1. Veterans Health Gateway Tutorial 2.0
Triage and Health Information Solution

2. Start Screen
When the user clicks on the VHG button in the TeleCare Record Manger (TRM) software, VHG opens and the Start screen appears. Most of the required information is automatically transferred from Telecare Record Manager (TRM).

3. Start Screen
If the user is not connected to TRM, then he or she must enter the required information.

4. In either case, the user must choose a Call Reason from the list.
Start Screen
In either case, the user must choose a Call Reason from the list.

5. Then the user clicks on Start.
Start Screen
Then the user clicks on Start.
Note: the format of the Encounter: Start screen may vary, depending on which version of VHG is used.

6. Locate Chief Complaint Screen
If the user has not already done so, he or she must briefly interview the caller, in order to identify the caller’s current symptoms. The user must then choose the Chief Complaint, which is the most serious, specific symptom.
VHG advances to the Locate Chief Complaint screen. VHG filters algorithms according to age and gender. In this case, all algorithms are appropriate for a 55 year old male.

7. Locate Chief Complaint Screen3
… or choose a Chief Complaint in the General or Skin lists. 1
If the caller has symptoms, the user may perform a Symptom Search for the Chief Complaint, … 2
… use the golden model to find the Chief Complaint, …

8. 1. Chief Complaint Search: Text Search
Enter text into the search field to perform a search for a symptom algorithm, post-op condition algorithm or case-management algorithm, and then click on Go.
This is the MOST powerful way to find the most appropriate Chief Complaint.
Dispo

9. 1. Chief Complaint Search: Text Search
The resulting search provides all of the algorithms that contain the word “chest”. In the resulting list, click on the algorithm that best represents the patient’s chief complaint, in order to start the triage process.
This is the MOST powerful way to find the most appropriate Chief Complaint.
Dispo and Start OVER

10. 2. Chief Complaint Search: Golden Model
Click on the golden model to access the most commonly used symptoms that correspond to the chosen body region.

11. 2. Chief Complaint Search: Golden Model
In the resulting list, click on the algorithm that best represents the patient’s chief complaint, in order to start the triage process. Remember: this is not the entire list of algorithms that apply to the chest.

12. 2. Chief Complaint Search: Golden Model
Click on this image, in order to access posterior body regions on the golden model.

13. 2. Chief Complaint Search: Golden Model
Click on the golden model to access the most common symptoms that correspond to the back. Remember: this is not the entire list of algorithms that apply to the back.

14. 3. Chief Complaint: General and Skin
These lists contain the most common general algorithms and skin algorithms.
Click on the algorithm that best represents the patient’s chief complaint, in order to start the triage process.

15. Duration of Complaint and Pain Score
Current Patient information is displayed.
The user may access past triage encounter records on this patient by clicking on the double arrows, in order to expand the list of Past Encounters.
After the user chooses an algorithm, he or she advances to the Duration of Complaint screen.

16. Duration of Complaint and Pain Score
The user must enter a duration for the chief complaint. If the caller chief complaint is pain, the user must choose a corresponding pain score.

17. Choose a value for the duration of the Chief Complaint.
Duration of Complaint
Choose a value for the duration of the Chief Complaint.

18. Choose a unit for the Duration of the Chief Complaint.
Duration of Complaint
Choose a unit for the Duration of the Chief Complaint.

19. Click on Continue in order to advance to the first triage question.
Pain Score
Choose a value for the pain score. In this case, Rash (Localized) does not require this action.
Click on Continue in order to advance to the first triage question.

20. A rationale is provided for each question.
Question Screen
A rationale is provided for each question.
After the user completes the documentation in the Duration of Complaint screen, VHG advances to the Question screens.

21. Question Screen: Answering Questions
The user may click on the Previous button to go back to the previous question. This action resets the triage decision–making and allows the user to change the answer to the previous question.

22. Question Screen: Answering Questions
The user must answer Yes or No to the question in order to proceed. The user should use his or her best judgment if the caller does not know the answer to the question.

23. Question Screen: Glossary Words
The user may click on an underlined word, in order to view a glossary definition.

24. Question Screen: Glossary Words

25. Question Screen: Answering Questions
If the user answers Yes to a question . . .

26. Question Screen: Answering Questions
If the user answers Yes to “You have taken your temperature” . . .
. . . the positive responses are displayed on the left side of the screen.

27. Question Screen: Answering Questions
. . . he or she chooses the highest temperature in degrees F., and . . .

28. Question Screen: Answering Questions
. . . records the temperature to the nearest tenth of a degree.

29. Question Screen: Answering Questions
After the temperature has been entered, the user clicks on the Continue button.

30. Question Screen: Answering Questions
VHG utilizes pregnancy, blood pressure and weight loss calculators, which are similar to the temperature documentation function.
When the Positive responses satisfy a triage endpoint, or urgency recommendation, VHG immediately advances to the Disposition screen . . .

31. Disposition Screen: VHG Recommendation
On the Disposition Screen, VHG provides a System Recommendation. This is the follow-up interval, within which the patient should receive care from a health care provider.

32. Disposition Screen: System Concern
VHG provides a “System Concern”, which is a condition or a list of conditions. This list represents conditions that cause the most concern, given the caller’s presentation. The System Concern does NOT represent an exact diagnosis for the caller.

33. Disposition Screen: Nurse Recommendation
If the user disagrees with the VHG Recommendation, he or she may choose an alternate follow-up interval for the Nurse Recommendation.

34. Disposition Screen: Location
The user must document the follow-up Location by choosing an option from the list.

35. Disposition Screen: Agreement
The user must document Patient Agreement, which reflects whether or not the patient agrees with the given follow-up recommendation.

36. Disposition Screen: Redirection
The user must perform a Redirection Survey, by choosing an option from the list.

37. Disposition Screen: Modifier
The user may choose a Modifier, which represents a reason for shortening the follow-up interval. For example, the user may have decided to change the follow up interval from 2-8 hours, to Urgent (now), because the caller has multiple chronic illnesses.

38. Disposition Screen: Nurse Notes
The user may enter notes in the Nurse Notes field.

39. Disposition Screen: Patient Education
Copied health information is automatically placed in the Patient Education field. Please see the future section in this presentation, “Accessing Health Information at the End of Triage”, for more information about this feature.

40. Disposition Screen: Adding Negative Responses
The user may choose to add Negative responses to the Triage Encounter Note. The user clicks on the double arrows, in order to expand the Add Pertinent Negatives list.
IMPORTANT: users should not use the “Add Pertinent Negatives” function if Telecare administrative policy prohibits adding Negative responses to the Encounter Report. Please check with your administrator.

41. Disposition Screen: Adding Negative Responses
The user may click in the checkboxes, in order to add Negative responses to the Triage Encounter Report, . . .
IMPORTANT: users should not use the “Add Pertinent Negatives” function if Telecare administrative policy prohibits adding Negative responses to the Encounter Report. Please check with your administrator.

42. Disposition Screen: Adding Negative Responses
. . . or the user may click in the “Select all negatives” checkbox, in order to add all Negative responses to the Triage Encounter Report.
IMPORTANT: users should not use the “Add Pertinent Negatives” function if Telecare administrative policy prohibits adding Negative responses to the Encounter Report. Please check with your administrator.
When the user is finished, he or she clicks on “Save and Preview Report,” in order to advance to the Preview Report screen.

43. The nurse may edit the text in the report.
Preview Report Screen
The format of the report may vary, depending on which version of VHG is used.
The nurse may edit the text in the report.

44. Preview Report Screen
The user may return to the Disposition screen by clicking on the Dispo Button. This action allows the user to change information on the Disposition screen, and then view the report again.
The user clicks on “Finalize Report” when he or she is finished editing the report. VHG proceeds to the Final Report screen.

45. Final Report Screen
This is the final version of the report: the user may not edit this text.

46. Final Report Screen
Click on “Return to TRM” in order to send the report to TRM. The VHG browser will close and workflow continues in TRM.

47. Final Report Screen
In the rare event that TRM or CPRS is not available, the user can continue to use VHG. When the user reaches the Final Encounter Report screen, the user must 1) copy the Triage Encounter note and paste it into another application, such as Notepad. And then, when TRM and CPRS are available, 2) the note must be copied from Notepad and pasted into TRM or CPRS. The user may also print the report by clicking on Print.

48. Accessing Health Information at the End of Triage
Related health information and care instructions

49. Accessing Patient Education Information
. . . or by clicking on the Care Advice links below. These links provide access to information that corresponds with the System Concern.
On the Disposition screen, the user may access Patient Education information from the libraries by entering text into the Library Search field and clicking on Go . . .

50. Accessing Patient Education Information
The user may click on a link to advance to specific information.

51. Accessing Patient Education Information
The user may click on a link to advance to related information.

52. Accessing Patient Education Information
For example, if the user clicks on a link to advance to the corresponding topic in the health information library. . .

53. Accessing Patient Education Information
. . . VHG advances to the corresponding topic: Home Treatment of Fever.
Click on the grey banner, in order to access the corresponding section of text.

54. Accessing Patient Education Information
The corresponding text is displayed under the grey banner.

55. Accessing Patient Education Information
Clicking on underlined text provides a glossary definition.
Clicking on blue highlighted text advances VHG to the corresponding topic in the Health Information Libraries.

56. Accessing Patient Education Information to the Record
The user accesses another section by clicking on a grey banner.

57. Accessing Patient Education Information to the Record
The corresponding text is displayed under the grey banner, and the previous text disappears.

58. Adding Patient Education Information to the Record
If the user reads information to the caller, he or she may select the text, in order to add it to the encounter record . . .

59. Adding Patient Education Information to the Record
. . . by placing the mouse pointer at the end of the desired text, holding down the left mouse button…

60. Adding Patient Education Information to the Record
. . . and moving the pointer to the beginning of the desired text.

61. Adding Patient Education Information to the Record
Hi-lighted instructions are included on the left side of the screen.
When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the triage encounter record. The user clicks on OK, in order to confirm the action.

62. Adding Patient Education Information to the Record
Click on Dispo to return to the Disposition screen.

63. Disposition Screen
When the user returns to the Disposition screen, copied health information has been automatically placed in the Patient Education field.

64. Providing Health Information to Callers
When a caller does not require triage

65. Completing an Education Call
. . . or 2) click on one of the health information library tabs. 2 1
If the patient calls for health information and does not have symptoms, the nurse may access reference health information in two ways: 1) perform a search by entering text into the search field and click Go . . .

66. Completing an Education Call
For example, the user may enter the text string, “b-a-c-k”, and then click on Go.

67. Completing an Education Call
Click on Back Pain: Overview, in order to access the topic from the Disease Library.
VHG provides search results for b-a-c-k.

68. Completing an Education Call
. . . VHG advances to the corresponding topic: Back Pain.
Click on the grey banner, in order to access the corresponding section of text.

69. Completing an Education Call
The corresponding text is displayed under the grey banner.

70. Completing an Education Call
Clicking on underlined text provides a glossary definition.
Clicking on blue highlighted text advances VHG to the corresponding topic in the Health Information Libraries.

71. Completing an Education Call
If the user reads information to the caller, he or she may select the text, in order to add to the encounter record . . .

72. Completing an Education Call
. . . by placing the mouse pointer at the end of the desired text, holding down the left mouse button…

73. Completing an Education Call
. . . and moving the pointer to the beginning of the desired text.

74. Completing an Education Call
Hi-lighted instructions are included on the left side of the screen.
When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the encounter record. The user clicks on OK, in order to confirm the action.

75. Completing an Education Call
Additional resources are available on the right side of the screen: 1) Related Images, 2) Related News, 3) Spanish and 4) Web Search.

76. Completing an Education Call
Click on the double arrows to expand or close the menu lists.

77. Completing an Education Call
Click on the page number to advance through the list of items in the menu.

78. Completing an Education Call
Click on an item in the menu to open it.

79. Completing an Education Call
Click on Dispo to proceed to the Disposition screen.

80. Completing an Education Call
When the user returns to the Disposition screen, copied health information is automatically placed in the Patient Education field.

81. Completing an Education Call
If the user wants to arrange follow-up, he or she may choose a follow-up interval under Nurse Recommendation.

82. Completing an Education Call
And then, the user may choose a Follow-up Location.

83. Completing an Education Call
The user may document Patient Agreement by choosing an option from the list. This response reflects whether or not the patient agrees with the given follow-up recommendation.

84. Completing an Education Call
The user may enter additional notes in the Notes field.

85. Completing an Education Call
Click on “Save and Preview Report,” in order to advance to the Preview Report screen and finish the record.

86. Veterans Health Gateway
Navigation Buttons
Veterans Health Gateway

87. Always use the VHG navigation buttons.

88. Never use the browser navigation buttons.

89. Navigation Button: Locate Chief Complaint Screen
The Dispo button allows the user to advance to the Disposition screen. The user may take this action if there is no need for a triage algorithm. For example, when the caller states that the patient is actively seizing.

90. Navigation Buttons: Duration of Complaint and Pain Score Screen
The Dispo button allows the user to advance to the Disposition screen.
The Start Over button returns the user to the Chief Complaint screen. This action allows the user to choose another Chief Complaint and resets the triage decision-making to correspond to the new chief complaint.

91. Navigation Buttons: Question Screen
The Previous button allows the user to go back one screen.
The Dispo button allows the user to advance to the Disposition screen.
The Start Over button returns the user to the Chief Complaint screen. This action allows the user to choose another Chief Complaint and resets the triage decision-making to correspond to the new chief complaint; however, all currently collected responses are saved and recorded in the Triage Encounter Record.

92. Navigation Buttons: Disposition Screen
The Previous button allows the user to go back one screen.
The Start Over button returns the user to the Chief Complaint screen. This action allows the user to choose another Chief Complaint and resets the triage decision-making to correspond to the new chief complaint; however, all currently collected responses are saved and recorded in the Triage Encounter Record.

93. Navigation Buttons: Information Libraries
The Previous button allows the user to go back one screen.
The Dispo button allows the user to advance to the Disposition screen.

94. Valuable assistance for the user
Accessing Images
Valuable assistance for the user

95. Triage Questions: Viewing Images
The user may click on an image, in order to see an enlarged view.

96. Triage Questions: Viewing Images
The user must use the close buttons in order to close the image window.

97. Health Information Libraries: Viewing Images1
The user may view images in the health information libraries by 1) clicking on a title in the Related Images section on the right side of the screen, . . .
. . . or 2) clicking on the camera icons in the text. 2

98. 1. Viewing Related Images
Related Images are displayed in the same window. The user must use the Previous or Dispo buttons in order to proceed.

99. 2. Viewing Images Using the Camera Icons
Clicking on the camera icon displays the image in a pop-up window.

100. 2. Viewing Images Using the Camera Icons
The user must use the close buttons in order to close the image window.

101. Aborting the Clinical Encounter
Providing an alternative for infrequent mistakes

102. Aborting a Clinical Encounter
Rarely, a user may wish to Abort a clinical encounter, e.g., when the user starts an encounter on the wrong patient. This action aborts the decision-making process and completely erases all of the data collected during the triage session. In order to Abort, click on the Dispo button from any screen in VHG . . .

103. Aborting a Clinical Encounter
. . . and then click on the Abort button on the Disposition screen.

104. Final Report Screen
This takes the user to a blank Final Report screen. The only option is to return to TRM by clicking on the Return to TRM button, which closes the VHG application. After returning to TRM, the user must complete the assessment in TRM or launch another triage encounter by clicking on the VHG button in the TRM application.

105. Thank You
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