256 Did You Know� Clinical Reminders by HC111123035923

VIEWS: 7 PAGES: 105

									256 Did You Know…
 Clinical Reminders
    Christopher Lopez, MD
        Orlando VAMC

     JoAnn Seppelt, CRNP
      Philadelphia VAMC
                      Objectives

• Provide an intermediate level of understanding
  of clinical reminders
• Take a quick tour of the inner workings of a
  reminder
• Be able to discuss reminders more intelligently
• Provide an array of useful bits of information
• How reminders impact providers
• Have you utter, “I didn’t know that”

                                                    2
Available Reminders




                      3
                              Basic Logic
          Applicable?
   Does pt meet cohort criteria?


         No               Yes

Not Applicable
    Folder               Any Exclusions?


                        Yes                No

           Not Applicable
               Folder                 Fulfills resolution criteria?


                                                 Yes                  No

                                    Reminder Resolved           Reminder Due
                                   (In Applicable Folder)     (On Cover Sheet)
                    Cohort

• The group of people to be
  evaluated
• Examples:
  –Diabetic patients
  –Heart failure patients
  –Patient with history of MI

                                6
          “Finding” or “Finding Item”

• Information that can be searched by the
  reminder.
• Already exists somewhere else in VistA
  – Lab test results (from your site’s lab)
  – Medications (from med lists)
  – Diagnostic codes (from problem lists,
    encounters)
  – Immunizations
  – Progress note titles


                                              7
                         Term

• Collection of similar findings grouped
  together to simplify programming
• Example: LDL
  – Lab may run a direct LDL or calculated LDL
  – If either lab is acceptable to satisfy the
    reminder, we can combine both labs into a
    single Term called LDL.




                                                 8
                          Taxonomy
•   ICD-9 codes and/or CPT codes grouped
    together to describe one disease entity.
•   Example:
     •   250.00 Diabetes Type 2 or unspecified
     •   250.01 Diabetes Type 1
     •   250.4 Diabetes with renal manifestations
     •   250.5 Diabetes with ophthalmic manifestions
     •   250.6 Diabetes with neurological manifestations
     •   250.9 Diabetes with unspecified complication


    Combined into single taxonomy called “Diabetes”

                                                           9
                      Health Factors
• Findings created for information not existing
  elsewhere in VistA.
• Tells you facts about the patient
• Information is typically collected by reminders
• Examples:
  –   refused flu shot
  –   outside LDL
  –   life expectancy < 6 months
  –   outside colonoscopy result


                                                    10
How do you get more information?




                               11
     Did you know that the top
    rows and bottom row of the
     chart stay constant as you
            switch tabs?


  Did you know the reminder
clock is available from any tab?

                                  12
Icon Legend




              13
Cover Sheet – 2 Ways to Access




                            14
Notes Tab > Reminders Drawer




                          15
              Clinical Maintenance
While completing a reminder dialogue, click on
 Clinical Maintenance button




                                                 16
            Clinical Maintenance

• Status
  – Due Date
  – Last Done
• Cohort
• Why it is due for this patient
• Resolution of reminder


                                   17
 Clinical Maintenance Example
When was my last tetanus shot?




                                 18
Clinical Maintenance - Td example




                              19
        Why is pneumovax due in a
               35 year old?




Diagnosis of diabetes coded 4/7/99
caused the reminder to become due.   20
For Patient Education Reminders…




                              21
Reminder Inquiry




                   22
              HEART FAILURE ACE-I OR ARB USE

•   HEART FAILURE ACE-I OR ARB USE No. 209
•   --------------------------------------------
•   Print Name:                     Heart Failure ACE or ARB Use
•   Class:                      LOCAL
•   Sponsor:
•   Review Date:
•   Rescission Date:
•   Usage: CPRS, REPORTS
•   Related VA-* Reminder:
•   Reminder Dialog:                   HEART FAILURE ACE INHIBITOR USE
•   Priority:




                                                                         23
                                            Reminder Description
                                               (See handout)
Reminder Description:                                           of the renin-angiotensin system (RAS) and the
ACE Inhibitor use within 24 months prior to admission for       sympathetic nervous system (SNS) the pathophysiology
heart failure was introduced as a VA Performance                of heart failure has resulted in the development of drugs
Measure in FY2003. This reminder is designed to                 that have improved morbidity and mortality associated
prompt the provider to consider ACEI use in heart failure       with HF.
patients with an ejection fraction of <40%, unless
ACE/ARBs are contraindicated. This performance                  The cornerstone of proper medical treatment in patients
Measure was updated in FY2005 to allow use of an                with heart failure due to left ventricular systolic
ARB. (see below)                                                dysfunction (as opposed to diastolic dysfunction) is the
                                                                prescription of an angiotensin-converting enzyme
Contraindications include  to both ACE/ARB include:             inhibitor (ACEI). Numerous trials have demonstrated the
allergy or intolerance to both types of medications,            role of ACEIs in improving HF symptoms and functional
bilateral renal artery stenosis or renal artery stenosis with   status as well as in decreasing the frequency of
a single kidney, chronic renal dialysis, moderate or
                                                                hospitalization and mortality rate.
severe aortic stenosis, pregnancy, K+ >5.5 that cannot
be reduced, symptomatic hypotension or other reason             More recent trails demonstrate that ARBs have an
documented by provider.                                         important role in HF treatment and LVSD. The VALIANT
                                                                trial directly compared an ACEI with an ARB (as well as
Severe cough secondary to an ACE-I should prompt the            the combination of the two) in patients with signs and
provider to switch to an Angiotensin receptor blocker           symptoms of heart failure or LVSD after acute
(ARB) or angiotensin II receptor antagonist (AIIRA).            myocardial infarction. In this trial, the ARB was
                                                                statistically "non-inferior" to ACEIs in this patient
FY05 Update Rationale:   Pharmacologically, the value of        population. This study was the first to demonstrate the
diuretics, ACE inhibitors, B-blockers and digitalis has         equivalence of ARBs in the patient after myocardial
been established by the results of numerous large scale         infarction. As a result, effective January 1, 2005, the
clinical trails, and the evidence supporting a central role     CMS/JCAHO Technical Measures has approved the
for their use is compelling and persuasive. Over the past       inclusion of ARBs in measures AMI-3 and HF-3.
several years, understanding of the effect of activation
                                                                                                                       24
                                Technical Description
Technical Description:
  This reminder is due for patients with a diagnosis on file of heart
  failure unless there is entry of one of the following health factors:
   A) ACE CONTRAINDICATED and B) ARB CONTRAINDICATED
   C) EJECTION FRACTION 40% OR HIGHER (resolves reminder for 3 years)
   D) NO ACE-ON VA STUDY
   E) ACE/ARB NOT USED FOR OTHER REASONS

An entry in the allergy/adverse reaction package will satisfy EPRP reviewer for this measure.
    However clinical reminders are not able to use entries in the allergy/adverse reaction package at
    this time.

Definitions (updated from FY05 technical manual):
Excludes patients with:
      Documentation of participation in a clinical trial testing alternatives to ACEIs or ARB as first-line
          heart failure therapy
      One or more of the following reasons for not prescribing ACEI or ARB documented in the
          medical record:
             1. ACEI and ARB allergy
             2. Moderate or severe aortic stenosis
             3. Other reasons documented by MD/DO/NP/PA. Note must explicitly link the reason with
                the non-prescription of both ACEI and ARB.



                                                                                                         25
              Baseline Frequency

• Do In Advance Time Frame: Wait until
  actually DUE
• Sex Specific:
• Ignore on N/A:
• Frequency for Age Range: 1 year for all
  ages
• Match Text:
• No Match Text:

                                            26
         Before we cover the rest of the
           Reminder Inquiry sheet…


• KISS
• The logic is simple
• Abbreviations are simple
• Don’t let the long sentences
  scare you – it breaks down
  easily
                                           27
             Goal: Be able to interpret this

Customized PATIENT COHORT LOGIC to see if the
  Reminder applies to a patient:
FI(1)!FI(8)&'(FI(5)!FI(12)!(FI(3)&FI(10))!FI(6))

Expanded Patient Cohort Logic:
FI(VISN 8 HEART FAILURE )!FI(PATIENT STATES
  HISTORY OF CHF)&'(FI(VISN 8* EJECTION
  FRACTION 40% OR HIGHER)!FI(VISN 8* ACE/ARB
  NOT USED FOR OTHER REASONS)!(FI(VISN 8* ACE
  INHIBITOR CONTRAINDICATED)&FI(VISN 8* ARB
  CONTRAINDICATED))!FI(VISN 8* NO ACE-ON VA
  STUDY))


                                                   28
Venn Diagrams




   1        2
           Boolean Logic

• Bool·e·an (bōō'lē-ən)
• adj.
• Of or relating to a logical combinatorial
  system treating variables, such as
  propositions and computer logic elements,
  through the operators AND, OR, NOT, and
  XOR

                           Dictionary.com

                                            30
1 or 2
 1!2
1 or 2 or 3
 1!2!3
1 and 2
 1&2
1 and 2 and 3
  1&2&3
not 2
 „2
1 and not 2
   1&„2
                        Population




                 Lion
Flower                                   Squash
         Cat                 Dog                  CPU



                1                    2
                      !
               plant or animal




                         Cohort
                        Population




                 Lion
Flower                                   Squash
         Cat                  Dog                 CPU



                1                    2
               plant and animal




                          Cohort
                      Population




               Lion
Flower                             Squash
         Cat                Dog             CPU




               Not plant




                        Cohort
                          Population




                   Lion
Flower                                 Squash
          Cat                    Dog            CPU




         not    ( plant or animal )




                            Cohort
                           Population




                    Lion
Flower    Cat                               Squash
                                  Dog



                1                       2
         not    ( plant or animal )



                               CPU
                             Cohort
               Parenthesis

5 * 10 + 5 * 10       = 550
5 * (10 + 5) * 10     = 750
(5 * 10) + (5 * 10)   = 100
5 * (10 + (5 * 10))   = 300


                              43
         5                         6
 (plant or animal) and not (cat or machine)
    1          2                   3           4
                          7
7th step = 5th step answer less items found in 6th step
     (item must be in group 5 but not in group 6)
        6th step = calculate cat OR machine
        5th step = calculate plant OR animal

              4th finding item = machine?
              3rd finding item = cat?
              2nd finding item = animal?
              1st finding item = plant?
    (plant or animal)
and not (cat or machine)




                           45
                                      Population




                               Lion
  Flower                                             Squash
                  Cat                        Dog               CPU

             1                         2
     (plant or animal) and not (cat or machine)

               Lion         Squash
Flower
                                                   Cat
                      Dog
                                                         CPU
         Cat



         Cohort
                    Taxonomy

What if we were to consider lion and cat to
 be in the same taxonomy called cat?




                                              47
                                      Population




                               Lion
  Flower                                                 Squash
                  Cat                        Dog                     CPU

             1                         2
     (plant or animal) and not (cat or machine)

               Lion         Squash                 Cat       Lion
Flower
                      Dog                                           CPU
         Cat



         Cohort
                                 Boolean Logic

            CUSTOM LOGIC STRING                              COHORT
•   plant or animal                              flower, cat, lion, dog, squash
•   plant and animal                             no findings
•   not (plant or animal)                        computer
•   not plant or animal                          cat lion dog computer
•   (plant or animal) and not (cat or machine)   flower lion dog squash


If I define cat and lion to be both the same (i.e. in the cat taxonomy)…
• (plant or animal) and not (cat or machine)         flower dog squash




                                                                           50
           Now back to Reminders…

• In our example, make some simple
  substitutions.
  – Plant = diagnosis of heart failure
  – Animal = patient reports history of heart failure
  – Cat = EF > 40%
  – Machine = ACE contraindicated




                                                   51
           Abbreviations/Notations

•   !     or
•   &     and
•   ‟     not
•   FI    finding item
•   ()    Used around a number signifies the
          order in which it was programmed
• FI(5)   Finding item 5 = the 5th finding item
          defined by the reminder author
• ()      Also used to group and nest

                                              52
          Abbreviations/Notations

•   A    active
•   DC   drug class
•   HF   health factor
•   I    inpatient
•   N    non-VA medication
•   O    outpatient
•   TX   taxonomy
•   T    today
                                    53
                 Finding Item 1
               Reminder Taxonomy

VISN 8 HEART FAILURE (FI(1)=TX(79))

Finding Type: REMINDER TAXONOMY

Use in Patient Cohort Logic: AND

Beginning Date/Time: T-2Y



                                      54
            VISN 8 Heart Failure Taxonomy

• Following information available only to reminder
  managers who have additional VistA menus:
  – Ascertain which specific ICD9 codes are included
  – FY03 codes for heart failure added:
     • 428.20-428.43
     • Edit Date: JAN 4,2003 17:55
     • Edit By: ________________
  – Deleted codes
     • 428.30-428.33 (diastolic heart failure without systolic
       component)
  – Patient Data Source: EN,IN,-INM,PL

                                                                 55
                       Finding Item 8
                       Health Factor

PATIENT STATES HISTORY OF CHF (FI(8)=HF(673542))

Finding Type: HEALTH FACTOR

Health Factor Category: REMINDER FACTORS

Use in Patient Cohort Logic: AND

Beginning Date/Time: T-1M



                                              56
                              Finding Item 2
                              Reminder Term
VISN 8* OUTSIDE ACE INHIBITOR (FI(2)=RT(221))

Finding Type: REMINDER TERM

Use in Resolution Logic: OR

Beginning Date/Time: T-1Y

Mapped Findings:
Mapped Finding Item: HF.OUTSIDE MED - ACE INHIBITOR
Health Factor Category: OUTSIDE ACE
Beginning Date/Time: T-1Y

Mapped Finding Item: DC.CV800
RX Type: N
Status List: ACTIVE


                                                      57
                                FI(2) – More Info
                      Accessible only for reminder managers
•   Description: Use of outside ACE-Inhibitor medication findings

•   Edit History:

•     Edit Date: NOV 12,2003 18:38   Edit By: ________
•     Edit Comments: Copied from VISN 8 OUTSIDE ACE INHIBITOR

•     Edit Date: NOV 9,2004 21:27  Edit By: ________
•     Edit Comments: Added non-VA meds ACE-I

•     Edit Date: JAN 16,2005 16:09       Edit By: ________
•     Edit Comments:

•   Findings:

•              Finding Item: OUTSIDE MED - ACE INHIBITOR (FI(1)=HF(673100))
•              Finding Type: HEALTH FACTOR
•        Health Factor Category: OUTSIDE ACE
•         Beginning Date/Time: T-1Y

•               Finding Item: CV800 (FI(2)=DC(66))
•               Finding Type: VA DRUG CLASS
•                  Rx Type: N
•               Status List: ACTIVE




                                                                              58
                     Finding Item 3
              Reminder Term – Health Factor
VISN 8* ACE INHIBITOR CONTRAINDICATED
  (FI(3)=RT(215))

Finding Type: REMINDER TERM

Use in Patient Cohort Logic: AND NOT

Mapped Findings:

Mapped Finding Item: HF.ACE INHIBITOR
  CONTRAINDICATED

Health Factor Category: CONTRAINDICATED MEDS

                                               59
                       Finding Item 4
                         Drug Class
CV800 (FI(4)=DC(66))

Finding Type: VA DRUG CLASS

Use in Resolution Logic: OR

Beginning Date/Time: T-14D
Ending Date/Time: T+90
Rx Type: A
Status List: *




                                        60
                    Finding Item 5
             Reminder Term – Health Factor
VISN 8* EJECTION FRACTION 40% OR HIGHER
  (FI(5)=RT(219))

Finding Type: REMINDER TERM

Use in Patient Cohort Logic: AND NOT
Beginning Date/Time: T-5Y

Mapped Findings:
Mapped Finding Item: HF.EJECTION FRACTION 40%
  OR HIGHER

Health Factor Category: EJECTION FRACTION

                                                61
                      Finding Item 9
                      Reminder Term

VISN 8* ACTIVE USE OF VA ACE-I (FI(9)=RT(223))

Finding Type: REMINDER TERM
Use in Resolution Logic: OR
Beginning Date/Time: T-1M

Mapped Findings:
Mapped Finding Item: HF.PATIENT ON ACE FROM THIS
  VA
Health Factor Category: REMINDER FACTORS



                                                   62
                                                                            Finding Item 9
                                                                            Health Factor
•   VISN 8* ACTIVE USE OF VA ACE-I                                            No.223
•   ----------------------------------------------------------------------------
•   Class:                 VISN
•   Sponsor:
•   Date Created:
•   Review Date:

•   Description:
•     Describes active VA ACE-Inhibitor use. This term may be used when local
•     sites use batch computer processing of Pharmacy prescriptions to indicate
•     "released" or when the current pharmacy profile does not accurately
•     indicate the supply of ACE-I medication.

•   Edit History:

•      Edit Date: NOV 12,2003 18:42   Edit By: _______
•      Edit Comments: Copied from VISN 8 ACTIVE TREATMENT WITH VA ACE-I

•      Edit Date: NOV 13,2003 00:19                Edit By: _______
•      Edit Comments:

•      Edit Date: JAN 2,2004 12:00  Edit By: ________
•      Edit Comments: No changes made

•   Findings:

•               Finding Item: PATIENT ON ACE FROM THIS VA (FI(1)=HF(673568))
•               Finding Type: HEALTH FACTOR
•         Health Factor Category: REMINDER FACTORS




                                                                                             63
                         Cohort Logic
Customized PATIENT COHORT LOGIC to see if the
  Reminder applies to a patient:
      FI(1)!FI(8)&'(FI(5)!FI(12)!(FI(3)&FI(10))!FI(6))

Expanded Patient Cohort Logic:
   FI(VISN 8 HEART FAILURE )!FI(PATIENT STATES
       HISTORY OF CHF)&'(FI(VISN 8* EJECTION
    FRACTION 40% OR HIGHER)!FI(VISN 8* ACE/ARB
   NOT USED FOR OTHER REASONS)!(FI(VISN 8* ACE
    INHIBITOR CONTRAINDICATED)&FI(VISN 8* ARB
    CONTRAINDICATED))!FI(VISN 8* NO ACE-ON VA
                         STUDY))


                                                         64
         Cohort Logic - Expanded

FI(1)!FI(8)&'(FI(5)!FI(12)!(FI(3)&FI(10))!FI(6))

           is exactly the same thing as

FI(VISN 8 HEART FAILURE)!FI(PATIENT STATES
     HISTORY OF CHF)&'(FI(VISN8* EJECTION
 FRACTION 40% OR HIGHER)! FI(VISN8* ACE/ARB
NOT USED FOR OTHER REASONS)!(FI(VISN8* ACE
 INHIBITOR CONTRAINDICATED)&FI(VISN8* ARB
  CONTRAINDICATED))!FI(VISN8* NO ACE-ON VA
                   STUDY))

                                                   65
            Customized Patient Cohort Logic

FI(1)!FI(8)&'(FI(5)!FI(12)!(FI(3)&FI(10))!FI(6))
   1                               2
(1 or 8) AND NOT (5 or 12 or (3 and 10) or 6)

  1 = heart failure taxonomy
  8 = pt states has history of heart failure
  5 = EF ≥ 40%
  12 = ACE and ARB not used for other reasons
  3 = ACE contraindicated
  10 = ARB contraindicated
  6 = Involved in study where ACE not given


                                                   66
                     Resolution Logic

Default RESOLUTION LOGIC defines findings that resolve
  the Reminder:

     FI(2)!FI(4)!FI(9)!FI(11)!FI(13)!FI(14)!FI(15)

Expanded Resolution Logic:
FI(VISN 8* OUTSIDE ACE INHIBITOR)!
  FI(CV800)! FI(VISN 8* ACTIVE USE OF VA
  ACE-I)! FI(VISN 8* OUTSIDE ARB)! FI(CV805)!
  FI(VISN 8* NON-VA MEDS: ACE/ARB)! FI(ACE
  COMBINATION MEDICATIONS)


                                                     67
                             Resolution Logic

What resolves the reminder

         FI(2)!FI(4)!FI(9)!FI(11)!FI(13)!FI(14)!FI(15)

          2 OR 4 OR 9 OR 11 OR 13 OR 14 OR 15

•   2 = FI(VISN 8* OUTSIDE ACE INHIBITOR)
•   4 = FI(CV800) = ACE-I
•   9 = FI(VISN 8* ACTIVE USE OF VA ACE-I)
•   11 = FI(VISN 8* OUTSIDE ARB)
•   13 = FI(CV805) = ARB
•   14 = FI(VISN 8* NON-VA MEDS: ACE/ARB)
•   15 = FI(ACE COMBINATION MEDICATIONS)

                                                         68
69
                  Branching Logic

• What is it?
  – Ability to control the content of a reminder
    dialog based on evaluation of a REMINDER
    TERM


• The dialog display changes based on the
  evaluation of a Reminder Term



                                                   70
           Branching Logic Example

       Patient Has Diabetes

   Not on                    Insulin
   insulin
         Reminder dialog            Reminder dialog



Diabetes Education         Insulin Teaching
                                                 71
            Branching Logic Reminders
                              Enter HF
                                                    Enter HF

                             Enter HF
                     Enter HF
                                          Insulin
                                         Teaching
       Enter HF   Enter HF
                                             Enter HF
Enter HF
                      Insulin
    Not on insulin                                     Enter HF




                                                               72
           Branching Logic Example

• If NOT on insulin the term will evaluate as
  false and display the dialog for diabetic
  education

• If ON insulin – the term will evaluate as
  true and display the education that
  pertains to insulin use.



                                                73
                                                        1




                                                        2




                                                        3




Branching logic also can suppress part of a reminder
  that has already been completed. However, the
  reminder will not resolve until all parts are done.

                                                            74
2




3




    75
3




    76
             Functional Findings (FF)


• Perform a computation on the result of a
  regular findings
• Functions available
  – MRD (most recent date)
  – Count
  – Min_Date (minimum date=oldest date)
  – Max_Date (maximum date=most recent date)

                                             77
78
           Functional Findings (FF)

         MRD (1) > MRD (13)
              FI(1) = IHD diagnosis
              FI(13) = Inactivate IHD reminder

FF is true if: the most recent date of FI (1) is greater
         than the Most recent date of FI (13)

  1999 – Patient incorrectly coded with IHD diagnosis
  2005 – Patient “does not have IHD” selected on reminder
  2007 – Patient now has a new diagnosis of IHD. When
         information is entered on the encounter form,
         the IHD reminder will again become due for this patient.
                                                              79
 Patient has a diagnosis
of Ischemic Heart Disease
          FI (1)



From the reminder, patient
 Does not have Ischemic
Heart Disease is checked
 (creates a health factor)
          FI (13)


Reminder is resolved until a
New diagnosis of Ischemic
Heart Disease is entered on
    the encounter form

                               80
                   Function Findings

• Allows the reminder to turn on and off for
  very specific reasons.
  – Count function allows you to turn off the
    reminder once some something has been
    done.
     • Smoking counseling done three time

  – Occurrence count- searches for up to the N
    for a finding. Default=1
     • For a HbA1c with an occurrence count of 3, the
       clinical maintenance will display the last 3 HbA1c’s

                                                          81
          Where Health Factors Appear

• Information bits collected by clinical
  reminders
• Appears in the bottom pane of a progress
  note
• Ad hoc health summaries
• Entered automatically in encounter forms




                                             82
  Where do Health Factors Appear?


 Findings entered by reminder dialogs are
displayed at the bottom of the progress note




  Important to check after completing reminders


                                                  83
                Where do Health Factors Appear?



Encounter form under
 “Health Factors” tab




List of health factors
completed at this visit



                                             84
         Where does information go?

• Health factors get stored in a database in
  Austin
• Many health factors have national
  mapping




                                               85
       How is Information Extracted?

• KLF
• Proclarity
• Clinical Reminder Reports




                                 86
            Accessing Remote Clinical
                   Reminders


• Occasionally patients split time between
  multiple VA sites
• Clinical reminder data can be retrieved
  through Remote Data or VistaWeb
  – Can avoid duplication
  – Dependent on individual sites as to which
    reminders show up


                                                87
88
89
90
That can‟t be right!


          … but I guess it is.




                                 91
                        Reports

• If information is entered correctly and the
  right question is asked, it is possible to run
  statistics on providers in a short period of
  time.
• Summary Reports vs. Detailed Reports




                                               92
                     Managing Reports

• Detailed reports on individual reminders to
  identify specific patients with that reminder due
   – Single reminders for individual providers
   – Single reminders for groups of providers
• Save reports that can be used every month
   – Helpful for huge lists of reminders and clinics
• Can import data into Excel for manipulation of
  data
• Can store reports securely on Sharepoint for
  easy distribution


                                                       93
                    Effective Dates

• Reminder reports can be run for both
  future and past dates
   – Past dates:
    • To determine if a facility, clinic or individual
      is improving on a measure
    • To evaluate performance
  – Future dates:
    • Run detailed reports ahead of time so
      patients can be scheduled before the
      reminder is actually due
                                                     94
Reminder Reports




                   95
Report Card




              96
Sample Report Card




                     97
Nobody Wants to be the Worst




                           98
99
                      Patient Lists

• A list of patients with a due reminder can
  now be sent to a patient list.

• The list can then be:
  – Copied to a new list.
  – Copied to a OERR team list
  – Used as the patient list in a reminder report



                                                    100
                    Patient Lists

•   Can be assigned to specific users: public
    or private

•   Can be used to create health summaries
    on the list of patients

•   Can be used to get demographics


                                           101
                    Patient Lists

• Demographics
  – Address
  – Phone number
  – Age
  – Inpatient episodes
  – Next appointment
  – Reminder Due/Last Done Status



                                    102
               Reporting System

• Do you know who is responsible for
  maintaining your reminders?
• Clinical Reminders can stop working
  properly for any number of reasons.
  – Patches
  – CPT code changes
• Need let end users know who to contact.


                                            103
                     Summary

• Brief tour of clinical reminders
• Defined basic construct and basic logic
• Showed ways of finding information on
  reminders
• How clinical reminder information is used
• Hopefully interested some to continue to
  more advanced classes


                                              104
             For More Information

• If interested in learning to build your own
  clinical reminders, take Clinical Reminders
  Distance Learning class.
  – Organized by Jerry Rutherford
  – Taught by Alan Montgomery, Anne Rega,
    Rob Silverman, and Dr. Bryan Volpp




                                            105
                For More Information

• Sharepoint Classes
  – Was offered Monday 8/20/07
• Excel Classes
  – Was offered Monday 8/20/07
• Power Point Classes
  – Was offered Monday 8/20/07
  – Also available on Web Based Training
• VeHU e-Xpress train:
vaww.vehu.med.va.gov/Search/eXpresstrain.cfm

                                               106
107

								
To top