RPMS EHR Reminders

1. Health Services RPMS EHR Reminders Lisa Lyon, RN, BSN, CDE Clinical Informatics Coordinator Cherokee Nation Health Services Tahlequah, OK

2. Learning Objectives • Explain how using EHR reminders can improve patient care • Explain how using EHR reminders can improve data integrity • Describe how using EHR reminders can assist in meeting National Standards of Care

3. Who uses Reminders • Anyone wanting to deliver high-quality health care in the system • Providers • Case managers • Diabetes program • Public health nurses • Behavioral health

5. Using EHR Reminders to Improve Patient Care

6. Using EHR Reminders to Improve Patient Care • Case managers use when pre-screening chart as part of IPC • Providers use during visit • To alert them to tests or exams that might have been missed

7. How Behavioral Health Uses Reminders • IPC “Team” approach • Reminder for Depression Screen • Reminder for Intimate Partner Violence

8. How Public Health Nursing Uses Reminders • Immunization forecast • Flu shot for adults • Pneumovax for high risk patients

13. Reminder Icon Legend

14. Using EHR Reminders to Assist in Meeting National Standards of Care

15. Using EHR Reminders to Assist in Meeting National Standards of Care • Diabetes Reminders that can be used

16. Reminder Detail

17. Reminder Detail • Subject: CA reminder • Applicable: Due every 1 year for ages 51Y to 80Y within cohort. ____________________ • REMINDER APPLICABLE if age 51-80 • -and no history of neoplasm of the colon • -and no evidence of colonoscopy in past 9yrs 9mos • -and no evidence of sigmoidoscopy or barium enema in past 4yrs 9mos • REMINDER DUE if no Fecal test done in past year • REMINDER ON if due within 3 months • REMINDER RESOLVED • -Fecal test resulted • -Colonoscopy done (status N/A for 9yrs 3mos) • -Sigmoidoscopy or barium enema (status N/A for 4yrs 9mos) ____________________

18. Changing Reminders to Fit Your System • Dr. Q. had a 90 y/o male that had a PSA reminder. • Ilooked at Evidence Based Medicine Articles and conducted a literature review. • Regarding research on the top age PSA Cut-Off for screening. It does not appear that there is a top age, but rather when a patient’s life expectancy based on age and health is expected to be less than 10 years. • Based on this, I sent the following back to the providers; • “Let me know if you want me to move forward with getting this to Med Exec. I really do appreciate the diligence you all exude in seeing that everything is correct”.

19. Changing Reminders to Fit Your System • I did find this on the American Cancer Society site; • The APCF Medical Advisory committee, composed of urologists, radiation oncologists, an internist, and a physiatrist ……They further recommend that screening after age 75 should be considered individually. • Went back to the provider with this response. • “Based on this, would you like to take the topic to Med Exec and see if there could be a consensus reached on what everyone wants the top age to be. If we set the top-age for 75 or 80 or 85 (whatever was decided upon), then the system will not remind you to check a PSA, but you would just have to know and look it up each time”.

20. Changing Reminders to Fit Your System • We did take it to Medical Executive Committee, they voted on looking at PSAs on a case by case basis after age 75, and the reminder was changed to reflect that.

21. Changing Reminders to Fit Your System

23. Using Reminders to Improve Data Integrity • Osteoporosis Reminder

24. Using Reminders to Improve Data Integrity • We have had some patients that have asthma reminders and DM reminders, when they do not have asthma or DM • Prompts an investigation into the record to see if there are incorrect diagnosis • If so, then record goes back to the provider for a correction • If original documenting provider is not still working in system, the Medical Director takes care of correction

25. Using Reminders to Improve Data Integrity

26. Reminder Patch-Changes • CAC/Reminder Lead/Site Manager will HAVE to be sure to install the newest TIU patch first because there are new TIU objects in this patch that are going to be used in the new reminders/dialogs. • Will need to run a list of current reminders, prior to installing the Reminders patch • A list of all reminders you are using on your system and inactivate all that you are not using and clean out the reminder exchange getting rid of all the old ones you are not using.

27. Reminder Patch-Changes • In the recent webinar about the upcoming Reminder Patch, recommended that the CAC/Reminder-Lead get with the end users to see what reminders they are wanting to deploy.  • They also said that the DM, HIV and Chlamydia reminders are all quite different and should be priority to update • Existing reminders will need to be replaced with latest reminders so that sites are using the most current information. 

28. Reminder Patch-Changes • The  day that the patch is installed all reminders will go to the reminder exchange but all routines will be laid over the top but will not automatically install. • CAC/Lead will have to go to the reminder exchange and install all reminders before the system will accurately locate the information needed to resolve the reminders.  • If CAC/Lead does not install from the exchange it will show that all reminders are due whether they are or not. 

29. Reminder Patch-Changes • If you need to see if a reminder is installed you can go to the Reminder Inquiry in the EHR-Reminders menu and enter “??” • If it’s listed there then it is installed and should be working.

30. Reminder Recommendations • Take Reminders course • Watch OIT Reminder Office Hours • Check OIT Training page for information • Check with Area CAC for local trainings • Amy Rubin offered these for Oklahoma Area • Assign someone as Reminders Lead • Collaborate with others for ideas, help, expertise

31. Questions??

32. Contact Information • lisa-lyon@cherokee.org • 918-772-0022