Chronic Disease or Consultant Templates

1. Chronic Disease or Consultant Templates What part of the story do you want to reuse?

2. Chronic Disease or Consultant Templates -- Subjective Patient ID Age, Sex, Referral Source, PCP Basic Hx of the condition Presentation Past Medications and why they were stopped Complications Current status and symptoms Patient�s understanding and goals

3. Patient ID� The Code PATIENT ID:�� This �*age*�� old ||PAT_SEX|| �*Accomp_By�� was referred by:� ||REFSRC1_NAME_FIRST|| ||REFSRC1_NAME_LAST||,� ||REFSRC1_NAME_SUFFIX||.�� || IF PAT_SEX = "male" {His} ELSE {Her} || current PCP is || CLINICALELEMENT<Patient PCP> ||. || IF PAT_SEX = "male" {His} ELSE {Her} || current complaints are noted above.

4. Patient ID�How it Prints PATIENT ID:�� This 23 yr� old male accompanied by his brother, John, was referred by:� Donald T. Stewart, MD.�� His current PCP is LuAnn Chen, MD. His current complaints are noted above.

5. Data for Diabetes Presentation Date of Diagnosis ||CLINICALELEMENT<Diabetes Diagnosis Date>|| Story of presentation ||CLINICALELEMENT<Presentation of Diabetes>|| ||CLINICALELEMENT<Presentation2 of Diabetes>|| Initial fasting glucose ||CLINICALELEMENT<Initial FBS Diabetes>|| Initial random glucose ||CLINICALELEMENT<Initial Random Glucose>|| Initial HgbA1c ||CLINICALELEMENT<Initial HgbA1c>||

6. Presentation: Type II Diabetes�The Code The patient was diagnosed with diabetes around || CLINICALELEMENT<Diabetes Diagnosis Date> when IF PAT_SEX = "male" {he} ELSE {she} presented with CLINICALELEMENT<Presentation of Diabetes>, CLINICALELEMENT<Presentation2 of Diabetes>.� IF PAT_SEX = "male" {His} ELSE {Her} initial fasting glucose was CLINICALELEMENT<Initial FBS Diabetes>, initial random glucose was CLINICALELEMENT<Initial Random Glucose>, and initial HgbA1c was CLINICALELEMENT<Initial HgbA1c>||.

7. Presentation: Type II Diabetes�How it Prints The patient was diagnosed with diabetes around Summer 2006, when he presented with abnormal glucose noted on routine exam, no prior DKA, and > 20 lb weight loss.� His initial fasting glucose was 176 - 200, initial random glucose was unknown, and initial HgbA1c was 8.9.

8. Past Medications � the code: The following oral diabetes medications have been used in the past:� ||IF CLINICALELEMENT<Past DM Med 0 Name> = "" {none} ELSE { CLINICALELEMENT<Past DM Med 0 Name> was stopped because CLINICALELEMENT<Past DM Med 0 Reason>,} IF CLINICALELEMENT<Past DM Med 1 Name> <> "" { CLINICALELEMENT<Past DM Med 1 Name> was stopped because CLINICALELEMENT<Past DM Med 1 Reason>,}� IF CLINICALELEMENT<Past DM Med 2 Name> <> "" { CLINICALELEMENT<Past DM Med 2 Name> was stopped because CLINICALELEMENT<Past DM Med 2 Reason>,}� IF CLINICALELEMENT<Past DM Med 3 Name> <> "" { CLINICALELEMENT<Past DM Med 3 Name> was stopped because CLINICALELEMENT<Past DM Med 3 Reason>,} IF CLINICALELEMENT<Past DM Med 4 Name> <> "" { CLINICALELEMENT<Past DM Med 4 Name> was stopped because CLINICALELEMENT<Past DM Med 4 Reason>.} ||

9. Past Medications� how it prints: The following oral diabetes medications have been used in the past:� Amaryl was stopped because of hypoglycemia, Glucotrol was stopped because of headache,� rosiglitazone was stopped because edema, The following lipid lowering medications have been used in the past: none � � �� The following ACE inhibitor medications have been used in the past: none � � The following ARBs have been used in the past: none � �

10. Chronic Disease or Consultant Templates -- Subjective Patient ID Age, Sex, Referral Source, PCP Basic Hx of the condition Presentation Past Medications and why they were stopped Complications Current status and symptoms Patient�s understanding and goals

11. Complications of Diabetes Neuropathy Pain, numbness, gastroparesis, orthostasis Nephropathy Urine Protein, Creatinine, eGFR Eye Complications Retinopathy, cataracts Skin Ulcers Location, infection present?

12. Neuropathy Code using Lab Data Values Neuropathy:���� �del�|| LAB<SymetDistDysesthes> ||������ �*EditSymetDistDysesthes� �del�|| LAB<Mononeuropathy> ||������������� �*EditMononeuropathy� �del�|| LAB<Distal Numbness> ||������������� �*EditDistalNumbness� �del�|| LAB<Gastroparesis>||������� �*EditGastroparesis� �del�|| LAB<Orthostatic Sx> ||����������������� �*EditOrthostaticSx� �del�|| LAB<Diarrhea> ||������������������������� �*EditDiarrhea�

13. Neuropathy-what you see in the template �del� SymetDistDysesthes: none ������ �*EditSymetDistDysesthes� �del� Mononeuropathy: none ������������� �*EditMononeuropathy� �del� Distal Numbness: none ������������� �*EditDistalNumbness� �del� Gastroparesis: none ������ � �*EditGastroparesis� �del� Orthostatic Sx: none ����������������� �*EditOrthostaticSx� �del� Diarrhea: none ������������������������� �*EditDiarrhea�

14. Quick Text to Edit a Line

15. Neuropathy-if you click an *Edit�. quicktext

16. Nephropathy Initial Presentation Data First Abnormal Microalbumin/Creatinine First Abnormal 24 hour urine protein First Creatinine over 1.6 Most Recent Values 24 hour urine protein Spot urine protein Microalbumin/Creatinine Blood Creatinine Estimated GFR Dialysis status Nephrologist

17. Nephropathy�Initial Presentation First run through on how to put this together: Nephropathy first abnormal values: ||CLINICALELEMENT<First Abnormal Microal/Creat>|| �*Edit1stAbnMicroal/Creat� ||CLINICALELEMENT<First Abn 24 Hr Urine Protein>|| �*Edit1stAbn24HrUrineProtein� ||CLINICALELEMENT<First Creatinine over 1.6>|| �*Edit1stCreatinineOver1.6�

20. �Natural Language� conditional logic || IF CLINICALELEMENT<First Abnormal Microal/Creat> = "" {We have no record of previous abnormal Microalbumin/Creatinine ratios.} ELSE {PAT_FNAME's first abnormal Microalbumin/Creatinine ratio was CLINICALELEMENT<First Abnormal Microal/Creat>.} IF CLINICALELEMENT<First Abn 24 Hr Urine Protein> = "" {We have no record of previous abnormal 24- hour urine protein values} ELSE {IF PAT_SEX = "male" {His} ELSE {Her} first abnormal 24 hour urine protein value was CLINICALELEMENT<First Abn 24 Hr Urine Protein>.} IF CLINICALELEMENT<First Creatinine over 1.6> = "" {We have no record of previous creatinine values over 1.6.} ELSE {The patient's first serum creatinine value over 1.6 was CLINICALELEMENT<First Creatinine over 1.6>.} ||

21. �Natural Language,� the way it prints Nephropathy: Mickey's first abnormal Microalbumin/Creatinine ratio was 146 on 05/17/2007. His first abnormal 24 hour urine protein value was 2.5 grams in June, 2007. The patient's first serum creatinine value over 1.6 was 1.8 in February 2005.

22. Most Recent Renal Values � the Code Most recent recorded renal values: �del�|| LAB<MICROALB/CREAT>[-Date] ||�� �*EditMicroal/Creat��del�|| LAB<24Hr Urine Protein>[-Date] ||� �*Edit24HrUrineProtein� �del�|| LAB<PROTEIN-UA>[-Date] ||��������� �*EditProtein-UA� �del�|| LAB<CREATININE>[-Date] ||���������� �*EditCreatinine� || IF LAB<Race> = "Black" or LAB<Race> = "Hsp-Black" {LAB<eGFR(BLK)>[-Date] �*EditeGFR(BLK)� � ������������������� ELSE��� { LAB<eGFR(NBLK)>[-Date]��*EditeGFR(NBLK)� }���|| �del�|| LAB<Dialysis>[-Date] ||���������������� �*EditDialysis� �del�|| LAB<*Nephrologist> || �*Edit*Nephrologist�

23. Recent Renal Values � How it Looks

24. Current Diabetes Sx: the Code �del�|| LAB<HypoglycemicEpisod>||����� �*EditHypoglycemicEpisod� �del�|| LAB<LowerExtrPains> ||������������ �*EditLowerExtrPains� �del�|| LAB<LowerExtrNumbness>||����� �*EditLowerExtrNumbness� �del�|| LAB<Polyuria> ||������������������������� �*EditPolyuria� �del�|| LAB<Polydipsia>] ||������������������� �*EditPolydipsia� �del�|| LAB<Blurred Vision> ||��������������� �*EditBlurredVision� �del�|| LAB<Early Satiety> ||���������������� �*EditEarlySatiety� �del�|| IF PAT_SEX = "male" {LAB<Erectile Dysfunct>������������� �*EditErectileDysfunct�}||��

25. Current Diabetes Sx: How it Looks HypoglycemicEpisod: frequent moderate����� *EditHypoglycemicEpisod LowerExtrPains: none ������������ *EditLowerExtrPains LowerExtrNumbness: none����� *EditLowerExtrNumbness Polyuria: none ������������������������� *EditPolyuria Polydipsia: none ������������������� *EditPolydipsia Blurred Vision: none ��������������� *EditBlurredVision Early Satiety: none ����������������� *EditEarlySatiety Erectile Dysfunct: none������������� *EditErectileDysfunct��

26. *EditHypoglycemicEpisod

27. After Clicking EditHypoglycemicEpisodes

28. Current Status�using a table to present past values � the code

29. How it shows in the template

30. What it shows the next time

31. Chronic Disease or Consultant Templates -- Subjective Patient ID Age, Sex, Referral Source, PCP Basic Hx of the condition Presentation Past Medications and why they were stopped Complications Current status and symptoms Patient�s understanding and goals

32. Patient understanding and plan Blood glucose level where hypoglycemic Sx noted CLINICALELEMENT<Hypoglycemic Sx Level> Does the patient carry ID of diabetes? LAB<Carries DM ID?> Does the patient carry glucose? LAB<Carries Glucose?> Does the patient carry glucogon? LAB<Carries Glucogon?> Does the patient have a diabetes-aware buddy? LAB<BuddyAwareDMCare?> Who is the buddy? CLINICALELEMENT<Buddy Aware Hypoglycemic Care>

33. Patient understanding - code Hypogylcemic Plan: The patient notices the symptoms of low glucose when his glucose level is less than ||CLINICALELEMENT<Hypoglycemic Sx Level>||. �*EditHypoglycemicSxLevel� || IF PAT_SEX = "male" {He} ELSE {She} IF LAB<Carries DM ID?> = "yes" {carries or wears identification that he has diabetes} ELSE {does not carry or wear identification that he has diabetes} IF LAB<Carries Glucose?> = "yes" {, carries glucose}� IF LAB<Carries Glucagon?> = "yes" {, carries glucagon}. ||� �*EditHypoglycemicPlan� || IF LAB<BuddyAwareDMCare?> = "yes" {The patient has people close to IF PAT_SEX = "male" {him} ELSE {her} who are aware of the symptoms of hypoglycemia and who know what to do to help, should he develop those symptoms. These people are CLINICALELEMENT<Buddy Aware Hypoglycemic Care>} ELSE {The patient does not have anyone close to IF PAT_SEX = "male" {him} ELSE {her} who is aware of the symptoms of hypoglycemia and who knows what to do to help, should he develop these symptoms. IF PAT_SEX = "male" {He} ELSE {She} was advised to seek out several people to assume this role.}� || �*EditBuddyAwareHGCare�

34. Patient understanding � when the template opens