272H Unleash the Power of Reminder Dialogs

1. 272H � Unleash the Power of Reminder Dialogs Anne Rega, Hines Chief Information Office Field Office Eghosa Guobadia, CAC Philadelphia VAMC Joseph (Gus) O�Neil, VISN 1 Clinical Reminders Manager Good Afternoon and you�re welcome to this VeHU session. This is session 272H � Unleash the Power of Reminder Dialogs And it is presented by � Anne Rega, from the Hines Chief Information Office Field Office Eghosa Guobadia, CAC Philadelphia VAMC Joseph (Gus) O�Neil, VISN 1 Clinical Reminders ManagerGood Afternoon and you�re welcome to this VeHU session. This is session 272H � Unleash the Power of Reminder Dialogs And it is presented by � Anne Rega, from the Hines Chief Information Office Field Office Eghosa Guobadia, CAC Philadelphia VAMC Joseph (Gus) O�Neil, VISN 1 Clinical Reminders Manager

2. Learning Objectives Definition of Reminder Dialog templates Creation of Health Factors to record patient care events. Building the Reminder Dialog components Use of Element and Group dialogs to automate CPRS order entry Using Branching Logic in reminder dialogs Use of the �FORM LETTERS� TIU document class. Learning Objectives � 1.� Definition of Reminder Dialog templates, and the advantages they offer over TIU note templates. 2.� Creation of Health Factors to record patient care events, and associating them with reminder dialog components. 3.� Building the Reminder Dialog components, such as Prompts, Elements and Groups. 4. Use of Element and Group dialog findings to automate CPRS order entry 5.� Using Branching Logic in reminder dialogs to expedite Patient care. 6. Use of the �FORM LETTERS� document class to create progress notes, pre-formatted to print notes out of CPRS as letters. Learning Objectives � 1.� Definition of Reminder Dialog templates, and the advantages they offer over TIU note templates. 2.� Creation of Health Factors to record patient care events, and associating them with reminder dialog components. 3.� Building the Reminder Dialog components, such as Prompts, Elements and Groups. 4. Use of Element and Group dialog findings to automate CPRS order entry 5.� Using Branching Logic in reminder dialogs to expedite Patient care. 6. Use of the �FORM LETTERS� document class to create progress notes, pre-formatted to print notes out of CPRS as letters.

3. Introduction What are Reminder Dialogs? One of the documentation interfaces available in CPRS. Can also be utilized as Note templates, without specific association to a Clinical Reminder. Introduction � What are Reminder Dialogs? They are one of the documentation interfaces available in CPRS. Although they are used to document the processing of Clinical Reminders, they can also be utilized as Note templates, without specific association to a Clinical ReminderIntroduction � What are Reminder Dialogs? They are one of the documentation interfaces available in CPRS. Although they are used to document the processing of Clinical Reminders, they can also be utilized as Note templates, without specific association to a Clinical Reminder

4. Introduction cont. Advantages of Reminder Dialogs over regular TIU note templates � Enable recording of patient health events with Health Factors. Decision-support to CPRS users Advantages of Reminder Dialogs over regular TIU note templates � (1) They enable recording of patient health events with Health Factors. These Health Factors are data objects, against which reports can be run, effectively converting CPRS notes into databases of patient information. (2) They provide Decision-support to CPRS users � by selective display of appropriate documentation options, depending on either what the user clicks on the dialog template, OR on pre-existing health events in the patient�s chart recorded with Reminder Terms.Advantages of Reminder Dialogs over regular TIU note templates � (1) They enable recording of patient health events with Health Factors. These Health Factors are data objects, against which reports can be run, effectively converting CPRS notes into databases of patient information. (2) They provide Decision-support to CPRS users � by selective display of appropriate documentation options, depending on either what the user clicks on the dialog template, OR on pre-existing health events in the patient�s chart recorded with Reminder Terms.

5. Introduction cont. Design of a Reminder Dialog template is based on the blueprint Collaboration � between Providers and CACs, is required to produce this blueprint Design of a Reminder Dialog template is based on the blueprint developed for the new note, and this blueprint is produced from collaboration between the providers who will be using the new note in CPRS, and the CAC who is aware of the possibilities and engineering limitations in creating reminder dialogs. Design of a Reminder Dialog template is based on the blueprint developed for the new note, and this blueprint is produced from collaboration between the providers who will be using the new note in CPRS, and the CAC who is aware of the possibilities and engineering limitations in creating reminder dialogs.

6. Introduction cont. For this class, we are going to demonstrate reminder dialog creation by creating the ## RAD MAM NOTE reminder dialog (where ## is your student number). For this class, we are going to demonstrate reminder dialog creation by creating the ## RAD MAM NOTE reminder dialog (where ## is your student number).For this class, we are going to demonstrate reminder dialog creation by creating the ## RAD MAM NOTE reminder dialog (where ## is your student number).

7. Introduction cont. Derived from the RADIOLOGY MAMMOGRAPHY NOTE reminder dialog, currently in use at Philadelphia VAMC Used by Radiologists to document BIRADS category scores for mammography screen studies, using Health Factors. This class is in no way intended to promote the use of the RADIOLOGY MAMMOGRAPHY NOTE. This dialog is derived from the RADIOLOGY MAMMOGRAPHY NOTE reminder dialog, which is currently in use at Philadelphia VAMC, and it is used by Radiologists to document BIRADS category scores for mammography screen studies in CPRS, using Health Factors. At Philadelphia VAMC, a local mandate in 2007 required mammogram results to be recorded by radiologists in a retrievable, reportable format, coded according to BIRADS scores, and ensure reliable tracking of the patient notification about mammogram results. This class is in no way intended to promote the use of the RADIOLOGY MAMMOGRAPHY NOTE. This dialog is derived from the RADIOLOGY MAMMOGRAPHY NOTE reminder dialog, which is currently in use at Philadelphia VAMC, and it is used by Radiologists to document BIRADS category scores for mammography screen studies in CPRS, using Health Factors. At Philadelphia VAMC, a local mandate in 2007 required mammogram results to be recorded by radiologists in a retrievable, reportable format, coded according to BIRADS scores, and ensure reliable tracking of the patient notification about mammogram results. This class is in no way intended to promote the use of the RADIOLOGY MAMMOGRAPHY NOTE.

8. Introduction cont. The CPRS note title for this reminder dialog was created in the �FORM LETTERS� TIU document class To permit printing of the progress note from CPRS as a Notification Letter to the patient, without sensitive, patient-identifying information appearing on the printout from CPRS. The CPRS note title for this reminder dialog was created in the newly developed �FORM LETTERS� TIU document class, to permit printing of the progress note from CPRS as a Notification Letter to the patient, without sensitive, patient-identifying information appearing on the printout from CPRS. The CPRS note title for this reminder dialog was created in the newly developed �FORM LETTERS� TIU document class, to permit printing of the progress note from CPRS as a Notification Letter to the patient, without sensitive, patient-identifying information appearing on the printout from CPRS.

9. Introduction cont. No Third-party software. A sample blueprint for this dialog will be included with the class documentation on the VeHU website. Screen prints of parts of the finished ## RAD MAM NOTE reminder dialog follow - Nothing described in this class is Third-party software. A sample blueprint for this dialog will be included with the class documentation on the VeHU website Screen prints of parts of the finished nn RAD MAM NOTE reminder dialog are displayed in the following slides - Nothing described in this class is Third-party software. A sample blueprint for this dialog will be included with the class documentation on the VeHU website Screen prints of parts of the finished nn RAD MAM NOTE reminder dialog are displayed in the following slides -

10. Fig.1 - ## RAD MAM NOTE Figure 1 shows what is displayed when the ## RAD MAM NOTE title is selected. It allows for selection of the BIRADS Category score for the patient�s mammogram by the radiologist, and this records the score in Vista-CPRS with Health FactorsFigure 1 shows what is displayed when the ## RAD MAM NOTE title is selected. It allows for selection of the BIRADS Category score for the patient�s mammogram by the radiologist, and this records the score in Vista-CPRS with Health Factors

11. Fig. 2 - expansion of the BIRADS Category 0 Group dialog Figure 2 shows expansion of the BIRADS Category 0 group dialog, showing the Patient Notification options available for patients with that BIRADS Category score. Each Patient Notification option has its own element dialog Figure 2 shows expansion of the BIRADS Category 0 group dialog, showing the Patient Notification options available for patients with that BIRADS Category score. Each Patient Notification option has its own element dialog

12. Fig.3 - display of the Patient Notification option element dialogs. Figure 3 � shows selection of the �Additional mammogram films recommended� Patient Notification option Selection of that element dialog opens up the Prompts for documenting the method of patient notification.Figure 3 � shows selection of the �Additional mammogram films recommended� Patient Notification option Selection of that element dialog opens up the Prompts for documenting the method of patient notification.

13. Fig.4 � Note produced before signature (or before �Saving without Signature�) Figure 4 shows the note that would be produced after clicking the �Finish� button, before signature (or before �Saving without Signature�), displayed in lower part of the reminder dialog window. Figure 4 shows the note that would be produced after clicking the �Finish� button, before signature (or before �Saving without Signature�), displayed in lower part of the reminder dialog window.

14. Fig.5 � Note displayed in CPRS, showing the �FORM LETTERS� note title formatting Figure 5 shows the note displayed in CPRS, after signature (or after �Saving without Signature�), showing the letter formatting available for Note Titles included in the �FORM LETTERS� TIU document classFigure 5 shows the note displayed in CPRS, after signature (or after �Saving without Signature�), showing the letter formatting available for Note Titles included in the �FORM LETTERS� TIU document class

15. Fig.6 - display of the Patient Notification prompts, for �OTHER� type of decision. Clicking on the �Finish� button will present a plaintext field Figure 6 shows the ## RAD MAM NOTE displaying the Patient Notification options. In this case, the Radiologist decided to select the �OTHER� type of Patient Notification. Clicking on the �Finish� button will present the Radiologist with a plaintext field to type in the �OTHER� decisionFigure 6 shows the ## RAD MAM NOTE displaying the Patient Notification options. In this case, the Radiologist decided to select the �OTHER� type of Patient Notification. Clicking on the �Finish� button will present the Radiologist with a plaintext field to type in the �OTHER� decision

16. Fig.7 � Plaintext field that pops-up after �Finish� button clicked. Figure 7 shows the Plaintext field that pops-up after �Finish� button clicked.Figure 7 shows the Plaintext field that pops-up after �Finish� button clicked.

17. Fig.8 � Note displayed in CPRS, after use of the plaintext field Figure 8 shows the note displayed in CPRS, after use of the plaintext fieldFigure 8 shows the note displayed in CPRS, after use of the plaintext field

18. Using your Vista Account Make sure you keep CAPS LOCK on throughout this hands-on session When creating entries in ANY VISTA File, you should ALWAYS use UPPER CASE. Double click on the �Reflection� icon on your desktops Access Code is: ##VEHU Verify Code is: VEHU## Elec Sig Code is: VEHU## Where ## is the student number listed at the workstation where you are sitting Using your VISTA Account � Make sure you keep CAPS LOCK on throughout this hands-on session VISTA treats UPPER CASE, Mixed Case, and lower case differently: (XYZ, Xyz, xyz). If you type one of these, VISTA may not find the same entry in a different case. At home, when creating Dialog Display text, you would probably use Mixed Case, as appropriate. For this class, we want you to KEEP CAPS LOCK ON throughout. When creating entries in ANY VISTA File, you should ALWAYS use UPPER CASE. Double click on the �Reflection� icon on your desktops Access Code is: ##VEHU Verify Code is: VEHU## Elec Sig Code is: VEHU## Where ## is the student number listed at the workstation where you are sitting Using your VISTA Account � Make sure you keep CAPS LOCK on throughout this hands-on session VISTA treats UPPER CASE, Mixed Case, and lower case differently: (XYZ, Xyz, xyz). If you type one of these, VISTA may not find the same entry in a different case. At home, when creating Dialog Display text, you would probably use Mixed Case, as appropriate. For this class, we want you to KEEP CAPS LOCK ON throughout. When creating entries in ANY VISTA File, you should ALWAYS use UPPER CASE. Double click on the �Reflection� icon on your desktops Access Code is: ##VEHU Verify Code is: VEHU## Elec Sig Code is: VEHU## Where ## is the student number listed at the workstation where you are sitting

20. Generating Patient Lists With the recording of medical events (in this case BIRADS scores) with Health Factors, Patient Lists can be generated based on such Health Factors Rule Sets are used to generate such patient lists, in the Reminder Patient List Manager Menu. The creation of Rule Sets involves - mapping Health Factors to Reminder Terms mapping Reminder Terms to Finding Rules (3)mapping Finding Rules to Rule Sets, and the Rule Sets specify the logic that determines the cohort of patients included in the Patient List. GENERATING PATIENT LISTS � With the recording of medical events (in this case BIRADS scores) with Health Factors, Patient Lists can be generated based on such Health Factors, to detect all patients for whom a selected Health Factor is present, during a specified time interval. Rule Sets are used to generate such patient lists, in the Reminder Patient List Manager Menu. The creation of Rule Sets involves � the mapping of the Health Factors to Reminder Terms, and then the mapping of these Reminder Terms to Finding Rules, and then (3) the mapping of these Finding Rules to Rule Sets, and the Rule Sets specify the logic that determines the cohort of patients included in the Patient List. Once the Rule Set has been created, it can be used as a Report Template, to generate Patient Lists repeatedly on different occasions (i.e. with different Beginning and End dates) GENERATING PATIENT LISTS � With the recording of medical events (in this case BIRADS scores) with Health Factors, Patient Lists can be generated based on such Health Factors, to detect all patients for whom a selected Health Factor is present, during a specified time interval. Rule Sets are used to generate such patient lists, in the Reminder Patient List Manager Menu. The creation of Rule Sets involves � the mapping of the Health Factors to Reminder Terms, and then the mapping of these Reminder Terms to Finding Rules, and then (3) the mapping of these Finding Rules to Rule Sets, and the Rule Sets specify the logic that determines the cohort of patients included in the Patient List. Once the Rule Set has been created, it can be used as a Report Template, to generate Patient Lists repeatedly on different occasions (i.e. with different Beginning and End dates)

21. Generating Patient Lists (cont.) Once Rule Sets have been set-up, the Patient Lists can be produced by non-IT Department users Such users will require � - Vista Access - PXRM EXTRACT PATIENT LIST secondary menu. The following slides show use of a Rule Set, called �ZZ (RS) MAMMO BIRADS CATEGORY 0� to detect patients with �BIRADS Category 0� health factor recorded in their charts, from July 2007 to December 2007. Enter at the prompt: ^PATIENT LIST MANAGEMENT Once the Rule Sets have been set-up, the Patient Lists can be produced by non-IT Department personnel (QA Clinicians or ADPACS for instance) but these users must be granted Vista Access and the PXRM EXTRACT PATIENT LIST secondary menu. The following slides show how a Patient List may be generated using a Rule Set. In this instance the Rule Set is called �ZZ (RS) MAMMO BIRADS CATEGORY 0�, to detect patients with �BIRADS Category 0� health factor recorded in their charts, from July 2007 to December 2007. From your main Vista menu, enter at the prompt - ^PATIENT LIST MANAGEMENT Once the Rule Sets have been set-up, the Patient Lists can be produced by non-IT Department personnel (QA Clinicians or ADPACS for instance) but these users must be granted Vista Access and the PXRM EXTRACT PATIENT LIST secondary menu. The following slides show how a Patient List may be generated using a Rule Set. In this instance the Rule Set is called �ZZ (RS) MAMMO BIRADS CATEGORY 0�, to detect patients with �BIRADS Category 0� health factor recorded in their charts, from July 2007 to December 2007. From your main Vista menu, enter at the prompt - ^PATIENT LIST MANAGEMENT

22. This slide shows the Patient List Management menu. The names of pre-existing patient lists are displayed and scrolling down with the down arrow button shows more names of patient lists. The lower portion of the screen shows menu options available. In this instance Create Patient List (CR) is selected.This slide shows the Patient List Management menu. The names of pre-existing patient lists are displayed and scrolling down with the down arrow button shows more names of patient lists. The lower portion of the screen shows menu options available. In this instance Create Patient List (CR) is selected.

23. At the �Select PATIENT LIST name� prompt, you type in the name of the new patient list you are creating. In this instance it is the �200 BIRADS 0 PTS FROM JULY07 TO DEC07� patient list. Selecting YES at the �Secure list� prompt, makes the patient list private to you. You may want to purge the list automatically by selecting YES at the next prompt At the �Select LIST RULE SET:� prompt, type in the name of the Rule Set that will determine the patient cohort for the list Enter the Beginning and Ending dates at the following prompts. After the prompts asking to include deceased or test patients, specify when you want the job to start. At the �Select PATIENT LIST name� prompt, you type in the name of the new patient list you are creating. In this instance it is the �200 BIRADS 0 PTS FROM JULY07 TO DEC07� patient list. Selecting YES at the �Secure list� prompt, makes the patient list private to you. You may want to purge the list automatically by selecting YES at the next prompt At the �Select LIST RULE SET:� prompt, type in the name of the Rule Set that will determine the patient cohort for the list Enter the Beginning and Ending dates at the following prompts. After the prompts asking to include deceased or test patients, specify when you want the job to start.

24. After entering the job start time, your screen will return to the Patient List Manager menu. Take note of the of the new line item for the patient list job that has started. After entering the job start time, your screen will return to the Patient List Manager menu. Take note of the of the new line item for the patient list job that has started.

25. Generating Patient Lists (cont.) Patient List reports are usually completed in minutes, except if the cohort is very large (All patients DUE for Flu Vaccine, for instance) The following slides show completed Patient Lists and how they can be utilized Patient List reports are usually completed in minutes, except if the cohort is very large (All patients DUE for Flu Vaccine, for instance) The following slides show completed Patient Lists and how they can be utilized From your main Vista menu, enter at the prompt - ^PATIENT LIST MANAGEMENT Patient List reports are usually completed in minutes, except if the cohort is very large (All patients DUE for Flu Vaccine, for instance) The following slides show completed Patient Lists and how they can be utilized From your main Vista menu, enter at the prompt - ^PATIENT LIST MANAGEMENT

26. Select the number for the patient list you wish to review and enter, and then at the �Select Action� prompt, select DSP (Display Patient List)Select the number for the patient list you wish to review and enter, and then at the �Select Action� prompt, select DSP (Display Patient List)

27. The selected patient list will be displayed. Use the down arrow button to scroll through all the names if desired.At the prompt select Demographic ReportThe selected patient list will be displayed. Use the down arrow button to scroll through all the names if desired.At the prompt select Demographic Report

28. A series of prompts will appear, allowing various demographic items to be included with the patient�s name when the report is printed out or exported. In the report shown below, the patient�s Current Address, Phone Number and Appointment date are selected by entering 1,2 at the first prompt and 1 at the next promptA series of prompts will appear, allowing various demographic items to be included with the patient�s name when the report is printed out or exported. In the report shown below, the patient�s Current Address, Phone Number and Appointment date are selected by entering 1,2 at the first prompt and 1 at the next prompt

29. At the �Delimited Report:?� prompt, select �Y� to create a delimited report, for export to a text document and further parsing of the report�s format. If you wish to merely print the report to the screen, select �N� at the �Delimited Report:?� promptAt the �Delimited Report:?� prompt, select �Y� to create a delimited report, for export to a text document and further parsing of the report�s format. If you wish to merely print the report to the screen, select �N� at the �Delimited Report:?� prompt

30. If a Delimited Report is selected, specify the delimiter character. And then at the �DEVICE: HOME//� prompt, enter the appropriate machine commands If a Delimited Report is selected, specify the delimiter character. And then at the �DEVICE: HOME//� prompt, enter the appropriate machine commands

31. Sample of report captured from SmarTerm session in (Notepad) text file

32. Related Sessions Patient List creation and support are discussed in another VeHU 2008 session, the 318H � Clinical Reminders Extracts session. Methods and detailed instructions for the creation of Reminder Terms, Finding Rules and Rule Sets used to support Patient List creation are discussed in another training session offered at the 2008 VeHU conference, the 318H � Clinical Reminder Extracts class. Methods and detailed instructions for the creation of Reminder Terms, Finding Rules and Rule Sets used to support Patient List creation are discussed in another training session offered at the 2008 VeHU conference, the 318H � Clinical Reminder Extracts class.