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IHS - EHR Version 1.1 Indian Health Service - Electronic Health Record

IHS - EHR Version 1.1 Indian Health Service - Electronic Health Record. Chris Lamer, PharmD Stephanie Klepacki. The Wellness Tab and CRS. Patient Education. Condition Topic Readiness to learn Level of understanding Provider Time Goal Comment. Patient Education Codes.

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IHS - EHR Version 1.1 Indian Health Service - Electronic Health Record

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  1. IHS - EHR Version 1.1Indian Health Service - Electronic Health Record Chris Lamer, PharmD Stephanie Klepacki The Wellness Tab and CRS

  2. Patient Education

  3. Condition Topic Readiness to learn Level of understanding Provider Time Goal Comment Patient Education Codes DM-EX-DIST-P-CCL-5min- GS-Will walk 3x per week- Does not exercise

  4. Patient Education Codes • Local development • Submitted and approved by PEP-C • Added to the Protocol manual & RPMS • Protocols • Outcomes • Standards • Lesson plans

  5. Patient Education and CRS • Used in the following GPRA measures • Tobacco Cessation (Counseling) • Tobacco (TO-, -TO) • Secondhand Smoke (-SHS) • Alcohol Screening (FAS Prevention) • Alcohol and Other Drugs (AOD) • Intimate Partner/Domestic Violence Screening • Domestic Violence (DV-, -DV)

  6. Patient Education and CRS (cont’d) • Depression Screening • Depression (DEP-) • Behavioral and Social Health (BH-) • Suicidal Behavior (SB-) • Postpartum Depression (PDEP-) • Comprehensive CVD-Related Assessment • Tobacco Screening (TO-, -TO, -SHS) • Lifestyle Counseling • Nutrition/Medical Nutrition Therapy (-N, -MNT) • Exercise (-EX) • Lifestyle Adaptation (-LA)

  7. Patient Education and CRS (cont’d) • Used in the following non-GPRA measures • Tobacco Use and Exposure Assessment • Alcohol Screening and Brief Intervention (ASBI) in the ER (CRS 8.0) • Nutrition and Exercise Education for At Risk Patients • Appropriate Medication Therapy after a Heart Attack & in High Risk Patients (3 topics; breastfeeding education is used as a contraindication for statin therapy)

  8. Patient Education and CRS (cont’d) • Prenatal HIV Testing (HIV counseling measure; not HIV testing measure) • Pre-Diabetes/Metabolic Syndrome (Tobacco Screening, Lifestyle Adaptation) • Medications Education

  9. Patient Education and CRS (cont’d) • Patient Education Report • Available from the CRS Other National Reports Menu dedicated entirely to the following patient education measures • Rate of User Population Patients Receiving Patient Education • Rate of Time by Provider Discipline • Rate for Top 25 Diagnoses/Disease State with Education • Rate for Top 25 Education Topics • Rate for Top 15 Provider Disciplines Who Educated • Rate of Patient Understanding of Education • Goal Setting (CRS 8.0)

  10. Health Factors and Exam Codes

  11. Health Factors and CRS • Used in the following GPRA measures • Tobacco Cessation • Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, or Cessation-Smokeless • Quit Tobacco Use: Previous Smoker, Previous Smokeless • Comprehensive CVD-Related Assessment • Tobacco Screening: Any Tobacco Health Factor • Alcohol Screening (FAS Prevention) • Screening: Any Alcohol Health Factor (i.e. CAGE)

  12. Health Factors and CRS (cont’d) • Used in the following non-GPRA measures • Tobacco Use and Exposure Assessment • Screening: Any Tobacco Health Factor • Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, Cessation-Smokeless • Smokeless Tobacco Users: Current Smokeless, Current Smoker and Smokeless, or Cessation-Smokeless • Exposure to Tobacco Smoke: Smoker in Home or Exposure to Environmental Tobacco Smoke

  13. Health Factors and CRS (cont’d) • Alcohol Screening & Brief Intervention in the ER (CRS 8.0) • Screening: Any Alcohol Health Factor (i.e. CAGE) • Positive Screen: CAGE 1/4, 2/4, 3/4 or 4/4 • Pre-Diabetes/Metabolic Syndrome • Tobacco Screening: Any Tobacco Health Factor

  14. CRS and Exam Codes • Used in the following GPRA measures • Diabetic Retinopathy • Diabetic Retinal Exam: Exam Code 03 • Access to Dental Service • Annual Dental Visit: Exam Code 30 • Alcohol Screening (FAS Prevention) • Alcohol Screening: Exam Code 35 • Intimate Partner/Domestic Violence Screening • Domestic Violence Screening: Exam Code 34 • Depression Screening, Comprehensive CVD-Related Assessment • Depression Screening: Exam Code 36

  15. CRS and Exam Codes (cont’d) • Used in the following non-GPRA measures • Diabetes Comprehensive Care • Diabetic Retinal Exam: Exam Code 03 • Diabetic Foot Exam: Exam Code 28 • Diabetes: Access to Dental Service • Annual Dental Visit: Exam Code 30 • Alcohol Screening & Brief Intervention in the ER (CRS 8.0) • Alcohol Screening: Exam Code 35 • Positive Screen: Exam Code 35 w/positive result • Pre-Diabetes/Metabolic Syndrome • Depression Screen: Exam Code 36 • Fall Risk Assessment • Fall Risk Screen: Exam Code 37

  16. Personal Health Component

  17. CRS Asthma Measures • Non-GPRA asthma topics included in the Selected Measures (Local) Reports • Asthma • Active Clinical patients with two asthma-related visits (Dx of 493) during the Report Period or categorized in ARS as persistent (active patients as Severity 2, 3 or 4). Broken down by age groups 0-5, 5-64, 65+. • Active Clinical patients from measure above who were hospitalized for asthma during the report period.

  18. CRS Asthma Measures (cont’d) • Asthma Quality of Care (HEDIS measure) • Active Clinical patients ages 5-56 with persistent asthma w/o emphysema or COPD who received one dispensed prescription for primary asthma therapy medication during the report period. Broken down by age groups: 5-9, 10-17, 18-56. • Persistent asthma defined by diagnosis and/or medication data or inclusion in ARS as active patient with severity level of 2, 3, or 4. • Primary asthma therapy includes: Inhaled Corticosteroids, Nedocromil, Cromolyn Sodium, Leukotriene Modifiers or Methylxanthines

  19. CRS Asthma Measures (cont’d) • Asthma and Inhaled Steroid Use • Active Clinical patients ages 1+ in ARS as persistent or who have had two asthma-related visits during the report period who were prescribed an inhaled corticosteroid during the report period. Broken down by age groups: 1-4, 5-19, 20-44, 45-64, 65+. • Excludes patients active in ARS with a severity of 1 during the report period. • Inhaled corticosteroid includes: Mometasone (Asmanex), Beclovent, Qvar, Vancenase, Vanceril, Vanceril DS, Bitolerol (Tornalate), Pulmicort, Pulmicort Respules, Pulmicort Turbohaler, Salmeterol/fluticasone (Advair), Triamcinolone (Azmacort), Fluticasone (Flovent).

  20. CRS and Refusals • Refusals count for many measures. Some of the GPRA measures that count refusals include: • Diabetic Retinopathy (retinal exam) • Access to Dental Services (dental visit) • Adult Immunizations: Influenza • Pap Smear • Mammogram • Colorectal Cancer Screening • Depression Screening • Prenatal HIV Testing

  21. Immunizations

  22. CRS Immunization Measures • CRS uses immunization data in the following topics • Childhood Immunizations (19-35 Months): DTaP, IPV/OPV, MMR, Hepatitis B, HiB, Varicella, Pneumococcal • Adolescent Immunizations (13 and 13-17 Years): MMR, Hepatitis B, Varicella, Td/Tdap, Meningococcal, HPV • Adult Immunizations (50 Years and Older): Influenza, Pneumococcal • CRS also includes contraindications and parent/patient refusals

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