Category Archives: News

How to Invalidate Documentation in Paragon Clinician Hub?

In Paragon Clinician Hub, when a document has been entered under the wrong visit ID or for any other reason the document needs to be removed from the record, it needs to be Invalidated.

If you have received a notice stating that you need to make this change, please utilize the instructions below. For additional visual training, a screen shot and a link to a video has been added below as well.

  1. Go to Census, locate visit where the document should be entered by entering the Visit ID supplied by Medical Records into the search field.
  2. Recreate the note under the correct visit ID, noting that the date is editable.
  3. Go back to the Census Tab.
  4. Locate visit where the document is entered in error by entering the “wrong” Visit ID supplied by Medical Records into the search field.
  5. Open the note in question, and locate the icon next to red X in the upper right hand corner; click the invalidate icon and choose a reason for invalidating.

Video on how to Invalidate:


PERT Alert (Pulmonary Embolism Response Team)

PERT is an interdisciplinary effort to provide rapid assessment and treatment based upon the patient’s condition and best practice guidelines. Research has shown that a systematic approach to treating pulmonary embolism (PE) patients will increase time to treatment and decrease adverse events including mortality and long term heart failure.


A PERT ALERT is initiated on all patients diagnosed with a Sub-Massive or Massive PE to establish a mechanism for key personnel to rapidly evaluate and accurately risk stratify to provide evidence-based care and treatment. Patients are risk stratified in to 3 categories: Low Risk, Sub-Massive, or Massive.  Potential patients appropriate for Catheter Based Treatment (CBT) are those stratified as Sub-Massive and Massive. Most patients qualify for Catheter Based Treatment. The goal of CBT is the removal of the obstructing thrombi from the pulmonary arteries to facilitate right ventricular recovery, and to improve symptoms and survival. This includes reduction of long term heart failure. CBT uses significantly less tPA than medical treatment (or systemic treatment), thus reducing bleeding complications. Few patients receive Surgical Pulmonary Embolectomy. By providing a systematic evidence based approach, we may be able to get patients to surgery before they decompensate to a point of no return.


The initial key person to contact is the Interventional Cardiologist on call for PERT ALERT. Additional persons can include pulmonologist, surgeon, hospitalist, hematologists and pharmacist. Nursing provides support by closely monitoring the patient’s condition for deterioration, ensuring rapid completion of tests such as Stat CT Scan, Stat Echo, EKG and lab work, and administering medications.


PERT Alerts should be called by the physician receiving the report of a confirmed PE.  Once a PERT Alert has been activated a PERT Alert Algorithm will be followed as indicated in the PERT Alert Policy, #9856-261.  The PERT Alert Policy went into effect system wide effective May 1st, 2018.  The interventional cardiologist on call for PERT Alert can be found via the ED Call schedules.

PERT – PE Risk Stratification- pocket card- working document

New Citrix Receiver – Rollout Begins 6/18/18

The IT Team announced an upgrade to the Citrix Receiver 4.9 for all hospital service areas. The new Citrix Receiver is designed to eliminate desktop clutter and allow end users to manage their Citrix icons in a convenient “storefront.”  The rollout will take place June 18th through June 22nd.  The Help Desk will staff additional agents during the rollout and the Desktop Team will round on units to provide Support.  The rollout schedule is as follows:

  • Monday, June 18th              Pharmacy & Lab
  • Tuesday, Junet 19th             Inpatient Nursing Units, Physician devices, Registration
  • Wednesday, June 20th        Surgical Services
  • Thursday, June 21st             Medical Imaging
  • Friday, June 22nd                 Care Coordination

Citrix Receiver Training Guide

Paragon 14 upgrade


Paragon will be upgraded from version 13.x to version 14


Saturday 3/17/18 at 10p to Sunday 3/18/18 5p

What will be unavailable?

All Paragon applications including Clinician Hub (physician access) and Clinical care station ((nursing access)

What will be available?

PACS, MPF (medical records), T systems, OB and anesthesia Centricity, MUSE and CVIS

For instructions on accessing MPF during downtime see here.

What about labs?

Labs will be printed and placed in the paper chart.

What about notes?

Physicians will dictate notes during downtime.

What about orders?

Paper order sheets and prescriptions will be used during downtime.

What are the new features in Paragon 14?

  1. Updated Patient Card: Patient demographics are easier to see in the upper left hand corner.
  2. Patient Profile (NEW): Report containing information such as advanced directives, allergies, demographics, family history, implants, home medications etc are now available in a single report. This report can be customized by the end user for their practice
  3. New flowsheet search capabilities: Some flowsheets such as Lab can get very difficult yo navigate especially on long admissions. This new search function will allow the user to quickly scroll the needed row. In this example I searched for “chest”. I was taken to the Chest X-ray row with the specific row highlighted.
  4. Prescription writer: Now allows for secure electronic submission of controlled substances


Video Language Line Now Available

In order to address our interpreter needs across campuses, we are going to test a new interpreter device that will better serve our community. We have 3 Interpreter on Wheels (IOW) devices that we will pilot for 2 weeks, beginning 11/8/17. The device will allow us to meet Joint Commission standards as hospitals are required to use a qualified interpreter when communicating with patients & families who have limited English proficiency.

You simply choose from 35 different  languages including American Sign Language and a qualified interpreter will join you via IPad Video Web Camera. In caring for patients 24/7 this will provide a more personalized approach in comparison to the phone service we currently use.

ED Specialists, Chaplains and Interpreter Team Lead will be trained as super users for your convenience on 11/8/17. However, the intuitive product will have written instructions attached. We can begin to use the devices 11/8/17.

The IOW will be stored in the ED of CHM, CHH & CHW. If you would like to use the device, please contact ED and sign out the IOW. There will be a log sheet which will ask you to provide some feedback as we consider using this tool for patient care. After usage the device will ask you to rate it 1-5.

Influenza Vaccination in Patients with Egg Allergy


January 11, 2018

Influenza Vaccination in Patients with Egg Allergy

David J. Amrol, MD reviewing Greenhawt M et al. Ann Allergy Asthma Immunol 2018 Jan .

All available flu vaccines are safe in all egg-allergic patients.

Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)

Target Audience: All providers who administer influenza vaccines


Historically, patients with egg allergy have been told to avoid flu vaccines, because most flu vaccines are produced in embryonated chicken eggs; the concern was that a vaccine might contain residual egg protein, which could lead to anaphylaxis. Many studies have shown that flu vaccines are safe for egg-allergic patients, but many physicians still have been hesitant to vaccinate such patients. This updated practice parameter incorporates recent data on flu vaccine safety in egg-allergic patients, including children.

Key Recommendations

  • Flu vaccines should be administered annually to patients with egg allergy of any severity, with no need to ask recipients about egg-allergy status and no special precautions beyond those recommended for administering any vaccine to any patient. This recommendation applies to both injected and intranasal formulations (although the latter should not be used in the 2017−2018 flu season).
  • Non−egg-containing vaccines can be used but are not necessary or preferred over standard vaccines.
  • The intranasal live attenuated flu vaccine also might be used, if it’s shown to be efficacious and is approved for use.

Egg-allergic patients can be vaccinated safely with any available age-appropriate flu vaccine, with no special precautions, regardless of egg-reaction history (including anaphylaxis). Concern for egg allergy only adds another barrier to universal flu vaccination, and this practice parameter concludes by stating the following: “Vaccine providers and screening questionnaires do not need to ask about the egg allergy status of recipients of influenza vaccine.”

Editor Disclosures at Time of Publication

Disclosures for David J. Amrol, MD at time of publication

Consultant / Advisory boardCSL Behring; Horizon Pharmaceuticals

Greenhawt M et al. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol 2018 Jan; 120:49. (