Regard User Guide

IT Clinical Applications Education Management Team

Table of Contents Overview: ............................................................................................... 3 Note Requirements: .................................................................................. 3 Launching Regard:.................................................................................... 4 Change Base Note: ................................................................................... 4 Note Overview – Diagnosis: ....................................................................... 4 Editing Diagnoses:.................................................................................... 5 Dismissing Diagnoses:............................................................................... 6 Shelved Diagnoses: .................................................................................. 7 Adding Specificity to Diagnoses: ................................................................. 8 Note Overview – Supporting Evidence Bullets:............................................... 8 Critical Lab Indicator:.............................................................................. 10 Copying the Note: .................................................................................. 10 Copying a Single Diagnosis: ..................................................................... 10 Diagnosis Details:................................................................................... 11 Resources & Feedback:............................................................................ 13 Technical Support:.................................................................................. 13

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User Guide: Regard

Overview: Regard is an artificial intelligence (AI) tool that reviews clinical patient data, recommends diagnoses, and generates relevant language and data to create or enhance clinician progress notes. This guide will review the functionality and features of Regard. Upon launching in a patient’s chart, Regard analyzes the last Assessment & Plan from the current encounter and all available patient data. Regard will: ▪ Recommend new diagnoses not already mentioned in the note ▪ Generate relevant supporting evidence bullets for any covered diagnosis, both new and previously mentioned ▪ Alert the provider to recently updated evidence since the previous note ▪ Suggest diagnosis title modifiers in compliance with CDI guidelines Providers can accept or dismiss recommendations at their discretion. Regard will remember these selections and monitor covered diagnoses until the patient is discharged. Note Requirements: Certain formatting guidelines must be followed for Regard to properly parse the progress note and align supporting evidence bullets: ➢ Note templates must include the header “Assessment and Plan” so we can find this section to copy forward. ➢ Numbers or hashtags (#) need to be placed before each diagnosis so the system can distinguish them from other text. ➢ Spaces between unrelated diagnoses so that supporting evidence can be organized under associated diagnoses. Note: related diagnoses can be “stacked” to reduce duplicate supporting evidence bullets.

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Launching Regard: Regard is available as a tab within Cerner EHR. Although it appears that Regard is part of the EHR, it sits on top and pulls information from the EHR. Information in Regard does not become part of the legal medical record until the clinician pastes into and signs the note. From the left menu column. You may need to scroll down toward the bottom of the menu.

Change Base Note: Regard will pull in the Assessment & Plan from the last progress note, also known as the base note. The date and time of the base note is displayed at the top of Regard. If another note is preferred, the user can click Change base note to select and load the appropriate note.

Upon loading the preferred note, a popup will notify the user that any current edits will be lost. This action is not reversible.

Note Overview – Diagnosis: Regard will recognize diagnoses mentioned by the provider in the base note and for which an algorithm has been created, as well as identify new diagnoses based on review of patient data from current and previous encounters. The green bar will show the number of previously identified diagnoses that have updated information, as well as any new diagnoses recommended by Regard.

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The screenshot below displays a non-covered diagnosis and Regard supported diagnosis that was in the base note, as well as a new diagnosis that Regard is suggesting.

The diagnosis toolbar contains the following action icons.

Editing Diagnoses: Providers can add free text to diagnosis lines, as needed.

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Adding Diagnoses: Additional diagnoses can be manually added by hovering between diagnoses and clicking the Add Dx button. Regard will automatically add a hashtag or number, based on the note format.

If the added diagnosis is covered by Regard, the Live Dx feature will automatically launch. While the condition did not meet the criteria in the algorithm, once Live Dx recognizes the condition, Regard will display relevant supporting evidence and populate the Dx Details.

Dismissing Diagnoses: Newly identified diagnoses will be automatically added to the note, unless they are dismissed by the provider using the diagnosis toolbar. Dismissed Regard covered diagnoses appear at the bottom of the note throughout the encounter, will continue to be monitored and can be restored, if appropriate.

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Stacking Diagnoses: Regard will recognize multiple diagnoses listed on one or more lines, however without spaces between, as “stacked” diagnoses . Evidence bullets for all conditions will be displayed together. For example, both below conditions include Hypertension and Hyperlipidemia.

Shelved Diagnoses: The Shelf helps to reduce note bloat by condensing stable, chronic, or resolved conditions. Currently, the shelf header is Stable/Chronic/Resolved, however this is editable by the clinician and will appear when copied and pasted into the note in the EHR. To move a condition to the shelf by hovering over a condition and click the Shelve Dx icon . The diagnosis moves to the shelved section at the bottom of the note. Regard generated evidence lines added to the note will collapse. Evidence lines formerly in the monitor section are moved to Dx Details. Any clinician entered bullets will remain with the shelved diagnosis. Click the drop-down arrow to see the Regard bullets previously displayed. Only the diagnosis and clinician entered lines will appear when the note is copied into the EHR.

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If clinicians want to add lines to shelved conditions, we recommend they move the condition back into the active section of the note. To do this, simply select the Move Dx button and select the desired location to place the condition in the Regard note. Any Regard evidence is restored to the way it was displayed prior to shelving the diagnosis. Adding Specificity to Diagnoses: Diagnoses will appear shaded in peach when the diagnosis can be further specified. Hover over the peach diagnosis and the Specification Opportunity window will open and suggest specifications to that diagnosis that complies with CDI guidelines. Click in the line to manually type the specification where you want it to display on the diagnosis line.

Type in the word ‘diastolic’ and the peach shading will no longer display.

Note Overview – Supporting Evidence Bullets: Evidence bullets suggested by Regard will appear below covered diagnoses next to a color- coded bar or “gutter”.

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While diagnoses are automatically added to the note unless dismissed, evidence bullets must be added individually by clicking anywhere on the bullet. Added bullets will appear above the gray dotted line ( ) in the order in which they were clicked.

Evidence bullets suggested by Regard that are modified in any way, i.e., removing text, dates, capitalizing, etc., will lose tracking and not be updated by Regard.

The absence of a gray or green gutter indicates that Regard has lost “ownership” of the bullet. If additional commentary is needed, it is recommended to add the text as a separate line.

The remaining bullets can be left “below the line” for context surrounding the condition and monitored by Regard or removed from view by clicking the trash can icon . Deleted/ removed Regard generated evidence lines will continue to be tracked and visible in Dx Details.

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Critical Lab Indicator: Regard will highlight critically high or critically low lab values indicated by , regardless of where the condition appears in the Regard note. In the example below, the critical lab indicator appears when the Covid-19 condition is listed in the main section, Shelved section and Dismissed Dx section of the Regard window.

Copying the Note: Once the note has been finalized, the provider can click Copy Note at the top of Regard to copy all text above the line to paste into their progress note. Icons, gutters, and evidence bullets below the line will not appear in the pasted text.

Copying a Single Diagnosis: There are occasions that a clinician only wants to include an individual condition in their note rather than using Regard to fully edit and then copy/paste the entire note into the EHR, using the Copy Dx feature. Simply add evidence lines and any other information, click the Copy icon ( ), and paste in the note within the EHR.

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This functionality is useful: ➢ Attesting resident notes when they want to add a missed condition ➢ Notes for patients that are later in their stay and not much has changed with other diagnoses.

Diagnosis Details: Providers can see more information about a condition by clicking the condition name underlined in blue to view additional information in the Dx Details panel. In the example below, Pneumonia is selected and now highlighted, as the additional details for this condition are now displayed in the Dx Details panel.

The secondary panel opens to the right in full-size Regard.

Dx Details includes clickable tabs for stacked diagnoses.

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Dx Details includes the following sections: ➢ How is this Dxed? Click on this link to view the Condition Summary providing details on the clinical logic used to diagnose the condition. ➢ Regard Dx Lines section contains the original evidence bullets suggested by Regard

o Will be collapsed, so click the down arrow to expand

o Accepted bullets appear with a check mark

o Monitored bullets can be added “above the line” and dismissed bullets can be restored from the status column o The bar or gutter will appear green for new or updated evidence

➢ Additional Dx Details – supporting data for the diagnosis that is typically not presented as evidence bullets but can provide insight as to why Regard suggested the diagnosis. Users can click Show All to see the full list. o Additional lab results, PRN and other medications, risk calculations, etc. o Dx Source: Documents – links to progress notes or consult reports that pertain to the condition. o Dx Source: Problem List – documentation of the diagnosis in the problem list. o Supporting Evidence – links to imaging and other diagnostic reports as evidence to support the diagnosis

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➢ Table – a visual representation of patient data for the condition. It functions as a filtered chart, showing the relevant medications, vitals, and labs for the selected condition. ➢ Timeline – vitals and labs collected from the patient over time. Users can hover over a data point to view the collection date and click it to jump to that date in the table.

Resources & Feedback: Two buttons appear at the bottom of the secondary panel:

➢

Help & Resources – a quick guide to Regard’s basic functionality, list of current diagnoses, links to diagnosis

summaries and contact information for Regard technical support.

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Regard Feedback – a comment box for users to submit feedback and concerns along with a screenshot to Regard’s technical support team for review. Users can include their email address if they wish to be contacted with status updates.

Technical Support: For urgent support, users can contact Regard technical support at support@withregard.com. A support member will be in touch as soon as possible.

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IT Clinical Applications Education Management Team

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