EHR Reminders - Sharing Local Reminders & Dialogs LCDR Susan Pierce-Richards, MSN, ARNP

Introduction Local Reminders and Dialogs include: –Copied National Reminders with modifications –Locally created Reminders and Dialogs that solve a particular clinical problem –Locally created Reminders and Dialogs providing support for a particular standard of care or protocol –Can be shared between sites with a little modification Reminder and Dialog development is labor intensive for the CAC. Well developed Reminder and Dialog tools have very positive impacts on both patient care and provider documentation. So…. SHARE tools that work.

Objectives At the end of this presentation, the CAC will be able to: Pack and export a reminder (.PRD file) to the Pub folder of your RPMS server Attach a packed reminder to an Move a packed reminder/dialog (.PRD file) to an accessible location for import –Usually the Pub folder of your RPMS folder Import a packed reminder/dialog Install a packed reminder/dialog Customize installed reminder/dialog for your site

Need to know and do before you begin… What can I export from Reminders: Reminder Reminder with linked dialog –Check to see that the dialog you want exported is properly linked If you want to export just the dialog: –Create blank reminder called Blank with name dialog –Export the blank reminder with dialog What can I import into Reminders: Reminder Reminder and linked dialog Any reminder part Any dialog part TIU template fields embedded in dialogs

Need to know and do before you begin… What does NOT import: Local TIU objects Local Quick orders Local Lab, Med, etc During import, you’ll be prompted to substitute your local items. Have these exact names ready. ASK YOUR SITE MANAGER: Where is the Pub folder for your RPMS server –It will look something like this g:\pub\ What is the IP address of your RPMS server Pub folder. –It will look something like this ftp:// /pub/ftp:// /pub/ –ADD this FTP site to your “My Network Places” folder (see next slides)

Add RPMS pub folder to your “My Network Places” Go to the “Start Menu” Choose “My Network Places”

Click on “Add a network place” to bring up the “add network place wizard”, then click “next”

Click on “Choose another network location”, then “next” to open the next window: You may see other entries, but use the one that looks like a folder with a bar underneath it.

Input the address you got from your Site Manager (see earlier slide)  In this example, some numbers are replaced with “#” for security. Also, a specific “Reminders” folder was created in the pub folder by the Site Manager. You can name the folder whatever you like, to help you remember what it is. 

Finish, and open the folder if desired:

1.Go to your Outlook mail, select new message and “attach” 2.Click on “My Network Places” on the left side of the Insert File dialog box. 3.The Add Network Place Wizard will come up—click “next” Alternative method

Click Next.

Here enter the address of the Pub folder your Site Manager gave you (see slide 5). Click Next.

Click Next.

Enter a name. Click Next.

Click Finish.

Now you can more easily move files in and out of your Pub folder

Exporting Reminder: Scenario: You have begun using reminders. You already made modifications to the National Mammogram reminder and dialog. Another CAC likes your format and has asked that you send him the reminder and dialog.

Steps to Export a Reminder Verify dialog is linked to reminder if you want to export an associated dialog “Pack” the reminder –Use “Create Exchange File Entry” in Reminder Exchange –Add notes with pertinent info like local Quick Order names, objects used Export the reminder –Use “Create Host File” –This places a.prd file on your Pub drive

Step 1 – Verify Reminder Dialog Linked If you want a dialog packed with the reminder, check to make sure the dialog is linked – you can look at the reminder definition: YAK-MAMMOGRAM 2007 No Print Name: Mammogram Class: LOCAL Sponsor: Review Date: Usage: CPRS, DATA EXTRACT, REPORTS Related VA-* Reminder: Reminder Dialog: IHS-MAMMOGRAM 2007

Step 2 – “Pack” the Reminder Go to Reminder Exchange (BEH-REM-EXC) Clinical Reminder Exchange Sep 11, :37:22 Page: 1 of 8 Exchange File Entries. Entry Source Date Packed 1 BLANK for TO Dialogue HEALT 2 IHS-ALCOHOL SCREEN 2007 HOSPITA 3 IHS-ALLERGY HOSPITA 4 IHS-ASTHMA PLAN 2007 HOSPITA 5 IHS-ASTHMA PRIM PROV 2007 HOSPITA 6 IHS-ASTHMA SEVERITY 2007 HOSPITA 7 IHS-ASTHMA STEROID 2007 HOSPITA 8 IHS-BLOOD PRESSURE HOSPITA 9 IHS-COLON CANCER 2007 HOSPITA 10 IHS-DEPRESSION SCREEN 2007 HOSPITA + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// cfe Create Exchange File Entry

Select Reminder Definition to pack: YAK-MAMMOGRAM 2007 LOCAL Enter a description of the reminder you are packing. ==[ WRAP ]==[ INSERT ]================== =================[ 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 Contains quick order: GMRQO CHS Mammogram prior to install either create this exact quick order OR have ready the exact name of your site's Mammogram consult ***add information about site specific items in the reminder – quick orders, objects, lab names, etc. This will assist the CAC who imports this reminder/dialog*** ====== Enter keywords or phrases to help index the reminder you are packing. Separate the keywords or phrases on each line with commas. ==[ WRAP ]==[ INSERT ]================== =================[ H=Help ]==== MAMMOGRAM Do you want to save changes? Yes

This is the Exchange File Entry you created that now can be exported == ==== Clinical Reminder Exchange Sep 11, :41:19 Page: 7 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB HEALT 62 YAK-DM ASPIRIN HEALT 63 YAK-DM EYE EXAM HEALT 64 YAK-DM THIAZOLIDINEDIONE MO HEALT 65 YAK-HF ACE/ARB HEALT 66 YAK-HF B BLOCKER HEALT 67 YAK-HF DIURETIC HEALT 68 YAK-MAMMOGRAM HEALT 69 YAK-MAMMOGRAM 2007 HEALT 70 YAK-PAIN CONTRACT DRUG SCRE HEALT + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry

Step 3 – Exporting Reminder ====== Clinical Reminder Exchange Sep 11, :41:19 Page: 7 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB HEALT 62 YAK-DM ASPIRIN HEALT 63 YAK-DM EYE EXAM HEALT 64 YAK-DM THIAZOLIDINEDIONE MO HEALT 65 YAK-HF ACE/ARB HEALT 66 YAK-HF B BLOCKER HEALT 67 YAK-HF DIURETIC HEALT 68 YAK-MAMMOGRAM HEALT 69 YAK-MAMMOGRAM 2007 HEALT 70 YAK-PAIN CONTRACT DRUG SCRE HEALT + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// chf Create Host File Select Entry(s): (61-70): 69 Enter a path: c:\tmp\// g:\pub\ ←this is the Pub folder (see “Ask your site manager” slide) Enter a file name: MAMMOGRAM 2007_YAKAMA ←use consistent nomenclature with name, date, site Will save selected entries to host file g:\pub\MAMMOGRAM 2007_YAKAMA.PRD?: Y// ES

Now the file is ready to send Open and click on the paper clip to attach Go into My Network Places Click on the Network Place you created earlier Attach the PRD file as you would any other file and send via

Importing a Reminder SCENARIO: Your Clinical Director wants some changes to the National Mammogram Reminder and Dialog. He was at a CD Meeting and learned that another site had exactly what he wants for your site. That site’s CAC attached the reminder file to an . You’re not sure what to do next…

Open the with the attached PRD file Right click on the file, click SAVE AS Click on My Network Places and navigate to the Pub folder you set up earlier Step 1: Move file to the Pub folder

Now save it to the Pub folder here You will be able to load this to the Reminders Exchange

Step 2: Load Host File to the Reminders Exchange Clinical Reminder Exchange Sep 12, :42:34 Page: 1 of 8 Exchange File Entries. Entry Source Date Packed 1 BLANK for TO Dialogue HEALT 2 IHS-ALCOHOL SCREEN 2007 HOSPITA 3 IHS-ALLERGY HOSPITA 4 IHS-ASTHMA PLAN 2007 HOSPITA 5 IHS-ASTHMA PRIM PROV 2007 HOSPITA 6 IHS-ASTHMA SEVERITY 2007 HOSPITA 7 IHS-ASTHMA STEROID 2007 HOSPITA 8 IHS-BLOOD PRESSURE HOSPITA 9 IHS-COLON CANCER 2007 HOSPITA 10 IHS-DEPRESSION SCREEN 2007 HOSPITA + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// LHF

Enter the path for the Pub file Enter a path: c:\tmp\// g:\pub\ ←this is the Pub folder (see “Ask your site manager” slide) The following PRD files were found in g:\pub\ Lead test 24 months.PRD Lead test 36_72 months.PRD Lead test 9_12 month old.PRD MAMMOGRAM 2007_YAKAMA.PRD PNEUMOVAX.PRD PRENATAL SCREENING.PRD Tobacco_ _yakama.PRD WSP ADULT IMM TEST.PRD YAK PRENATAL PLAN.PRD YAK_MAMM_2007.PRD Enter a file name: YAK_MAMM_2007.PRD ←you must type this exactly

Step 3: Install from the Exchange like you would any other reminder Clinical Reminder Exchange Sep 12, :49:46 Page: 7 of 8 Exchange File Entries. + Entry Source Date Packed 61 YAK-DM ACE/ARB HEALT 62 YAK-DM ASPIRIN HEALT 63 YAK-DM EYE EXAM HEALT 64 YAK-DM THIAZOLIDINEDIONE MO HEALT 65 YAK-HF ACE/ARB HEALT 66 YAK-HF B BLOCKER HEALT 67 YAK-HF DIURETIC HEALT 68 YAK-MAMMOGRAM HEALT 69 YAK-MAMMOGRAM 2007 HEALT 70 YAK-PAIN CONTRACT DRUG SCRE HEALT + + Next Screen - Prev Screen ?? More Actions CFE Create Exchange File Entry IH Installation History CHF Create Host File LHF Load Host File CMM Create MailMan Message LMM Load MailMan Message DFE Delete Exchange File Entry LR List Reminder Definitions IFE Install Exchange File Entry RI Reminder Definition Inquiry Select Action: Next Screen// IFE Select Entry(s): (61-70): 69

READ the Reminder description. Hopefully the exporting site identified items you need to either create or have ready when you install Exchange File Components Sep 12, :52:59 Page: 1 of 3 ComponeFile Entry Category Exists Reminder: YAK-MAMMOGRAM 2007 Source: RICHARDS,SUSAN P at YAKAMA HEALTH CENTER IHS Date Packed: Description: Females 40 to 70 should have yearly mammograms. Mammograms are found by CPT code, radiology exam or from the women's health pack Contains quick order: GMRQO CHS Mammogram prior to install either create this exact quick order OR have ready the exact name of your site's Mammogram consult Keywords: No keywords given Components: + Enter ?? for more actions IA Install all Components IS Install Selected Component Select Action: Next Screen//IA

Install Reminder, Accept Defaults Select Action: Next Screen// ia Install all Components Only programmers can install routines. REFUSAL TYPE entry MAMMOGRAM 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 Only programmers can install Reminder Computed Findings. REMINDER TAXONOMY entry IHS-MAMMOGRAM 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 TAXONOMY entry IHS-BILATERAL MASTECTOMY 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 YAK-MAMMOGRAM 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: I//nstall or Overwrite the current entry

Install the dialog Dialog Components Sep 12, :02:22 Page: 1 of 1 Packed reminder dialog: IHS-MAMMOGRAM 2007 Item Seq. Dialog Findings Type Exists 1 IHS-MAMMOGRAM 2007 dialog X 2 1 HD MAMMOGRAM element X Finding: *NONE* 3 3 HD ELIGIBILITY element Finding: *NONE* 4 5 OI MAMMOGRAM element Finding: GMRQO CHS Mammogram (ORDER DIALOG) X + Next Screen - Prev Screen ?? More Actions DD Dialog Details DT Dialog Text IS Install Selected DF Dialog Findings DU Dialog Usage QU Quit DS Dialog Summary IA Install All Select Action: Quit//IA Install reminder dialog and all components with no further changes:Y//YES

Replacing Item on Install If you had not created the GMRQO CHS Mammogram, you would be prompted to make a change: Install reminder dialog and all components with no further changes:Y// ES FINDING entry Q.GMRQO CHS Mammogram does not exist. Select one of the following: D Delete (from the reminder/dialog) P Replace (in the reminder/dialog) with an existing entry Q Quit the install Enter response: p Replace (in the reminder/dialog) with an existing entry Select ORDER DIALOG NAME: GMRZ Mammogram Now that element maps to your quick order

Tips… Installing an imported reminder is really no different from installing a National Reminder and Dialog Local terms will need to be mapped (add local labs, meds, etc) Taxonomies may error out – if the reminder contains taxonomies, make sure that the exporting site provides you with the codes they used so you can recreate it (just like National Template installs) Like TIU templates, sites may have used a locally created Object – you will need to either replace this with your own, or create one with the identical name TEST TEST TEST TEST…just as you would with a newly loaded National Reminder

Backing up Local Reminders Strongly consider using the export instructions to ‘back up’ your local reminders and dialogs. Place them in a folder on a server that is backed up regularly (consult with IT).

Take Home Message…. Avoid duplication of effort –If someone else has created a tool that works, then import and customize –If you have created a tool that works, then share with others –DO include brief notes alerting other sites of terms, quick orders, objects and other site specific data that will need to be adapted when imported

We are developing a forum for collaboration, sharing and information exchange. If you are a CAC who has developed or is developing local Reminders and Dialogs at your site and is interested in collaborating with others, please send your contact information to Susan Pierce-Richards.

Resources Clinical (EHR) Reminders Manual ftp://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/ Recorded WebEx trainings: EHR Reminders – Copying and Customizing National Reminders EHR Reminders – Customizing National Dialogs Future WebEx trainings on creating reminders, dialogs and report will be announced via the EHR ListServ and Area CACs. Please send suggestions for future EHR Reminders WebEx trainings to: