Reminder Dialogs

Introduction Reminder Dialogs allow a user to resolve the reminder by entering data into the progress note and PCC Saves a step and user does not need to do any typing Dialogs can be turned into templates to be used on the notes tab

Introduction Dialogs are usually a resolution to a reminder – i.e. documentation of a diabetic foot exam However, they may be used to enter PCC data even if there isn’t a reminder, as in patient education

What is a dialog? Way to record data in PCC and in progress note Looks like TIU template

What is a dialog? One click can open up other choices Can use check boxes or radio buttons As the user opens up a box, data goes into the progress note and/or PCC

What is a dialog? Prompts for comments can be added Health factor of PREVIOUS SMOKER was added to PCC Progress note is being created

What is a dialog? Education topics can be addressed Prompt for level of understanding

What is a dialog? When finished is clicked, the data is inserted into the progress note The data that went to PCC is visible at the bottom

PCC Data Data went to PCC and is on the wellness tab

3 ways to get a dialog Import one through Reminder Exchange Auto-generate one after a reminder is created Create one from scratch making each piece

Dialog Menus Start out on the main Reminder Manager Menu Menu is DM Reminder Dialog Management

Only 2 options Dialog Parameters Reminder Dialogs

DI- Reminder Dialogs Opens up to the reminders View Use CV to see the other items

Dialog Pieces Choose from: P prompt E dialog element R reminder dialog F forced value G dialog group S result group T result element These are the building blocks of the dialog Prompts are the smallest piece Prompts go on elements Elements go into dialogs or they can go into groups Groups go in dialogs

D for dialogs Always check for where you are Check Status Is it linked? AD for adding

Look at the dialog

Look at the Progress Note Text

Clean it up – Delete items not needed Edit what it says in the progress note Add new elements if desired Auto-generate does NOT make any groups. It does make the elements You can choose to re-make the dialog and put the elements into groups if desired

Display text and progress note text These two can be different The display text is what the person entering the note sees Example: DIALOG/PROGRESS NOTE TEXT: Alcohol Screening - Enter results of the CAGE test ALTERNATE PROGRESS NOTE TEXT: CAGE test scores

Reminder Exchange Dialogs Dialogs entered through reminder exchange are inactive If the reminder has been added to the EHR, this message will appear

Activate the dialog In RPMS, go to the list of dialogs Choose the one you wish to edit

Review the dialog Choose ED to edit the dialog

Edit the Dialog NAME: IHS-TOBACCO SCREEN// DISABLE: DISABLED IN EXCHANGE SURE YOU WANT TO DELETE? Y (Yes) CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: TOBACCO TEST// Select SEQUENCE: 20//

Edit a Dialog Element You can edit a dialog element by choosing the number from the dialog screen Choices are – E Edit dialog – C Copy and replace – D Delete element

Make a dialog from Scratch What do you need? Write it on paper first Work from the bottom up, prompts, elements, groups, dialog

Dialog to Make Dialog closed

Groups Open Up Group contains Elements

Fully Expanded Dialog after creation Groups Elements – Education Topics – Order Prompts

Prompts – the smallest level Those that start with PXRM come with reminders. All others are build from those A prompt must be attached to an element AND the comments prompt must also be included

Prompts Select DIALOG to add: SIDE EFFECTS Are you adding 'SIDE EFFECTS' as a new REMINDER DIALOG (the 79TH)? No// Y Prompt NAME: SIDE EFFECTS// DISABLE Prompt: CLASS: L LOCAL SPONSOR: REVIEW DATE: PROMPT CAPTION: Side Effects EXCLUDE FROM PROGRESS NOTE: DEFAULT VALUE: Select CHECKBOX SEQUENCE:

Elements – Where the work happens Naming Conventions – ED Education topics – HF Health Factors – EX Exams – IM Immunizations – OI Orderables – HD or TX for text only or headers

Elements – without PCC Data Select DIALOG to add: HD HTN TAKING MEDS Are you adding 'HD HTN TAKING MEDS' as a new REMINDER DIALOG (the 80TH)? No// DISABLE: CLASS: L LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE:  Not doing PCC Data ORDERABLE ITEM: FINDING ITEM:  Not doing PCC Data

Elements – No PCC DIALOG/PROGRESS NOTE TEXT: – Is patient taking medications as directed? ALTERNATE PROGRESS NOTE TEXT: – Patient’s medication compliance EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX: Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE:

Elements – Add Prompts Select SEQUENCE: 1 ADDITIONAL PROMPT/FORCED VALUE: SIDE EFFECTS prompt LOCAL...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: 1 YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCES VALUE: PXRM COMMENTS OK? Yes//  Need this one for local prompts to appear

Element – Education Topic Select DIALOG to add: ED HTN MEDICATIONS Are you adding ‘ED HTN MEDICATIONS' as a new REMINDER DIALOG (the 83TH)? No// YNAME: ED HTN MEDICATIONS// DISABLE: CLASS: L SPONSOR: REVIEW DATE: RESOLUTION TYPE: DONE AT ENCOUNTER

Element – Education Topic ORDERABLE ITEM: FINDING ITEM: ED.HTN-MHTN-MEDICATIONS HTN-MEDICATIONS HTN-M...OK? Yes// DIALOG/PROGRESS NOTE TEXT: The patient is able to verbally summarize their medication regimen and the importance of compliance with therapy. Edit? NO// ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX:

Element – Education Topic Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: 1 ADDITIONAL PROMPT/FORCED VALUE: PXRM LEVEL 1 PXRM LEVEL OF SEVERITY prompt NATIONAL 2 PXRM LEVEL OF UNDERSTANDING prompt NATIONAL CHOOSE 1-2: 2 PXRM LEVEL OF UNDERSTANDING prompt NATIONAL OVERRIDE PROMPT CAPTION: START NEW LINE: 1 YES EXCLUDE FROM PN TEXT: REQUIRED: 1 YES Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT// OVERRIDE PROMPT CAPTION: PXRM COMMENT// START NEW LINE: Y YES EXCLUDE FROM PN TEXT: REQUIRED:

Element - Order Select DIALOG to add: OI HYPERTENSIVE MEDS Are you adding 'OI HYPERTENSIVE MEDS' as a new REMINDER DIALOG (the 84TH)? No// DISABLE: CLASS: LOCAL// SPONSOR: REVIEW DATE: RESOLUTION TYPE: ORDERED...OK? Yes// Y (Yes) ORDERABLE ITEM: FINDING ITEM: Q.PSOZM HYPER PSOZM HYPERTENSION MEDS...OK? Yes//

Element - Order DIALOG/PROGRESS NOTE TEXT: Check to order or change medications Edit? NO// ALTERNATE PROGRESS NOTE TEXT: Medication change ordered Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX: Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: Input your edit comments. Edit? NO//

Group – Makes it prettier A group allows you to put several elements together. Groups can be hidden until clicked so they act like templates Users may select 1 or more items in the group

Group Select Item: Quit// AD Add Select DIALOG to add: GRP HTN LIFESTYLE CHANGES Are you adding 'GRP HTN LIFESTYLE CHANGES' as a new REMINDER DIALOG (the 97TH)? No// Y NAME: GRP HTN LIFESTYLE CHANGES Replace DISABLE: CLASS: L

Groups SPONSOR: REVIEW DATE: RESOLUTION TYPE:  Would apply ORDERABLE ITEM:  to entire group FINDING ITEM:  GROUP CAPTION: PUT A BOX AROUND THE GROUP: y

Group SHARE COMMON PROMPTS: 0 1 yes 0 no MULTIPLE SELECTION: 2 0 NO SELECTION REQUIRED 1 ONE SELECTION ONLY 2 ONE OR MORE SELECTIONS 3 NONE OR ONE SELECTION HIDE/SHOW GROUP: H

Groups GROUP HEADER DIALOG TEXT: Check to document lifestyle changes discussed with patient Edit? NO// GROUP HEADER ALTERNATE P/N TEXT: The following lifestyle changes were discussed with the patient/family: Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX:  If you want it mandatory or for headers NUMBER OF INDENTS: 2

Groups INDENT PROGRESS NOTE TEXT:y Select ADDITIONAL FINDINGS: Select SEQUENCE: 1 DIALOG ELEMENT: ED HTN-WEIGHT CONTROL dialog element LOCAL...OK? Yes// EXCLUDE FROM PN TEXT: Select SEQUENCE: 2 ……Continue to add elements to the group

Group view

Group – progress note text

Dialog – The upper level The dialog is now ready to be created Dialog can be made up of elements and/or groups

Dialog Select Item: Quit// AD Add Reminder Dialog GENERATE DIALOG AUTOMATICALLY: Y// NO Select DIALOG to add: HTN INTERVENTION Are you adding 'HTN INTERVENTION' as a new REMINDER DIALOG (the 98TH)? No// y NAME: HTN INTERVENTION DISABLE: CLASS: l LOCAL SPONSOR:

Dialog REVIEW DATE: SOURCE REMINDER: HTN INTERVENTION LOCAL Select SEQUENCE: – Can enter the sequence number for what you want on the dialog OR

Dialog Select the dialog Select Sequence: Quit// 5 ARE YOU ADDING 5 AS A NEW SEQUENCE NUMBER: N// y YES Select new DIALOG ELEMENT: GRP HTN LIFE

Dialog Puts it in Often leave spaces between items for later editions Easiest way to edit a dialog Can edit, delete, copy items

Finished dialog

Attaching to a Reminder A dialog made this way does not need to be attached to a reminder It can be a dialog template to be used in notes If it has a source reminder, you must go back to the reminder and attach it. Select CV to change view and go to R for reminders

Attaching Choose LR to link reminder LINKED REMINDER DIALOG: HTN INTERVENTION reminder dialog LOCAL...OK? Yes//

Attaching How do you view this reminder? Add it to the list for the EHR and then test All changes must be made in RPMS No editing in the GUI

Test the Dialog Add this reminder to list Start a note View the reminder

Test the dialog Make changes until it looks the way you desire Then make it available for all needed clinicians

Test the dialog If you added any orders, are they working correctly?

Making a Dialog TIU Template A dialog can be used as a note template Education dialogs are good examples since you don’t always know when you are going to do the education They are still made in RPMS but not attached to a reminder When finished, they must be available to TIU

Attach to Parameter TIU TEMPLATE REMINDER DIALOGS may be set for the following: 1 User USR [choose from NEW PERSON] 3 Service SRV [choose from SERVICE/SECTION] 4 Division DIV [DEMO HOSPITAL] 5 System SYS [DEMO.CIAINFORMATICS.COM]

TIU TEMPLATE REMINDER DIALOG Enter selection: 5 System DEMO.CIAINFORMATICS.COM - Setting TIU TEMPLATE REMINDER DIALOGS for System: DEMO.CIAINFORMATICS.COM - Select Display Sequence: 1 Display Sequence: 1// 1 Clinical Reminder Dialog: TEST// TEST reminder dialog LOCAL...OK? Yes// (Yes) Select Display Sequence: 2 Are you adding 2 as a new Display Sequence? Yes// YES Display Sequence: 2// 2 Clinical Reminder Dialog: HTN INTERVENTION reminder dialog LOCAL...OK? Yes// (Yes)

EHR Template Editor

TIU Reminder Dialog New Type – Reminder Dialog Make a new template

Reminder Templates Attach it to the reminder dialog

Reminder Templates Its now available in the template drawer

Reminder Templates These templates CANNOT be part of any other TIU template If you add it as a “sub template”, TIU will skip over it

Questions