EHR Reminders -Copying and Customizing National Reminders

LCDR Susan Pierce-Richards, MSN, ARNP

Introduction

National Reminder logic is based on the default logic in the Health Maintenance Reminders (HMR). Like the HMR, the logic can be customized for your site.

National Reminders cannot be edited but may be copied as a Local Reminder. Local Reminders MAY be edited.

If you still display the HMR on the Health Summary, consider making the same logic changes so the Clinical (EHR) Reminders and HMR display the same information.

Objectives

At the end of this presentation, the CAC will be able to:• Copy a National Reminder to a local name• Make basic changes to the reminder logic for use at

the local site– Change age in baseline frequency age range set– Change reminder frequency and effective period in a

reminder finding– Change the condition of a refusal finding– Change how far back to look for a diagnosis in a cohort– Add refusal finding to a reminder

Overview

• You will need to copy the National Reminder. Use consistent naming conventions Examples:– Change prefix to local site (Yak-Mammogram)– Append name (IHS-Mammogram_Yakama)

• You will need to change any text to reflect the logic changes

• You can link the National Reminder to your local dialog

Scenario 1 – Mammogram Reminder

National Reminder logic:– Due yearly for women 50-70 years of age who do not

have a history of a bilateral mastectomy– Refusal turns off reminder for 1 year

Your Medical Staff wants the Mammogram reminder to:– Begin at 40 years of age – Refusal to turn off Reminder only for 1 day so other

clinicians can encourage patient to have service done

Script for MammogramCOPY National Reminder

YAKAMA HEALTH CENTER IHS RPMS-EHR Management Version 1.1 Reminder Configuration

CFM Reminder Computed Finding Management ... DEF Reminder Definition Management ... DLG Reminder Dialog Management ... EXC Reminder Exchange INF Reminder Information Only Menu ... PAR Reminder Parameters ... RPT Reminder Reports ... SPO Reminder Sponsor Management ... TAX Reminder Taxonomy Management ... TRM Reminder Term Management ... TST Reminder Test

YAKAMA HEALTH CENTER IHS RPMS-EHR Management Version 1.1 Reminder Definition Management

CPY Copy Reminder Definition EDT Add/Edit Reminder Definition INQ Inquire about Reminder Definition LST List Reminder Definitions

Select the reminder item to copy: IHS-MAMMOGRAM 2007 NATIONALPLEASE ENTER A UNIQUE NAME: YAK-MAMMOGRAM 2007

The original reminder IHS-MAMMOGRAM 2007 has been copied into YAK-MAMMOGRAM 2007

Do you want to edit it now? y YES

Select one of the following

A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web AddressesSelect section to edit: a All reminder details

NAME: YAK-MAMMOGRAM 2007//

PRINT NAME: Mammogram//

CLASS: LOCAL//SPONSOR:REVIEW DATE:USAGE: *//

RELATED REMINDER GUIDELINE:

INACTIVE FLAG:

REMINDER DESCRIPTION:Females 50 to 70 should have yearly mammograms.Mammograms are found by CPT code, radiology exam or from the women's health package

==[ WRAP ]==[ INSERT ]========< REMINDER DESCRIPTION >=======[ <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

<=======T=======T=======T=======T=======T=======T=======T=======T=======TTECHNICAL DESCRIPTION: No existing text Edit? NO//

Change the age in description to 40 to 70

PRIORITY:

Baseline FrequencyDO IN ADVANCE TIME FRAME: 3M//SEX SPECIFIC: FEMALE//IGNORE ON N/A:

Baseline frequency age range setSelect REMINDER FREQUENCY: 1Y// REMINDER FREQUENCY: 1Y// MINIMUM AGE: 50Y//40Y MAXIMUM AGE: 70Y// AGE MATCH TEXT: No existing text Edit? NO// AGE NO MATCH TEXT: No existing text Edit? NO//Select REMINDER FREQUENCY:

Enter new Min Age of 40Y

Findings

Choose from:CF IHS-MAMMOGRAMREF MAMMOGRAMRT IHS-MAMMOGRAM TERMSTX IHS-BILATERAL MASTECTOMYTX IHS-MAMMOGRAM 2007

Select FINDING: ref.ma

Searching for a REFUSAL TYPE, (pointed-to by FINDING ITEM) MAMMOGRAM ...OK? Yes// y (Yes)FINDING ITEM: MAMMOGRAM//MINIMUM AGE:MAXIMUM AGE:REMINDER FREQUENCY: 1DRANK FREQUENCY:RANK FREQUENCY:USE IN RESOLUTION LOGIC: OR//USE IN PATIENT COHORT LOGIC:EFFECTIVE PERIOD: 1Y// 1DEFFECTIVE DATE:CONDITION: I V="MAMMOGRAM"//I V=“MAMMOGRAM BILAT”CONDITION CASE SENSITIVE:FOUND TEXT: No existing text Edit? NO//NOT FOUND TEXT: No existing text Edit? NO//

Change this to 1 day so the reminder is due again tomorrow if refused

Refusals must point to local term

Edit if needed (see next page – look at

Health Summary to see local term)

Change this to 1 day so refusal expires tomorrow

Health Summary Display of Refusal---------------- PATIENT REFUSALS FOR SERVICE (max 2 years) ----------------

Sep 08, 2008 MAMMOGRAM BILAT (MAMMOGRAM)

Refusal Type: REFUSED SERVICE

This is local term to usefor condition

Select REMINDER FREQUENCY:

Findings

Choose from:CF IHS-MAMMOGRAMREF MAMMOGRAMRT IHS-MAMMOGRAM TERMSTX IHS-BILATERAL MASTECTOMYTX IHS-MAMMOGRAM 2007

Select FINDING:

Patient Cohort and Resolution LogicCUSTOMIZED PATIENT COHORT LOGIC (OPTIONAL):GENERAL PATIENT COHORT FOUND TEXT:Patient is in age (50 to 70) for yearly mammograms unless bilateral mastectomy

Edit? NO// YES==[ WRAP ]==[ INSERT ]===< GENERAL PATIENT COHORT FOUND T >==[ <PF1>H=Help ]====Patient is in age (40 to 70) for yearly mammograms unless bilateralmastectomy

<=======T=======T=======T=======T=======T=======T=======T=======T=======T>==

Change the age in description to 40 to 70

GENERAL RESOLUTION FOUND TEXT: No existing text Edit? NO//

GENERAL RESOLUTION NOT FOUND TEXT:Mammogram results have not been found in the computer

Edit? NO//

Reminder DialogLINKED REMINDER DIALOG: IHS-MAMMOGRAM 2007//

Web Addresses for Reminder InformationSelect URL:

It is still linked to the national dialog.If you wanted to link it to your own,

you could change this here

Now you are done editing the reminder. Now go to your Cover Sheet, remove the National and add the Local Reminder

Local Mammogram Reminder display

Now you can see the servicewas refused, but the reminder

stays due

TEST…TEST…TEST…TEST…TEST

Scenario 2 – DM HGB A1C Reminder

National Reminder logic:– Due yearly patients with a visit diagnosis

of Diabetes or problem list entry in the past 2 years

Your Medical Staff wants the DM HGBA1C reminder to be applicable for patients who have EVER had a diabetes diagnosis

Script for DM HBGA1CCOPY National ReminderSelect Reminder Definition Management Option: rc Copy Reminder Definition

Select the reminder item to copy: IHS-DIAB HGBA1C 2007PLEASE ENTER A UNIQUE NAME: YAK-DIAB HGBA1C 2007

The original reminder IHS-DIAB HGBA1C 2007 has been copied into YAK-DIAB HGBA1C2007.

Do you want to edit it now? y YES

Select one of the following:

A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web Addresses

Select section to edit: f Findings

Findings

Choose from:RT IHS-HGBA1CTX IHS-DIABETES DX 2007

Select FINDING: tx.ihs-dia

Searching for a REMINDER TAXONOMY, (pointed-to by FINDING ITEM) IHS-DIABETES DX 2007 LOCAL ...OK? Yes// y (Yes)

FINDING ITEM: IHS-DIABETES DX 2007//MINIMUM AGE:MAXIMUM AGE:REMINDER FREQUENCY:RANK FREQUENCY:USE IN RESOLUTION LOGIC:USE IN PATIENT COHORT LOGIC: AND//EFFECTIVE PERIOD: 2Y// @ SURE YOU WANT TO DELETE? y (Yes)EFFECTIVE DATE:USE INACTIVE PROBLEMS:CONDITION:CONDITION CASE SENSITIVE:FOUND TEXT:

Edit? NO//NOT FOUND TEXT: No existing text Edit? NO//

The effective period tells the reminderhow long the finding is valid. If blank,

the reminder looks at ALL available data. So if you wanted to patients with dx in past

5 years, put 5Y here.

Now go into the Reminders Cover sheet

• Remove IHS-DIAB HGBA1C 2007

• Add YAK-DIAB HGBA1C 2007

(the local one you just made)

TEST…TEST…TEST…TEST…TEST

Scenario 3 – DM Dental Exam Reminder

National Reminder logic:

– Due yearly patients with diabetes

Your Medical Staff wants the DM Dental reminder to:

– Turn off for 1 year if refusal documented

Script for DM Dental Exam

Find exact term for “condition”

• Enter a refusal for Dental Exam on a Test Patient

• Look at the Health Summary

---------------- PATIENT REFUSALS FOR SERVICE (max 2 years) -------------

Sep 08, 2008 DENTAL EXAM (EXAM)

Refusal Type: REFUSED SERVICE

Here is the term you will usefor “condition”

COPY National Reminder

Select Reminder Definition Management Option: rc Copy Reminder DefinitionSelect the reminder item to copy: IHS-DIAB DENTAL EXAM 2007 NATIONALPLEASE ENTER A UNIQUE NAME: YAK-DIAB DENTAL EXAM 2007

The original reminder IHS-DIAB DENTAL EXAM 2007 has been copied into YAK-DIAB DENTAL EXAM 2007.Do you want to edit it now? y YES

Select one of the following:

A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web Addresses

Select section to edit: f Findings

Findings

Choose from:CF IHS-DENTALEX DENTAL EXAMTX IHS-DENTAL CODETX IHS-DIABETES DX 2007

Select FINDING: REF.EXAM

Searching for a REFUSAL TYPE, (pointed-to by FINDING ITEM)

Searching for a REFUSAL TYPE EXAM ...OK? Yes// y (Yes) Are you adding 'EXAM' as a new FINDINGS (the 5TH for this REMINDER DEFINITION)? No// y (Yes)FINDING ITEM: EXAM//MINIMUM AGE:MAXIMUM AGE:REMINDER FREQUENCY:RANK FREQUENCY:USE IN RESOLUTION LOGIC: OR 1 OR 2 OR NOTChoose 1-2: 1 ORUSE IN PATIENT COHORT LOGIC:EFFECTIVE PERIOD: 1YEFFECTIVE DATE:CONDITION: I V="DENTAL EXAM"CONDITION CASE SENSITIVE:FOUND TEXT: No existing text Edit? NO//NOT FOUND TEXT: No existing text Edit? NO//

Findings

Enter the item exactly as displayed on Refusalsection on health summary (prior slide)

Now go into the Reminders Cover sheet

• Remove IHS-DIAB DENTAL EXAM 2007

• Add YAK-DIAB DENTAL EXAM 2007

(the local one you just made)

TEST…TEST…TEST…TEST…TEST

Reminder is now turned off for 1 year if refusal is documented

Resources

Clinical (EHR) Reminders Manualftp://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/