EHR User Guide
Overview of how to use Curbside when integrated with your EHR.
Overview
This document is for users at institutions that have integrated Curbside pathways and workflows into their EHR solution. By leveraging SMART on FHIR APIs and interoperability, Curbside integrates clinical guidelines at your point of care so clinicians can place orders and automate notes within your EHR. The content available in Curbside is customized to your institution and maintained and approved by your clinical leadership. Curbside is patient specific and launches as a utility when a patient chart is opened.
Your clinical guidelines will typically be presented using pathways or workflows maintained by your clinical team in Curbside, but standard content web pages like WikeEM may also be included. Pathways are standard decision tree based algorithms, while workflows use a series of questions to gather information and work through the guideline.
Accessing Curbside
There are multiple ways to integrate Curbside with your EHR, and most institutions implement multiple options to support different clinical situations and workflows. For all options described below, Curbside access is managed through your EHR and does not require additional user setup.
Tab In Header: This is the one of the most common integration options making Curbside available from any patient chart.
Storyboard Notification: The storyboard on the left hand pane in Epic (see screenshot) can be a configured to provide a soft alert that guides users to relevant Curbside content if specific clinical conditions for this patient are met. An example of storyboard notification is in red in the middle of the screenshot to the right.
BPA Notification: BPA notifications can also be configured and are generally most useful for high specificity conditions. A neonate with fever as their chief complaint is a good example, but a patient with a chief complaint of chest pain may be too general as there are multiple clinical guidelines that may be relevant depending on other clinical factors.
Link from a Lab Result: Curbside Curbside content can be linked from any UA or other specific result.
Selecting Content
This section focuses on using the Curbside library to find content. In some instances you may skip this step and be guided directly into a specific piece of content detailed in the next section.
Curbside provides multiple options to access your clinical content:
Enter text directly into the the search bar
Click one of the filtering options below the text search bar
Suggested: The default list includes content based on institution and individual utilization as well as patient profile
Starred: Content you previously starred for easy access
Recent: Recently used content
Categories: Clinical categories provide groups of content (e.g. ED, cardiac, abdominal, etc.) for more focused searching
Calculators: Access to our library of clinical calculators
Click the content name to open
Content Overview
The image below shows the major sections of your content view. Parts of this view may change depending on the design of your selected content and real time interactions, but below we describe the overall functionality and how to modify your views to display orders, resources, and other content.
Header Menu
The Header Menu is at the top of the Curbside display and the includes the following features:
Institution Logo: Clicking the logo will close the current view and return to the Curbside Homescreen
Back / Forward Arrows (): Move forward and backward through your navigation history
Homescreen (): Clicking will close the current view and return the user to the Curbside Homescreen, or return the user to content if they are in the Orders screen
Search: Allows you to search for and navigate to different clinical content
Orders (): Opens the Orders list where you can view selected orders or search for additional orders to add, or click to return to the content display
Notes (): Clinical decisions from the workflow are tracked automatically and can be cut and pasted into your notes to streamline your workflow, or notes can be added manually
More (): Additional menu items
Tools (): Includes antibiograms and utilization metrics
Settings ( ): User profile information
Support (): To provide feedback to or request support from the Curbside Health team
Content Toolbar
The Content Toolbar is below the Header Menu. This toolbar includes the content name and the functionality described below. If you see a dropdown arrow to the right of the content name, this can be used to jump to specific components of a workflow.
The features below move across the toolbar from the left to right. Note that a specific item may not appear if the menu item is already displayed or it is unavailable for this content. For example, some pathways may not have a corresponding workflow so the workflow icon would not display.
Star (): Tags this content for quick access to on your homepage
Show Orders Cart (): Click to display the Orders Cart
Pathway (): Change Content Display to the decision tree pathway
Workflow (): Change the Content Display to the workflow
WikEM (): Displays linked WikEM supporting evidence in the main window
Resources (): Display supporting materials aligned to this content, including:
Evidences
Antibiograms
Videos
Calculators
Feedback (): Share feedback with the clinical authors from your institution
Metrics (): Display utilization metrics
Content Display
The main window on the left of your display is usually a pathway or workflow maintained in Curbside by your local clinical team, but it could also be a WikEM, Orthobullets, or other best practice webpage. The type of content drives how you will interact with it.
Workflows
Workflows use a question and answer approach to guide you through the clinical best practice. Each successive question or set of questions is based on previous responses so the orders, clinical recommendations, and supporting resources and materials are tailored to your responses. Moving back through the workflow and changing answers may change orders and recommendations.
Pathways
Pathways use decision trees to present the clinical best practice. Where the workflow guides the clinician and only shows orders and recommendations based on the clinician input, the pathway includes the entire decision tree. Clicking the blue icons, videos, or links embedded in the pathway will provide additional clinical information and context, or scan the QR to view on your iOS mobile device.
Pathway Features & Navigation
Pathways open with the top section displayed and allow users to drag and resize the pathway as needed.
Moving the Pathway: Click the pathway to drag what part is displayed
Add Orders: If a node has orders, click on individual orders or the Add All () option in upper right corner to add to your Orders Cart. More details on Orders are included below.
View Evidence and Other Supporting Details: Pathways supports layers of information and you can click on instructional videos or icons on the nodes, like this evidence icon (), for additional clinical information.
Access the Pathway On a Mobile Device: Scan the QR code in the there is a node that includes your institution name a QR code scan this with an iOS mobile device to view on our mobile app.
Node ID Enable / Disable (): Displays or hides the node ID under each shape
Zoom to Starting Node (): Resets your display to the first pathway node
Zoom to Fit (): Click this button to automatically set the zoom so the entire pathway is displayed
Zoom In
Slide the zoom bar to the right, click the “+” or click the percentage to enter a different value ()
Mouse: Roll the scroll wheel forward (if available on your mouse)
Mousepad: Spread your fingers as you would to increase the size of a photo on your phone
Zoom Out
Slide the zoom bar to the left, click the “-” or click the percentage to enter a different value ()
Mouse: Roll the scroll wheel backwards (if available on your mouse)
Mousepad: Pinch your fingers as you would to decrease the size of a photo on your phone
WikEM or Other Best Practice Webpage
For WikeEM or other best practices web pages, this will be a direct link to an external web site. In this example, the content is not customized to your institution like the Curbside pathways and workflows.
Orders, Recommendations, & Sharing
This section allows the clinician to view orders, recommendations, and share a customizable encounter summary. These sections are displayed as you interact with Curbside content, but each section has a close option in the upper right corner.
Orders
Orders are integrated with and can be added from pathways and workflows. In workflows, orders display in this section as the questions are answered. For pathways, the order must be clicked in the pathway node to add the Orders list. Additional orders can be added by clicking the Orders () icon on the Content Toolbar. The checkbox indicates the order is selected and the clinician always has the ability to change the selection.
Curbside orders are pushed into Epic unsigned so we can leverage existing EHR security protocols. All orders must be sent from Curbside using the Send Orders () button, and then accepted and signed in your EHR to complete the order.
To close the Orders section, click the circled X that displays when your mouse is in the upper right corner of the Orders section. Selected orders will remain after closing. To reopen the orders click, click the Show Orders Cart ()menu item in the Content Toolbar.
In addition, some implementations support additional order modifications when hovering on the order line:
Click the checkbox to the left to remove the order from the Orders Cart, but keep it visible in the Orders list
Click the edit icon ()to modify the order parameters such as frequency, duration, and indications
Click the X to remove the order from the Orders List and, if selected, remove it from the Orders Cart
Recommendations
Recommendations are only part of workflows. They provide additional clinical guidance from your local content owners that is tailored based on your responses. They are optional and may not display for every workflow. To close this section, click the X in the upper right hand corner.
Sharing
The Share () feature allows you to easily distribute information about the encounter information to the patient or someone they designate via email, text, or as a printout. The available information to share includes orders, recommendations, and relevant resources. After clicking the Share button,the clinician can click the checkboxes to select which pieces of information to share. This feature is currently only available from the Orders section in workflows.
To share the encounter summary:
Click the Share () button at the bottom of the Orders, Recommendations, & Sharing section
Enter the email and phone number to share with
Click the checkbox(es) to select content to share
Use the Right hand side to confirm your encounter summary
Click Share () when ready
Close the Share window by clicking the X in the upper right corner
Resources, Feedback, Or Metrics
If this section is open, it displays either the Resources, Metrics or Feedback.
Resources (): Primarily used in workflows to provide evidence, videos, links, calculators and other supporting material. For pathways, this information is typically displayed on the pathway or layered in a node.
Feedback (): Allows users to provide positive or constructive feedback directly to your local clinical content owners.
Metrics (): Display content utilization and frequency.
You can toggle between these displays using the menu items in the Content Toolbar described above, or close out the view by clicking the X in the upper right corner.
Have questions, feedback or need assistance? Email us at support@curbsideup.com.