Question and Answer Session March 6,2019 1400 EST Audio:(605) 472-5228 Access code: 934039 Dr. Samuel Eng

1. Question: On behalf of Tonya Brooks, RN-CTMC: Could you suggest adding a Falls assessment in TSWF? I also noticed in the Joint Commission meetings "falls" is a hot topic on their agenda. Answer: The May release will include the falls risk assessment (STEADI screener) as a separate form with screener and decision support tools.

2. Question: Why did we switch to the DVPRS Pain rating scale? Answer: This was a Defense Health Agency Procedural Instruction. (DHAPI 6025.04) Listed on pages 12 and 13 of the document.

3. Question: Why would I need to reset the annual questions and how do I do it? Answer: Questions are added and taken away, so the field needs to be reset to see what is new. *Reminder* to reset a field, click the red X in the top left hand corner. Each year (‘Annual Questions’) these questions need to be asked. Updates are made in accordance with approved PCMH change requests that include inspectable items, i.e The Joint Commission (TJC). Refreshing the ‘Annual Questions’ guarantees new questions will populate and old questions will be removed.

4. Question: What is a Primary Opioid Provider? Answer: A provider that is responsible for prescribing a long term opioid patient their opioid medications (previous term used was ‘Sole Provider’). Any PCM provider can write prescriptions, but a Primary Opioid Provider is the designated person to write prescriptions for controlled drugs, so that it can be better monitored.

5. Question: In the Medication Reconciliation box, why is the bottom half for providers only? Answer: Medication reconciliation can officially only be completed by the providers. Medication compliance should be completed by the technician.

6. Question: Why is there a notation, ‘<< Note accomplished in TSWF Core >>’ in the HPI box? Answer: To quickly identify that this note was done in a TSWF form and can be copied forward from. Please do not delete it or start your documentation above it. You want to see it at the very top of the S/O section, when you are looking at previous notes to copy forward form.

7. Question: Why is it important to clear obsolete terms and how do you do it? Answer: You want to clear this area because selected terms will go into your note, which can cause Tier 1 errors or incorrect data to be added to your note. Terms selected on this tab USED to be in older versions of the forms, but are still being copied forward if not unchecked here. Clicking ‘uncheck all’ removes these terms from your note. *Reminder* this is the last step in your copy forward process.

8. Question: Can you start documenting in one TSWF form and then switch to another? Answer: Yes you can, within the suite of forms. There are CORE Compatible forms and then Specialty forms. In General: The ‘Base Forms’ and ‘CPG Based Forms’ are grouped together on the left hand side. All of these forms are compatible with each other. The ‘Behavioral Health- Specialty Forms & Miscellaneous/Other Forms’ are meant to be used alone (exceptions on the next slide).

8A. Exceptions to think about concerning “Behavioral Health- Specialty Forms & Miscellaneous/Other Forms” You can go from PCM forms to OB but going back would entail a lot of clean up. There are a lot of CF fields on OB that aren’t on the PCM forms. In/Out, SHPE, and Zika have no hx terms so are safe. TBI and Sports Med were made to play nice, so they are also ok. The ones that aren’t compatible are CM, DzM, IBHC, and BH Spec.

9. Question: What is the ‘undo’ button? Answer: This reverses or ‘undoes’ your latest click, it can fix your last mistake (It resets boxes back to their default state.). Clicking ‘undo’ too many times will erase actions back as many times as it is clicked, and there is not a ‘redo’ function.

10. Question: What part of the form is expected for the provider to fill out and what part should the technician fill out? Answer: Provider- Reviews/Updates(Information brought forward from the technician) and completes all aspects of the note i.e. HPI, ROS, PE, Assessment, and Plan. Technician- Ideally you would have your technician fill out as much as their skill level and training allows of them. This helps them to grow as a technician and prepares our AD folks for when they are in a deployed setting. In general it consists of an HPI, PFSH, Screening and a general ROS.

11. Question: Should I be filling the first tab out with the patient in the room or can I use paper? Answer: The most efficient way is to fill out the TSWF form while in the room with the patient. When computers are unavailable in patient rooms, paper encounter worksheets (Which TSWF creates, please find on website) can be filled out. Once back at your desk you can populate this information into AHLTA. * NOTE* This is double documenting, but when computers are unavailable in the patient rooms or are not functioning, the choices are limited.

12. Question: Can you please explain the Occ Health box, it is new and I’m not sure what needs to be populated in there? Answer: The ‘OCC. HX (History) and Exposure’ field was designed to help satisfy Joint Commission RC.02.01.01 EP 28 which calls for documenting “work history”. Of course, the requirement is based on good clinical practice of having a background understanding of what your patient might routinely be exposed to and isn’t limited to active duty members. That field is a place to briefly record any health-relevant environmental exposures from occupation or hobbies. It’s not intended for performing or documenting a full occupational assessment, but just highlights what might be relevant to primary care. Examples might include routine high noise levels, fuels, oils, spouse with high deployment ops tempo, or even “potential exposures as clinical staff”. We are aware of no specific content requirement.

13. Question: How far back can I go in previous encounters, when I complete the Open Not Checked In process? Answer: This depends on the MTF, most sites have an AHLTA limitation of one year when copying forward previous encounters. Please note the ‘Include Cancelled and LWOBS’ check box on the far right hand side of screen. This allows you to copy forward from a previous ONCI encounter that may have been Cancelled/LWOBS.

14. Question: How do I load these forms as my favorite and can I make my form my default? Answer: You can add TSWF forms as favorites, but not as defaults. To add a form to your favorites: Go to template management Select expanded search Type in TSWF Select ‘enterprise’ View TSWF suite of forms Right click the form you want Select ‘add favorite’ (seen here) This process will add the TSWF form to your favorites list. It’s also recommended to add navigator, if you use multiple forms. The Navigator allows you access to all of the TSWF forms (You do not have to load them individually).

15. Question: How should validated screeners be asked? Answer: Screeners should be asked verbatim, as they are validated screeners and by changing any of the words you will invalidate the screener. *Suggestion*: Print and laminate the screeners. Have patients utilize a grease pencil to answer the questions in the room with the support staff.

16. Question: Why use TSWF AIM forms instead of MEDCIN Trees? Answer: The purpose of the TSWF Alternate Input Method (AIM) form is to maintain continuity of the patient’s medical record, where the current available EHR does not. The TSWF AIM form integrates clinical workflow for the PCMH team. Usage of a combination of MEDCIN terms and TSWF AIM may corrupt the copy forward process at future visits and there is a DHA instruction stating to use the TSWF AIM forms in the PCMH model.

17. Question: How to you use data collected on TSWF AIM forms? Answer: We use and create unique MEDCIN terms and provide a list of those unique terms to the requesting working groups (Clinical Pharmacy, IBHC, MHSPHP, CPG, LBP). The Working Groups then request through the DHA informatics group J- 9, who provide the information/data pulls back to the working groups. Other TSWF AIM forms like the MHSPHP feed into CarePoint methodologies for population health.