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EHR Reminders - Sharing Local Reminders & Dialogs

EHR Reminders - Sharing Local Reminders & Dialogs. LCDR Susan Pierce-Richards, MSN, ARNP. Introduction. Local Reminders and Dialogs include: Copied National Reminders with modifications Locally created Reminders and Dialogs that solve a particular clinical problem

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EHR Reminders - Sharing Local Reminders & Dialogs

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  1. EHR Reminders -Sharing Local Reminders & Dialogs LCDR Susan Pierce-Richards, MSN, ARNP

  2. Introduction Local Reminders and Dialogs include: • Copied National Reminders with modifications • Locally created Reminders and Dialogs that solve a particular clinical problem • Locally created Reminders and Dialogs providing support for a particular standard of care or protocol • Can be shared between sites with a little modification Reminder and Dialog development is labor intensive for the CAC. Well developed Reminder and Dialog tools have very positive impacts on both patient care and provider documentation. So…. SHARE tools that work.

  3. Objectives At the end of this presentation, the CAC will be able to: • Pack and export a reminder (.PRD file) to the Pub folder of your RPMS server • Attach a packed reminder to an email • Move a packed reminder/dialog (.PRD file) to an accessible location for import • Usually the Pub folder of your RPMS folder • Import a packed reminder/dialog • Install a packed reminder/dialog • Customize installed reminder/dialog for your site

  4. Need to know and do before you begin… What can I export from Reminders: • Reminder • Reminder with linked dialog • Check to see that the dialog you want exported is properly linked If you want to export just the dialog: • Create blank reminder called Blank with name dialog • Export the blank reminder with dialog What can I import into Reminders: • Reminder • Reminder and linked dialog • Any reminder part • Any dialog part • TIU template fields imbedded in dialogs

  5. Need to know and do before you begin… What does NOT import: • Local TIU objects • Local Quick orders • Local Lab, Med, etc During import, you be prompted to substitute your local items. Have these exact names ready. ASK YOUR SITE MANAGER: • Where is the Pub folder for your RPMS server • It will look something like this g:\pub\ • What is the IP address of your RPMS server Pub folder. • It will look something like this ftp://10.243.168.54/pub/ • ADD this FTP site to your “My Network Places” folder (see next slides)

  6. 1. Go to your Outlook email, select new message and “attach”2. Click on “My Network Places” on the left side of the Insert File dialog box.The Add Network Place wizard will come up – click NEXT

  7. Click Next.

  8. Here enter the address of the Pub folder your Site Manager gave you (see slide 5).Click Next.

  9. Click Next.

  10. Enter a name.Click Next.

  11. Click Finish.

  12. Now you can more easily move files in and out of your Pub folder

  13. Exporting Reminder: Scenario: You have begun using reminders. You already made modifications to the National Mammogram reminder and dialog. Another CAC likes your format and has asked that you send him the reminder and dialog.

  14. Steps to Export a Reminder • Verify dialog is linked to reminder if you want to export an associated dialog • “Pack” the reminder • Use “Create Exchange File Entry” in Reminder Exchange • Add notes with pertinent info like local Quick Order names, objects used • Export the reminder • Use “Create Host File” • This places a .prd file on your Pub drive

  15. Step 1 – Verify Reminder Dialog Linked If you want a dialog packed with the reminder, check to make sure the dialog is linked – you can look at the reminder definition: YAK-MAMMOGRAM 2007 No. 108 -------------------------------------------- Print Name: Mammogram Class: LOCAL Sponsor: Review Date: Usage: CPRS, DATA EXTRACT, REPORTS Related VA-* Reminder: Reminder Dialog: IHS-MAMMOGRAM 2007

  16. Step 2 – “Pack” the Reminder Go to Reminder Exchange (BEH-REM-EXC) Clinical Reminder Exchange Sep 11, 2008 09:37:22 Page: 1 of 8 Exchange File Entries. Entry Source Date Packed 1 BLANK for TO Dialogue RICHARDS@YAKAMA HEALT 06/25/2008@17:45:56 2 IHS-ALCOHOL SCREEN 2007 HAGER@DEMO HOSPITA 07/24/2008@11:46:22 3 IHS-ALLERGY HAGER@DEMO HOSPITA 07/24/2008@09:57:25 4 IHS-ASTHMA PLAN 2007 HAGER@DEMO HOSPITA 07/24/2008@09:57:50 5 IHS-ASTHMA PRIM PROV 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:07 6 IHS-ASTHMA SEVERITY 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:22 7 IHS-ASTHMA STEROID 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:45 8 IHS-BLOOD PRESSURE HAGER@DEMO HOSPITA 07/24/2008@09:59:12 9 IHS-COLON CANCER 2007 HAGER@DEMO HOSPITA 07/24/2008@10:09:19 10 IHS-DEPRESSION SCREEN 2007 HAGER@DEMO HOSPITA 07/24/2008@10:01 + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// cfe Create Exchange File Entry

  17. Select Reminder Definition to pack: YAK-MAMMOGRAM 2007 LOCAL Enter a description of the reminder you are packing. ==[ WRAP ]==[ INSERT ]==================< >=================[ <PF1>H=Help ]==== Females 40 to 70 should have yearly mammograms. Mammograms are found by CPT code, radiology exam or from the women's health pack Contains quick order: GMRQO CHS Mammogram prior to install either create this exact quick order OR have ready the exact name of your site's Mammogram consult ***add information about site specific items in the reminder – quick orders, objects, lab names, etc. This will assist the CAC who imports this reminder/dialog*** <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== Enter keywords or phrases to help index the reminder you are packing. Separate the keywords or phrases on each line with commas. ==[ WRAP ]==[ INSERT ]==================< >=================[ <PF1>H=Help ]==== MAMMOGRAM -------------------------------------------------------------------------------- Do you want to save changes? Yes

  18. This is the Exchange File Entry you created that now can be exported <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== Clinical Reminder Exchange Sep 11, 2008 09:41:19 Page: 7 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:35:43 62 YAK-DM ASPIRIN RICHARDS@YAKAMA HEALT 08/13/2007@14:36:02 63 YAK-DM EYE EXAM RICHARDS@YAKAMA HEALT 08/13/2007@14:36:21 64 YAK-DM THIAZOLIDINEDIONE MO RICHARDS@YAKAMA HEALT 01/25/2008@14:00:34 65 YAK-HF ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:37:32 66 YAK-HF B BLOCKER RICHARDS@YAKAMA HEALT 08/13/2007@14:37:47 67 YAK-HF DIURETIC RICHARDS@YAKAMA HEALT 08/13/2007@14:38:02 68 YAK-MAMMOGRAM RICHARDS@YAKAMA HEALT 03/19/2008@08:19:15 69 YAK-MAMMOGRAM 2007 RICHARDS@YAKAMA HEALT 09/11/2008@09:37:54 70 YAK-PAIN CONTRACT DRUG SCRE RICHARDS@YAKAMA HEALT 12/07/2007@11:08:13 + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry

  19. Step 3 – Exporting Reminder <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== Clinical Reminder Exchange Sep 11, 2008 09:41:19 Page: 7 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:35:43 62 YAK-DM ASPIRIN RICHARDS@YAKAMA HEALT 08/13/2007@14:36:02 63 YAK-DM EYE EXAM RICHARDS@YAKAMA HEALT 08/13/2007@14:36:21 64 YAK-DM THIAZOLIDINEDIONE MO RICHARDS@YAKAMA HEALT 01/25/2008@14:00:34 65 YAK-HF ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:37:32 66 YAK-HF B BLOCKER RICHARDS@YAKAMA HEALT 08/13/2007@14:37:47 67 YAK-HF DIURETIC RICHARDS@YAKAMA HEALT 08/13/2007@14:38:02 68 YAK-MAMMOGRAM RICHARDS@YAKAMA HEALT 03/19/2008@08:19:15 69 YAK-MAMMOGRAM 2007 RICHARDS@YAKAMA HEALT 09/11/2008@09:37:54 70 YAK-PAIN CONTRACT DRUG SCRE RICHARDS@YAKAMA HEALT 12/07/2007@11:08:13 + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// chf Create Host File Select Entry(s): (61-70): 69 Enter a path: c:\tmp\// g:\pub\←this is the Pub folder (see “Ask your site manager” on slide 5) Enter a file name: MAMMOGRAM 2007_YAKAMA ←use consistent nomenclature with name, date, site Will save selected entries to host file g:\pub\MAMMOGRAM 2007_YAKAMA.PRD?: Y// ES

  20. Now the file is ready to send • Open email and click on the paper clip to attach • Go into My Network Places • Click on the Network Place you created in Slides 6-12 • Attach the PRD file as you would any other file and send via email

  21. Importing a Reminder SCENARIO: Your Clinical Director wants some changes to the National Mammogram Reminder and Dialog. He was at a CD Meeting and learned that another site had exactly what he wants for your site. That site’s CAC attached the reminder file to an email. You’re not sure what to do next…

  22. Step 1: Move file to the Pub folder • Open the email with the attached PRD file • Right click on the file, click SAVE AS • Click on My Network Places and navigate to the Pub folder that you set up in slides 6-12

  23. Now save it to the Pub folder here • You will be able to load this to the Reminders Exchange

  24. Step 2: Load Host File to the Reminders Exchange Clinical Reminder Exchange Sep 12, 2008 14:42:34 Page: 1 of 8 Exchange File Entries. Entry Source Date Packed 1 BLANK for TO Dialogue RICHARDS@YAKAMA HEALT 06/25/2008@17:45:56 2 IHS-ALCOHOL SCREEN 2007 HAGER@DEMO HOSPITA 07/24/2008@11:46:22 3 IHS-ALLERGY HAGER@DEMO HOSPITA 07/24/2008@09:57:25 4 IHS-ASTHMA PLAN 2007 HAGER@DEMO HOSPITA 07/24/2008@09:57:50 5 IHS-ASTHMA PRIM PROV 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:07 6 IHS-ASTHMA SEVERITY 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:22 7 IHS-ASTHMA STEROID 2007 HAGER@DEMO HOSPITA 07/24/2008@09:58:45 8 IHS-BLOOD PRESSURE HAGER@DEMO HOSPITA 07/24/2008@09:59:12 9 IHS-COLON CANCER 2007 HAGER@DEMO HOSPITA 07/24/2008@10:09:19 10 IHS-DEPRESSION SCREEN 2007 HAGER@DEMO HOSPITA 07/24/2008@10:01 + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// LHF

  25. Enter the path for the Pub file (see slide 5) Enter a path: c:\tmp\// g:\pub\ ←this is the Pub folder (see “Ask your site manager” on slide 5) The following PRD files were found in g:\pub\ Lead test 24 months.PRD Lead test 36_72 months.PRD Lead test 9_12 month old.PRD MAMMOGRAM 2007_YAKAMA.PRD PNEUMOVAX.PRD PRENATAL SCREENING.PRD Tobacco_6 25 08_yakama.PRD WSP ADULT IMM TEST.PRD YAK PRENATAL PLAN.PRD YAK_MAMM_2007.PRD Enter a file name: YAK_MAMM_2007.PRD ←you must type this exactly

  26. Step 3: Install from the Exchange like you would any other reminder Clinical Reminder Exchange Sep 12, 2008 14:49:46 Page: 7 of 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:35:43 62 YAK-DM ASPIRIN RICHARDS@YAKAMA HEALT 08/13/2007@14:36:02 63 YAK-DM EYE EXAM RICHARDS@YAKAMA HEALT 08/13/2007@14:36:21 64 YAK-DM THIAZOLIDINEDIONE MO RICHARDS@YAKAMA HEALT 01/25/2008@14:00:34 65 YAK-HF ACE/ARB RICHARDS@YAKAMA HEALT 08/13/2007@14:37:32 66 YAK-HF B BLOCKER RICHARDS@YAKAMA HEALT 08/13/2007@14:37:47 67 YAK-HF DIURETIC RICHARDS@YAKAMA HEALT 08/13/2007@14:38:02 68 YAK-MAMMOGRAM RICHARDS@YAKAMA HEALT 03/19/2008@08:19:15 69 YAK-MAMMOGRAM 2007 RICHARDS@YAKAMA HEALT 09/11/2008@10:51:12 70 YAK-PAIN CONTRACT DRUG SCRE RICHARDS@YAKAMA HEALT 12/07/2007@11:08:13 + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen//IFE Select Entry(s): (61-70):69

  27. READ the Reminder description. Hopefully the exporting site identified items you need to either create or have ready when you install Exchange File Components Sep 12, 2008 14:52:59 Page: 1 of 3 ComponeFile Entry Category Exists Reminder: YAK-MAMMOGRAM 2007 Source: RICHARDS,SUSAN P at YAKAMA HEALTH CENTER IHS Date Packed: 09/11/2008@10:51:12 Description: Females 40 to 70 should have yearly mammograms. Mammograms are found by CPT code, radiology exam or from the women's health pack Contains quick order: GMRQO CHS Mammogram prior to install either create this exact quick order OR have ready the exact name of your site's Mammogram consult Keywords: No keywords given Components: + Enter ?? for more actions IA Install all Components IS Install Selected Component Select Action: Next Screen//IA

  28. Install Reminder, Accept Defaults Select Action: Next Screen// ia Install all Components Only programmers can install routines. REFUSAL TYPE entry MAMMOGRAM already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry Only programmers can install Reminder Computed Findings. REMINDER TAXONOMY entry IHS-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry

  29. REMINDER TAXONOMY entry IHS-BILATERAL MASTECTOMY already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry REMINDER DEFINITION entry YAK-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: I//nstall or Overwrite the current entry

  30. Install the dialog Dialog Components Sep 12, 2008 15:02:22 Page: 1 of 1 Packed reminder dialog: IHS-MAMMOGRAM 2007 Item Seq. Dialog Findings Type Exists 1 IHS-MAMMOGRAM 2007 dialog X 2 1 HD MAMMOGRAM element X Finding: *NONE* 3 3 HD ELIGIBILITY element Finding: *NONE* 4 5 OI MAMMOGRAM element Finding: GMRQO CHS Mammogram (ORDER DIALOG) X + Next Screen - Prev Screen ?? More Actions DD Dialog Details DT Dialog Text IS Install Selected DF Dialog Findings DU Dialog Usage QU Quit DS Dialog Summary IA Install All Select Action: Quit//IA Install reminder dialog and all components with no further changes:Y//YES

  31. Replacing Item on Install If you had not created the GMRQO CHS Mammogram, you would be prompted to make a change: Install reminder dialog and all components with no further changes:Y// ES FINDING entry Q.GMRQO CHS Mammogram does not exist. Select one of the following: D Delete (from the reminder/dialog) P Replace (in the reminder/dialog) with an existing entry Q Quit the install Enter response: p Replace (in the reminder/dialog) with an existing entry Select ORDER DIALOG NAME: GMRZ Mammogram Now that element maps to your quick order

  32. Tips… Installing an imported reminder is really no different from installing a National Reminder and Dialog • Local terms will need to be mapped (add local labs, meds, etc) • Taxonomies may error out – if the reminder contains taxonomies, make sure that the exporting site provides you with the codes they used so you can recreate it (just like National Template installs) • Like TIU templates, sites may have used a locally created Object – you will need to either replace this with your own, or create one with the identical name • TEST TEST TEST TEST…just as you would with a newly loaded National Reminder

  33. Backing up Local Reminders Strongly consider using the export instructions to ‘back up’ your local reminders and dialogs. Place them in a folder on a server that is backed up regularly (consult with IT).

  34. Take Home Message…. Avoid duplication of effort • If someone else has created a tool that works, then import and customize • If you have created a tool that works, then share with others • DO include brief notes alerting other sites of terms, quick orders, objects and other site specific data that will need to be adapted when imported

  35. We are developing a forum for collaboration, sharing and information exchange. If you are a CAC who has developed or is developing local Reminders and Dialogs at your site and is interested in collaborating with others, please send your contact information to Susan Pierce-Richards. susan.richards@ihs.gov

  36. Resources Clinical (EHR) Reminders Manual ftp://ftp.ihs.gov/pubs/EHR/Training/Guides/EHR Reminders Guide.doc Clinical (EHR) Reminders Patch 1005 National Reminder Set Up guide will be released with the patch and patch notes. Other reminders resources: ftp://ftp.ihs.gov/pubs/EHR/Training/Guides/EHR%20Reminders/ Recorded WebEx trainings: https://ihs-hhs.webex.com/mw0305l/mywebex/default.do?siteurl=ihs-hhs&service=7 • EHR Reminders – Copying and Customizing National Reminders • EHR Reminders – Customizing National Dialogs Future WebEx trainings on creating reminders, dialogs and report will be announced via the EHR ListServ and Area CACs. Please send suggestions for future EHR Reminders WebEx trainings to: susan.richards@ihs.gov

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