Anatomy and Physiology of Reminder Dialogs

What is a Dialog? Look, feel, and act like a note template BUT they are not note templates. List of statements and associated findings that appear in a dialog box in the EHR used to resolve a reminder. Generated from a reminder definition or created manually. Must be defined and linked to reminders before clinicians can resolve reminders through the EHR. Dialog boxes appear when specific reminders are selected, with a list of checkbox items that have been defined as potential actions to satisfy the reminder.

How do Dialogs get Created? Auto-generated once Reminder has been established –Auto generates elements –Does NOT auto generate groups –Once created user will need to confirm that all elements meet user needs & group them if they prefer dialog groups Manually Created –Create your own dialog elements –Create your own dialog groups –Create your additional prompts –Create your own dialogs to support guidelines

Pro’s/Con’s of Auto-Generated Dialogs Pro’s: –Automatically linked to a reminder –Includes all elements for the reminder findings –Auto creates the appropriate prompts Con’s –Includes all the elements for the findings –Requires you to review them to ensure they are all appropriate –Does not generate groups, only elements

Pro’s/Con’s of Manually Generated Dialogs Pro’s: –Don’t have a lot of unwanted auto generated prompts to clean up Con’s: –Requires you to link the dialog to the reminder in separate step –Must have naming convention –Must know what dialog prompts to associate the finding item

Basic Building Blocks for Dialog Resolution: –Where was it done? In clinic vs historical –How was it done? Ordered vs Other –Did it get done? Refused Finding Item: –What was done? Immunization, Orderable Item, Health Factor, Exam, etc Additional Prompts: –Allows you to completely document the finding item Document lot #, injection site, comments, etc.

Resolution Types Done at encounter –Capture items such as exams and health factors in the note without having to jump from the note tab to the health factor/exam tab Done elsewhere –Historical entries such as colonoscopy, mammograms, paps, HIV screening, exams, immunizations, etc Ordered –Order a consult, lab, med, radiology, nurse order, etc as soon as you complete the note Contraindicated –This resolution type does not work for IHS Other –Use for health factors Patient Refused –Only works for Immunizations currently

Types of Finding Items ED.EntryName to select a EDUCATION TOPICS IM.EntryName to select a IMMUNIZATION ST.EntryName to select a SKIN TEST EX.EntryName to select a EXAM HF.EntryName to select a HEALTH FACTOR CPT.EntryName to select a PROCEDURE ICD9.EntryName to select a ICD9 DIAGNOSIS VM.EntryName to select a VITAL TYPE don’t use, VA TX.EntryName to select a TAXONOMY Q.EntryName to select a ORDER DIALOG MT.EntryName to select a MEASUREMENT TYPE

Adding Additional Finding within an Element 1.Adding additional findings automatically “stuffs” the code (Pt Ed, ICD, CPT, etc) into PCC. As with superbill associations, use judiciously and only when it is true every time it is done. Remember codes don’t update themselves. If you stuff a code and new ICD9 codes come out, you have to update these manually ONLY use unique codes as additional findings – don’t use the same additional finding in multiple dialogs (so don’t use ED.CA-TESTS for Pap, Mamm and Colon Cancer – use education unique to the element) 2.Look at the EHR to get an idea what prompts you will need (if any) to enter appropriate information for your findings and addl findings Pt Ed needs Level of Understanding, Length, etc Exams need result Imms need lot #, dose, route, vis, etc Comments are generally a good thing to offer the user

PromptDescription NAMEThis is the name of the dialog entry. Reminder dialog entries will default to the name of the reminder for ease in identifying the reminder dialog entry. Dialog elements that are auto-generated use the following naming convention: Finding type prefix _Name from finding file_ _Resolution Status. Your site might want to create one or more special namespaces for dialog entries that you create locally. SOURCE REMINDERThis identifies which reminder definition is associated with this "Reminder Dialog" entry. "Reminder Dialog" type entries are the only entries that require this field. DISABLEThis field disables use of this dialog when it contains text. The text should be a short message explaining why the use of this dialog has been disabled, because it will be displayed if this dialog is selected. TYPEThis field defines what type of dialog component this entry is. The type determines the processing that can occur with this entry. CAPTIONThe caption is used for prompt, dialog group, and reminder components. When a prompt has a caption defined, this is the text that should be used whenever the prompt is asked (i.e., Comment:). A dialog group can use the caption field to specify a header to use on a box around the group of dialog elements. The reminder dialog component can use the caption to specify a header to use on a box around the dialog elements for a reminder. BOXThis flag is used to determine whether the components will be presented to the user in a box. If the caption field is defined, it will appear as header text within in the top line of the box. NUMBER OF INDENTSThis is the number of indents that should be made before presenting the group's components/elements. Indent is used only for dialog groups. (optional) SHARE COMMON PROMPTSThis field is used only for a dialog group where different dialog elements have common prompts. Prompts will be shared for all dialog element unless otherwise selected. GROUP ENTRYThis is used for dialog groups only. 1 indicates that only one element in the dialog group can be selected (radio button and one must be checked) 2 indicates that one or more elements must be selected. (check boxes, at least 1 must be checked) 3 indicates that either none or one selection is required. (radio button, can be left blank) 0 or null indicates no selection required. (check boxes, no restrictions) Dialog Element Definitions

COMPONENTS (Multiple) SEQUENCE This field contains the components that are used to process a reminder. Generally the components relate to the TYPE of entry in the REMINDER DIALOG file: Reminder dialogs have dialog group or dialog element components. Dialog groups have a combination of dialog element components. Dialog elements have prompt and forced value components. This field specifies the order in which this item will be displayed or processed. (multiple field). ITEMThis field points to a dialog which is subordinate to this dialog. NOTE: The parent dialog menu or one of its ancestors cannot be entered as an item. OVERRIDE PROMPT CAPTION This text will override the caption for this component in the reminder dialog, when the component is a prompt. When the text is blank, the caption from the prompt entry will be used. START NEW LINEThis flag allows the user to have some control of the display of prompts related to a dialog element. EXCLUDE FROM PN TEXT This flag controls whether or not a component will be excluded from the progress note text when the component is acted upon REQUIREDAdditional prompt must be checked (defaults to not required) RESOLUTION TYPEThis field contains what type of resolution is represented by this dialog entry. FINDING TYPEIf an additional prompt is restricted to use with only one type of finding item, this field contains the mnemonic of the finding type. The mnemonics allowed are: CPTProcedure EDEducation Topic EXExam HFHealth Factor IMImmunization OIOrderable Item POVDiagnosis (ICD9) STSkin Test MTVital Measurement FINDING ITEMThis field contains the finding item represented by this dialog entry. ORDERABLE ITEMOrderable item from the reminder definition. ADDITIONAL FINDINGSIf additional finding items should be posted if the dialog is checked, then they should be entered in this field. The field is relevant to both dialog element and dialog group type records. DEFAULT VALUEThis is the default value for an additional prompt. FORCED VALUEThis is the value used for a forced value type dialog. EXCLUDE FROM PROGRESS NOTE This field indicates that the question text of the dialog element will be excluded from the progress note. (optional).

PROMPT CAPTIONThis is the caption that will be used for this prompt. This caption can be overridden by the OVERRIDE PROMPT CAPTION field in the ITEMS multiple, which can be more specific for the instance of the prompt. DIALOG/PROGRESS NOTE TEXTThis field is only required if the text on the progress note differs from the dialog text. ALTERNATE PROGRESS NOTE TEXT This field defines alternate text to add to the progress note when the progress note text needs to be different from the dialog text. (i.e., Dialog/ Progress Note Text displayed is "Place Influenza Order," but the Alternate Progress Note Text is "Ordered Influenza Vaccine at this encounter."). If there is no text in this field the dialog text will be added to the progress note. CHECKBOX SEQUENCEComment prompts (with a GUI Process ID of COM) can have a number of checkboxes associated with the comment prompt. GUI PROCESS IDIf an additional prompt or forced value is created by copying one of the PXRM prompts, the GUI Process ID field will automatically be populated by the copy process. HIDE/SHOWGROUPThis is used for dialog groups. 1 indicates that the group will be hidden until checked; 0 indicates that the group will be displayed. SUPPRESS CHECKBOXIf the field is set to SUPPRESS the dialog element or group header will be displayed without a checkbox. Otherwise the WP text will be presented with a checkbox. INDENT PROGRESS NOTE TEXTIn a dialog group, the dialog questions can be indented. This field allows the progress note text to be indented also. RESULT CONDITIONCAN'T BE ALTERED EXCEPT BY PROGRAMMER. CLASSThis is the class of definition. National definitions cannot be edited. N NATIONAL V VISN L LOCAL SPONSORThis is the name of a group or organization that sponsors the reminder. REVIEW DATEThe review date determines when the definition should be reviewed to verify that it is current with the latest standards and guidelines. EDIT HISTORYIf changes were made, the date and the name of the user making the changes will be inserted automatically. You can optionally type in a description of the changes made during the editing session.

Dialog Group Prompt Definitions PromptDescription DISABLEDialog will not be displayed in the EHR if there is anything in this field. RESOLUTION TYPEUsed for future reporting. (Optional) FINDING ITEMFinding item to be posted to orders, if the group is checked (optional). GROUP CAPTIONText to appear as box caption if there is a box around the group (not included in P/N) (optional). PUT A BOX AROUND THE GROUPA box will be drawn around the elements in the group - defaults to no box. SHARE COMMON PROMPTSIf elements in the group have a common additional prompt (i.e., comment) this will be displayed only once. (optional) MULTIPLE SELECTIONEnter 1 for one selection only. Enter 2 for one or more. Enter 3 for none or one selection. Enter 0 for no selection required. 1 ONE SELECTION ONLY 2 ONE OR MORE SELECTIONS 3 NONE OR ONE SELECTION 0 NO SELECTION REQUIRED HIDE/SHOW GROUPHide the group elements until the group checkbox is checked - defaults to show. GROUP HEADER DIALOG TEXTText for the group checkbox (this will be added to the Progress Note). GROUP HEADER P/N TEXTText for the P/N if this differs from the field above. (optional) EXCLUDE FROM PROGRESS NOTEExclude the group header text from the P/N. (optional) NOTE: This now only applies to the group header text. Individual elements in the group must now be marked EXCLUDE FROM P/N individually using the ED option in the group edit. SUPPRESS CHECKBOXDisplay group header with no checkbox - defaults to do not suppress. NUMBER OF INDENTSNumber of indents for elements in the group. (optional) INDENT PROGRESS NOTE TEXTIndent P/N the same as the dialog - defaults to no indent. (optional) ADDITIONAL FINDINGSAdditional finding items to be posted to orders, when the dialog group checkbox is checked. (optional) SEQUENCEDisplay sequence number and dialog elements (multiple field).

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

Dialog Pieces Choose from: D Reminder Dialogs E dialog element F forced value G dialog group P prompts R reminders RG* result group (MH) RE* result element (MH) *MH not used in IHS 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

Auto-Generate a Dialog Select Item: Quit// ad Add Reminder Dialog GENERATE DIALOG AUTOMATICALLY: Y// SELECT REMINDER TO GENERATE DIALOG FROM: IHS-ALCOHOL SCREEN NATIONAL ENTER A UNIQUE DIALOG NAME: IHS-ALCOHOL SCREEN// OVERWRITE EXISTING REMINDER DIALOG ? YES// LINK DIALOG TO REMINDER: YES// ENABLE DIALOG: NO//  May want this to be a yes REPLACE ANY EXISTING DIALOG ELEMENTS? NO// –Be very careful if you ever set this to YES

Look at the dialog

Look at the Progress Note Text

It’s very messy….

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

Groups Elements Text Only After a lot of editing, and grouping it can look like this…

Here’s an example immunization dialog with prompts. Prompts Element Group Text only Element All the words in the grey box are “Dialog Text.” This is what goes into RPMS… the “Finding Item” and “Additional Findings” This is Progress note text. Usually the same as Dialog text. Can use Alternate text.

Reminder Dialog Script

Naming conventions Use consistent prefix Make sure you know its yours – consider appending with site names if you make significant changes and for groups HD text CPT ICD9 ED EX IMM (national uses IM, consider using IMM for locally created ones) HF TX taxonomy GP groups (national uses GRP, consider GP for locally created ones) PR prompts

Recommended Process Write out what you want to create Then answer these questions: Resolution: –Where was it done? In clinic vs historical –How was it done? Ordered vs Other –Did it get done? Refused Finding Item: –What was done? Immunization, Orderable Item, Health Factor, Exam, etc –Is there any other additional findings? “stuffing” of CPT code, and patient education when giving an immunization Additional Prompts: –Allows you to completely document the finding item Document lot #, injection site, comments, etc.

Hands on Practice Alcohol – Cage Script Cage Questions: 1.Have you ever felt you should cut down on your drinking? Yes/no 2.Have people annoyed you by criticizing your drinking? Yes/no 3.Have you ever felt bad or guilty about your drinking? Yes/no 4.Have you ever had a drinking 1 st thing on the morning to steady your nerves or to get rid of a handover? Yes/no

Alcohol Script – PCC elements Record CAGE Score –Cage Score 0/4 –Cage Score 1/4 –Cage Score 2/4 –Cage Score 4/4

Alcohol Script – Quick order Scoring two or more affirmative should create a high index of suspicion. Four affirmative answers indicates alcoholism. Click below to order a social consult

EHR Reminders Customizing National Dialogs

Recommended Process COPY the existing IM DTAP DONE element into a local name. If you do not, you run the risk of this being overwritten by a released element of the same name on installation at a later date. Once you have this done, you can either: 1.Edit the National Dialog 2.Create your own dialog and link this to the National Reminder

Navigating the Dialog screens BEH-REM-DLG-DLG will get you here

AR All reminders LR Linked Reminders QU Quit CV Change View RN Name/Print Name Select Item: Next Screen//CV TYPE OF VIEW: R// E D dialog, P prompts, R reminder view Always look to upper left corner to see where you are (in this case elements)

Script for IM EXAMPLE DTAP DIALOG VIEW (DIALOG ELEMENTS) +Item Dialog Name Dialog type Status 65 HF CAGE 2/4 Dialog Element 66 HF CAGE 3/4 Dialog Element 67 HF CAGE 4/4 Dialog Element 68 HS ASTHMA PLAN Dialog Element 69 IHS-EXAM Dialog Element 70 IM DTAP DONE Dialog Element 71 IM DTAP DONE ELSEWHERE Dialog Element 72 IM DTAP REFUSED Dialog Element 73 IM EXAMPLE DTAP Dialog Element 74 IM HEP A ADLT DONE Dialog Element 75 IM HEP A ADLT DONE ELSEWHERE Dialog Element 76 IM HEP A ADLT REFUSED Dialog Element 77 IM HEP A PED DONE Dialog Element 78 IM HEP A PED DONE ELSEWHERE Dialog Element 79 IM HEP A PED REFUSED Dialog Element 80 IM HEP B ADLT DONE Dialog Element Next Screen - Prev Screen ?? More Actions >>> AD Add CV Change View INQ Inquiry/Print CO Copy Dialog PT List/Print All QU Quit[J Select Item: Next Screen// 73 Dialog Name: IM EXAMPLE DTAP Not used by any other dialog

NAME: IM EXAMPLE DTAP// DISABLE: CLASS: LOCAL// this will always be local SPONSOR: leave blank REVIEW DATE: leave blank RESOLUTION TYPE: DONE AT ENCOUNTER// ORDERABLE ITEM: FINDING ITEM: DTAP// since you copied the existing one, no change needed DIALOG/PROGRESS NOTE TEXT: Patient received dtap immunization at this encounter you can change if you like Edit? NO// ALTERNATE PROGRESS NOTE TEXT: No existing text you can put text here if you want the text in the progress note to be different from what is displayed in the dialog Edit? NO// EXCLUDE FROM PROGRESS NOTE: put yes only if you want the text to display only and not be in the note or saved to PCC, otherwise leave blank. SUPPRESS CHECKBOX: if you have a display item and don’t want a check box to confuse your user, put a “1” here, for this - leave blank

Select ADDITIONAL FINDINGS: ?? This is where you can add additional findings. ?? Will give you an idea what is available and how to search '^' TO STOP: You may enter a new ADDITIONAL FINDINGS, if you wish If additional finding items should be posted if the dialog is checked then they should be entered in this field. The field is relevant to both dialog element and dialog group type records. Enter one of the following: USE CAPS, the prefix is case sensitive ED.EntryName to select a EDUCATION TOPICS ED.WH-PAP SMEAR*** only enter pt ed if unique (that is, do not use ED.IMM-PT LIT for multiple immunization elements) IM.EntryName to select a IMMUNIZATIONS IM.TDAP ST.EntryName to select a SKIN TEST ST.PPD EX.EntryName to select a EXAM EX.DEPRESS HF.EntryName to select a HEALTH FACTORS HF.ALC CPT.EntryName to select a PROCEDURE CPT ICD9.EntryName to select a ICD9 DIAGNOSIS ICD9.V06.1 VM.EntryName to select a VITAL TYPE don’t use – use measurement MT Q.EntryName to select a ORDER DIALOG Q.LROQO HGBA1C, Q.ORZM MENU NAME MT.EntryName to select a MEASUREMENT MT.BP To see the entries in any particular file type If you simply enter a name then the system will search each of the above files for the name you have entered. If a match is found the system will ask you if it is the entry that you desire. '^' TO STOP: However, if you know the file the entry should be in, then you can speed processing by using the following syntax to select an entry:. or. or. Also, you do NOT need to enter the entire file name or message to direct the look up. Using the first few characters will suffice.

Select ADDITIONAL FINDINGS: CPT Searching for a PROCEDURE, (pointed-to by ADDITIONAL FINDINGS) Searching for a PROCEDURE DTAP VACCINE, < 7 YRS, IM DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP), FOR USE IN INDIVIDUALS YOUNGER THAN 7 YEARS, FOR INTRAMUSCULAR USE...OK? Yes// y (Yes) DO NOT ADD THE VACCINE ADMINISTRATION CPT CODE or Generic IMM PT ED CODES AS ADDITIONAL FINDINGS ON IMMUNIZATION ELEMENTS!!!!!!!!!!!!!!!!!!!!!!!!! Have users select Pt Ed separately (Pt Ed is already included in the national dialog) OR choose Pt Ed for the specific ICD9 for the imm (example shown) Select ADDITIONAL FINDINGS: ICD9.V06.1 Searching for a ICD9 DIAGNOSIS, (pointed-to by ADDITIONAL FINDINGS) Attempting FILEMAN lookup...V06.1 V06.1 DIPHTHERIA-TETANUS-PERTUSSIS...OK? Yes// y (Yes) ADDITIONAL FINDINGS: V06.1// ED.V V06.1-L DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V06.1-L 2 V06.1-L DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V06.1-L 3 V06.1-L DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V06.1-L 4 V06.1-L DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V06.1-L 5 V06.1-L DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V06.1-L Press to see more, '^' to exit this list, OR CHOOSE 1-5: 1 DIPHTHERIA-TETANUS-PERTUSSIS-PATIENT INFORMATION LITERATURE V 06.1-L Select ADDITIONAL FINDINGS: Now add your Additional Findings

To check your work, when you return to “additional findings” prompt, put in ? – it will show you what you have entered Select ADDITIONAL FINDINGS: CPT.90700// ? Choose from: V DIPTHERIA-TETANUS-PERTUSIS-PATIENT INFORMATION LITERATURE Now, you copied the national element, so you know that the prompts for Immunization entry are included in the element. Now you need to figure out if you need additional prompts. You don’t need more prompts for CPT or ICD9 codes, but you DO need some prompts for Patient Ed (minimum Level of Understanding and Length). Any comment written will enter text in all v file entries.

Now add any more prompts. In this case, we’ll replace #5 with Level of Understanding, add #6 with Length and add back #7 Comment RESULT GROUP/ELEMENT: Select SEQUENCE: 5// ?? PXRM prompts are national prompts. When I build my own dialogs, I usually number 5,10,15 etc to allow for future additions Choose from: 1 PXRM LOT NUMBER 2 PXRM IMM SITE 3 PXRM VOLUME 4 PXRM IMM VIS DATE 5 PXRM COMMENT You may enter a new COMPONENTS, if you wish This field specifies the order in which this item will be displayed or processed.

National Prompts Not all delivered prompts are functioning yet, blue are functioning as designed currently CIAV REFUSAL TYPE prompt LOCAL PXRM ADD TO PROBLEM LIST prompt NATIONAL PXRM COMMENT prompt NATIONAL PXRM CONTRAINDICATED prompt NATIONAL PXRM IMM REFUSED prompt NATIONAL PXRM IMM SITE prompt NATIONAL PXRM IMM VIS DATE prompt NATIONAL PXRM LEVEL OF SEVERITY prompt NATIONAL PXRM LEVEL OF UNDERSTANDING prompt NATIONAL PXRM LOT NUMBER prompt NATIONAL PXRM OUTSIDE LOCATION prompt NATIONAL PXRM PED GOALS prompt NATIONAL PXRM PED LENGTH prompt NATIONAL PXRM PED OUTCOME prompt NATIONAL PXRM PED REFUSED prompt NATIONAL PXRM PED SETTING prompt NATIONAL PXRM PRIMARY DIAGNOSIS prompt NATIONAL PXRM QUANTITY prompt NATIONAL PXRM REACTION prompt NATIONAL PXRM READING prompt NATIONAL PXRM REFUSED forced value NATIONAL PXRM REPEAT CONTRAINDICATED forced value NATIONAL PXRM RESULT (EXAM) prompt NATIONAL PXRM RESULT (SKIN TEST) prompt NATIONAL PXRM SERIES prompt NATIONAL PXRM SKIN GIVEN prompt NATIONAL PXRM SKIN READ DATE prompt NATIONAL PXRM SKIN READER prompt NATIONAL PXRM VISIT DATE prompt NATIONAL PXRM VOLUME prompt NATIONAL

SEQUENCE: 5// ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT// 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: YES// EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: 6 ADDITIONAL PROMPT/FORCED VALUE: PXRM PED LENGTH prompt NATIONAL...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: n NO Select SEQUENCE: 7 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT prompt NATIONAL...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE:

Now you have your new prompts Answer with COMPONENTS SEQUENCE, or ITEM Choose from: 1 PXRM LOT NUMBER 2 PXRM IMM SITE 3 PXRM VOLUME 4 PXRM IMM VIS DATE 5 PXRM LEVEL OF UNDERSTANDING 6 PXRM PED LENGTH 7 PXRM COMMENT

Now we’ll edit the National Dialog Using CV option, Change View to “D” for Dialog. You want then select the IHS-PED DTAP IMMUN

Choose to EDIT the dialog We need to replace this with the one You made, and you see it is in a “group” So we need to CV to the Group Menu

Navigate to the Group menu screen, go back 1 menu, select CV and change view to G for Group Then select “3” for GRP DTAP PED

We’ll simply replace the IM DTAP DONE with the one we made

CURRENT DIALOG ELEMENT/GROUP NAME: GRP DTAP PED Used by: IHS-PED DTAP IMMUN (Reminder Dialog) reminds you where its used NAME: GRP DTAP PED// DISABLE: CLASS: LOCAL// SPONSOR: REVIEW DATE: RESOLUTION TYPE: ORDERABLE ITEM: FINDING ITEM: GROUP CAPTION: PUT A BOX AROUND THE GROUP: YES// SHARE COMMON PROMPTS: NO// MULTIPLE SELECTION: ONE OR MORE SELECTIONS// HIDE/SHOW GROUP: HIDE// GROUP HEADER DIALOG TEXT: Check to document immunization information. Edit? NO// GROUP HEADER ALTERNATE P/N TEXT: Immunization information Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX: NUMBER OF INDENTS: 2// INDENT PROGRESS NOTE TEXT: INDENT// Select ADDITIONAL FINDINGS: Select SEQUENCE: 15// 5 this is the one we want to replace SEQUENCE: 5// DIALOG ELEMENT: IM DTAP DONE// IM EXAMPLE DTAP dialog element LOCAL...OK? Yes// (Yes)

Hit return until you get back to CV, then CV back to the Dialog menu, then select the IHS-PED DTAP IMMUNE to see if the changes are there. As you can see, the new element is now in the GRP DTAP PED

The New Display with all the additions! Remember to log out/log back in to see the changes Dialog Note Text PCC entry