Tobacco-Caused Disease in Adults", enter appropriate comments and Save.

Measure Developer Description

0027 NCQA The percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies. Rationale This measure assesses different facets of providing medical assistance with smoking cessation or tobacco use. Smoking is the leading preventable cause of premature death in the United States and is identified as a causal factor in more than 25 diseases and health problems (USDHHS 2004). In 2003, based on evidence that cessation strategies are effective in improving health outcomes, the USPSTF recommended that clinicians screen adults for tobacco use and provide tobacco cessation interventions. Interventions to control smoking are also strategically important because of the financial burden: approximately $167 billion in annual health related economic losses, when considered with other tobacco use causes. This measure facilitates efforts to implement recommended clinical practices and guidelines and subsequently reduce mortality rates and health problems related to smoking and tobacco use. Clinical United States Preventative Services Task Force (USPSTF): The USPSTF guideline Recommendation strongly recommends that clinicians screen all adult for tobacco use and provide tobacco cessation interventions for those who use tobacco products. The USPSTF found good evidence that brief smoking cessation interventions, including screening, brief behavioral counseling (less than 3 minutes), and pharmacotherapy delivered in primary care settings, are effective in increasing the proportion of smokers who successfully quit smoking and remain abstinent after 1 year. Veterans' Affairs/Department of Defense: The VA/DoD's Clinical Practice Guideline for the Management of Tobacco Use recommends that any person (age greater than 12 years) who is eligible for care in the Veterans Health Administration (VHA) or the Department of Defense (DoD) health care delivery system should be screened for

tobacco use and should be asked about tobacco use at most visits. Tobacco users should be advised to quit and assessed for willingness to quit at every visit. All tobacco users who are willing to quit should be offered an effective tobacco cessation intervention, including: pharmacotherapy, counseling, and follow up. Tobacco users attempting to quit should be prescribed one or more effective first line pharmacotherapies for tobacco use cessation. The guideline also cites strong evidence that minimal counseling (lasting less than three minutes) increases overall tobacco abstinence rates. Public Health Service: The Public Health Service Clinical Practice Guideline recommends that clinicians engage in a number of activities to aid tobacco users in quitting, which include: Implement an office wide system that ensures that, for EVERY patient at EVERY clinic visit, tobacco use status is queried and documented (repeated assessment is not necessary in the case of the adult who has never used tobacco or has not used tobacco for many years, and for whom this information is clearly documented in the medical record). In a clear, strong, and personalized manner, urge every tobacco user to quit. As every tobacco user if he or she is willing to make a quit attempt at this time (e.g., within the next 30 days). Provide practical counseling (problem solving/training). Recommend the use of approved pharmacotherapy, except in special circumstances. Provide supplementary materials.

NQF 0031 - Breast Cancer Screening HOW TO DO THIS IN AC: Breast cancer screening can only be met in female patients aged 42-68 years who have had a visit within the past 2 years. On the Most Recent Encounter page, select the Decision Support button in the upper right hand corner. On the first tab (Health Maintenance Screenings) select the Breast Cancer screening, enter appropriate comments and Save. Measure Developer Description 0031 NCQA The percentage of women 4069 years of age who had a mammogram to screen for breast cancer. Rationale This measure assesses the percentage of women in a specific age demographic who had a mammogram to screen for breast cancer. Breast cancer is the most common cancer diagnosed in women in the United States and is the second leading cause of death from cancer. Awareness of the importance of early detection serves as a significant preventive measure in improving correlated health outcomes. Among women with undetected breast cancer, mammography correctly identifies breast cancer 83%95% of the time (IOM, 2004). Additionally, mammography screening has been shown to reduce mortality by 20%30% (IOM 2004). This measure facilitates efforts toward early detection of breast cancer and acceleration of treatment upon diagnosis. Clinical The IOM recommends that women aged 40-69 years of age have mammogram Recommendation screening. Much of the information on screening mammography can appear conflicting for women who are considering getting a mammogram. Today, most screening guidelines recommend mammograms every one to two years for women 40 and older. Measure Developer Description Rationale Clinical Recommendation

NQF 0032 - Cervical Cancer Screening

HOW TO DO THIS IN AC: Cervical cancer screening can only be met in female patient's age 23-63 years who have had a visit within the encounter period. This screening can be met in 2 ways, in orders or in decision support. To do this on the orders screen, create an order for a Pap Smear (CPT Q0091) from the Lab tab on the orders screen. To complete this from Decision support go to Most Recent Encounters and select the Decision Support button. Select Cervical cancer screening from the first tab (HM Due) and enter comments and Save. Measure Developer Description 0032 NCQA The percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer. Rationale This measure assesses the percentage of women in a specific age demographic who receive appropriate screening for cervical cancer. The American Cancer Society predicted that in 2009, nearly 11,270 women would be newly diagnosed with cervical cancer and 4,070 women would die of cervical cancer. The financial burden is also noteworthy: treatment for cervical cancer cost about $2 billion in 2004 (CDC). The American Cancer Society reported that screening can save lives, stating that the overall five-year survival rate for cervical cancer is nearly 71%, with a survival rate of 92% for detection in the earliest stage (2010). This evidence is corroborated by the fact that from 19551992, the mortality rate from cervical cancer declined by 74% because of screening. This measure facilitates efforts toward early detection of cervical cancer and acceleration of treatment upon diagnosis. Clinical American Cancer Society (ACS, Nov 2002): Test approximately 3 years after onset Recommendation of vaginal intercourse, but no later than age 21; intervals annually, every 2-3 years for women 30 with 3 negative cytology tests. U. S. Preventive Services Task Force (USPSTF, Jan 2003): Test within 3 years of onset of sexual activity or age 21, whichever comes first; intervals of at least every 3 years. American College of Obstetricians and Gynecologists (ACOG, Aug 2003): Approximately 3 years after onset of sexual intercourse, but no later than age 21; annually, every 2-3 years for women 30 with 3 negative cytology tests.

NQF 0034 - Colorectal Cancer Screening HOW TO DO THIS IN AC: Colorectal cancer screening can only be met in female patients age 50-74 years who have had a visit within the past 2 years. This criteria can be met in 2 ways, in Decision Support and with CPT codes. To meet with Decision Support, go to the Most Recent Encounters screen and select the Decision Support button. In the first tab (HM Due) double click on the Colorectal Cancer Screening enter appropriate comments and Save. The other way to meet this criteria is to use an appropriate CPT code when signing the superbill (including 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, 45392) Measure Developer Description Rationale 0034 NCQA The percentage of adults 5075 years of age who had appropriate screening for colorectal cancer. This measure assesses the percentage of patients in a specific age demographic who receive appropriate screening for colorectal cancer. Colorectal cancer is the third leading cause of cancer related deaths in the United States for both men and women, and was expected to be the primary cause of 49,920 deaths in 2009. In 2009, there were 106,100 new cases of colon cancer and 40,870 new cases of rectal cancer. Screening decreases mortality rates by detecting cancerous formations in the early and most curable stage; as a result, the mortality rate has been dropping for more than 20 years because of early identification of polyps for removal prior to disease onset, as well as other colorectal cancers. Screening is also fiscally responsible, with studies showing cost savings of $40,000 per life year gained. This measure facilitates efforts toward early detection of colorectal cancer

and acceleration of treatment upon diagnosis. Clinical The United States Preventive Services Task Force: Recommendation The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years (A recommendation). The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening modalities for colorectal cancer (I statement). The American Cancer Society, The American College of Radiology, and the U.S. Multi Society Task Force on Colorectal Cancer: Tests that Detect Adenomatous Polyps and Cancer: Colonoscopy (every 10 yrs) Flexible sigmoidoscopy (every 5 yrs) fecal occult blood tests (FOBT) (A) Double contrast barium enema (DCBE) (every 5 yrs) Computed tomographic colonography (CTC) (every 5 years) Tests that Primarily Detect Cancer: gFOBT with high sensitivity for cancer (annually) FIT with high sensitivity for cancer (annually) sDNA with high sensitivity for cancer (interval uncertain)

NQF0043 - Pneumococcal Vaccination for Older Adults HOW TO DO THIS IN AC: Pneumococcal screening can only be met in patients aged 65 years and older who have had a visit within the past year. In the Most Recent Encounters screen, select the Decision Support button and in the second tab (HM: Immunizations and Shots) enter the information for Pneumococcal vaccine that was given to the patient. Measure Developer Description 0043 NCQA The percentage of patients 65 years of age and older as of January 1 of the measurement year who have ever received a pneumococcal vaccine. Rationale This measure monitors the appropriate and timely use of vaccines among age-appropriate older adults. Each year, 20% of Americans contract influenza (flu) (CDC 2009). Rates of infection are highest among children and immunosuppressed patients, while mortality is highest among adults over 64 years, children under 2 years and persons with chronic medical conditions (CDC 2008). More than 200,000 people are hospitalized for flu-related complications each year; 63% are 65 or older (CDC 2009; Thompson et al. 2004). The health impact of influenza on older adults is substantial and flu short vaccines are the most effective way to prevent severe illness complications and death. This measure facilitates efforts toward infectious disease prevention among a vulnerable subgroup of the population. Clinical The U.S. Preventive Services Task Force's Guide to Clinical Preventive Services Recommendation recommends pneumococcal vaccine for all immunocompetent individuals who are 65 and older or otherwise at increased risk for pneumococcal disease. Routine revaccination is not recommended, but may be appropriate in immunocompetent individuals at high risk for morbidity and mortality from pneumococcal disease (e.g., persons 75 years of age or with severe chronic disease) who were vaccinated more than five years previously (USPSTF, 1989).

NQF 0055 - Diabetes: Eye Exam HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period. In Most Recent Encounters select the Decision Support button and on the first tab (HM Due) double click on Screening for Diabetic Retinopathy, enter appropriate comments and Save. To enable this HM Due alert, select the Risk Factor button on Most Recent Encounters and select Diabetes from the Past Medical History Section. Measure 0055

Developer Description

NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional . Rationale This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who had an eye (retinal) exam performed. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including glaucoma and blindness. Diabetic retinopathy is the most common diabetic eye disease and causes 21,0004,000 new cases of blindness annually. The consensus among established clinical guidelines is that patients with both types of diabetes should have an initial dilated and comprehensive eye exam soon after diagnosis (ADA 2009). Guidelines also recommend consultation with an ophthalmologist for treatment options if a patient has any level of macular edema or diabetic retinopathy (proliferative and nonproliferative). This measure facilitates the prevention and long term management of retinal based complications for patients diagnosed with diabetes. Clinical American Diabetes Association (ADA) 2009: Recommendation Adults and children aged 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (B) Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. (B) Subsequent examinations for type 1 and type 2 diabetic patients should be repeated annually by an ophthalmologist or optometrist. Less frequent exams (every 23 years) may be considered following one or more normal eye exams. Examinations will be required more frequently if retinopathy is progressing. (B) Women with preexisting diabetes who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and be counseled on the risk of development and/or progression of diabetic retinopathy. (B) Eye examination should occur in the first trimester with close follow up throughout pregnancy and for 1 year postpartum. (B) Promptly refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (NPDR), or any proliferative diabetic retinopathy (PDR) to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy. (A) Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high risk PDR, clinically significant macular edema, and in some cases of severe NPDR. (A) The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as this therapy does not increase the risk of retinal hemorrhage. (A) NQF 0056 - Diabetes: Foot Exam HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period. In Most Recent Encounters select the Decision Support button and on the first tab (HM Due) double click on Recommendations for Diabetic Foot Care, enter appropriate comments and Save. To enable this HM Due alert, select the Risk Factor button on Most Recent Encounters and select Diabetes from the Past Medical History Section and Save. Measure Developer Description 0056 NCQA The percentage of patients aged 18 75 years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam). This measure assesses the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who had a foot exam performed. Diabetes mellitus (diabetes) is a group of diseases characterized by high

Rationale

blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including poor circulation, nerve damage or neuropathy in the feet and eventual amputation. Nearly 60%70% of diabetics suffer from mild or severe nervous system damage. The consensus among established clinical guidelines is that patients with both types of diabetes should have a foot exam soon after diagnosis and annually thereafter (ADA 2009). Comprehensive foot care programs can lower amputation rates by 45%85%. This measure facilitates the prevention and long term management of lower extremity based complications for patients diagnosed with diabetes. Clinical American Diabetes Association Guidelines/ Recommendations: Perform annual Recommendation comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10 g monofilament plus testing any one of: vibration using 128Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold). NQF 0059 Diabetes: High HbA1c HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period and who have codified labs. The numerator on this criteria increases when a codified lab, with a HgbA1C of 9% or higher, is imported on a patient with diabetes.

Measure Developer Description

0059 NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%. Rationale This measure assesses the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who demonstrate poor blood sugar control with an HbA1c level higher than 9 percent. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including poor blood sugar control. Studies have shown that improved glycemic control is correlated with a 40%decline in the development of associated microvascular complications (i.e., eye, kidney and nerve diseases) (ADA 2009). Clinical guidelines recommend regular HbA1c testing to facilitate patients' ability to improve and sustain acceptable levels (ADA 2009). This measure facilitates the prevention and long term management of high blood sugar levels for patients diagnosed with diabetes. Clinical American Geriatric Society Recommendation For frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as 8% is appropriate. (Level III, Grade B) For older persons, target hemoglobin A1C should be individualized. A reasonable goal for A1C in relatively healthy adults with good functional status is 7% or lower. (Level III, Grade B) American Diabetes Association Lowering A1C to below or around 7% has been shown to reduce microvascular and neuropathic complications of type 1 and type 2 diabetes. Therefore, for microvascular disease prevention, the A1C goal for nonpregnant adults in general is <7%. (A)

NQF 0061 - Diabetes and Blood Pressure Control HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period. Measure the patient's blood pressure and enter that information in the vitals in Most Recent Encounters and save the encounter.

Measure Developer Description

0061 NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2) who had BP <140/90 mmHg. Rationale This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who sustain adequate blood pressure control. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including poor blood pressure control and subsequent cardiovascular disease of varying severity. Maintaining a healthy blood pressure has been shown to reduce complications due to diabetes, with a 10 mm Hg reduction in systolic blood pressure lowering the risk of complications by 12% It also reduces the chance of cardiovascular disease among patient with diabetes by up to 50% and reduces the chance of other related complications (eye, kidney, nerve) by more than 25% This measure facilitates long term management of blood pressure levels for patients diagnosed with diabetes. Clinical American Association of Clinical Endocrinologists and American College of Recommendation Endocrinology (AACE/ACE): Recommends that a blood pressure determination during the initial evaluation, including orthostatic evaluation, be included in the initial and every interim physical examination. American College of Physicians (ACP): Blood pressure control must be a priority in the management of persons with hypertension and type 2 diabetes. American Diabetes Association (ADA): Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure >130 mmHg or diastolic >80 mmHg should have blood pressure confirmed on a separate day. Orthostatic measurement of blood pressure should be performed to assess for the presence of autonomic neuropathy. (Level of Evidence: E) American Geriatrics Society (AGS): Older persons with diabetes are likely to benefit greatly from cardiovascular risk reduction, therefore monitor and treat hypertension and dyslipidemias. JNC VII: Recommends that measurement of blood pressure in the standing position is indicated periodically, especially in those at risk for postural hypotension. At least two measurements should be made and the average recorded. After BP is at goal and stable, follow up visits can usually be at 3 to 6 month intervals. Co morbidities such as heart failure, associated diseases such as diabetes, and the need for laboratory tests influence the frequency of visits. National Kidney Foundation (NKF): Recommends that all individuals should be evaluated during health encounters to determine whether they are at increased risk of having or of developing chronic kidney disease. This evaluation of risk factors should include blood pressure measurement. NQF 0062 - Diabetes and Nephropathy HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes and nephropathy aged 18-75 years who have had a visit during the reporting period. In Most Recent Encounters select the Decision Support button and on the first tab (HM Due) double click on Screening for Diabetic Nephropathy, enter appropriate comments and Save. To enable this HM Due alert, select the Risk Factor button on Most Recent Encounters and select Diabetes from the Past Medical History Section.

Measure Developer Description

0062 NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2)

who had a nephropathy screening test or evidence of nephropathy. This measure assesses the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who are susceptible to developing kidney disease as a comorbidity. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin (NIDDK 2007). It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death (NIDDK 2007). Diabetes of either type may cause life threatening, life ending or life altering complications, including end stage kidney disease. Diabetes is the primary cause of kidney failure, accounting for 44% of newly diagnosed cases in 2005 (NIDDK 2007). Clinical guidelines recommend regular testing to evaluate urine albumin excretions and serum creatinine and the estimated glomerular filtration rate derived from serum creatinine, in addition to comparing measurements when screening for chronic kidney disease (ADA 2009; ACCE 2007). This measure facilitates the prevention and long term management of kidney disease for patients diagnosed with diabetes. Clinical American Diabetes Association 2009 Recommendation Perform an annual test to assess urine albumin excretion in type 1 diabetic patients with diabetes duration of 5 years and in all type 2 diabetic patients, starting at diagnosis. (E) Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion. The serum creatinine should be used to estimate GFR and stage the level of chronic kidney disease (CKD), if present. (E) In the treatment of the nonpregnant patient with micro or macroalbuminuria, either ACE inhibitors or ARBs should be used. (A) Rationale American Association of Clinical Endocrinologists (AACE) 2007 Screen all patients with diabetes mellitus for chronic kidney disease annually; screening should begin 5 years after diagnosis in patients with Type I DM and at the time of diagnosis in patients with Type II DM. Testing includes: Measurement of albumin to creatinine ratio in a spot urine specimen and o measurement of the estimated glomerular filtration rate derived from serum creatinine The following are diagnostic criteria for chronic kidney disease: o Estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin to creatinine ratio 30 mg albumin/g creatinine Microalbuminuria 30 mg albumin/g creatinine Macroalbuminuria 300 mg albumin/g creatinine (Grade A) Prescribe an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker in the antihypertensive regimen in the absence of contraindications. (Grade A) American Geriatrics Society (AGS) 2003: A test for the presence of microalbumin should be performed at diagnosis in patients with type 2 diabetes mellitus. After the initial screening and in the absence of previously demonstrated macro or microalbuminuria, a test for the presence of microalbumin should be performed annually. (Level III, Grade A) NQF 0064 - Diabetes: LDL Control HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period and who have codified labs. The numerator on Part 1 (High LDL) increases when a codified lab, with a LDL of >=100 mg/dl is imported on a patient with diabetes. The numerator on Part 2 (LDL <100) increases when the imported, codified LDL is <100 mg/dl.

Measure Developer Description Rationale

0064 NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2) who had LDL C <100mg/dL. This measure assesses the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who demonstrate poor low density lipoprotein (LDL) cholesterol levels. Diabetes mellitus (diabetes) is a

group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin . It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including poor cholesterol, specifically LDL. Clinical guidelines recommend lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and increased physical activity (ADA 2009). Statin therapy is suggested for eligible patients whose levels are consistently and significantly higher (ADA 2009). This measure facilitates long term management of LDL cholesterol levels for patients diagnosed with diabetes. Clinical American Diabetes Association: In most adult patients, measure fasting lipid profile Recommendation at least annually. In adults with low risk lipid values (LDL cholesterol <100 mg/dl, HDL cholesterol >50 mg/dl, and triglycerides <150 mg/dl), lipid assessments may be repeated every 2 years. ACE/AACE: Aggressive management of dyslipidemia in patients with diabetes mellitus is critical; treat patients to achieve the following goal: LDL C <100 mg/dL (<70 mg/dL is recommended for patients with diabetes mellitus and coronary artery disease). NQF 0067 - Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD HOW TO DO THIS IN AC: This screening can only be met in patients aged 18 years and older who have had 2 visits during the reporting period. In Write Scripts or Current meds, add a medically indicated anticoagulant medication (if the patient is not already on one). Measure Developer Description 0067 AMA Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy. Rationale Oral antiplatelet therapy is recommended for all patients with coronary artery disease. By limiting the ability of clots to form in the arteries, antiplatelet agents have proven benefits in reducing the risk of non fatal myocardial infarction, nonfatal stroke and death. Clinical Chronic Stable Angina: Class I Aspirin 75 325 mg daily should be used routinely in Recommendation all patients with acute and chronic ischemic heart disease with or without manifest symptoms in the absence of contraindications. Class IIa Clopidogrel is recommended when aspirin is absolutely contraindicated. Class III Dipyridamole. Because even the usual oral doses of dipyridamole can enhance exercise induced myocardial ischemia in patients with stable angina, it should not be used as an antiplatelet agent (ACC/AHA/ACP ASIM). Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Class I Aspirin 75 to 325 mg/dl in the absence of contraindications. Class I Clopidogrel 75 qd for patients with a contraindication to ASA (ACC/AHA). Acute Myocardial Infarction (AMI): Class I A dose of aspirin, 160 to 325 mg, should be given on day one of AMI and continued indefinitely on a daily basis thereafter. Trials suggest long term use of aspirin in the postinfarction patient in a dose as low as 75 mg per day can be effective, with the likelihood that side effects can be reduced. Class IIb Other antiplatelet agents such as dipyridamole, ticlopidine or clopidogrel may be substituted if true aspirin allergy is present or if the patient is unresponsive to aspirin (ACC/AHA). Coronary Artery Bypass Graft Surgery: Aspirin is the drug of choice for prophylaxis against early saphenous graft thrombotic closure and should be considered a standard of care for the first postoperative year. In general, patients are continued on aspirin indefinitely, given its benefit in the secondary prevention of AMI. Ticlopidine is efficacious but offers no advantage over aspirin except as an alternative in the truly aspirin allergic patient. Clopidogrel offers the potential of fewer side effects compared with ticlopidine as an alternative to aspirin for platelet inhibition. Indobufen appears to be as effective as aspirin for saphenous graft patency over the first postoperative year but with fewer gastrointestinal side effects. Current evidence suggests that dipyridamole adds nothing to the aspirin

effect for saphenous graft patency (ACC/AHA). NQF 0074 - Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol HOW TO DO THIS IN AC: This screening can only be met in patients aged 18 years and older who have had 2 visits during the reporting period. In Write Scripts or Current meds, add a medically indicated lipid lowering medication (if the patient is not already on one). Measure Developer Description 0074 AMA Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines). Rationale Studies have demonstrated that active treatment with lipid lowering therapy is associated with stabilization and regression of coronary atherosclerotic plaques and decreased incidence of clinical events. Recent clinical trials have further documented that LDL lowering agents can decrease the risk of adverse ischemic events in patients with established CAD. Clinical The LDL C treatment goal is <100 mg/dl. Persons with established coronary heart Recommendation disease (CHD) who have a baseline LDL C 130 mg/dl should be started on a cholesterol lowering drug simultaneously with therapeutic lifestyle changes and control of nonlipid risk factors (National Cholesterol Education Program [NCEP]).

NQF 0084 - Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation HOW TO DO THIS IN AC: This screening can only be met in patients aged 18 years and older with Heart Failure and Atrial Fibrillation, who have had 2 visits during the reporting period. In Write Scripts or Current meds, add Warfarin, if medically indicated (and if the patient is not already taking this medication). Measure Developer Description Rationale 0084 AMA Percentage of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy. Adjusted dose warfarin is highly efficacious in preventing thromboembolism in patients with AF and should be prescribed for all patients with AF and heart failure except those with contraindications to anticoagulation. Physicians should prescribe anticoagulants in patients with HF who have paroxysmal or persistent atrial fibrillation or a previous thromboembolic event (Class I, Level of Evidence: A).

Clinical Recommendation

NQF 0575 - Diabetes: HbA1c Control (<8%) HOW TO DO THIS IN AC: This screening can only be met in patients with diabetes aged 18-75 years who have had a visit during the reporting period and who have codified labs. The numerator on this criteria increases when a codified lab, with a HgbA1C of less than 8% is imported on a patient with diabetes. Measure Developer Description Rationale 0575 NCQA The percentage of patients 1875 years of age with diabetes (type 1 or type 2) who had HbA1c <8.0%. This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who demonstrate adequate blood sugar control with an HbA1c level lower than 8 percent. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life threatening, life ending or life altering complications, including poor blood sugar control. Studies have shown that improved glycemic control is correlated with a 40% decline in the development of associated microvascular complications (i.e.,

eye, kidney and nerve diseases)( ADA 2009). Clinical guidelines recommend regular HbA1c testing to facilitate patients' ability to improve and sustain acceptable levels (ADA 2009). This measure facilitates the maintenance and long term management of adequate blood sugar levels for patients diagnosed with diabetes. Clinical American Geriatric Society: Recommendation For frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as 8% is appropriate. (Level III, Grade B) For older persons, target hemoglobin A1C should be individualized. A reasonable goal for A1C in relatively healthy adults with good functional status is 7% or lower. (Level III, Grade B) American Diabetes Association: Lowering A1C to below or around 7% has been shown to reduce microvascular and neuropathic complications of type 1 and type 2 diabetes. Therefore, for microvascular disease prevention, the A1C goal for nonpregnant adults in general is <7%. (A) In type 1 and type 2 diabetes, randomized controlled trials of intensive versus standard glycemic control have not shown a significant reduction in CVD outcomes during the randomized portion of the trials. Long term follow up of the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) cohorts suggests that treatment to A1C targets below or around 7% in the years soon after the diagnosis of diabetes is associated with long term reduction in risk of macrovascular disease. Until more evidence becomes available, the general goal of <7% appears reasonable for many adults for macrovascular risk reduction. (B) Subgroup analyses of clinical trials such as the DCCT and UKPDS and the microvascular evidence from the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) trial suggest a small but incremental benefit in microvascular outcomes with A1C values closer to normal. Therefore, for selected individual patients, providers might reasonably suggest even lower A1C goals than the general goal of <7%, if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Such patients might include those with short duration of diabetes, long life expectancy, and no significant CVD. (B) Conversely, less stringent A1C goals than the general goal of <7% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and extensive comorbid conditions and those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self management education, appropriate glucose monitoring, and effective doses of multiple glucose lowering agents including insulin. (C )

Administration
The Administrator Window is where you can gain access to adjust various practice-wide settings and
features. Administrators with Admin Level Access can open the Administrative Options window either from: o the initial Login Window or the Amazing Charts Desktop by manually typing ADMIN into the Username field, or

o From the Amazing Charts Desktop under the View | Administrator Options link

After successfully logging in, the Administrative Options window will open.

The Administrator (Admin) Window

From within the Administrative Options window, you can configure and set various aspects to
customize Amazing Charts for your practice. These include: o Amazing Charts Offsite Backup Icon: From here you can launch the Amazing Backup and adjust where to save your data. o Amazing Synchronizer Icon: Launches the Synchronizer so you can take your data off site. o Amazing Utilities Icon: From within this section you can run a variety of maintenance tasks and database tests. o Interfaces Icon: Activate one or more of our Amazing Charts interfaces to third-party products. o HIEs & RHIOs Icon: Add and edit web-based Health Information Exchanges for use within Amazing Charts. o Import/Export Icon: Import and Export practice-wide data. o Practice (Licensing Info) Icon: Here you can adjust your practice address and other information. o Scheduling (Setup/Edit) Icon: Add/Edit, and adjust the scheduling components in Amazing Charts. o User Account (Configuration) Icon: Add/Edit the Amazing Charts User settings. o User Security (Advanced) Icon: Here you can turn on advanced security features such as requiring that user passwords are a certain number of characters.

o Audit Log Report Icon: The audit log keeps track of all database changes and transactions that
occur in Amazing Charts.

o Set Health Maintenance Icon: From here you can review and update your Health Maintenance o o o o o o o o o

rules. Set Practice Documents Icon: Store frequently used documents so you can access them quickly. Set Practice Templates Icon: Manage the practice-wide templates. Set Prescription Format Icon: Select your State format, layout format and preview your scripts. Set e-Rx (e-Prescribing) Icon: Here you can apply for Electronic Prescribing and manage your e-Prescribing account. Define Orders & Order Sets Icon: Select and create orders & order sets. Edit existing orders to your specifications. Define Tracked Data Headings Icon: Allow the user to add and edit data that will be displayed for tracking on the patient's Summary Page. Define Formal Health Record Icon: Select the items that you wish to include when printing a patient's Formal Health Record. Define Quick Code for Billing Icon: Allows you to enter frequently used CPT codes (e.g., office tests) to facilitate signing of charts. Miscellaneous Preferences Icon: Set practice-wide preferences such as Make Charts Read-Only If Opened By Another Provider.

Advanced Tools In addition to these, there are other tools and options under the Administrative Window Menubar There are five separate entries on the Menubar: File, Tools, Help, Debugging and Automated Tasks. Clicking on File, will bring up the following drop down menu: Admin Window File Menubar

Advanced Options Within The Admin Window File Menu

o Audit Log: Launches the Audit Log Report. See Audit Log Report. o Add a New Facility or Location: Add a new facility or location that can then be notated on a Superbill. o Add/Edit PHRs: Add, edit, hide, remove and change the order of, any Personal Health Records listed in o o o o o o
Amazing Charts. Change Admin Password: Allows the Admin to change their password. Update License & Online Services: Not sure. Reset Automatic Update Check: Resets the Amazing Charts Online Updater. Reset Database Connection: Resets the path to the database, allows the user to select a database that resides in another location. Please see Amazing Utilities for more information. Reset All Practice and User Preferences to Default: Resets all user specific and practice specific options throughout Amazing Charts. Logout: Logs out of the Administrator Options if you logged in via the Login Screen, if not this will simply close the Administrator Options window.

o Close: Closes the Administrator Options window.


Admin Window Tools Menubar

o o o o o o o o o o

Amazing Backup: Launches the backup utility. Amazing Synchronizer: Launches the synchronization utility. Amazing Utilities: Launches the Amazing Utilities. Backup Restore Utility: Launches the Amazing Backup utility. Patient Charts: Unlock all charts: Selecting this option will override the Make Chart Read Only If Opened By Another Provider' option, in the Miscellaneous Preferences. This option will unlock the patient's chart and allow a Provider to update the chart. Imported Items: Repair missing files & links: Use this utility to correct issues with Imported Items. Imported Items: Signoff all unsigned items: Use this tool to sign off a batch of unsigned Imported Items. CPT Database: Modify available codes: Add, edit, and delete CPT codes. Migrate Vaccines To V5 Codified Format: Use this utility to migrate any free text vaccines to codified vaccines. Reverse Vaccine Migration: Reverts your migrated vaccines back to their free text state.

Admin Window Help Menubar

o o o o o

Contents: Opens the Amazing Charts user manual. Online Wiki: An online How-To-Guide for users. Get Live Support: Need live help? This option will direct you to our website so you can get help immediately. Recommended Improvements: Send us your ideas and suggestions on how to improve Amazing Charts. About Amazing Charts: Displays the current version number of Amazing Charts. Also shows system information and database location.

Admin Window Debugging Menubar

o Turn On/Off Auto Bug Submission: On by default, this option will automatically pop up a bug submission o o
window, should Amazing Charts encounter an error. Turn On/Off Intense Debugging Mode: Turning on Intense Debugging mode displays errors to the user and records these errors to an error log. Error Log: View, print or delete the Amazing Charts error log.

Admin Window Automated Tasks Menubar

o The Automated Tasks window allows the user to turn on and turn off automatic updates to the database. o Currently the Pharmacy Table, within the Meds database, is set to automatically update. This function will
add new Pharmacies to the database as they become available.

o The Database Update is also on by default, and is set to run at a predetermined time. You may change the o
time of the update from the Automated Tasks window, by typing in a new time, or by using the arrow buttons. To turn off the update, uncheck the Task Enabled' box. Backup: The Amazing Charts backup schedule is also listed under the Automated Tasks window. Click here for more information on setting up automated backups.

Logging Into The Admin Window

Logging In It is within the Administrator Options window that you can add or edit users, change schedules, adjust your database information, and otherwise fine-tune how Amazing Charts works in your practice. To log into the Admin window, click the View menu on the main Amazing Charts Desktop window | Administrator Options. o Alternately, the administrator can click Ctrl+A to quickly open the login window.

Log Into The Admin Window Under The View | Administrator Options Menu On The Amazing Charts Desktop

When the login window appears, you will notice that the Administrative / Program Settings option is Log in with your Admin password to access the administrator options features (or select the
Financials & Accounting option to access that section). selected by default.

The Admin Login Window

Once you have successfully logged into the Administration window, you can adjust various aspects of
the Amazing Charts program by clicking on the desired button.

Practice Information
Much of the practice information is collected during the initial setup steps when first installing Amazing Charts. You can edit this information by clicking the Practice (Licensing) button in the Administrative Options window.

Amazing Charts is licensed to your practice name, and our license code will only function with your
practice name. Thus, changing the practice name after Amazing Charts has been registered will deactivate your license. If you need to change your practice name, you should contact us before messing with this. In most circumstances

(i.e., you are in compliance with our End User License Agreement), we'll provide you an updated license code without additional charge.

User Tab
Access to the User Setup window is through the Administrator window. Click the User Account (Configuration) button in the Administrator window to access the Users window. Amazing Charts values the safety of PHI and protects it in a number of ways, including encrypted files for electronic
transmission, encrypting passwords, locking out the program after a period of disuse, and allowing the system administrator to set password protection protocols. Security of Protected Health Information (PHI) is of the utmost importance because of HIPAA laws, CCHIT certification requirements, but most importantly, because it is the right thing to do. Advanced security features are discussed here. Setting User Roles & Access Levels When creating a new user, or editing an existing user, the administrator must set the access level (role) for any user (staff member). This provides a means to restrict access to various aspects of patient chart and PHI data. Amazing Charts Provider Levels are designed to work in a practice settings where the providers have access to the most information, with subsequent reduction in privileges for other employees when necessary. Provider Levels are: Highest: Providers access to all clinical data, able to sign notes and sign off labs & items imported into the medical record. High: Mid-Level Providers, Medical Students requiring a supervising provider (the supervising provider is selected from a list of the Highest level providers). There are 2 sub-options for this role: o Notes may be signed by a mid-level and then cosigned by a supervising provider; or, o Notes may only signed by the supervising provider (charts must be forwarded, rather than saved)

Medium: Nursing Low: Secretarial Lowest: Auditing/Research System Administrator: The Administrator can access the Administration window only, but no clinical data or patient records (PHI) other than audit logs and data being exported en mass. The administrator password is set during the initial installation of Amazing Charts, and can be changed under the Administrative Window Maintenance tab.

Adding, Modifying, And Inactivating Users The Users window allows you to enter new users who will be allowed access to Amazing Charts, edit existing user information, and inactivate users. The administrator can also require passwords to be reset at regular intervals and adjust various security settings, described here. Initial Password: The Administrator setting up the account will set the initial password the clinician or staff member will use when first logging into Amazing Charts. o Upon logging into the system, the user must set their own password which will be encrypted and replace the temporary password entered by the Admin. o This is to ensure that only the specific user has access to the system under their own account. Resetting The Password: The Administrator has the ability to reset a password for an existing user (e.g, the user has forgotten theirs). o Since advanced security features can be set to lock-out a user after failing to log in correctly, the Admin has the ability to both lock and unlock a user account by checking the "Lock out" option under the specified user. o A user who fails to log in within the allowed number of attempts will automatically be locked out until the Admin provides a temporary password. o To reset a password, the Administrator logs into the Administrative Options Window, selects the User's tab, and then selects the Edit Existing User option as reviewed below. After selecting the specific user from the drop down menu, the Security Administrator may hit Reset Password and enter a new temporary password. o The next time the user signs in, they will be required to set their own password.

The User's Tab within the Administrator Window (accessed from the Amazing Charts Desktop Under The View Menubar, or CTRL-A).

Create a New User A new user can be added by selecting the add a new user option and filling in the information requested. When doing so you will also have to enter in a user security level and password. 1. Open Admin window (Under the View | Administrative Window on the Amazing Charts Desktop) 2. Click on User Account (Configuration) button. 3. Select Add New User. 4. Enter New Users information (including security access and their usual role within the practice). 5. Click Add This User. Modify an Existing User To edit an existing user select the edit user option and edit the appropriate information. 1. Open Admin window (Under the View | Administrative Window on the Amazing Charts Desktop). 2. Click on User Account (Configuration) button. 3. Select Edit Existing User. 4. Pick user to be edited from drop down menu (including any change in security access/role information described here). 5. Modify the information as needed and click Save Info. 6. Restart Amazing Charts. Inactivate (Remove) a User (And Transfer Any Remaining Appointments Scheduled With That Provider) To inactivate a user, select the edit user" option, then choose the user you wish to inactivate. Click the Deactivate button.

By doing this, Amazing Charts will check to see if the user has any scheduled appointments. If they do, these
previously scheduled appointments must be transferred to another provider to prevent the horror show of a patient showing up for a scheduled appointment only to find the appointment isn't in your system. o If there are appointments still scheduled with the provider you are inactivating, Amazing Charts will ask you to transfer those appointments to another. o Clicking yes you wish to transfer the appointments when prompted. o Amazing Charts will open another window where it will ask you if you are sure that you want to do this, since these changes are irreversible (so be sure you have backed up Amazing Charts before going through this process). o If you are sure, click on the button that says OK. o At this point you will have to select an active provider to whom you will be transferring the scheduled appointments. o Then click the Click here to transfer all appointments button. o The last step is to select the button that says transfer appointments. o Amazing Charts will transfer the appointments to the selected provider. o Once completed the program will take you to the user tab where you can now hit the Deactivate button. After any of these actions you will need to hit the Save Changes button and restart the program in order for the changes to take affect. (Any users running Amazing Charts will have to restart the program or errors may occur.) To inactivate a user, follow these steps: 1. Open Admin window (Under the View | Administrative Window on the Amazing Charts Desktop) 2. Click on User Account (Configuration) button. 3. Select Edit Existing User. 4. Pick the user to be inactivated from the drop down menu. 5. Click Deactivate This User button. 6. Restart Amazing Charts.

The Confirmation Message Please note that all users must restart Amazing Charts for these changes to take effect.

User Security
Amazing Charts provides the system administrator (Admin) the ability to customize how much security is required for
access to Amazing Charts. This includes advanced security features that is accessible in the Administrative window by clicking the User Security (Advanced) button.

When clicked, the Security Access (Advanced) window will open.

The Security Access Window (opened from the Administrator Window | User Security (Access option)).

Within The advanced security window, the Administrator can define password standards for all users The Administrator can require passwords to be case sensitive, require a certain minimum number of
characters, and other options to decrease the risk of a security breach. Of course this needs to be balanced against the usability of getting into Amazing Charts to run your practice. The Administrator is able to activate any combination of user security settings, including activating all of the settings simultaneously. For overall usability during the trial period, the security options are set to off by default. To enable these options, select the ON' option located within the Enhanced Security area on the left side of the window. of Amazing Charts.

The various security features include: Require passwords to be case sensitive: Turning on this option will require that the user must have at least one capitalized letter in their password. (e.g. myPassword) Enabling this option will open a box to confirm the effect.

Selecting Yes' will prompt the Admin Password window to pop up. Enter your password to continue.

Require passwords to be alpha numeric: Turning on this option will require that the user must
have at least one numeral in their password. (e.g. mypassword1) Require passwords to be a minimum number of characters: Select this option to specify a minimum amount of characters a password must have. You can select between 3 and 10 characters as the minimum. Require user to change their password at set intervals: By default, this option is set to Do not require passwords to be changed'. However, the Administrator can set a password reset at the following intervals: 7 days, 14 days, 21 days, 2 months, 6 months, and annually.

Prevent users from using the same password used previously: Setting this option will restrict
the user from repeating a password. Select the number of previously used passwords, up to four, from the drop down list. You may also manually enter in the number of passwords a user cannot repeat.

Require Amazing Charts to log out after a period of inactivity: Set the duration, in minutes, in
which Amazing Charts will automatically log out if there is no input by the user. You can select from 1 minute to 30.

Lock-out a user after a failed number of log in attempts: The default setting is 10 attempts;
however, you can set this to as low as one attempt. Once a user is locked out, the Administrator will have to reset the user's password. Login Message: Set a message to display on the Amazing Charts login. This can be anything you wish, such as a friendly reminder about security.

Your message will show on the login screen

Once you are done making changes to any of the advanced user security settings, click on the Save Info' button. You will receive a confirmation message, noting that Amazing Charts will need to be restarted to implement the
changes.

Templates tab
In addition to being able to edit ones personal templates while working, practice-wide templates and
other global template changes can be configured within the Administrative window by clicking the Set Practice Templates button. Templates changes made here are not reversible, so ensure you have an adequate backup before adjusting templates from the Admin window.

The Templates window allows the Administrator to add, edit, or remove templates as required. When you are done editing templates, click the Close Window button, located in the lower left hand
corner (or the red X at the top right of the window).

Filtering Templates: To make editing and finding a template easier, you can filter and sort the
templates. To filter the templates, click the drop down arrow at the top of the screen. Filter the results to Show All Templates, CC, ROS, HPI, PMH, ALL, SH, FH, MEDS, PE, ASS, PLAN, COMMENTS, LETTER, ORDERS, ADDENDUM, EMAIL, REMINDER, SIGNOFF, and RESULTS.

Sorting Templates: Click the column header to sort Templates by the header's name. For example,
click the header User' to alphabetically sort templates by user name:

You can also display only those templates that are shared. To do so, click the check box next to
Show Shared Only'. Shared templates appear on the Practice-Wide Template area in the Template window accessible from most textboxes in Amazing Charts.

Overview of Template Structure

Templates have the following properties: o Location: The textbox in Amazing Charts that the template will be available for selecting. For o User: The name of the user who created the template. If you create a template while in the o o o o
Set Practice Templates screen, the user will be listed as ADMIN. Template Name: The title, or name, of the template. This will be shown when selecting a template for use in a chart or other textbox from which templates are selected. Text: This contains whatever clinical data, verbiage, or other description that is the information added to the textbox when using templates. Shared: Setting a template as shared will enable other users to view and to use that template. To set a template as shared, simply click the shared checkbox. These templates appear in the Practice-Wide Templates area of the template window. Weighting: Enter a numeric value to designate the weighting of a template. This is an advanced feature used for E&M Coding functionality.

example ROS templates are available in the Review of Symptoms textbox of the patient chart.

Adding New Templates

To add a template, click the Add Templates' button at the bottom of the screen. Next click the drop down arrow, under Location' to select where the template will be accessible. Next, enter the Template Name, or Title, of this template Finally, click the field under Template Text' to add the actual template text that will be added to the specified textbox when selecting this template. When you are done creating the template, click the Add Template' button to save your changes.

Editing Existing Templates

To edit a template, select the existing template from the list that you wish to alter. Click the Edit Template' button at the bottom of the screen. The Locations, Name, and Text will be Make the changes and when complete, click the Save Changes' button. o Alternately, you can edit a template by selecting the template and then editing the
populated with the selected information.

information directly within the grid, and change the Location of the template using the drop down menu:

Copy Templates Between Providers

This feature allows the Administrator to transfer one user's existing templates to another provider. To do this, select the Copy Templates to Provider options, then select the Provider's username whose
templates you wish to copy by clicking the drop down arrow located under Copy Templates From'. Next, select the Provider that will be receiving the template by selecting their name in the Add These Templates To' drop down list. Once the selections are made, click the Copy Templates' button to transfer the templates.

Delete Templates

To delete a template, select it from the grid and then click the Delete Template' button in the upper right hand corner of the screen. You cannot recover a deleted template.

Tracked Data tab


Configure the items you wish to include on the Tracked Data window in the Admin section of Amazing
Charts.

Click The Define Tracked Data Headings To Adjust Which Items You Tend To Track Add A New Tracked Item To add a new tracked data item, click the field near the asterisk (*) at the bottom of the item list. A flashing cursor will show up in the field. You may then type in your new item within the field. Hit the enter key to finish. You can continue to add new items by clicking the empty field.

Edit An Existing Tracked Item To edit an existing tracked data item type, double click the name of the item you wish to adjust and then make your changes. Click the enter key to save the changes.

Delete A Tracked Item To delete an existing item, highlight the item you wish to delete and then click the Delete Item' button.

When you are done editing Tracked Data Items, click Save' to save your changes, then click Close
Window' to exit the screen.

Financial Data
Summary of Financial data is accessible via the Admin window. When logging into the Admin window (under the View | Administrative Options menubar), select the Financial option.

Change The Admin Password


To change your Administrative Options password, select File' then select Change Admin Password', from the
Administrative Options window.

The Change Password for ADMIN screen

To change your password, enter your current password in the provided field. Enter you new password in the New
Password field. You may enter up to 15 characters for your new password. Re-enter your new password in the last field. Click OK' to save your new password, or Cancel' to discard any changes. When your enter new password, its strength will displayed under the Your New Password Strength.' Mixing capital and lowercase letters, adding numerals, and special characters, such as %, will add to the password's strength.

A poor password, less than six characters.

A fair password has some variation.

A good password will have more variation and special characters.

ePrescribing Setup
You can access the Administrative options from the View menu at the top of the main screen and entering in your ADMIN password or by logging in as ADMIN by manually typing ADMIN into the Username field of the login screen and entering your ADMIN password.

From the users screen you will need to click on the Edit an Existing User button located in the light purple menu pane to the left of the screen. Once you have selected to Edit an Existing User you must select the staff member you wish to enable prescribing rights for using the drop down arrow to the right of the Pick A User to Edit box located near the top of the users window.

Once you have selected the staff member you would like to enable prescribing for, you must check off the box marked as Allow user to prescribe located near the bottom of the users window and then select a provider to prescribe for. Then click Save Info. You can change the provider later, when writing a prescription.

Configuring Automatic Backup


Access the Automated Task window in the Admin Automated Tasks menubar. To adjust the Backup settings, click Backup' in the Tasks window. You will see when the next backup is scheduled to run. You can alter this time by typing in a new time, or using the
up and down arrows, next to the time field. We recommend you set the backup utility to send a message on each successful (or unsuccessful) completion of a backup. o To do so, check the box next to Send confirmation message on successful backup.' o Select the recipient of the confirmation name by selecting the name of the user, using the drop down menu next to the Send confirmation/error message to:' field.

Set Amazing Charts Backup To Inform A User (Or Group Of Users) The Status Of The Automated Backup

o To turn off the feature, uncheck the Task Enabled' box.

The Automated Task Window With Backup Settings

Backup Settings: To access the advanced backup settings, click the Backup Settings' button. Here you can set up multiple locations for the backup. These locations can be on the same computer, another You can also set other options, such as whether or not to include Imported Items with the backup. Please see the Amazing Backup section for more information.
computer on the network, or an external drive.

Audit Log
The Audit Log keeps track of all database changes and transactions that occur in Amazing Charts. If a record is changed, such as the addition or modification of a user, viewing, opening, or
documenting a clinical record, etc., this data is automatically stored in the Audit Log. Access the Audit Log by clicking on the Audit Log Report icon, on the Administrative Options window.

Accessing The Audit Log

The Audit Log is list of all happenings in Amazing Charts. Everything that any user does in Amazing
Charts is recorded for medicolegal reasons in the Audit Log. The Audit Log includes Patient ID, Name, and Date of Birth, User name, what actions the user performed (for example viewing patient information or signing a note), and what date and time the user performed these actions.

The Audit Log In Amazing Charts

At the top of the Audit Log window there are filters that can be applied to make looking for specific
information within the Audit Log easier. You can apply some, or all, of these filters simultaneously.

Filter The Audit Log To Make Analyzing The Data Easier

Filter By User: Defaults to All'. Click the drop down arrow to the right to select the name of a
specific user. Doing so will automatically filter the Log to show you only those actions performed by this user. Filter By Patient: Defaults to All'. Click the drop down arrow to the right to select the name of a specific patient. Doing so will automatically filter the Log to show you all activity on this patient's chart. Audit Start Date, Audit End Date: By default both will be populated with the date in which you access the Audit Log. Select the date range by clicking on the arrow on the right. A calendar will pop up, allowing you to select the appropriate date. You can also click on the day, month and year, and type the date. The Audit Log will refresh automatically with the new data.

The report generated by the Audit Log is divided into several columns. These include:

DateTime: The date and time a specific operation was performed. PatientID: The ID of a Patient in Amazing Charts. This column will only have data in it if a patient
chart is being accessed.

UserName: The name of the person who performed the operation listed. Operation: The type of operation performed. Operations are LOG ON, INSERT, DELETE, FORWARD,
etc. Description: A brief description of the operation. For example, the operation LOG ON will have a description USER NAME logged on. TableName: Refers to the location of data with the SQL database. Location: Refers to where this particular action was performed. An example would be Front Office PC, referring to the computer's name on the network. EventOutcome: Shows whether or not the operation was successful. Other possible messages are FAILURE and ACCESS DENIED.

Additional Audit Log Analysis Columns can be sorted by clicking on the header of the specific column. For example click the DateTime header to sort the information by date and time. The column can also be expanded to make reading the entries easier. Move the mouse cursor to the column separator until the cursor changes to a double ended arrow, the drag the mouse while holding the left mouse button.

You Can Widen One Or More Columns To Make Reading The Information Easier

Printing the Audit Log Report: You may print the Audit Log by simply clicking on the Print button in the lower right hand corner of the Audit Log screen.

Doing so will pull up a preview of the document to be printed:

To print the report click the printer icon in the upper left hand corner, and select your printer:

You may also wish to export the report. You can export the report as a text file, or as an .html file, viewable in any web browser. Click on the export icon in the upper left corner of the screen. Select the where the file is to be saved, and select the type of file:

Direct access to the Amazing Charts database is prohibited as such access may allow the Audit Log to be altered (either inadvertently or intentionally) or may allow PHI to be accessed without a logging of such activity. Since the Audit Log is a legal document that can be used in court, it must never be modified, altered, or bypassed. When you are finished viewing or printing information, click the Close Window' button in the lower left hand corner to exit the Audit Log Report.

Interfaces tab
Amazing Charts is able to interface with many third-party software and hardware applications. Various interfaces, To turn on one or more of these interfaces, click the Interface button in the Administrative Options window.
such as laboratory results, bi-directional ties to practice management, and equipment interfaces are available.

The Interfaces window will open.

Software interfaces or interfaces to labs, radiology, or other parties should be activated on the main Hardware interfaces, such as the Midmark Spirometer, should be activated on each computer on
which the device will be connected. To activate an interface, scroll through the interface window to find the name of the third-party service that you would like to activate. Double-click the name of the interface, and a new window will open, outlining whatever steps are necessary to activate that specific connection. computer where the Amazing Charts database is located.

Usually the following steps are required:


1. Click the Try It' button. A web browser will open up, detailing information about the interface, and pricing information.

2. Highlight the trial code, copy it, and then paste the trial number into the field provided.

3. Click the Install Files' button that will install any necessary files or folders that will be needed for the interface to function. 4. Click Save' to finish activating the interface, if necessary. 5. A confirmation window will appear letting you know that the interface activation was successful. Click OK' to continue.

When you are finished activating interfaces, click the Close Window' button on the Interfaces screen. You can now close the Administrative Options and go back to the main window in Amazing Charts. Once the lab (or other interface) company has pointed their software to place the files in their respective folder (and
tested to ensure it is working correctly), staff can start importing.

Define The Formal Health Record


The Define Formal Health Record window can be accessed by clicking on the Define Formal Health
Record icon, in the Administrator Options section.

Define What Is To Be Included In the Formal Health Record Through The Admin Window

Within this screen you can choose which items to include when printing a patient's formal health
record.

Select the items to include by clicking the check box next to the entry. Items selected will be included automatically when printing a patient's medical record. o These can be adjusted at the time of printing When you are done editing your selections, click the Save' button to save your changes and exit the
screen. To print a Formal Health Record, click here.

Configure Health Maintenance


You can configure the Health Maintenance (HM, or Decision Support) module, including setting up and
editing practice-wide Health Maintenance rules, by clicking on the Set Health Maintenance button in the Administrator Options window. To adjust how one or more rules are applied to an individual patient - and not to all patients within the practice - click here.

Health Maintenance & Decision Support for individual patient's is accessed by clicking the Decision
Support button within the patient chart. Setting Which Rules To Apply To Your Patients The Health Maintenance & Decision Support window allows you to search and filter the rules and decide how they should be applied within your practice. To set your own preferences and configure the decision support for health maintenance guidelines, click the Set Practice Preferences for HM button

Click The Set Practice Preference For HM Button To Adjust Health Maintenance Rules For Your Practice

When you click the Set Practice Preferences for HM button, the Health Maintenance Health Module Preferences
window will open. Turn on or off various settings to select which USPSTF grades you wish to apply to your patients. Click the Save button when finished to activate your changes.

Turn On Or Off USPSTF Recommendations In The Health Maintenance Module Preferences Window

You can search existing rules, and select filters to apply to the search. You can also inactivate rules you do not wish to use by selecting a rule and clicking the Inactivate button.

Adding Decision Support Rules You can add your own decision support rules from within the Manage Decision Support Rules window. Click the Add A Rule button to begin the process. Select the rule type and then fill in the Recommendation verbiage in the textbox. Add a web link and rule reference, if applicable. Set the parameters that Amazing Charts will apply with regard to patient age, frequency for age, frequency, etc. Amazing Charts will check these parameters and variables against the specific patient and alert the user to the rule if the settings match the patient.

Add A Decision Support Rule That Will Be Applied To Patients Within The Practice

When you are satisfied with your entries, click Add button. To add more specific criteria and conditions, such as diagnoses, click the Additional Settings tab after saving the new
rule.

Detailed Conditions Can Be Added To The Decision Support Rule

Here you can add one or more criteria that must apply for the rule to be triggered. Select the Name, Operator and Value, then click Add'. Repeat these steps to add additional criteria. To clear a rule, highlight the desired row within the grid and hit the Clear button.

To adjust how the criteria will be applied to each patient, double-click the row, which will bring up additional options.

Once you are done editing and adding criteria to the rule, hit the Save' button to close out the Rule Settings window,
and to return to the Manage Decision Support Rules window. Editing Decision Support Rules To edit an existing rule, select it from the list and adjust the parameters as outlined above. Note that adding and editing rules in the Manage Decision Support Rules window will effect all patients in the practice. To edit an individual patient's rules, and not affect all patient in the practice, use the Edit Rules For This Patient Only option described here.

Configure Health Information Exchanges (HIEs & RHIOs)


Health Information Exchanges (HIEs) and Regional Health Information Organizations (RHIOs) with
websites through which you can log into your own account can be configured in Amazing Charts to automatically populate the username and password fields. To configure HIEs and RHIOs, click the HIEs & RHIOs button in the Admin Window.

Configure Access To Your Local HIEs Or RHIOs From The Admin Window

The Health Information Exchanges (HIEs) window is used to store and configure access to an online
exchange by storing the URL and login credentials for quicker access directly through Amazing Charts. It is possible to add multiple HIEs (Health Information Exchanges) and RHIOs (Regional Health Information Organizations).

The Health Information Exchanges (HIE) Window Add An HIE To add a new HIE or RHIO, click the Add New' button. The HIE Login Configuration window will open. o Enter the name of the HIE or RHIO, and enter the login URL in the space provided. o Enter the Page Title of the login screen, or click the Get Page Title Automatically'. This is needed so Amazing Charts knows when the page has loaded correctly and is ready to be populated with the login and password information.

o Click the Test' button, a new window will appear, asking you to save your user name and
password. Click OK' to continue. future access.

o Enter your logon credentials, if required, and log into the site. The information will be saved for

Edit An HIE To edit an existing HIE or RHIO, highlight (select) the entry by left clicking the name. Then click the Edit button. Once you have made the changes, click the Save And Close' button.

Remove An HIE To remove an entry, highlight the site you wish to remove, and then click the Remove' button. Test An HIE You can test the automated login process by clicking the Test' button. Accessing An HIE or RHIO Access to the HIE or RHIOs occurs in the Imported Items window of the patient chart, or in the Orders Window.

Configure Place Of Service (PoS) Facilities


Use the Add a New Facility or Location function within the Admin window to add a new office location or Place of These are used when billing an encounter. To access this function, open the Administrative Options, then click File', then Add a New Facility or Location.'
Service (PoS).

Add the required information in the Offices And Facilities window that opens.

Adding, Editing and Removing an Office To add a new office location, type in the name and address of the new location, then click the Add' button. The new location will be added to the Office Location window.

To edit an existing entry, highlight the name in the Office Location window, edit the fields that need to be changed, To remove a location, highlight the name of the location, and click the Remove' button.
then click the Save' button.

Adding, Editing and Removing a Facility Adding, editing and removing new facilities are handled in the same manner that office locations are handled. In addition to the steps done for office locations, facilities frequently have a code associated with them that is required for proper billing. You can select the type of facility by clicking on the drop down menu under the Type Code' field. You may also enter a two digit place of service code in this field as well:

Place Of Service (PoS) Codes Used For Billing

When you are finished adding office locations and facilities click the Close' button to exit.

Add Patient Portal Connections To PHRs


To add or edit connections to various PHRs, click File' menu in the Admin window, then select Add/Edit PHRs' from
the Administrative Options window.

Adding A PHR To add a PHR double click within a blank row and type the name of the PHR into the space. Click the Save' button. The new PHR is added to the list.

To Edit Or Remove a PHR To edit an existing PHR, double click the name, and type in a new name for the PHR. You may also change the order in which the PHRs are displayed by clicking and dragging the row up or down. To remove a PHR simply check the box under the Remove column, then hit Save.' The entry will be removed the next time you enter the Add/Edit PHR screen. o Note that you will not be able to remove any PHR that has its Remove column grayed out.

Configure Practice Documents


The Set Practice Documents window can be accessed by clicking on the Set Practice Documents button in the Administrator Options window of Amazing Charts.

Practice Documents are files or websites that you frequently print and/or use for your patients. Amazing Charts can store these commonly used documents for easy access from a number of places
within Amazing Charts, including the Orders Window | Patient Education tab, the Most Recent Encounter window, the Demographics window and the Amazing Charts Desktop. These documents can be anything from patient education to practice administration documents.

Adding A Document You can add document by linking to them directly through the Internet, or you can add a document that is already located on a computer. (This can be on a local computer, or even another computer on your network.) Adding Documents From Online Sources: To add an online document, click one of the icons located at the top of the Practice Documents screen. Amazing Charts has included links to Up To Date, the Amazing Charts Online Repository, and to FamilyDoctor.org. Clicking on any one of the links will launch a web browser and direct you to that specific page. Once you find the information that you are looking for save the file to your computer's Desktop, or other location (don't break any copyright laws of course). Once you have the file saved click the Add A Document' button and browse to the location of the document and select open. You will now see the document in the Practice Documents window. Adding a Local Document: To add a document that is already stored on your computer, click the Add A Document' button, browse to the location, and click open.

To add a document located on the network, click the Add A Document' button, browse the network The document is added to the Practice Documents window.
to find the location of the file, and click open.

Editing A Document To rename a document from its default file name, right click the document's name in the list and a menu will appear. Click the Rename' option, and the Document Name window will appear. Enter the new name and click OK'.

To give the document a description, double click the description field. The Document Description
window will open, enter the name and click OK'. o Alternatively, you can right click the description field to bring up the context menu, and left click to select the Edit Description' option.

The document has now been renamed and given a new description:

Deleting a Document: To delete a document, highlight the document you wish to delete, and then click the Delete Selected Document' button. Viewing a Document: To view a document, simply double click the document name, or highlight the document and click the View Document' button. Importing a Document: If you are using Practice Documents from within a patient chart, you can directly import the item into the patient chart from within the Imported Items tab. When in the Imported Item window of the patient chart, click the Import button, then Import From Your Practice Documents Library' (or ctrl + d). Select the document, and then click Import Selected Document' in the lower right hand corner.

You will receive a confirmation message, and a dialogue box, asking if you would like to Import more
files.

Select Import From Practice Documents Library':

Select the file, click Import Selected File':

The file is now imported, and viewable in the patient's imported items:

Fix Imported Items Errors


The Imported Item Repair Utility is used to restore Imported Items to their correct place within the Amazing Charts
database. Use this utility if you are experiencing errors when accessing a patient's Imported Items. You should only run this utility after making a backup of Amazing Charts. You should only run this utility on the main Amazing Charts computer (or server). You should only run this utility if there are no other users logged into the system. To access the Imported Items utility, click Tools', and then click Imported Items: Repair missing links & files', on the Administrative window menu.

Access The Import Repair Utility Through The Tools Menu Of The Amazing Charts Administrator Window

The Imported Items Repair Utility window will open.

The Imported Item Repair Utility Has Three Steps

There are three steps to the Imported Items Repair utility. These steps should be performed in order. Please keep in mind that depending on the size of the database and the Do not interrupt or stop this process once it has been started.
size of the Imported Items folder, this process may take some time (minutes to hours).

o Step 1. Resurrect Incorrectly Tagged Items: This will repair items that are missing in a patient's
Imported Items. Any items that are found will show up in the default Provider's Inbox for sign-off.

o Step 2. Recover Lost Files: This step will make sure that a patient's Imported Items are saved to the
database.

o Step 3. Remove Bad Links: This step removes links that are pointing to files that no longer exist in the
patient's Imported Items. A backup of your data will be run during this step. Even though you may have made a backup, another one is made just to be damn sure.

The utility will inform you of what it finds and fixes.

Patient Images The Imported Item Repair Utility can also repair missing patient pictures (the ones in the Demographics window). To access this part of the utility, click the Patient Photos tab, then click the Remove Links to Missing Patient Photographs' button. You will receive a confirmation dialog box, stating that the process is complete, and whether or not there were any links removed.

To close the Imported Item Repair Utility, click the red X' at the top right of the window.

Interfaces
Amazing Charts offers an ever-growing list of interfaces which allow integration to other types of
software and services. All interfaces are turned on in the Admin section, under the Interface tab (see below). Select the desired interface and follow the directions to activate the link and install any required software. Most interfaces permit a free trial period during which you can determine if the interface is worth the added cost. Most interfaces have a onetime charge to activate the service, and are not re-billed so long as your practice subscribes to our Amazing Charts Guardian Angel Support (which allows us to update the link as this is required).

Electronic Prescribing
Electronic Prescribing is one of the 15 Core Criteria needed to meet Meaningful Use Standards. In order to use E-Prescribing in Amazing Charts you must subscribe to our Guardian Angel Support service and submit your credentials for verification through the program. You can purchase support from your account page which you can log in to at www.amazingcharts.net/ac. To submit your credentials for verification, you will need to go to the set e-Rx (e-Prescribing) window in the admin options. You can access the Administrative options from the View menu at the top of the main screen and entering in your ADMIN password or by logging in as ADMIN by manually typing ADMIN into the Username field of the login screen and entering your ADMIN password.

Once the admin options are open, click on the set e-rx button to view the electronic prescribing interface window.

Once the Set e-Rx window is open click on the Verify Credentials button.

You will receive a pop-up message telling you which email address your Amazing Charts account is tied to. If this address is incorrect, please log into your account page and update your account info so the proper email address is listed before submitting for verification.

If your email address is current then click the OK button and you will be taken to a website where you will need to fill out an electronic form with the proper account email address and other practice information.

Once you have completed and submitted the online form you will be taken to the AMAZING CHARTS ELECTRONIC PRESCRIBING LICENSE AGREEMENT. You must print this entire document on your practice letterhead, read, agree, sign, and date the contract. Once the document is completed you must fax the document to 866-929-6691. Verification of your credentials can take up to two weeks. Once verification is completed you will receive your verification code to activate the electronic prescribing service in your email account tied to your Amazing Chats license. Note: If any of the above steps are not completed you will not receive your verification code and the entire process may need to be performed a second time. Once you have received your verification code go back to the Administrative Options and open the Set e-Rx window again. Enter your code in the field for Step 2 in the box for Part A. In the Part B box, click the Activate Interface button. A new window will open asking you to agree to the terms of use for New Crop e-prescribing interface. You will need to read through the agreement and click the Agree button at the bottom of the page. The information in the Part C box will be pull from you're the Practice (Licensing Info) page in the Administrative Options. Make sure all red fields are populated and that none of them go over the character field limits. If you see a number in red next to a field you will need to shorten the entry. This will not affect your practice info, it will just ensure what you send through the New Crop interface meets their character limitations. Part D allows you to set which provider will receive renewals that cannot be matched to a provider in Amazing Carts. Part E offers you the Disable this interface checkbox should you opt not to use e-prescribing and the Account Administration button will open the New Crop Manager Page which will provide you with a list of the users and their user levels according to New Crop. The Save button is also in this section so you can save any changes made in this window.

Once the interface is activated you will want to make sure all user information is entered appropriately in the User Account (Configuration) section of the Administrative Options.

Providers must have License #, State, DEA #, and NPI (National Provider Identifier) entered along with all standard information required for any Amazing Charts user.

Once all user information has been properly entered and updated user can begin electronically prescribing. The Amazing Charts medication window provides access to print or fax prescriptions and manage a patient's medication list. In addition, Amazing Charts offers an interface to electronic prescribing as well as to EpocratesRx Online. Amazing Charts support electronic prescribing through New Crop, LLC. This interface allows secure data exchange with Sure Scripts for just $35/month for each full time prescriber. Amazing Charts E-prescribing includes:

Electronic prescription delivery via Surescripts Messenger Services or via faxing nationwide Comprehensive medication reference from Lexi-Comp Comprehensive managed care formulary from MediMedia and RxHub Medicare Part D Formularies Practice-wide refill management from one screen Automated allergy and drug review from First Data Bank Patient medication hand-outs (in 18 languages)
Registered users can activate Amazing Charts' e-prescribing features under the Administration section of the Amazing Charts EHR. More information on this interface is available on our website. Once activated, you can access the ePrescribing in the medication window's Electronic Prescribing tab. When you click this tab, patient information will appear in the window, downloaded securely from New Crop. You will also be given the ability to download and synchronize your local medication list with their active list online.

Epocrates
Amazing Charts ties to Epocrates online under the Drug Information Tab in the Medication Window. Clicking the tab will open Epocrates.

The first time it is used, you will need to enter your username and password to access EpocratesRX data. Amazing Charts supports both the free and the pro version.

Midmark/Brentwood Hardware
Amazing Charts Electronic Health Record software can interface directly with Midmark, a trusted leader in integrated digital diagnostic devices. You save time and reduce data entry errors by populating patient information directly from your Amazing Charts EHR software. Amazing Charts currently supports the IQ Digital Diagnostics System a combination of digital diagnostic devices and software solutions that make it fast and easy to capture, interpret and retrieve patient information. These products include: The Midmark IQecg makes your job easier with a range of reviewing and editing tools to help increase productivity and efficiency. The Midmark IQspiro Digital Spirometry System combines a digital spirometer with innovative software solutions that make it fast and easy to capture, interpret and retrieve patient information. The IQholter recorder is small and lightweight, making it easy and comfortable for your patient to wear. The readable, well-lit display and intuitive keypad make clinician navigation and menu control simple. Try It Free Try our import ability free for a 30 day trial period by entering Interface Trial Code 39SL457 in the space provided in Amazing Charts. Then Buy It If you wish to continue with the interface after the trial period, the cost is: $250 per practice (one time charge for those who subscribe to our Annual Updates & Upgrade plan*). Only Subscribers to our Guardian Angel Software Maintenance plan do not have to purchase annual interface licenses. Those who do not subscribe to this annual plan must renew interface licenses annually.

Holter
Amazing Charts can interface, and control, Midmark / Brentwood equipment, including their EZ Holter and Advance Holter. The equipment would need to be installed on your computer for the interface to function correctly.

Once their hardware is installed on the desired computer, turn on the interface in the Admin section of Amazing Charts. You can try our interface free to see if it works for you before paying. Follow the instructions below to activate Midmark Holter Interface.

Start off by double clicking on Midmark / IQmark Digital Holter. The new window will appear. Enter the 30 day trial code 39SL457, or enter the purchased code (provided by us). Once all the information has been entered, go to step 3 and Install the files, this process will take a few minutes. Finally, to finish the activation process, click on Save.

ECG
Amazing Charts can interface, and control, Midmark / Brentwood equipment, including their EZ Holter and Advance Holter. The equipment would need to be installed on your computer for the interface to function correctly. Once their hardware is installed on the desired computer, turn on the interface in the Admin section of Amazing Charts. You can try our interface free to see if it works for you before paying. Follow the instructions below to activate Midmark Holter Interface.

Start off by double clicking on Midmark / IQmark Digital ECG. The new window will appear. Enter the 30 day trial code 39SL457, or enter the purchased code (provided by us). Once all the information has been entered, go to step 3 and Install the files, this process will take a few minutes. Finally, to finish the activation process, click on Save.

Spirometry

Amazing Charts can interface, and control, Midmark / Brentwood equipment, including their EZ Holter and Advance Holter. The equipment would need to be installed on your computer for the interface to function correctly. Once their hardware is installed on the desired computer, turn on the interface in the Admin section of Amazing Charts. You can try our interface free to see if it works for you before paying. Follow the instructions below to activate Midmark Holter Interface.

Start off by double clicking on Midmark / IQmark Digital Spirometer. The new window will appear. Enter the 30 day trial code 39SL457, or enter the purchased code (provided by us). Once all the information has been entered, go to step 3 and Install the files, this process will take a few minutes. Finally, to finish the activation process, click on Save.

Handwriting Recognition
Tablet PCs come with integrated software which can recognize ones handwriting and transform it into typed text. Amazing Charts works seamlessly with this technology. Simply turn on handwriting recognition on your tablet PC, and the converted handwriting will be placed into the active text box in Amazing Charts. The trick is to be sure the cursor is in the desired text box, so the text is placed into that text box when the tablet operating system translates your scribble into text.

Voice Recognition
Amazing Charts works seamlessly with Dragon Naturally Speaking, Windows voice recognition software, and others. Install the voice recognition software and when run, your dictation will be placed into the active text box in Amazing Charts. The trick is to be sure the cursor is in the correct text box so the dictated words are placed in the correct text box. You can also use verbal commands to navigate around Amazing Charts. We are continually adding new control keys to allow verbal navigation of all parts of the program. If you find a key control missing, please let us know what you need added at our Recommend Improvements link. A note about Dragon Naturally Speaking (DNS) V10 and higher. We have learned that Nuance (the company that makes this) has added code into this version that prevents DNS Preferred from working with EHRs, including Amazing Charts. Seems Nuance feels docs can afford their significantly more expensive Medical version. While we feel this is a sleazy move, we don't have any say in the matter, and would usually tell you to use a competing application to hopefully encourage them to rethink this rather lame move - unfortunately, DNS is pretty amazing software, and so far we've not found a competitor that is as easy to use as Dragon. Thus, if you can find V9 or 9.5 preferred - that will work great, but V10 requires the Medical addition to function with EHRs. Join the discussion regarding this topic on our bulletin board.

X-Link
X Link software is a middleware program that allows various different types of software to communicate with each other. In this case, it allows Amazing Charts to have a bidirectional link to various practice management programs, including NDC Medisoft, Lytec, Medical Manager, Alta Point, AdvanceMD, and others (below is a more updated list). Here are some of the more frequently asked questions regarding X-Link, and more information is also available on our website. I have purchased Xlink. Is that all I need to get started? No, you will need to purchase the Amazing Charts interface that connects out program to Xlink (though there is a free 30 day trial code available which you can get by turning on the interface in Amazing Charts' Admin | Interfaces tab, under the X-Link option). Is there a charge for your interface? Yes there is a onetime charge of $500 if you have the Amazing Charts support plan. If you do not subscribe to the Amazing Charts support plan then the interface charge is a $500 yearly fee. There is a free 30 day trial of our interface available as discussed above. Do you set up the Xlink program? No, you need to install and activate the program through the vendor who sold you the X-Link product (especially since your first 3 months of support with them are included in the price of the software). When do I call Amazing Charts for the interface set up? You should call Amazing Charts and set up an appointment for the same day (or as close to it as possible) as your X-link appointment is scheduled to install and activate their program. What information does Xlink transfer? Xlink will transfer demographics to and from Amazing Charts and your billing program. Xlink will transfer billing charge detail from Amazing Charts into the billing system, including date of service, cpt, icd-9, and modifiers. Patient schedules will not transfer into either Amazing Charts or the billing system. Do I need a complete CPT and ICD-9 code library in my billing system prior to setting up the Xlink? Yes you will need to have a current and complete CPT and ICD-9 code library in your billing system prior to setting up Xlink. Can I register new patients in both systems? Yes you may register new patient demographics in Amazing Charts or your billing system. Can I transfer all my patient demographics into the other system? Yes you may do a onetime batch transfer all your patients into either Amazing Charts or your billing system. Is there someone that will show me how to you Amazing Charts and Xlink? Yes. Please contact us for an appointment so that we can guide you step by step on how Amazing Charts and Xlink function together on a daily basis. I am thinking about purchasing but would like a demonstration on how Amazing Charts and Xlink function as one. Please contact us and schedule a demonstration of how Amazing Charts and Xlink function as one.

Use X-Link
X-Link is complex and the setup process is not easy. You should contact the vendor from whom you purchased the program to get it installed and activated. After it is working, contact Amazing Charts and we can help configure it to interact with your practice management software. Here is how you can set

up the X-Link interface:

In the Interface tab, select the X-link Interface you wish to activate, keep in mind that there are several to choose from. Each interface will differ. We will provide an example of Medisoft Practice Management Interface. Enter the activation code on the top right hand and click on Install files. The Medisoft (or any other interface) representative would need to run the steps of locating the X-link Import Folder and Export Folder on the main pc. Once that has been completed on their end, click the Update button.

Instant Medical History


Amazing Charts interfaces with Primetime's Instant Medical History and Phreesia. These software programs allow patients to enter their own history before being seen by the provider. You must have Instant Medical History (IMH) / Phreesia installed for our interface to work. Once installed, you can activate this interface in the Admin section, under the interface tab. There is a free trial period available for this interface. If you have IMH and our interface turned on, whenever you pull a patient chart, Amazing Charts will automatically check to see if there is a patient file available to import. If so, you'll be given a chance to view and import some or all of the data provided by the patient.

Amazing Charts Services


Click here to learn about our current patient and practice services.

Guardian Angel Support and Updates (Maintenance)


Click here to learn about our Guardian Angel Support and Update service. Guardian Angel Support is our affordable software support and maintenance program, and includes all our standard program updates and upgrades, including medication, ICD-9, and CPT database updates. In addition, this service allows our support technicians to help you by phone, email, and online during our usual hours of 8 AM to 9 PM EST (5 AM to 6 PM PST). After hours emergency calls are monitored, and true Amazing Charts emergencies are usually responded to in short order throughout the night and weekends. But, like you, our off time is truly precious, and given the amazingly low cost of our annual support plan, please use this after-hours service only for true emergencies preventing access of your patient data.

OffSite Backup
Click here to learn about OffSite Backup, which is basically an insurance policy to insure we have your practice and patient data in the case of a catastrophe. See How do I...Backup Amazing Charts for other information on backing up Amazing Charts.

Amazing Charts Billling Services


Click here to learn more about the Amazing Charts Billing Service.

Help, STAT!
When in Amazing Charts, clicking the F1 Key will bring you to help on the window you are currently looking at.

Users subscribed to our Guardian Angel Support & Maintenance program can also get live support from within Amazing Charts by going to the Help menu. This will bring you directly to our Internet page from where we can log into your system to help you solve any problem you've run into. Other sources of help included with our Guardian Angel Support program are listed below: Email Live Online Chat & Remote Login Telephone techsupport@amazingcharts.com You can also reach us for a session at

http://amazingcharts.com/support/help-me-now/ . (This will allow us to log into


your computer remotely, if need be.) You can reach us toll-free at (866) 382-5932

I screwed up a note!
Q: I screwed up a patient's note, and it has been saved to their chart! What do I do?
A: Because of medico-legal issues, specifically the requirement to prevent a note, once electronically signed, from being changed, there is no way to go back and change a note after signing it. That said, one can add an addendum with a statement of the documentation error or omission. We are exploring a solution in future versions that will allow the ability to edit a prior note by striking out erroneous text with a strike-through line, thus maintaining medico-legal integrity, however this is not available currently.

I crashed before saving a note!


Q: I closed my note before saving it, but I had written a lot and don't want to start over!
A: As you document a patient encounter and move from field to field, Amazing Charts silently backs up the current note to file called LastNoteBackup.txt, which is located in the Amazing Charts folder on the computer on which you are working. This text file contains what you have documented and remains there until you open and begin documenting your next patient. Thus, if you accidentally close a chart, you can go to your Amazing Charts folder (by default, at C:\Program Files\Amazing Charts) and open the LastNoteBackup.txt file. You can open this text document with Microsoft Word, Wordpad, or Notepad, or another word processing program. Once open, you can cut and paste the text into the applicable text boxes in the patient's chart. In addition, Amazing Charts tracks when a note is saved correctly, so that if Amazing Charts or your computer crashes while you are documenting, the next time you start Amazing Charts, you'll be notified that a note wasn't completed correctly. In this instance, you can open back the note and then Forward or Save it.

Keep in mind that the LastNoteBackup and resurrecting a note backups are erased once you start to work on a new chart, so you must access it before working on another patient!

I entered practice data incorrectly!


Q: I messed up during the setup process, and entered my practice and user data incorrectly. How can I fix this? A: All the data you entered (e.g., practice setup, users, preferences, etc.) can be adjusted in the Administrator window. Click the desktop menubar View|Administrator Options, then log in with your Admin password. See Administrative Options for more information. Once in the Administrator window, you can edit the practice information under Practice Licensing Info button.

If you are timing out and need to purchase Amazing Charts, you are provided a mechanism to change the practice name before submitting for a registration key. The Amazing Charts registration key is tied to the practice name thus be sure you enter the practice name in Amazing Charts exactly how you wish it to appear at the top of your notes, letters, and prescriptions.

I can't see the whole screen!


Q: I can't see the entire Amazing Charts Desktop or Patient Chart! The screen is cut off. A: Amazing Charts requires a screen resolution of 1024 x 768 or higher. The vast majority of computers, graphic cards, and monitors support this without difficulties. To change your screen resolution, or check to be sure it is set correctly, right-click on the desktop and select Properties.

There are, however, some smaller computers and mini-systems that can't be set to a resolution of 1024x768 or higher, and thus are not easy to use with Amazing Charts. (Most of these small systems allow you to scroll the window to get anywhere on the screen, though this isn't an efficient or easy way to use Amazing Charts.) In rare instances, we've found some tablet PCs that appear to be set at 1024x768, but actually are not. If you can't see the entire Amazing Charts screen, try changing the screen resolution by right-clicking on the Windows desktop, and selecting the Properties option (even if it says 1024x768, or higher). Then change the resolution under the Settings tab to the maximum (as shown above), or minimum (e.g., 800 x 600), click Apply, then return to the Display Properties and change it back to 1024 x 768 or higher. This should solve the issue on these tablets with this unusual bug.

Amazing Charts requires a MINIMUM screen resolution of 1024x768 - but the higher the resolution, the better.

The Setup Assistant Restarted!


Q: I went to start Amazing Charts (after having used it successfully previously), and got an error message. To make matters worse, when I restarted Amazing Charts, the Amazing Charts Setup Assistant startedbut I've already loaded, run, and used the Amazing Charts program! Where's my precious data, why did this happen, and how can I be sure I'm not going to lose my data? A: Amazing Charts runs through a complex but step-wise sequence whenever it starts. If any of these steps fails, Amazing Charts will either notify you of the problem, behave unusually, or try to automatically recover. The most common result of this is that the Setup Assistant will start and ask you to locate the AmazingCharts.xml configuration file on the main computer (which tells Amazing Charts what it needs to know to connect to your database). It is okay to proceed with this and doing so will not cause you to lose data.

When you see this window you need to locate your main computer and the Amazing Charts directory within it (and the AmazingCharts.xml file within that). Usually, this is where you'll discover there is a problem - and is the reason the program failed to start up in the first place. There are a number of reasons you won't be able to locate the AmazingCharts.xml file on the main computer, although the most common problem is that your network isn't working correctly and during the start up process, Amazing Charts failed to connect to the database (click here for details on the startup sequence and how to troubleshoot problems). If it is not a network issue, and you can actually browse to your main computer and find the Amazing Charts directory within, then likely, your database has been moved, renamed, or otherwise irritated (e.g., corrupted). Another cause is if you or another program went messing about in the Windows registry (Always a no-no unless you know what you're doing). In any case, after you got your error message, Amazing Charts resets the registry link to your database, which triggered the Setup Assistant. What you should do now is continue the Amazing Charts Setup Assistant and click Next button until you get to the "Is this the main computer on which your Amazing Charts databases reside?" screen. Click the "No, I need to browse..." button. (Or if you are actually on the main server computer, click the "Yes, this is..." button. Browse to the Amazing Charts directory on the main computer, and you should see the AmazingCharts.xml configuration file (though, by default, you won't see the .xml suffix, just "AmazingCharts" as shown in the image below), and then click the Open button.

If that doesn't work, and now you're looking at the "Please enter your practice information" screen, then all is not yet lost - but you appear to be in the wrong folder, and your real database is not here. Be absolutely sure you've located the correct main computer with the Amazing Charts directory and AmazingCharts.xml file. (Most likely you have accidentally browsed to a computer or directory where Amazing Charts was installed in the past, along with SQL Server, but now your main database has been moved. If you are seeing the enter your practice name window, click the red X and try starting Amazing Charts again so you can browse to the correct location where you data resides. If you did find the correct database, and it is still asking for Practice Information, even though you've entered this before, then there really may be a problem. You should contact technical support for help, and we probably can figure it out. If you accidentally wrote over your Amazing Charts database, then you're probably screwed, and hopefully you have recently backed up your database or use our OffSite Backup service. We suggest you don't use your computer until you contact us, and we can help figure out if the overwritten or deleted database is recoverable. (Although there are many safeguards built into Amazing Charts to prevent one from doing so.) If you need your computer, or you realize the file is gone for good, then your last backed up copy will have to do (or a copy from our OffSite Backup servers, which hopefully you backed up within a day).

I can't get Amazing Charts running!


Q: Amazing Charts doesn't start when I try to run it! This help topic refers to users who have run Amazing Charts on this computer previously without problems but now are getting an error message when they try to start the program. (If you are setting up Amazing Charts for the first time on this computer, see this topic.) A: There are basically four reasons that Amazing Charts might encounter trouble when starting: The first, and by far the most common, is that a connection to the database can't be established, usually due to a network problem. Common reasons for this is that your computer's connection to your network has been dropped (e.g., you're using a wireless computer and walked out of range, or

somebody turned on the microwave down the hall and enough interference occurred that your wireless connection got messed up). Often your computer will automatically try to reconnect every few seconds and you'll be on your way without having to intervene. What you can do in the mean time, is open a browser and see if you can get to a webpage (such as www.amazingcharts.com). If you can get to a web page it implies your computer's network connection is working. Try restarting Amazing Charts... If you can browse to the Internet, but still can't start Amazing Charts, the problem is most likely not the network connection per se, but rather something blocking the connection (such as the main computer not having any available connections open, or some configuration error such as incorrect permissions set on the main Amazing Charts folder. Here is the startup sequence that Amazing Charts must go through each time it runs. The error message will help localize which step is failing and point you in the direction to solve it. An antivirus application, intrusion detection program, malware eradication program, and/or host based firewall setting has blocked part of Amazing Charts from running or functioning correctly. A list of known conflicting applications is found here and is updated regularly on our Help website (see link below). A damaged database can also prevent Amazing Charts from starting, although that would most likely be caught during the startup sequence. If you get to this spot, running Amazing Utilities may help identify what is broken and potentially fix it, though getting to this level is more serious. If Amazing Utilities doesn't solve the problem, try checking our website for the most common problems we currently know about. This link also has a number of registry repair utilities that may well solve the problem. These utilities won't cause any permanent problems, and could just solve the issue.

If the problem is successfully repaired, your program should now work correctly, and you should see your patient panel and any saved notes, schedule, and messages. If you continue to get an error, or don't find the data you expect, please contact technical support for more information.

My hard drive crashed that had my database!


Q: The hard drive that had my Amazing Charts program has died!
A: About 1% of practices experience a hard drive failure (or loss due to some office calamity such as fire, flood, or robbery) each year. If your Amazing Charts database and associated patient data files (_data01 and Imported Items directories) are gone, then the only hope in resurrecting your data is to use a backup. Amazing Charts includes a backup utility, which can be set to run at regular intervals. Each time the backup utility is run, it creates an encrypted backup file of your database, _data01, and Imported Items directories. By default the utility saves the data to the BACKUP folder on the main computer, however in this instance, since the main computer's hard drive isn't available, this backup does you no good. The backup utility also can be set to backup your critical files to other drives on your network, including CDs, DVDs, and thumb drives. We strongly recommend you backup to one of these sites on a different hard drive than your main computer's, though if you are reading this, you may not have done so. If you have, the Amazing Restore Utility can take the encrypted backup and automatically get everything back to the state you were in when you last ran the backup utility. The backup utility also automatically uploads your encrypted backup to our servers if you are a subscriber to our OffSite Backup service (if you are not, then you hopefully had in place a backup system that placed this data off site from your office). Another way to backup, not using the backup utility, is to simply copy and paste the critical files (AmazingCharts.mdf, AmazingCharts.ldf, _Data01 directory, and Imported Items directory) to another drive. (You could just copy the entire Amazing Charts directory on the main computer as well, but other than the files listed above, all the others are mostly replaceable). In any case, at this point you are looking to resurrect your data. To do so you need to chose your new main computer and install Amazing Charts by downloading it from our website. Install it to your main computer, and then walk through the initial setup questions, entering any practice info, user info, etc., as this will be overwritten when you resurrect your data. Next, go to the Amazing Charts directory on the main computer, and run the Amazing Restore

Amazing Charts keeps crashing!


Amazing Charts has started to do peculiar things like crash or screw-up! In rare instances, Amazing Charts might not start-up or run correctly after an error. This is usually a result of a crash by Amazing Charts, or another program on your computer, while Amazing Charts is accessing the Amazing Charts database. Usually this is due to a failure of the Amazing Charts database to properly close. First, and foremost, try restarting your computer(s) and/or router since 95% of the issues are solved by rebooting. If that doesn't work, the next step is to run Amazing Utilities. If still no luck, check out the steps under "I can't get Amazing Charts running!" If none of these solutions cure the problem, let us know!

There are mispellings in the drop down boxes!


Q: There is a misspelled item in one of the drop down boxes. A: The drop down combo boxes in the Patient Demographic window is generated by finding all the unique entries for each patient. In other words, if you've spelled New York for one patient like "Neu York" then that spelling will appear in the drop down box UNTIL you find the patient under which you misspelled it, and fix it.

To find the patient(s) on whom you made the error, use the Reports button

at the top of the Amazing Charts Desktop, and lookup the misspelled word. Go down the resultant list and fix each misspelling, and the problem will be solved.

Right mouse clicking doesn't work like it does in windows!


Q: Right mouse clicking doesn't work like it does in windows.
A: In Amazing Charts, right mouse clicking in text boxes is used to open templates to allow easy documentation. For those who would like to use the normal cut, copy, and paste window that usually pops up with a right mouse click in other Window's applications, you can hold the SHIFT Key down as you right mouse click in Amazing Charts text boxes, and the default right-mouse click window will open for you.

Errors & Bugs


Some problems, most commonly caused by a programming error, will cause a computer's operating system to freak out. These errors (e.g., asking the computer to divide a number by zero) are usually caught before the computer actually tries to solve the problem and ends up crashed. These caught errors often open a window to exclaim that the program you were using had some mistake in it. Windows will tell you what the mistake was, or what the program was trying to do. These error codes are clues for our developers to track down and fix the problem. Here we have included some information on various error codes sometimes seen by our clients (mostly on older versions of Amazing Charts) - and any easy solutions to the problem. For example common errors include: 429 error "ActiveX Can't Create Object": This error is usually due to a problem with one of the required data link libraries (dlls) used by Amazing Charts. Amazing Charts uses a number of dlls to run correctly. Dlls contain more programming code usually used by a number of programs and utilities, and thus this code is placed outside the main program. If you are running Amazing Charts.exe, and you get this, it usually means one of these dlls wasn't registered correctly during installation, or has since lost its registration. Amazing Charts provides various alerts and messages when the program encounters an unauthorized or other anticipated event.

Type of Error Login Failure

Message/Warning "Login information is incorrect."

Possible Reasons

Username not found in database Password is incorrect Login Failures have occurred more times
than is allowed by security settings.

Account Locked

SQL Server Connection Error

"Please contact the site administrator or technical support." "There is a problem preventing Amazing Charts from starting..."

Incorrect initial configuration of Amazing


Charts on the server (most commonly permission settings or database is read-only). Incorrectly configured network settings Firewall or anti-intrusion software has blocked the connection User has lost a connection to the database on another computer or the server usually due to a network problem (e.g., cable was unplugged, main computer has gone down) Database has become corrupted.

Directed To & Re User is informed an additional chances the security settin Administrator). User is directed to t administrator who c the account. User is provided info troubleshoot the cau information below).


Lost Database Connection Error "Amazing Charts can't connect to your database. This is usually due to a network error, such as a dropped connection by your router (e.g., going out of range while using a wireless router)...." "This version of Amazing Charts requires an update to your database."

Since this is most c lost network connec provided the ability t reconnect. Users ar instructions on step

Update Needed

Amazing Charts has been updated without User is directed to t

they can log in and running the Database Tuner (which adds fields to the database that are needed by the Database Tuner.exe database with the re latest version). information is here.

Most unanticipated (bug) events are caught by our bug tracking and submitting process, which is described here. Occasionally, an error will occur that is not caught by our bug and programming error system, this will cause the program to end abruptly and is described below. Type of Error Run Time Error Message/Warning "A runtime error has occurred." Possible Reasons Directed To

An unanticipated error related to the

The program ends ab program, the network, or other unanticipated message is displaye issue not caught by the above mechanisms submit a bug repor which alerts our tech or errors and bugs.

SQL Server Connection Errors There are many possible causes that prevent Amazing Charts from starting. A list of the startup events is here. Most commonly, the problem is related to the main computer (server) where the Amazing Charts databases reside. The error that opens will help you troubleshoot possible causes and provides more details of the specific error which may help clarify the underlying cause. Below is an example of this window. More information on installing and configuring Amazing Charts is here.

SQL Server Connection Error Message will open automatically with details about the specified error that prevents Amazing Charts to connect with the database.

Many errors can be solved by running the Amazing Utilities application, which is regularly updated to address the For an up-to-date list of current issues that can cause this error, click here. Of course contact us if you have an error code that doesn't resolve.
most frequently seen errors that our clients are experiencing.

Amazing Charts Specs & Technophile Information


Minimum System Specifications If you're buying a new computer, we recommend you get one that meets or exceeds these specifications: o Processor: Intel or AMD processor running at 2 GHz or faster - most processors made in the last two years will do just fine. o OS: Windows 7, Windows Vista, Windows XP, Windows Small Business Server 2003, or newer (with latest Service Packs). We recommend the Pro version of these - especially for the "main" computer or server. o RAM: 2 GB or more for local/client computers - 4 GB or more for the main/server computer. o Screen Resolution: 1024 x 768 or higher - this means some netbooks with screens of 10.1" or less will cut off some windows. o Hard Drive: At least 160 GB of free space. o Connectivity: An active Internet connection is not required for regular use, but will be needed for certain features such as ePrescribing and drug/drug interaction checking. Amazing Charts is designed and tested to function correctly on computers that meet the above specifications. While alternate configurations may be adjustable to work with Amazing Charts, these are neither recommended nor supported, and using the program on a set up that employs these (such as, terminal services, Citrix, Novell, or other thin-client configurations), may lead to data integrity issues and unexpected results. Use of Amazing Charts: Performance & Capacity Amazing Charts capacity is limited only by the processing power and network capabilities of the individual client as well as the built-in limitations of Microsoft SQL Server Express 2005 edition (i.e., one CPU use and a maximum 4 GB per database size). Amazing Charts can be run on an individual computer, be it a laptop, desktop, or tablet, on any computer system able to run one of our supported systems. While speed and performance are variable based upon a system's hardware (RAM, processor type and speed) and configuration (virtual memory), given a typical configuration some estimates may be made. If the practice is running on a single updated Windows XP computer with a Pentium IV processor, 1 GB of RAM and 2GB hard drive, common database queries and reports will experience response times of no greater than 2 seconds and usually under 1 second. In practices utilizing a server running Windows SBS 2003 on a Dell workstation networking through a Linksys 802.11g router with 24 ports via a local area network (LAN) and 15 concurrent users running Amazing Charts, users will experience a response time of no greater than 3 seconds. This estimate is based on computers being hardwired through Cat-5 Ethernet connections (Wireless connections are more variable and are significantly affected by signal strength). While Amazing Charts will work with wireless connections, there is a greater risk of dropped connections which could increase response time. However, standard b or g wireless networks with medium to strong signal strength will generally operate with less than a 3 second response time. Amazing Charts provides a utility to allow users to determine the response time to query and receive data from the database (whether connected directly to the server or across a wired or wireless network).

Amazing Utilities provides a menu item to test application and network performance from the client to the database. Installing Amazing Charts Amazing Charts is composed of a number of executable applications and associated files that are installed via a Wise for Windows installation package based on Microsoft Installer (MSI) standards. Known conflicts with various antivirus, intrusion detection, and malware eradication software, as well as issues that have occurred in association with various operating systems and end user hardware and software configurations, are addressed and regularly updated and posted on our website at www.amazingcharts.com/help. Amazing Charts currently employs SQL Server 2005 Express as its backend database. SQL Server is accessed by Amazing Charts through port 61607 by default, although during the initial configuration, if that port is already in use, Amazing Charts will sequentially search for the next sequential port that is available. During initial configuration, Microsoft Windows needs to be sure the Amazing Charts installation and instance of SQL Server is authorized to run on the user's computer and isn't a malicious application. Thus, by default, the built-in Windows Firewall (and other firewall programs we've tested, including Norton, Trend Microsystems, Avast, Malewarebytes, Spybot, and Webroot) may, depending on how they have been configured, block Amazing Charts' access to SQL Server or prevent one or more of the application's associated files from running. Once the user allows their firewall (or antivirus/intrusion-detection software) to let Amazing Charts run the various associated files and communicate through the specified port, the program continues.

For example, usually, when SQL Server is first used on all supported Microsoft operating systems, a window will automatically pop open asking if the user wishes to allow/unblock the firewall to allow the Amazing Charts instance to run. You should allow Amazing Charts to access SQL Server, or the program will not function. Sometimes, however, the firewall or intrusion-detection software, block occurs silently and in the background (based on the configuration of the user's program). Thus, the programs listed above, and other programs regularly added to our list on our Help site, should be disabled or uninstalled before installing Amazing Charts. Another known issue occurs during the initial configuration on Microsoft Vista, right-clicking on the application and setting the program to Run As Administrator is often required. A pop-up window in Amazing Charts instructs the user on how this is accomplished (the window is shown below).

Run as administrator warning window that opens automatically if Amazing Charts finds it does not have the required permissions to run correctly. Finally, Amazing Charts has its own built-in Virtual IT Person that can help walk through unblocking the firewall as well as setting up the initial configuration settings that Amazing Charts needs to interact with SQL Server. This Virtual IT Person prompts the user to sequentially solve the various steps needed to allow the program to access the database. These steps include: unblocking any firewalls, finding and defining one open port (61067 to 61087) for the MSSQL$AMAZINGCHARTS instance, starting the SQL Server service, and then testing to ensure the database can be queried and written to, proving the above steps were successful. Issues encountered during this sequence are provided in a subsequent window, which provides suggestions for remedying the problem.

The Virtual IT Database Administrator Window which automatically opens to help configure Amazing Charts on the server. Uninstalling Amazing Charts for the Technophile Amazing Charts is designed to protect user information, even in the event that the program is inadvertently uninstalled from a system. Using the Windows control panel to uninstall Amazing Charts removes the majority of Amazing Charts installed files, but does not remove the Amazing Charts database, certain settings that Amazing Charts uses to run, and files that the user imported into the system. There are registry entries, for example, located in the HKEY_CURRENT_USER\Software\VB and VBA Program\Settings\Amazing Charts which hold various preferences for the specific computer. These can be deleted if Amazing Charts will no longer be used on the computer. Amazing Charts may have installed the .net framework and/or SQL Server on the computer depending on the configuration chosen during the initial installation. The ACPrerequisites program in the Windows Control Panel can be removed, but you'll also have to uninstall SQL Server and the .net framework using the Windows control panel. Obviously you should be very careful as these are common applications produced by Microsoft and they and their associated dlls and other files may be used by other programs on your system. The other data is found in the Amazing Charts directory and includes the Amazing Charts database and patient files that have been imported into Amazing Charts after Amazing Charts installation. You can manually delete the Amazing Charts directory, but doing so will remove patient/practice files, so obviously ensure that the data is stored elsewhere or not needed before doing so.

Best Practices
The following are some obvious points regarding best security practices that should be kept in mind at all times. It is easy to become lax regarding these issues, but remaining vigilant will be your best protection against loss and breaching of your patients' personal health information (PHI) and practice's privacy.

Always use the encryption security when using a wireless networks. ( If wireless networks are used Amazing Never transmit unencrypted PHI information over an open network (e.g., ensure you see the lock icon on your Never store PHI information in an unencrypted format on removable media. (To encrypt PHI information, use
the Amazing Charts Data Encryption utility.) browser).
Charts requires that data should be password protected with WEP or WPA encryption.

Anatomy of the Amazing Charts Directory


Each computer running Amazing Charts will have a number of files automatically installed after running the Amazing Charts Installer. Shown below is the default location of the Amazing Charts directory (C: Drive | Program Files or Program Files (x86) directory) that holds these files.

The Amazing Charts Folder The Amazing Charts folder has a number of files which, taken in total, make up Amazing Charts.

AmazingCharts.exe is the main application. The AmazingCharts.exe (shown above) reads and stores information to the SQL Server database, AmazingCharts.mdf (the .ldf file holds the data waiting to be written to the .mdf file). Amazing Charts also reads information from codes.mdf and meds.mdf, although these databases are not written to and can be replaced with updated files as codes and medications are updated.

The Database Files A number of DLLs (Data Link Libraries) are required to facilitate the reading and writing of data by AmazingCharts.exe. The main DLLs are ACComObjects.dll, ACDataLib.dll, and Comclasses.dll, although there are a number of other associated files needed by Amazing Charts and Windows.

Some of the required dlls used by Amazing Charts to access the databases. The AmazingCharts.xml configuration file tells Amazing Charts whether the current directory is the main computer with the real databases in it, and if so, which port is used to access the databases.

The AmazingCharts.xml configuration file Amazing Charts also uses a number of utilities to perform various functions. These files are named to reflect what they do.

Other included applications that perform various functions. The Amazing Charts Help program (which you're most likely reading right now) is also found in this directory.

The Amazing Charts Help (achelp.chm) program Finally, there are a number of sub directories within the Amazing Charts folder that will contain various data accessed by Amazing Charts. As interfaces to third-party products are added, more directories for these individual interfaces will be automatically added.

Sub-directories found within the Amazing Charts folder.

Networking Problems
Amazing Charts goes through a complex set of steps to ensure it will be able to work correctly. Troubleshooting which step is failing can be done by starting Amazing Charts through a command line (i.e., "Amazing Charts.exe" -LogDetails) or by starting the program by double-clicking on the RunACwithDetailedLogging.bat file located in the Amazing Charts folder). This will record each step in the error.log file (saved to the temp directory), and upload to Amazing Charts in a bug report (though if you can't start the program, you can't automatically submit the bug report). Here is the sequence of steps that Amazing Charts goes through each time it starts up: 1. Are All Local Files Available? Are all the needed Amazing Charts files found on the local computer (including various dlls). If something is missing or not accessible, the AmazingChartsInstaller (a Windows installer program) will automatically start up and try to install the missing file.

2. Is the path to the main database set? If the path (stored in the registry) is found, Amazing Charts will move on to step 3. If there is no path found (e.g., the path has been reset), Amazing Charts will ask you to browse to the AmazingCharts.xml configuration file that tells the program, among other things, where the main database is located. 3. Can Amazing Charts reach ("ping") the computer that has the main database? Using the path in step 2., Amazing Charts will now ping the main computer. (If you are running Amazing Charts on the main computer, this step is skipped.) Pinging involves sending a small packet of data to the main computer and waiting to see if that computer accepts the data correctly. If so, the connection (and thus your network) is working. Pinging actually contains a number of complex steps, all of which are handled by the computer and router and entail resolving the computer address, routing the packets of information across the network and to the correct computer, listening for a response, etc. If any of these fail, step 3 will fail and you'll be left troubleshooting why the connection isn't working. Troubleshooting a connection failure is done step-wise to focus on finding the etiology of the failed connection: Can you browse to the Internet? In other words, can you load a web page such as NYTimes.com? If so, your computer is working as is the router, so you've narrowed the problem down to something occurring between the router and the main computer (or on the main computer). If you can't get onto the web, then there is a problem either with your computer or the connection to the router (e.g., a cable is unplugged, the router needs to be reset, or your computer isn't correctly connected to the router). While there are other reasons you may not be able to reach the Internet (the connection between the router and modem or ISP isn't working), but that shouldn't affect Amazing Charts ability to start up. 4. Can Amazing Charts locate the Amazing Charts folder on the main computer? If Amazing Charts can reach the main computer (or if it is running on the main computer) it then confirms there is an Amazing Charts folder where it should be (according to the path to the database in step 2, above). 5. Can Amazing Charts locate the individual files within the folder? Now Amazing Charts confirms the presence of the actual database files, Amazing Charts, codes, and meds (both the .mdf and the .ldfs). 6. Can Amazing Charts connect to SQL Server on the main computer? Amazing Charts now asks the main computer if it is running SQL Server and if so, is the Amazing Charts database accessible through the specified Port. These are configured automatically when you run install and run Amazing Charts on the main computer, and port information is one of the data saved in the AmazingCharts.xml configuration file (and why you need to find it initially). If SQL Server is running, and the main computer is able to say so, we move to the next step. 7. Can Amazing Charts communicate and control the Amazing Charts database on the main computer? Now we're getting really close and have proven most everything is configured correctly. The next step is to see if Amazing Charts can actually send commands that are accepted. Issues here have to do with permissions set in SQL Server (done automatically during the set up process on the main computer. 8. Can Amazing Charts write to the database? A test message is now written to the database. If it succeeds, all permissions are correct and we move to the next step. 9. Does the database have all the fields needed for this version of Amazing Charts to work? Amazing Charts now checks that the newest fields used by the program are in the database. If those fields are present, the program starts up and you are given the opportunity to log in. If a field is missing, it means the database must be tuned-up to work with your version of Amazing Charts (and the Database Tuner message appears). The database tuner is provided to practices that subscribe to our upgrades/maintenance and support service.

Releases & Builds


Amazing Charts provides regular updates to our program which include bug fixes and feature
additions/enhancements to the program.\

Amazing Charts has a well defined procedure for identifying and resolving issues discovered within our
application as described below: o All releases go through rigorous internal testing before release which occurs first on development machines followed by various other virtual and non-virtual hardware configured with XP, Vista, 7, SBS, with and without common third-party software such as Microsoft Office, antivirus programs, etc. o Programming errors encountered while using Amazing Charts automatically trigger a Bug Report window that collects system state and programming information and provides an area where you can add additional information that may help determine the cause of the error. You can then opt to submit the error to us, and review any information being submitted (to ensure no disclosure of PHI). o Submitted bug reports are collected and analyzed by Amazing Charts tech support and quality assurance (QA) team, and new or unrecognized issues are replicated to allow programming fixes to be engineered. o Similarly, you can submit feedback/suggestions for work-flow and other end user issues that are also analyzed by our development team and incorporated into new version builds. o If a bug fix is necessary, the programming changes are added to the Amazing Charts source control, compiled into the executables, which is subsequently compiled into the installer package. This hot-fix installer package is then internally tested as described in the first bullet point above. If the package passes internal testing, it is provided to beta testers as well as the client(s) who experienced the error, and confirmation of the solution occurs. o Beta testing continues for up to 8 weeks (depending on the number and extent of programming additions/changes) and then released as the official release, which is posted for download on our website. o Users can learn of the latest release via a number of methods including manually checking our website atwww.amazingcharts.com/download, a built-in version-checker, that queries our secure webservice to determine the number of our latest official and beta version (and then compares it to the version they are running to determine if a newer release is available), and via intermittent emails sent from Amazing Charts to the registered practice which describe the latest version. Finally, in the event of a critical error requiring immediate notification, Amazing Charts calls home via a secure webservice SOAP-formatted call over HTTPS each time a user successfully logs into the system and can receive from us an announcement (that can be color coded yellow to draw the user attention) and is displayed on the main Amazing Charts desktop.

All these methods include a link to our standard webpage that outlines the new/fixed features and
provides directions for installing the hot-fix (http://amazingcharts.com/versionupdateavail.htm), or, in the case of a critical issue announcement, to a specified URL describing the nature and impact of the critical issue.

Amazing Charts Web Page that shows the changes made to the program, and provides instructions for updating. Release Numbering Amazing Charts Releases are numbered sequentially with the standard software versioning format of Version Major. Version Minor. Version Revision. For example, the version 3.7.15 indicates that this is the 15th build of V3.7. In general, the major version is sequentially incremented when adding a number of significantly new features, the minor version is incremented when adding one or more sub-features, and the revision number is incremented as one or more bug-fixes and minor features are added or enhanced, including updated CPT/ICD codes databases. When Amazing Charts migrated from Microsoft Access to SQL Server as our backend database, our version number incremented from V3 (3.7.14, specifically) to V4 (4.0.58). Many of the revision builds are not officially released and are part of our numbering protocol used during internal testing. So for example, a client may see version 4.0058, then 4.0060 as the next offered version for use. The program is placed on our download site www.amazingcharts.com/downloads/downloads.htm and is available for any user with an internet connection of over 56kb to download. Downloading from the Amazing Charts website via an Internet is the primary source for our updates and fixes, however, if a client does not have an internet connection, we can provide a CD with the installation software. Clients without an Internet connection must, at quarterly intervals, contact Amazing Charts for a code to continue use of the program and to ensure a critical fix has not been released regarding which they are unaware.

Shortcut Keys
There are a number of shortcut keys in Amazing Charts to help you avoid needing to use the mouse. These keys are also critical to using voice recognition programs as they allow navigation around the program without using a mouse. Amazing Charts Desktop Window

Quit Logout Import Appointment Quest (.csv) file Print Daily Batch Import Patients (x- link) Add New Patient New Sticky Note User Preferences Templates Codes Consultant/Referring Providers Email/ Interoffice Messaging Schedule Admin Options Add Injections/ Immunizations Demographics Summary Sheet Last Encounter Prior Encounter Imported Items Account Info Pulled medications Print Orders/ Requisition Slip Pull/Export Bills by Date E- Prescribing Knowledge Extender (Know) Save Chart (To Your Inbox)

Ctrl-Q Ctrl-L Ctrl-F2 Ctrl-B Shift- Ins Ctrl-N Ctrl-Y Ctrl-U Ctrl- F1 F-12 Ctrl-R Ctrl-E Ctrl-S Ctrl-A Ctrl- I F5 F6 F7 F8 F9 F11 Ctrl-M Ctrl-O Ctrl-D Ctrl-P Ctrl-K Ctrl-S

Patient Chart (Most Recent Encounter Tab) New Note Print Current As Draft Print Progress Notes/Letters Cut Copy Paste Spelling User Preferences Templates Enlarge Text Box Patient Chart (Imported Items Tab) Import/Control Your Scanner Import File (s) Ctrl-S Ctrl-F Ctrl-N Ctrl-D Ctrl-P Ctrl-X Ctrl-C Ctrl-V Ctrl-F7 Ctrl-U Ctrl-T Ctrl-B

Patient Chart (Account Info Tab) Print as CMS/HCFA 1500 Print As Invoice Ctrl-H Ctrl-P

CCHIT STUFF
CCHIT certification is an onerous and painful process that many third-party insurers, including the government, use to define what an EHR must do to be called an EHR. To pass CCHIT-certification requires that an EHR is capable of 100% of the requirements for the year of certification. Testing of many of the issues is completed by a 3 judge panel observing hundreds of features and steps performed by Amazing Charts to ensure all the bells and whistles necessary to provide a meaningful EHR, as defined by the US government. Amazing Charts is compliant with these requirements and parts of these requirements are that the program provides the following details to the user. Network Protocols, services, and ports utilized by Amazing Charts It is necessary to have the following ports open or forwarded to facilitate proper functioning of Amazing Charts. All connections within your network, including workstations, should be configured by a System or Security Administrator. All ports should be configured with the maximum amount of security allowable by your network for adequate communications. TCP Port 80: An internet connection is required which utilizes TCP Port 80 (HTTP). All workstations, as well as the server, require internet connectivity to facilitate remote support by Intuitive Medical Software, although Port 80 is not specifically utilized for this connection. TCP Port 443: TCP Port 443 is utilized by Amazing Charts to facilitate file transfer for product updates and upgrades, as well as updates to the Drug Interaction database. This port is also utilized by the Rcopia engine for ePrescribing, should you choose to subscribe to that service. TCP Port 22: TCP Port 22 (SFTP) will need to be reviewed and/or configured on the machine/server where your Practice Management software resides. This Port is utilized to communicate HL7 messages containing patient demographics, appointment and billing information both to and from Amazing Charts. Your Practice Management software will generate HL7 messages containing patient demographic and appointment information. When the messages are received they are routed internally and processed by Amazing Charts. UDP Port 123: UDP Port 123 is required by Amazing Charts to facilitate proper timestamps for security logs and audit trails. This port is utilized by the National Time Protocol (NTP) service to synchronize the date and time on your network. Protocol / Service Summary Firewall Description Rule Outbound Internet Connection Inbound & Utilized to receive HL7 messages obtained by Outbound Amazing Charts from Lab Interfaces. Inbound & Utilized to synchronize the local server to the Outbound National Time Protocol (NTP). Outbound Utilized by Amazing Charts for product updates, including Drug Interaction data and ePrescribing. LAN Inbound Utilized to communicate queries between & Outbound Amazing Charts and the MSSQL database.

Protocol / Service HTTP SFTP

Port TCP 80 TCP 22

Windows Time UDP 123 Agent HTTPS TCP 443 MSSQL Service TCP 61067

In addition to standard Microsoft ports (noted above), APIs, dlls, ocx, and other applications found in a default Windows installation, Amazing Charts also may use a number of additional services, ports, and procedures to provide its full functionality. A listing of the network protocols, services, and associated applications and modalities is below: MICROSOFT SQL SERVER 2005 EXPRESS (VIA LAN/WEP/WPA, SQL SERVER SERVICE THROUGH PORT 61067). Amazing Charts backend database is provided by Microsoft SQL Server. Data exchanged between the application and database is secured through internal LAN connection or, if using wireless, over a WPA/WEP wireless connection. SQL SERVER service must be running on the server, and listens to port 61067 through which data is exchanged. Stored passwords are encrypted within the database. HARDWARE INTERFACES (VIA MICROSOFT AND THIRD-PARTY DRIVERS requires Window's standard or higher level privileges). Amazing Charts, through Microsoft Windows controllers, device drivers, and dlls interacts with

a number of I/O and other hardware devices. These devices come from a variety of manufacturers and follow industry standards with communication between the application and device being controlled on the host computer or network. Their interaction with Microsoft Windows allows them to interact with Amazing Charts through their drivers. o Printers: Amazing Charts can print a report through standard printers (via drivers provided by Microsoft or the specific hardware manufacturer); o Scanners: Amazing Charts can control some scanners that are twain-compliant through drivers licensed by Dosadi (EZGif.dll, EZJpeg.dll, EZPdf.dll, EZPng.dll, EZSymbol.dll, EZTiff.dll, Eztwain3.dll). o Midmark ECG, Spirometer, Holter: Amazing Charts uses the licensed Midmark SDK to allow our program to control and import reports generated by hardware (ECG, Spirometry, Holter) from Midmark Diagnostics. Their SDK is password-protected to ensure PHI integrity. SOFTWARE INTERFACES (VIA VARIOUS PROTOCOLS - requiring Window's standard or higher level privileges). There is no required middleware or supporting software other than what is included with our installer package or included as part of the Microsoft Windows operating system (XP, Vista, and Small Business Server 2003, 2005, and 2008 running the latest service pack) to run the majority of features in Amazing Charts. Third-party files required by, and distributed with our installation package include: o Easy HL7 drivers to allow for enhanced import/export of HL7 files (EHL7.dll, EHL7Runtime.LIC) o Various practice management programs via X-Link HL7 v2.3 or direct HL7 v2.3 files saved on the server in the Amazing Charts directory. An updated list of interfaced applications is here. o Various laboratory companies via HL7 v2.3 saved on the server in the Amazing Charts directory (the laboratory company is responsible for delivering the HL7 file securely to the Amazing Charts subdirectory Most labs do this via Hypersend, Lightning, or other secure FTP service that is installed by the specific laboratory company on the client's server). An updated list of interfaced applications is here. o ComponentOne drivers to allow for enhanced grids, tables, and other data elements (todg8.ocx, todl8.ocx, xadb8.ocx, tdbgpp8.dll, todgub8.dll, C1.Czip.dll) o WSpell spell check dictionary and driver (wspell.ocx, ssceam2.clx, sscema2.clx, tech.tlx, userdic.tlx) o MBSplit.ocx to allow for enhanced frame navigation within the Imported Items window of Amazing Charts o Chillkat drivers to allow for enhanced xml and encryption, compression, and secure uploading features (ChillkaXml.dll, Chillkatdotnet2.dll, vbzip10.dll, zip32.dll) OFFSITE BACKUP UTILITY (VIA VARIOUS PROTOCOLS LISTED BELOW - requiring Window's standard or higher level privileges). Amazing Charts provides OffSite Backup functionality that provides the ability to upload and download a saved copy of the practice and patient information at regular intervals defined by the user. o OffSite Backup Utility saves a copy of the Amazing Charts SQL Server database and Imported Items directory to the Backup Directory after being compressed (using theC1.C1Zip.dll) and encrypted (AES, 128 bit via ChilkatDotNet2.dll). o OffSite Backup Upload occurs over an secure FTP tunnel via AUTH TLS (AUTH SSL) protocol whereby the OffSite Backup utility issues an "AUTH TLS" command to convert the TCP/IP channel to a TLS encrypted channel. All communications from that point onward, including data transfers, are encrypted. o OffSite Backup Storage is maintained on secure servers managed by Rackspace, Inc. in their secure San Antonio, TX facility. By contractual agreement, physical access to the servers is protected by keycard protocols, biometric scanning protocols, and round-the-clock interior and exterior surveillance monitor which records any and all access. Only authorized data center personnel are granted access credentials and every data center employee undergoes multiple and thorough background security checks before hiring. The data center's HVAC system is N+1 redundant, and every 90 seconds all air in the data center is circulated and filtered to remove dust and contaminants. An advanced fire suppression system is designed to stop fires from spreading in the unlikely event of an occurrence and all cables are secured. All servers are powered by UPS (Uninterruptible Power Supply) systems which are also N+1 redundant with instantaneous failover if the primarly UPS fails. Only fully redundant, enterprise-class routing equipment is used and all routing equipment is housed in an additionally secured core routing room that is fed by its own redundant power supply. o OffSite Backup Downloads occur if a client requests access to a previously archived backup. It occurs via an encrypted HTTPS tunnel utilizing a 128 bit AES SSL protocol. E-PRESCRIBING VIA WEBSERVICES (through HTTPS conduit requires Window's standard or higher level privileges). Amazing Charts is a hybrid system (as defined by CCHIT) performing e-prescribing functionality in conjunction with our certified partner, NewCrop, LLC. Communication and transmission of PHI data related to standard e-prescribing functionality always occurs via an HTTPS encrypted tunnel through SOAP-formatted webservices provided, maintained, and updated by NewCrop LLC. TECHNICAL SUPPORT: Amazing Charts provides technical support services through a number of modalities including via telephone, Internet chat, and remote desktop. Amazing Charts personnel undergo extensive training in support techniques which involve backing up PHI before performing troubleshooting techniques. All personnel are employed directly by Amazing Charts (support of Amazing Charts is never outsourced) and have been trained and have signed

HIPAA and privacy agreements. In certain situations, our technical support Amazing Charts provides technical support through a number of modalities including IM/Chat technology licensed through Provide Support, LLC and GoToMeeting provided by Citrix ICA. All information transferred through these services, including an PHI, is transmitted via HTTPS employing 128 bit AES SSL encryption algorithms. Any internal transfer of PHI occurs over 128 bit AES SSL connections. Protected Health Information (PHI): Protection Against Confidentiality Failures Amazing Charts protects all Protected Health Information (PHI) transmitted over open networks, including the internet, through encryption protocol. Any data transfer necessary for the functioning of Amazing Charts is encrypted to protect against breaches of confidentiality. Amazing Charts encrypts with Advanced Encryption Standard (AES) or its predecessor 3DES and utilizes open protocols such as SSL (Secure Socket Layer) and its successor TLS (Transport Layer Security), XML, and S/MIME. TLS and SSL work by verifying the sending and receiving machine via a digital handshake that authenticates the networks and ensures data is being transferred to the proper locations. This is done through the use of encryption ciphers. The five most common ciphers used in a Windows environment are: _RSA_WITH_AES_128_CBC_SHA _RSA_WITH_AES_256_CBC_SHA LS_RSA_WITH_RC4_128_SHA TLS_RSA_WITH_3DES_EDE_CBC_SHA TLS_ECDHE_ECDSA_WITH_AES_128_CBC_SHA_P256

HL7protocol also verifies accurate connection through a digital handshake using SSH (Secure Shell) transfer protocol. It uses a Cipher and a Machine Authentication code (MAC): Cipher 3des Ciphers aes128-cbc,3des-cbc,blowfish-cbc,cast128-cbc,arcfour,aes192-cbc,aes256-cbc Macs hmac-sha1,hmac-ripmd160,hmac-sha1-96

Amazing Charts uses secured data transfer protocols for both hosted and client communications. Hosted communications include sending information from our OSBU or tech support upload site (for Amazing Charts review and testing by our technical support team). Client communications include transfers of laboratory or practice management services, e-Prescribing, and connecting to Amazing Charts SQL Server database. During all of these data transfers, PHI is only sent over protected networks. Remote connections are not directly supported by Amazing Charts software. For these clients, we recommend using an Open Virtual Private Network (VPN). VPNs transfer data using SSL protocol and encryption. Proper connection should always be verified prior to data transfer. Also Amazing Charts recommends using wired network connections for security, speed, and data integrity. If wireless networks are used Amazing Charts requires that data should be password protected with WEP or WPA encryption. The following 2 tables summarize hosted and client programs supported by Amazing Charts and what protocols and encryption they use to protect PHI data: APPLICATIONS USED IN CONJUNCTION WITH AMAZING CHARTS Amazing Charts uses the following hosted programs: Amazing Charts downloads for off-site backups (OSBU) and file uploads (accessible only from within our SSL protected network), Citrix ICA GotoMeeting to sign into client's computers, and HL7 to send information from laboratory company servers (if applicable). Application Amazing Charts OSBU upload Amazing Charts OSBU download Security Protocol FTPS using AUTH TLS HTTPS Encryption Method AUTH TLS* SSL ,128 bit AES Comments

For Off-Site Bac uploads

Part of OSBU se downloading to c of data

Scanning Citrix ICA

N/A HTTPS

N/A SSL, 128 bit AES

Scanning is don machines

Connects Amaz servers for use o providing technic

clients

HL7

FTPS

SSH 128 bit 3DES

For sending HL7 to Lab and Prac application serve

Done on local ne printers * Our method of doing secure FTP file transfers is by AUTH TLS (also known as AUTH SSL). The client connects on the standard unencrypted FTP port 21 and then issues an "AUTH TLS" command to convert the TCP/IP channel to a TLS encrypted channel. All communications from that point onward, including data transfers, are encrypted. Transport Layer Security (TLS) is the successor to Secure Sockets Layer (SSL). It is a cryptographic protocol that provides secure communications on the Internet for such things as email, FTP, and other data transfers. There are slight differences between SSL 3.0 and TLS 1.0, but the protocols are substantially the same. AMAZING CHARTS CLIENTS' SERVER COMMUNICATIONS Amazing Charts allows and has set up the following communication protocols for clients: e-Prescribing for electronic prescription writing and access to First DataBank drug database (via NewCrop, LLC), HL7 for communicating to laboratory and practice management (PM) companies, SQL Server database for local interaction with clients' database. Application e-Prescribing (through NewCrop, LLC) HL7 SQL Server Security Protocol XML/HTTPS Encryption Method SSL 128 bit AES Comments

Printing

N/A

N/A

e-Prescribing inclu updates, allergies codes

FTPS LAN/WEP or WPA

SSH 128 bit AES N/A

For communication PM servers

Internal communic application and SQ SQL Server service

Protected Health Information (PHI): Protection Against Integrity Failures When communications is necessary over open networks, Amazing Charts protects any PHI communicated against integrity failures. Amazing Charts communications of PHI are all hashed and secured to protect against integrity failures using Secured Hash Algorithm 1 (SHA1) or it successor. SHA1 uses an encryption method that ensures proper data transfer and is utilized by both SSL and SSH. In SHA1 even small differences in content are translated into large differences in hash due to the avalanche effect, protecting against integrity failures. As with SSL and SSH, SHA1 uses a shared key to determine the hashing method. SHA1 uses the same digital handshake over SSL protocols as noted in 6.13 to determine the shared key: _RSA_WITH_AES_128_CBC_SHA _RSA_WITH_AES_256_CBC_SHA LS_RSA_WITH_RC4_128_SHA TLS_RSA_WITH_3DES_EDE_CBC_SHA TLS_ECDHE_ECDSA_WITH_AES_128_CBC_SHA_P256 Over SSH, it uses the Machine Authenticated Code (MAC) configuration: MACs hmac-sha1, ,hmac-ripmd160,hmac-sha1-96 Remote connections are not directly supported by Amazing Charts software. For these clients, we recommend using an Open Virtual Private Network (VPN). VPNs transfer data using SSL protocol and encryption. Proper connection should always be verified prior to data transfer. Also Amazing Charts recommends using wired network connections for security, speed, and data integrity. If wireless networks are used they should be password protected with WEP or WPA encryption. The tables below outline the data transfer methods utilized by Amazing Charts (hosted) or our clients (client) applications to prevent integrity failure. APPLICATIONS USED IN CONJUNCTION WITH AMAZING CHARTS Amazing Charts uses the following hosted programs: Amazing Charts downloads for off-site backups (OSBU) and file

uploads (accessible only from within our SSL protected network), Citrix ICA GotoMeeting to sign into client's computers, and HL7 to send information from laboratory company servers (if applicable).
Application AMAZING CHARTS Citrix ICA HL7 Transfer Protocol FTPS HTTPS FTPS Integrity Protection SSL/SHA1 SSL/SHA1 SSH/SHA1 Comments

To connect to AMAZING CHARTS offSite Backup (OSB support data uploads For communications through Citrix ICA servers for re

Communication between Laboratory and Practice Management (PM) systems and AMAZIN

AMAZING CHARTS CLIENTS' SERVER COMMUNICATIONS Amazing Charts allows and has set up the following communication protocols for clients: e-Prescribing for electronic prescription writing and access to First DataBank drug database (via NewCrop, LLC), HL7 for communicating to laboratory and practice management (PM) companies, SQL Server database for local interaction with clients' database.
Application Scanning and Printing Amazing Charts ePrescribing Transfer Protocol N/A FTPS XML/HTTPS Integrity Protection N/A SSL/SHA1 SSL/SHA1 Comments Done onsite with internal network Computers

For uploads to AMAZING CHARTS off-site backup (OS support data uploads

Send and receive information from ePrescribing inclu information, allergies, ICD9 codes and Practice Mana systems and Amazing Charts servers

HL7

FTPS

SSH/SHA1

Communication between Laboratory and PM system servers for information including demographics, sch results

SQL Server

LAN/WEP or WPA

N/A

Local network connection to Amazing Charts databas

Protected Health Information (PHI): Protection Against False Nodes Nodes are electronic devices attached to the network that allow communication of data via the internet or Ethernet (LAN). In order for secure network functioning, nodes must correctly identify each other prior to any data transfer. This is done with a Symmetric Key Exchange or SSL/TSL Certificate. Symmetric key exchanges are utilized when there is a two-way connection between nodes, while SSL/TSL Certificates are used when 1 node originates the communication (often used with lab interfaces). The Keys and Certificates must match on both nodes and be authenticated before data transfer can occur. The 2 tables below show the protocols, method of node authentication and applications used by AMAZING CHARTS (hosted) or clients' (client) servers. APPLICATIONS USED IN CONJUNCTION WITH AMAZING CHARTS Amazing Charts uses the following hosted programs: Amazing Charts downloads for off-site backups (OSBU) and file uploads (accessible only from within our SSL protected network), Citrix ICA GotoMeeting to sign into client's computers, and HL7 to send information from laboratory company servers (if applicable). Application AMAZING CHARTS Citrix ICA HL7 Transfer Protocol FTPS HTTPS FTPS Node Authentication SSL Certificate SSL Certificate Symmetric Key Comments

To connect to AMAZING CHARTS offSite Backup ( technical support data uploads For communications through Citrix ICA servers for

Communication between Laboratory and Practice Management (PM) systems and AMA servers

AMAZING CHARTS CLIENTS' SERVER COMMUNICATIONS Amazing Charts allows and has set up the following communication protocols for clients: e-Prescribing for electronic prescription writing and access to First DataBank drug database (via NewCrop, LLC), HL7 for communicating to laboratory and practice management (PM) companies, SQL Server database for local interaction with clients' database. Application Scanning and Printing Transfer Protocol N/A Node Authentication N/A Comments Done on client's internal network

Amazing Charts ePrescribing HL7 SQL Server

FTPS XML/HTTPS FTPS LAN/WEP or WPA

SSL Certificate SSL Certificate

For uploads to AMAZING CHARTS off-site backup technical support data exchange

Bidirectional communication between ePrescribing servers

Symmetric Key and SSL Bidirectional communication between Laboratory a Certificate and clients' servers N/A

Local network connection to Amazing Charts data

Time Clock & Audit Log Security Amazing Charts requires utilization of Windows Time Agent which employs the NTP protocol, version 4.1.b. Windows Time Agent is configured to check pool.ntp.org as its primary source and time.nist.gov as its secondary source every 15 minutes. If the time on the domain controller does not match the source, Windows Time Agent will automatically synchronize all machines within the domain to the proper date and time. The NTP synchronized date is utilized for all timestamps in Amazing Charts, including security functions, audit trails, security logs and SQL query records. When an event is triggered in Amazing Charts the following information is recorded: The NTP Timestamp; The machine name that triggered the event; The user name that performed the action; The component (e.g. The exact location in the software where the event transpired); The event type (e.g. System, Security, Security Admin, Patient or User events); The event (e.g. Record Viewed, Record Updated, Record Added, Record Deactivated); The Patient ID, if the component (event location) occurred in a patient's chart; and The result (e.g. event was successful or event failed).

Amazing Charts also records all SQL statements that are issued to the database in full context, along with the NTP Timestamp, the User's unique ID and the Sender ID. End users are not granted direct access to the database; therefore, tampering or falsification of audit trails and security logs is not possible. Virus/Malware Free Programs Amazing Charts installer files and software releases and new builds are housed on our internal server and regularly checked for viruses, trojan horses, worms and other malware. We utilize the most up-to-date versions of both Spybot Search & Destroy and Lavasoft AdAware. Trojans, rootkits, spyware, worms, and viruses are blocked by these programs, as well as tracking cookies, and many ActiveX applications. These applications run constantly in the background to prevent any data corruption or invasion by malware. In addition, full system antivirus scans with the latest antivirus software (McAfee Security) on our build servers are run each night to ensure no malware has found its way into the system. Additionally, prior to a new release a full system scan with both Lavasoft's AdAware and Spybot's Search & Destroy are run. If any threats are found, they are quarantine and destroyed by the Amazing Charts system administrator. Only if the system is completely free of all malware, and behaving as expected, will our newest release be distributed.

Security Features & Password Constraints Amazing Charts provides the password security features mandated by CCHIT, including the ability to require users to change their password at regular intervals, require passwords to be case sensitive, alpha-numeric, and a minimum number of characters. Amazing Charts can also be set to lock-out a user after a specified number of failed log-in attempts (all of which are documented in the audit log), and provides the ability to disallow users from using previously used passwords. All passwords are stored in an encrypted field within the database. Amazing Charts utilizes Advance Encryption Standard (AES) for password encryption. AES is the standard utilized by the government for data encryption. It is comprised of 3 block ciphers with each cipher having a 128 bit block size and varying key sizes. This standard has been analyzed extensively including by the National Institute of Standards and Technology (NIST) and is used extensively worldwide. All passwords in Amazing Charts are encrypted using AES and stored in our SQL server database. Current passwords are stored in the ProviderSecurity table and past passwords are stored in the ProviderSecurityPast table. In addition to AES encryption, the database where the passwords are stored is inaccessible to both hosted and client users as an added layer of security. If a data file, which includes passwords is sent, the entire file is encrypted, leading to double encryption of user passwords. The only transfer of password data that can occur is through transfer of the database and this occurs through off-site backup (OSBU) to our backup site or through upload to our Technical Support.

When files are sent through our OSBU, the database files are encrypted with AES (leading to double encryption of passwords) and transferred securely via File Transfer Protocol over SSL (FTPS using Auth TLS). Files sent through our upload to Technical Support follow the same procedures and are encrypted with AES and transferred securely via Auth TLS. Should a client wish to move an encrypted database to a computer off-site (at home for example) Amazing Charts recommends creating an encrypted backup using our Backup Utility and transferring the backkup file through the use of removable storage media. Users could also use a program such as Open VPN, which also employs an SSL Protocol. We don't recommend this method, however, as any remote machine that will be connecting to the network need to verify the encryption list before a connection is established. Electronic Prescribing Amazing Charts offers electronic prescribing (ePrescribing) through Surescripts (via New Crop LLC engine). New Crop uses Lexi-Comp's Multum database as its source of drug information. This includes drug/drug, drug/disease, and drug/allergy interactions (your patients' allergies and disease information are automatically and securely transferred to New Crop). ePrescribing offers the benefit of sending prescriptions directly to pharmacies electronically. This saves both the patient and the staff time. All transmissions are protected and secure so only the pharmacy can see the information that is being sent. With Amazing Charts ePrescribing, patients' allergy and diagnosis codes used to make sure there are no drug/allergy or drug/disease interactions. More on ePrescribing functionality is discussed here.

Data Encryption

Overview

Amazing Charts includes hashing and data encryption capabilities to meet current and future requirements for Data Encryption. Our security library includes the following capabilities: Create a hash value or message digest for user data using industry standard cryptographic hash functions. Encrypt user data using industry standard symmetric key algorithms. Decrypt user data using industry standard symmetric key algorithms. Securely transmit user data and hash values to remote systems. The Amazing Charts security library is built on top of the Microsoft .NET System.Security.Cryptography assembly.

Secure Hashing

The Amazing Charts security library supports cryptographic hashing of any user data to ensure data integrity. Hash values are computed using SHA-1 or SHA-2 standards. The following algorithms are supported: SHA-1 SHA-256 SHA-384 SHA-512

Encryption

The Amazing Charts security library supports data encryption using the industry standard AES 256 symmetric key algorithm. The encryption algorithm uses a 256 bit key, a 128 bit block size, and a CBC cipher mode. The encryption API requires a user supplied password with the data to encrypt, and passwords can optionally be validated to ensure that they are strong." A salt value is also used to provide additional security. The library also supports decrypting data that was encrypted by Amazing Charts as long as the calling program provides the original password used to encrypt the data.

Secure Message Exchange

Data can be securely transmitted from Amazing Charts using our secure web service: https://services.amazingcharts.net/MessageExchange/MessageExchangeService.svc This web service has the following features: Callers can send user data (typically PHI data such as HL7 messages or CCD messages) and corresponding hash

values securely using encrypted HTTPS/SSL transmissions to the Amazing Charts web server. The message body can contain plain text or encrypted data, but in either case the data is encrypted during transmission. Messages are stored on the Amazing Charts server for later retrieval. Callers can request a list of the messages that are currently available for their facility. Callers can retrieve a message and its corresponding hash value from the web service. This web service is deployed on a web server that is identified by a Thawte SSL web server certificate. All communication with the web services is transmitted using HTTPS/SSL and is therefore encrypted, thus providing integrity, privacy, and mutual authentication for the data transmission.

Data Encryption Utility Program

The Data Encryption utility program demonstrates the security capabilities available in Amazing Charts. This program can e accessed y selectng the ncrypton item on the Advanced dptons menu of the AmaAing Utilities program.

Creating Hash Values

On the PHI File tab of the Data Encryption utility, open a data file and view the contents of the file:

Figure 1 - Open Data File

Click the Create Hash button to generate a cryptographic hash value for this data. The hash values are created using the SHA-1 secure hash algorithm. The hash value will be displayed in the Hash Result Log box. Subsequent clicks of the button will repeat the process and add the new hash values at the top of this log. You can also modify the data and click the Create Hash button again to verify that a different hash value is created

Figure 2 - Create a Hash Value

Figure 3 - Hash Value for Modified Data

Secure Data Transmission

Send Data to Web Service To transmit data using the AmaAing harts secure message exchange we service, open a data file on the PHI tab (see Figure 1 - Open Data File above). Enter a description for the message. This will be used later to identify the message to the user during retrieval. lick the Send PHl and hash to secure we service link on the form to securely transmit the data and the hash value to the web service. A dialog box will be displayed to verify that the message was sent.

Figure 4 - Send Data to Secure Web Service

The data and hash value are transmitted to the web service using HTTPS/SSL. This transport protocol provides encryption and data integrity for the transmitted data. This is also true for data this is retrieved using the web service (see below). Receive Data from Web Service Select the Receive PHl ta on the Data ncrypton utlity. lick the Refresh Availa le link. The list will show the descriptions for any available messages:

Figure 5 - Get Available Messages

lick the Retrieve PHl uion to download the message data and its hash value from the secure we service. The message data will be displayed on the form along with the original hash value that was sent to the web service (the original hash value is displayed in the Retrieved Hash ox):

Figure 6 - Retrieve Message from Secure Web Service

Verify Integrity of Retrieved Data To verify the integrity of the data retrieved from the web service, simply click the reate Hash uion. This will generate a hash value for the retrieved data using the Amazing Charts security library, and this value will match the original has value (shown in the Retrieved Hash box) if the data has not changed:

Figure 7 - Verify Integrity of Retrieved Message

Encrypting Data

To encrypt data using the Data Encryption utility program, open a data file on the PHI tab (see Figure 1 - Open Data File above). Enter a password for the encryption process. Note that this password will be required to decrypt the data later. lick the ncrypt uion to encrypt the data. Note that the data is encrypted using the AES 256 symmetric key algorithm (256 bit key). Our encryption and decryption algorithms are built on top of the Microsoft .NET System.Security.Cryptography assembly.

Figure 8 - Encrypt Data

The encrypted data can then e saved to a fle y clicking the Save ncrypted uion.

Decrypting Data

To decrypt data with the utility, select the ncrypted File ta and open an encrypted fle (see Encrypting Data above to learn how to create an encrypted file).

Figure 9 - Open Encrypted File

Make sure you enter the password that was used to encrypt the data, and then click the Decrypt uion :

Figure 10 - Decrypt Data

Secure Transmission of Encrypted Data

Send Encrypted Data to Web Service To transmit encrypted data using the AmaAing harts secure message exchange we service, open a PHI file and encrypt the data as described previously (see Encrypting Data). Enter a description for the encrypted message. This will be used later to identify the encrypted message to the user during retrieval. lick the Send encrypted data to secure we service link on the form to securely transmit the encrypted data and its hash value to the web service. A dialog box will be displayed to verify that the message was sent.

Figure 11 - Send Encrypted Data to Web Service

The encrypted data and a corresponding hash value are transmitted to the web service using HTTPS/SSL. This transport protocol provides encryption and data integrity for the transmitted data. This is also true for data this is retrieved using the web service (see below).

Receive Encrypted Data from Web Service Select the Receive PHl ta on the Data ncrypton utlity. lick the Refresh Availa le link. The list will show the descriptions for any available messages:

Figure 12 - Get List of Available Messages

Select the encrypted message you wish to retrieve and click the Retrieve PHl uion to download the encrypted message and its hash value from the secure web service. The encrypted message data will be displayed on the form along with the original hash value that was sent to the web service (the original hash value is displayed in the Retrieved Hash ox):

Figure 13 - Retrieve Encrypted Message

To decrypt the message, enter the password used during encrypton and click the Decrypt uion . Once decrypted, the user can also verify the data integrity y clicking the reate Hash uion.

About Amazing Charts Window

About Amazing Charts


The About Amazing Charts window has information on the current version installed, the location of the databases to which this program is currently attached, as well as links to a few features intermittently needed. Register Amazing Charts: This button is visible during the trial period. If you decide to purchase Amazing Charts before the end of the trial period, it is done by clicking this button. Verifying the practice: In order to use some of the advance (and restricted) features of Amazing Charts (such as prescription writing), the practice must be verified so we know who you are. This can be done by clicking the link to Verify the Practice. Check for Updates: Clicking this button will have Amazing Charts go online to see if there is an updated version available. Recommend Improvements: Click this button to open a window and submit your ideas and suggestions on making Amazing Charts better. These suggestions are delivered to the development team and are used as we plan our upcoming features and changes. Turn On/Off Debugging: Occasionally you may want the program to perform advanced debugging. This is helpful if you are experiencing an issue that is intermittent in nature, since we must be able to replicate a problem in order to solve it. This button toggles debugging mode as standard or advanced. System Information: This button will open Windows system information window. It is sometimes used by tech support when clarifying how a specific computer is set up and configured.

User Preferences
User preferences can be set under the menubar: Edit | My Preferences | User Preferences. Preferences allow the individual user that is logged in to change the way their version of Amazing Charts functions. Preferences include setting various alert window to appear or not appear, automatically run spell check prior to signing a note or letter, changing ones password, etc. We continually add additional preferences so that users have a more efficient experience. To learn how to submit your preference ideas, click here.

HIPAA Alert
The HIPAA Alert is a warning message that will appear when you are about to perform an activity that has HIPAA ramifications (e.g., printing out a patient chart). You should fill in the salient information when you see this alert. More information on how Protected Health Information (PHI) integrity is maintained is discussed here.

Restarting Amazing Charts


For certain changes and database updates to take effect, Amazing Charts will ask you to restart the program. During routine database maintenance (e.g., running Amazing Utilities), it is wise to have Amazing Charts not running on any computer that attaches to the main database. During these times you will be asked to shut down or restart the program as necessary.

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