National Reminders - Colon Cancer Screening

Introduction The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at your site. This will put all the national reminders into the Reminder Exchange file. The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at your site. This will put all the national reminders into the Reminder Exchange file.

Preparation Document pxrm contains setup of each reminder. Check the taxonomy Check for reminder terms Check for orders Document pxrm contains setup of each reminder. Check the taxonomy Check for reminder terms Check for orders

First Time – Step 1 Use the steps that follow to install 2 reminders or see the webex for installing the tobacco reminder The immunization forecaster and one other that is commonly used such as the tobacco reminder, weight, or blood pressure Use the steps that follow to install 2 reminders or see the webex for installing the tobacco reminder The immunization forecaster and one other that is commonly used such as the tobacco reminder, weight, or blood pressure

First Time-Step 2 Use the Parameters menu on the Reminder Setup menu to TURN ON the reminders Use the ACT (Reminder GUI Resolution Active) parameter and set to YES at the system level Use the Parameters menu on the Reminder Setup menu to TURN ON the reminders Use the ACT (Reminder GUI Resolution Active) parameter and set to YES at the system level

First Time – Step 3 Set up the CAC to configure in the GUI Set the CFG- Allow EHR Configuration in GUI parameter from the same menu Set it by class for the CAC class

First Time – Step 4 Set the parameter CVR – EHR Cover Sheet reminder list This list will only have the 2 reminders you have installed

First Time –Step 5 You should now be able to access the GUI Select a patient for whom the reminder will be due If the alarm clock is RED and the X is gone, you are ready to proceed You should now be able to access the GUI Select a patient for whom the reminder will be due If the alarm clock is RED and the X is gone, you are ready to proceed

Add to GUI Click on the alarm clock Select the action drop down menu Choose Edit Cover Sheet Reminder List Select system level Click on the alarm clock Select the action drop down menu Choose Edit Cover Sheet Reminder List Select system level

Add to GUI –Step 6 Select the 2 reminders making the Immunization forecaster the first Move them to the right Click apply and OK Log out of the GUI

First Time – Step 7 Go back to the reminder parameters Select NEW – New reminder parameters Turn this on to YES for the system Log back into the GUI For now, this will look the same, but as you add more reminders to the GUI, they should appear Go back to the reminder parameters Select NEW – New reminder parameters Turn this on to YES for the system Log back into the GUI For now, this will look the same, but as you add more reminders to the GUI, they should appear

Colon Cancer Screen

Reminder Exchange – Install Reminder Choose the Colon Cancer 2007 reminder

Reminder Installation Select IFE to install the reminder Review the reminder Select IFE to install the reminder Review the reminder

Install the Components REMINDER TAXONOMY entry IHS-SIGMOIDOSCOPY already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-SIGMOIDOSCOPY already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

Error on Taxonomy If there is an error in the taxonomy, you need to build it manually The screen shows what this error would look like Use the pxrm o document to determine what codes are in this taxonomy. If there is an error in the taxonomy, you need to build it manually The screen shows what this error would look like Use the pxrm o document to determine what codes are in this taxonomy. REMINDER TAXONOMY entry IHS-ASTHMA 2007 is NEW, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: I// nstall or Overwrite the current entry The update failed, UPDATE^DIE returned the following error message: MSG("DIERR")=1^1 MSG("DIERR",1)=701 MSG("DIERR",1,"PARAM",0)=3 MSG("DIERR",1,"PARAM",3)= MSG("DIERR",1,"PARAM","FIELD")=.01 MSG("DIERR",1,"PARAM","FILE")= MSG("DIERR",1,"TEXT",1)=The value ' ' for field SELECTABLE DIAGNOSIS in SE LECTABLE DIAGNOSIS SUB-FIELD in file REMINDER TAXONOMY is not valid. MSG("DIERR","E",701,1)= REMINDER TAXONOMY entry IHS-ASTHMA 2007 did not get installed! Examine the above error message for the reason.

Taxonomy Creation

General Taxonomy Data NAME: IHS-SIGMOIDOSCOPY// BRIEF DESCRIPTION: Sigmoidoscopy codes// CLASS: VISN// SPONSOR: REVIEW DATE: PATIENT DATA SOURCE: EN,PL,IN// USE INACTIVE PROBLEMS: INACTIVE FLAG: General Taxonomy Data NAME: IHS-SIGMOIDOSCOPY// BRIEF DESCRIPTION: Sigmoidoscopy codes// CLASS: VISN// SPONSOR: REVIEW DATE: PATIENT DATA SOURCE: EN,PL,IN// USE INACTIVE PROBLEMS: INACTIVE FLAG:

Taxonomy Creation ICD0 Range of Coded Values Select ICD0 LOW CODED VALUE: 45.42// ? Answer with ICD0 RANGE OF CODED VALUES ICD0 LOW CODED VALUE You may enter a new ICD0 RANGE OF CODED VALUES, if you wish Answer must be 3-7 characters in length. Select ICD0 LOW CODED VALUE: 45.42// ICD0 LOW CODED VALUE: 45.42// ICD0 HIGH CODED VALUE: 45.42// Select ICD0 LOW CODED VALUE: ICD0 LOW CODED VALUE: 45.42// ICD0 HIGH CODED VALUE: 45.42// Select ICD0 LOW CODED VALUE: ICD0 Range of Coded Values Select ICD0 LOW CODED VALUE: 45.42// ? Answer with ICD0 RANGE OF CODED VALUES ICD0 LOW CODED VALUE You may enter a new ICD0 RANGE OF CODED VALUES, if you wish Answer must be 3-7 characters in length. Select ICD0 LOW CODED VALUE: 45.42// ICD0 LOW CODED VALUE: 45.42// ICD0 HIGH CODED VALUE: 45.42// Select ICD0 LOW CODED VALUE: ICD0 LOW CODED VALUE: 45.42// ICD0 HIGH CODED VALUE: 45.42// Select ICD0 LOW CODED VALUE:

Taxonomy Creation Select CPT LOW CODED VALUE: G0104// CPT LOW CODED VALUE: G0104// CPT HIGH CODED VALUE: G0104// Select CPT LOW CODED VALUE: CPT LOW CODED VALUE: 45330// CPT HIGH CODED VALUE: 45345// Select CPT LOW CODED VALUE: Select CPT LOW CODED VALUE: G0104// CPT LOW CODED VALUE: G0104// CPT HIGH CODED VALUE: G0104// Select CPT LOW CODED VALUE: CPT LOW CODED VALUE: 45330// CPT HIGH CODED VALUE: 45345// Select CPT LOW CODED VALUE:

Taxonomy Creation After the taxonomy is created Re-load the reminder and use SKIP when you reach the taxonomy installation After the taxonomy is created Re-load the reminder and use SKIP when you reach the taxonomy installation

Other Taxonomies – Colorectal cancer REMINDER TAXONOMY entry IHS-COLORECTAL CANCER already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-COLORECTAL CANCER already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

Colorectal Cancer ICD9 Codes: Range Code ICD Diagnosis MAL NEO HEPATIC FLEXURE MAL NEO TRANSVERSE COLON MAL NEO DESCEND COLON MAL NEO SIGMOID COLON MALIGNANT NEOPLASM CECUM MALIGNANT NEO APPENDIX MALIG NEO ASCEND COLON MAL NEO SPLENIC FLEXURE MALIGNANT NEO COLON NEC MALIGNANT NEO COLON NOS ICD9 Codes: Range Code ICD Diagnosis MAL NEO HEPATIC FLEXURE MAL NEO TRANSVERSE COLON MAL NEO DESCEND COLON MAL NEO SIGMOID COLON MALIGNANT NEOPLASM CECUM MALIGNANT NEO APPENDIX MALIG NEO ASCEND COLON MAL NEO SPLENIC FLEXURE MALIGNANT NEO COLON NEC MALIGNANT NEO COLON NOS Range Code ICD Diagnosis MAL NEO RECTOSIGMOID JCT MALIGNANT NEOPL RECTUM Range Code ICD Diagnosis SEC MALIG NEO LG BOWEL Range V10.05-V10.05 Code ICD Diagnosis V10.05 HX OF COLONIC MALIGNANCY

Colorectal Cancer CPT Codes: Range Code CPT Short Name REMOVAL OF COLON REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY Range Code CPT Short Name REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY Range Code CPT Short Name LAPARO TOTAL PROCTOCOLECTOMY LAP COLECTOMY W/PROCTECTOMY LAPARO TOTAL PROCTOCOLECTOMY CPT Codes: Range Code CPT Short Name REMOVAL OF COLON REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY Range Code CPT Short Name REMOVAL OF COLON/ILEOSTOMY REMOVAL OF COLON/ILEOSTOMY Range Code CPT Short Name LAPARO TOTAL PROCTOCOLECTOMY LAP COLECTOMY W/PROCTECTOMY LAPARO TOTAL PROCTOCOLECTOMY

Other Taxonomies - Colonoscopy REMINDER TAXONOMY entry IHS-COLONOSCOPY 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-COLONOSCOPY 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

Other Taxonomies- Colonoscopy ICD0 Codes: Range Code ICD Operation/Procedure ENDOSC LG BOWEL THRU ST Range Code ICD Operation/Procedure FLEX FIBEROPTIC COLONOSC Range Code ICD Operation/Procedure CLOSED BX OF LARGE INTESTINE Range Code ICD Operation/Procedure CONDYLECTOMY ICD0 Codes: Range Code ICD Operation/Procedure ENDOSC LG BOWEL THRU ST Range Code ICD Operation/Procedure FLEX FIBEROPTIC COLONOSC Range Code ICD Operation/Procedure CLOSED BX OF LARGE INTESTINE Range Code ICD Operation/Procedure CONDYLECTOMY

Other Taxonomies- Colonoscopy CPT Codes: Range Code CPT Short Name SURGICAL COLONOSCOPY Range Code CPT Short Name DIAGNOSTIC COLONOSCOPY COLONOSCOPY W/FB REMOVAL COLONOSCOPY AND BIOPSY COLONOSCOPY, SUBMUCOUS INJ COLONOSCOPY/CONTROL BLEEDING LESION REMOVAL COLONOSCOPY LESION REMOVE COLONOSCOPY LESION REMOVAL COLONOSCOPY COLONOSCOPY DILATE STRICTURE COLONOSCOPY W/STENT Range G0105-G0105 Code CPT Short Name G0105 COLOREC CANCR SCR; COLNSCPY HI RIS CPT Codes: Range Code CPT Short Name SURGICAL COLONOSCOPY Range Code CPT Short Name DIAGNOSTIC COLONOSCOPY COLONOSCOPY W/FB REMOVAL COLONOSCOPY AND BIOPSY COLONOSCOPY, SUBMUCOUS INJ COLONOSCOPY/CONTROL BLEEDING LESION REMOVAL COLONOSCOPY LESION REMOVE COLONOSCOPY LESION REMOVAL COLONOSCOPY COLONOSCOPY DILATE STRICTURE COLONOSCOPY W/STENT Range G0105-G0105 Code CPT Short Name G0105 COLOREC CANCR SCR; COLNSCPY HI RIS

Other Taxonomies- Colonoscopy Range G0121-G0121 Code CPT Short Name G0121 COLOREC CNCR SCR;COLNSCPY NO HI RS Range Code CPT Short Name COLONOSCOPY COLONOSCOPY WITH BIOPSY COLONOSCOPY FOR FOREIGN BODY COLONOSCOPY FOR BLEEDING COLONOSCOPY & POLYPECTOMY COLONOSCOPY, LESION REMOVAL COLONOSCOPY W/SNARE Range G0121-G0121 Code CPT Short Name G0121 COLOREC CNCR SCR;COLNSCPY NO HI RS Range Code CPT Short Name COLONOSCOPY COLONOSCOPY WITH BIOPSY COLONOSCOPY FOR FOREIGN BODY COLONOSCOPY FOR BLEEDING COLONOSCOPY & POLYPECTOMY COLONOSCOPY, LESION REMOVAL COLONOSCOPY W/SNARE

Other Taxonomies- Colonoscopy Range Code CPT Short Name COLONOSCOPY W/STENT Range Code CPT Short Name COLONOSCOPY W/SNARE Range Code CPT Short Name COLONOSCOPY W/ENDOSCOPE US Range Code CPT Short Name COLONOSCOPY W/STENT Range Code CPT Short Name COLONOSCOPY W/SNARE Range Code CPT Short Name COLONOSCOPY W/ENDOSCOPE US

Other Taxonomies – Barium Enema REMINDER TAXONOMY entry IHS-BARIUM ENEMA already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-BARIUM ENEMA already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

Other Taxonomies- Barium Enema CPT Codes: Range Code CPT Short Name CONTRAST X-RAY EXAM OF COLON CONTRAST X-RAY EXAM OF COLON Range G0106-G0106 Code CPT Short Name G0106 COLOREC CANCR SCR; SIGMOIDSCOPY Range G0120-G0120 Code CPT Short Name G0120 COLOREC CANCR SCR;COLNSCPY BA ENEM CPT Codes: Range Code CPT Short Name CONTRAST X-RAY EXAM OF COLON CONTRAST X-RAY EXAM OF COLON Range G0106-G0106 Code CPT Short Name G0106 COLOREC CANCR SCR; SIGMOIDSCOPY Range G0120-G0120 Code CPT Short Name G0120 COLOREC CANCR SCR;COLNSCPY BA ENEM

Other Taxonomies -Fecal Occult Lab Test REMINDER TAXONOMY entry IHS-FECAL OCCULT LAB TEST already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-FECAL OCCULT LAB TEST already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

Fecal Occult Lab Test CPT Codes: Range Code CPT Short Name OCCULT BLOOD, FECES Range Code CPT Short Name ASSAY TEST FOR BLOOD, FECAL Range G0107-G0107 Code CPT Short Name G0107 COLOREC CNCR SCR;FECL-OCCLT BLD TS Range Code CPT Short Name OCCULT BLOOD TEST CPT Codes: Range Code CPT Short Name OCCULT BLOOD, FECES Range Code CPT Short Name ASSAY TEST FOR BLOOD, FECAL Range G0107-G0107 Code CPT Short Name G0107 COLOREC CNCR SCR;FECL-OCCLT BLD TS Range Code CPT Short Name OCCULT BLOOD TEST

Reminder Term REMINDER TERM entry IHS-FECAL OCCULT BLOOD already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry REMINDER TERM entry IHS-FECAL OCCULT BLOOD already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry

Reminder Definition REMINDER DEFINITION entry IHS-COLON CANCER 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry REMINDER DEFINITION entry IHS-COLON CANCER 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// kip, do not install this entry

Installing the Dialog Install the dialog after the reminder is installed It may appear that you are installing the reminder again Look to the upper left to see where you are Install the dialog after the reminder is installed It may appear that you are installing the reminder again Look to the upper left to see where you are

Installing the Dialog Look here for directions Select IA again for dialog pieces

Attach to the Reminder You are usually asked to attach the dialog to a reminder I have named the dialogs and the reminders the same If you are not asked during the install, you can manually attach them when you activate the dialog You are usually asked to attach the dialog to a reminder I have named the dialogs and the reminders the same If you are not asked during the install, you can manually attach them when you activate the dialog

Dialog Installation An X should be by all the pieces of the dialog

Activate the Dialog All dialogs installed through reminder exchange are disabled. Exit out of Reminder Exchange and go to the DM (Dialog Management) Select Reminder Managers Menu Option: DM Reminder Dialog Management DP Dialog Parameters... DI Reminder Dialogs Choose DI (Reminder Dialogs) All dialogs installed through reminder exchange are disabled. Exit out of Reminder Exchange and go to the DM (Dialog Management) Select Reminder Managers Menu Option: DM Reminder Dialog Management DP Dialog Parameters... DI Reminder Dialogs Choose DI (Reminder Dialogs)

Activate the Dialog The initial View is of reminders, use CV and Select D to go to dialogs

Activate Dialogs

Activate the Dialog Choose the dialog by number then ED

Activate Dialog NAME: IHS-COLON CANCER 2007 Replace DISABLE: DISABLED IN EXCHANGE SURE YOU WANT TO DELETE? Y (Yes) CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-COLON CANCER 2007// NAME: IHS-COLON CANCER 2007 Replace DISABLE: DISABLED IN EXCHANGE SURE YOU WANT TO DELETE? Y (Yes) CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-COLON CANCER 2007//

Activate Dialog

Add Lab Tests to Reminder Term Reminder Term Management CPY Copy Reminder Term EDT Reminder Term Edit INQ Inquire about Reminder Term Reminder Term Management CPY Copy Reminder Term EDT Reminder Term Edit INQ Inquire about Reminder Term

Add Lab Tests to Reminder Term If you have a fecal occult blood test in the lab (not a micro test) you should add it to the reminder term IHS-FECAL OCCULT BLOOD All Lab reminder terms need to be set up at the site If you have a fecal occult blood test in the lab (not a micro test) you should add it to the reminder term IHS-FECAL OCCULT BLOOD All Lab reminder terms need to be set up at the site NAME: IHS-FECAL OCCULT BLOOD Replace CLASS: VISN// REVIEW DATE: DESCRIPTION: No existing text Edit? NO// Select FINDING ITEM: LT.FECAL Searching for a LABORATORY TEST, (pointed- to by FINDING ITEM) Searching for a LABORATORY TEST 1 FECAL BLOOD GUIAC retired 6/99 2 FECAL BLOOD FECAL OCCULT BLOOD 3 FECAL FAT RANDOM FAT, QUAL. 4 FECAL GLUCOSE FECAL REDUCING SUBSTANCE 5 FECAL LACTOFERRIN FECAL WBC- LATEX TEST Press to see more, '^' to exit this list, OR CHOOSE 1-5: 2 FECAL OCCULT BLOOD Are you adding 'FECAL OCCULT BLOOD ' as a new FINDINGS (the 1ST for this REMIN DER TERM)? No// Y (Yes) EFFECTIVE PERIOD:

Add to GUI Click on the alarm clock Select the action drop down menu Click on the alarm clock Select the action drop down menu

Add to GUI Choose Edit Cover Sheet Reminder List

Add to GUI Select where you are going to add them. The choices are in the middle section The available reminders are on the bottom left. Move them over using the arrows Click apply when finished Select where you are going to add them. The choices are in the middle section The available reminders are on the bottom left. Move them over using the arrows Click apply when finished

Add to GUI

TEST,TEST,TEST Pick patients where the reminder is not applicable – (Age) Pick patients where the reminder is applicable but not due Pick patients where the reminder is applicable and due Is it correct?? Pick patients where the reminder is not applicable – (Age) Pick patients where the reminder is applicable but not due Pick patients where the reminder is applicable and due Is it correct??

Testing Use reminder maintenance to see what the computer found Right click on the reminder and choose clinical maintenance Use reminder maintenance to see what the computer found Right click on the reminder and choose clinical maintenance

Reminder Inquiry Default PATIENT COHORT LOGIC to see if the Reminder applies to a patient: (SEX)&(AGE)&'FI(6) Expanded Patient Cohort Logic: (SEX)&(AGE)&'FI(IHS-COLORECTAL CANCER) Default PATIENT COHORT LOGIC to see if the Reminder applies to a patient: (SEX)&(AGE)&'FI(6) Expanded Patient Cohort Logic: (SEX)&(AGE)&'FI(IHS-COLORECTAL CANCER)

Default RESOLUTION LOGIC defines findings that resolve the Reminder: FI(1)!FI(2)!FI(3)!FI(4)!FI(5) Expanded Resolution Logic: FI(IHS-SIGMOIDOSCOPY)!FI(IHS- COLONOSCOPY 2007)!FI(IHS-FECAL OCCULT BLOOD)! FI(IHS-BARIUM ENEMA)!FI(IHS-FECAL OCCULT LAB TEST) Default RESOLUTION LOGIC defines findings that resolve the Reminder: FI(1)!FI(2)!FI(3)!FI(4)!FI(5) Expanded Resolution Logic: FI(IHS-SIGMOIDOSCOPY)!FI(IHS- COLONOSCOPY 2007)!FI(IHS-FECAL OCCULT BLOOD)! FI(IHS-BARIUM ENEMA)!FI(IHS-FECAL OCCULT LAB TEST)

Logic- Reminder Inquiry

Check the dialog Start a note Find the reminder in the reminders drawer Double click on the reminder and review the dialog Start a note Find the reminder in the reminders drawer Double click on the reminder and review the dialog

Check the Dialog

Check the dialog If you wished, you could add a quick order for the lab test. Since this reminder is generally resolved through procedures, they are not in the dialog If you wished, you could add a quick order for the lab test. Since this reminder is generally resolved through procedures, they are not in the dialog