EHR Patch Updates Office Hours EHRv1.1p8, TIUv1.0p1008, BHSv1.0p5 What’s new, What’s changed...
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Transcript of EHR Patch Updates Office Hours EHRv1.1p8, TIUv1.0p1008, BHSv1.0p5 What’s new, What’s changed...
EHR Patch Updates Office Hours
EHRv1.1p8, TIUv1.0p1008, BHSv1.0p5
What’s new, What’s changed
IHS-Office of Information TechnologyEHR Program
Office Hour Presenters• CDR Susan Pierce-Richards, ARNP, OIT EHR Project Lead• CDR Mary Ann Niesen, PharmD, OIT, ARRA Deployment Pharmacist• Barbara Hess, DHA, OIT EHR Project analyst
Agenda• Introduction• Presenters
– Office Hour Presenters have different specialties within the EHR system who will be responding to your questions
• Questions/Answers– Please do not put your phone “On Hold” during the conference call– “Raise your hand” through the WebEx features provided– Please state your name/site– Please state your question clearly– Please keep background noise to a minimum to better hear the
questions/answers• Patch 8 Resources
– Patch 8 resources will be placed on FTP site (RPMS patch folder) for your review after session
– If you can not access the FTP site please e-mail [email protected] for a copy
Chart Review
Supports GUI entry into the new “V Updated/Reviewed” file
This is a visit related file that stores 9 “Clinical Actions”Allergy List Reviewed
Allergy List Updated
No Active Allergies
Medication List Reviewed
Medication List Updated
No Active Medications
Problem List Reviewed
Problem List Updated
No Active Problems
Chart Review
The Chart Review component allows for the documentation of a visit related clinical action for the Allergy, Medication and Problem lists.
The Chart Review component’s primary function is to provide GUI entry of data used for Meaningful Use Reporting.– The ability to document “no active medications,” “no
active problems”
Chart Review
The Chart Review component also provides the following options to support documentation requirements for accreditation and local policy.– To document that allergies were reviewed by a
clinician at a visit – To verify “no active allergies” after initial
documentation of “no known allergies”– The ability to document that the each list was
reviewed by clinician
Chart Review
The Chart Review function also automatically captures list updates.– Add, change, discontinue medication– Add, inactivate, reactivate, review, mark
inability to assess allergies– Add or edit a problem
This will automatically store “Updated” when changing visit context/changing patients.
“Chart Review” Component
Chart Review
The Chart Review actions are available in 2 places:
“Chart Review Component” that may be placed on the toolbar or other location
Right click menu of the Adverse Reaction, Medication List and Problem List cover sheet components.
Review and No Active actions are placed in the signature and signed with the rest of the visit actions such as allergies, orders, etc.
ConfigurationAdd object using Design Mode.
Probably best suited to a toolbar so that users may access this regardless of location in chart.
You MUST add the Chart Review component to the GUI in order for the Cover Sheet right click menu top operate correctly
ConfigurationProperties
You may change the button label by changing the text in REVIEWEDCAPTION value
You may change hover hint adding local guidance by changing the text in the REVIEWHINT value
Chart Review – Business RulesThe Chart Review component is “per user per visit,” so the
buttons are “reset” for each user on a given visit.e.g.: Nurse documents that she reviewed problem list. The provider then determines that the existing problem on the list is resolved and inactivates the problem. Provider may then document “no active problems.” Both clinical actions store in the V Updated/Reviewed file with date/time stamp and user who entered data.
• Documentation of “no active medications” and “no active problems” is used in Meaningful Use Reporting.
Chart Review – Business Rules• Documentation of “reviewed” is currently at the discretion
of the site however the following is a suggested use of the “Reviewed” and “No Active Allergies” functionality– Documentation of “reviewed” on the adverse reaction
component may be used for staff to document that they reviewed the allergies/adverse reactions – a common requirement of accrediting bodies.
– Entry of no known allergies into the adverse reaction component should still be used. Once “No Known Allergies” is documented in the Adverse Reaction component, subsequent verifications can be documented by selecting “no active allergies” using the Chart Review button or right click menu.
“No Active Problems” or “No Active Medications”
When no items exist on Problem list, users may document “No Active Problems”
• Clicking corresponding chart review button• Right click in Cover Sheet component
“No Active Allergies”
• If a patient has “No Allergy Assessment” is it extremely important that if they have no allergies that an entry of “No Known Allergies” is still entered into Adverse Reaction Component
• This will enter an “Updated Allergy List” clinical action into the V Updated/Reviewed file in the background (stored when you exit the visit)
“No Active Allergies”
• When this patient returns at a later date (or the info is confirmed by another clinician later in the visit based on local policy) then use the Right Click (or Chart Review button) to document verifying “No Active Allergies”
“Reviewed”
When items exist on Medication list, for example, users may document “Reviewed”
• Clicking corresponding chart review button• Right click in Cover Sheet component
“Updated”• Added a problem
• Note the [U] on the problem list Button
• Nothing will show up on the signature tool – no action is required by the user
• When you leave visit it will store the Updated Problem list to the V Updated/Reviewed file
----------------------------- V UPDATED/REVIEWED -----------------------------
CLINICAL ACTION: PROBLEM LIST UPDATED PATIENT NAME: TEST,PATIENT
VISIT: APR 29, 2011@13:08 DATE/TIME ENTERED: APR 29, 2011@13:10:33
ENTERED BY: RICHARDS,SUSAN
EVENT DATE AND TIME: APR 29, 2011@13:08:54
ENCOUNTER PROVIDER: RICHARDS,SUSAN
CLINICAL ACTION: PROBLEM LIST REVIEWED PATIENT NAME: TEST,PATIENT
VISIT: APR 29, 2011@13:08 DATE/TIME ENTERED: APR 29, 2011@13:10:33
ENTERED BY: RICHARDS,SUSAN
EVENT DATE AND TIME: APR 29, 2011@13:08:54
ENCOUNTER PROVIDER: RICHARDS,SUSAN
Signature box
• User may uncheck if did not perform action• Status changes after signature
Health Summary Display (no action by CAC needed)
------- CURRENT MEDICATIONS (TWICE DURATION OF RX - MINIMUM 60 DAYS) -------
03/24/11 MEDROXYPROGESTERONE 150MG/ML #1 (90 days) INJECT 150MG INTRA-MUSCULARLLY NOW 03/16/11 ORX-1 PILL # (30 days) Dispensed at: OUTSIDE MED TAKE ONE (1) BY MOUTH (EHR OUTSIDE MEDICATION)03/16/11 OUTSIDE OTC MEDICATION #1 (EHR OUTSIDE MEDICATION)03/16/11 OUTSIDE PRESCRIPTION #1 (EHR OUTSIDE MEDICATION)02/22/11 WARFARIN 5MG TABS #14 (14 days) -- Ran out 03/08/11 TAKE ONE (1) TABLET BY MOUTH DAILY
Medication List Reviewed On: Apr 05, 2011 By: RICHARDS,SUSANMedication List Updated On: By: No Active Medications Documented On: By:
Allergies – new menu options
• Entered in error• Inactivate (and
reactivate) allergies• Inability to assess
Allergies – Unable to Assess
• Right click from Adverse Reaction Component
• RPMS GMRA application
Allergy – Unable to Assess
• If no reactions on list, displays on header bar• If entries, displays on “agent” list• Display removed after entry of “no allergies” or
“reviewed” or adding adverse reaction (is stored for audit purposes)
Allergy – New/Updated mandatory fields
Nature of Reaction is now pre-populated and not editable
Event codes – listed from most specific to least specific
Source of info – self explanatory
Allergy – Event Code
• New event codes• Most specific to least
specific• These are SNOMED
codes (another clinical terminology system, required for EHR Certification)
Allergy – New/Updated optional fields
These fields refer to the onset of reported signs/sympoms
Date/time defaults to NOW but may be changed
Source is optional
Allergies – enhanced detail
Added to detail:
Ingredients
Inactivation info
Reactivation info
Last modified info
Allergies – enhanced verifier dialog
Button to view drug classes and ingredients
Verifier may now make changes to editable fields and this does not change the originator of the allergy
Verifier date/time is stored as is last modified
Vital Entry – Last Known WellThe ability to document “Last
Known Well”
Specifically and only used in the Meaningful Use Clinical Quality Stroke Measures.
Value is always WELL. Document the date/time as follows:
– If witnessed onset, document date/time of onset of stroke symptoms.
– If date/time of onset un-witnessed, document date/time the patient was without stroke symptoms
C32/CCD Viewer• The BJMD package is
designed to generate industry standard CCD in Healthcare Information Technology Standards Panel C32 format and transmit them to Indian Health Service C32 repositories and authorized third parties using Web Services.
C32/CCD ViewerDESCRIPTION:• The C32/Continuity of Care Documents (CCD) Clinical Summary (BJMD) software is
a component of the Indian Health Service (IHS) Resource and Patient Management System (RPMS).
• It provides facilities for generating industry standard CCD in Healthcare Information Technology Standards Panel (HITSP) C32 format (version 2.1). CCD/C32 documents are transmitted to IHS C32 repositories or to authorized third parties using Web Services (WS). C32/CCD Clinical Summary documents will be referred to as “C32 documents” and the C32/CCD Clinical Summary software will be referred to as the “C32 software” in this document.
• The primary function of the C32 Viewer component is so that the user will have the ability to see transmitted patient health summaries from an external source through a view component in the EHR. The user will then be able to create a C32 extract from EHR based patient and encounter context selected in the EHR header bar.
C32/CCD viewer
C32/CCD Viewer Configuration
• Add “C32 Viewer Launch Button” component to EHR – best suited to a toolbar or header area – using design mode
C32/CCD Viewer Configuration
C32/CCD Viewer Configuration• SiteUrl: http://<your site’s RPMS server
address><port>/csp/C32<your site’s UCI>/BJMD.Prod.Service.DocumentRepository.cls
• Replace the parts between and including the brackets with your site specific information. It will look like this.
• The number in italics below (57772) is the default port for Ensemble Web Services, so it should work for most sites, but if a site is running multiple instances of Ensemble, the correct port number may be 57773 or 57774/5/6/etc.
• http://10.243.60.7:57772/csp/C32WSP/BJMD.Prod.Service.DocumentRepository.cls
• NOTE: this component depends on the Vangent supplied C32 package which may need to be set up separately
Parameters – BEHOXQ SHOW HINT
– BEHOXQ SHOW HINT• This option sets the hover hint on the notifications to show or not
show.• You may set this to NO to hide the hover hint or YES to display• Option accessible from XPAR General parameters menu and
BEH-NOT-PAR-HNT (Set Show Hint Dialog option)
Parameters BEHOXQ SHOW HINT
Right click on notifications tab
User may turn on or off Show Hint
Parameter sets default
Parameters -BEHORX DOSAGE FORM
– BEHORX DOSAGE FORM• This option sets the dosage form used in the outside meds for
Unknown medication documentation to set the action to “validate”. Recommend setting this to MISCELLANEOUS now.
• Option accessible from XPAR General parameters menu and BEH-MED-OMD (Outside Med Dosage Form)
Parameters -BEHORX SPLITTER PANE
– BEHORX DOSAGE FORM– BEHORX SPLITTER SIZE
• This parameter sets the proportions of the panes on the medication management component.
• Option accessible from XPAR General parameters menu and BEH-MED-SPL (Med Tab Splitter Pane)
Parameters –BEHORX SPLITTER PANEThe input format is: 20;25;60;75
<inpatient top>;<inpatient bottom>;<outpatient top>;<outpatient bottom>
The numbers represent the size percentage of the two splitters.
Outpt Meds
=========Top Splitter=============
Outside Meds
=========Bottom Splitter==========
Inpatient Meds
Default values are:
If your patient is Inpatient: 20;25
If your patient is Outpatient: 60;75
Non Hospital sites
Set for System
25;50;75;99 (the ‘99’ effectively hides the inpatient pane)
The percentages speaks to where the pane starts – so in the Non-hospital site example above 25;50;75;99
Inpatients: the outside meds pane starts 25% down from top and inpatient meds in the middle. At a site with no hospital you will never see this.
Outpatients: the outside meds pane starts 75% down from top and the inpatient is not visible but you can see the splitter control to move into view. (good for a site that is NOT a hospital and would NEVER look at inpatient.
BEHORX SPLITTER PANE example
BEHORX SPLITTER PANE example
So in the following examples
------- Setting BEHORX SPLITTER SIZE for System: DEMO-HO.BEM.IHS.GOV -------
Value: 25;50;75;99//
The first 2 numbers represents the display when you view a patient who is an INPATIENT
The second 2 numbers represents a patient who is not admitted, so is outpatient
Parameters –BEHOVM NEW DATE DEFAULT
– BEHOVM NEW DATE DEFAULT• This option sets the default radio button for Select New Date/Time
on the Vital Entry component. You may default this to “Now” or “Current Visit”
• Option accesable from the XPAR General Parameters menu and BEH – VIT – SND (Select New Date Default option
Patient is INPATIENT status
Patient is OUTPATIENT(not Inpatient status)
TIU 1.0 p1008
Read notes carefully – there is a post install routine that must be run by the individual who installs your patch– Includes a new document class and title named DISCHARGE
INSTRUCTIONS– New fields and parameter were added to allow sites to
configure the header and footer printout of the DISCHARGE INSTRUCTION note.
– Includes new document titles that will be used in meaningful use reporting logic
– E-COPY DISCHARGE INSTR RECEIVED – E-COPY DISCHARGE INSTR NOT RECEIVED
TIU 1.0 p1008Create the special TIU TEMPLATES that you wish to use
in the headers and footers. – These templates should be created in the EHR as you would
create any TIU TEMPLATE. – TIU OBJECTS are OK but TIU TEMPLATE FIELDS cannot be
used since the header and footer are only called by the printing routine.
– Users will NOT see these headers and footers inside the EHR. – If you want to use visit data in a header or footer, it must be an
object that starts with VISIT and not with V (those are only for the GUI)
– Site may wish to put these templates into a special folder so that people don't use them in regular notes although there is no reason why they would not work inside a regular note
TIU 1.0 p1008
Add TIU TITLEs to the DOCUMENT CLASS of DISCHARGE INSTRUCTIONS.– One title is sent with this patch. – Any other titles that the site wishes to use these special
headers and footers will need to be created for this special DOCUMENT CLASS
TIU 1.0 p1008
Add the headers and footers to the title(s) you have created. Use the following menu options:
Start in the RPMS-EHR CONFIGURATION MANAGER menu and choose TIU.
CLN TIU Menu for Clinicians ...
HIS TIU Menu for Medical Records ...<- THIS ITEM
PAR TIU Parameters ...
TIU 1.0 p1008
HIMS Special HIMS TIU Reports ...
IPD Individual Patient Document
LAD List of Active Document Titles
MPD Multiple Patient Documents
PDM Print Documents Menu ...
SIG Awaiting Signature Listing
SSD Search for Selected Documents
STR Statistical Reports ...
TMM TIU Maintenance Menu ...<- This item
UPL TIU Upload Menu ...
VUA View a User's Alerts
TIU 1.0 p1008
DDM Document Definitions (Manager) ...<==THIS ITEM
TAT TIU Alert Tools
TPM TIU Parameters Menu ...
TTM TIU Template Mgmt Functions ...
UCM User Class Management Menu ..
TIU 1.0 p1008
DDM1 Edit Document Definitions
DDM2 Sort Document Definitions
DDM3 Create Document Definitions
DDM4 Create Objects
DDM5 List Object Descriptions
DDM6 Create TIU/Health Summary Objects
DDM7 Title Headers/Footers <==THIS ITEM
TIU 1.0 p1008Use the option BTIU TITLE HEADER/FOOTER to add the titles with their headers and
footers. These titles need to be in the DOCUMENT CLASS of DISCHARGE INSTRUCTIONS. This menu option is added to the DOCUMENT DEFINITIONS MENU (BTIU MENU DOC DEF MGR)
Select Document Definitions (Manager) Option:
DDM7 Title Headers/Footers
Select Division for PNs Outpatient Batch Print: DEMO
Select the title you wish to add headers/footers to Select NOTE TITLE: DISCHARGE INSTRUCTIONS TITLE TITLE
...OK? Yes// (Yes)
HEADER TEMPLATE: SAMPLE HEADER// <=name of template you made
FOOTER TEMPLATE: SAMPLE FOOTER//<=name of template you made
BHS V1.0 p5
• Updated allergy components to reflect the changes in the allergy package delivered with GMRA 4.0 patch 1001 and EHRv1.1 patch 8 (which included GMRA 4.0 patch 1002)
• New “Detailed Adr/Alg” which is a highly detailed report for case review, problem resolution
• Fixed display of measurement object to display both systolic and diastolic blood pressure.
Detailed Allergy report-------------------------- DALL - Detailed Allergies
---------------
Title: ALL ALLERGY/ADVERSE REACTION (AR)
Drug:
ALLERGY: DIGOXIN
Drug Classes: DIGITALIS GLYCOSIDES
Ingredients: DIGITALIS
(V/Historical)
REACTION: BRACHYCARDIA
Originator: CAROLYNN D HOSEY
Title: Carolynn Hosey RN
Date/Time: 12/21/2010 11:15
Verified on: Dec 22, 2010@15:39:48
Verified by: NELSON,GARY
INACTIVE-UNKNOWN: THIS IS SILLY
Drug Classes: TETRACYCLINES
Ingredients: TETRACYCLINE
OXYCODONE
(V/Historical)
REACTION: AGITATION
Inactivation: MAY 31, 2011@08:44:29( REACTION IS TOLERABLE )
Inactivated by: RICHARDS,SUSAN P
Originator: Susan Pierce-Richards, ARNP
Title: Nurse Practitioner
Date/Time: 12/14/2007 17:25
Verified on: Dec 28, 2007@17:34:48
Verified by: RICHARDS,SUSAN P
Resourceslinks will be active AFTER patches released!
EHRv1.1p8 guideftp://ftp.ihs.gov/rpms/patches/ehr_0110.08o.pdfTIUv1.0p1008 notesftp://ftp.ihs.gov/rpms/patches/tiu_0100.1008nBHSv1.0p5 notes (Health Summary Components)ftp://ftp.ihs.gov/rpms/patches/bhs_0100.05n