1. Health Maintenance And Disease Management
NextGen Guidelines
Health Maintenance
And
Disease Management

2. Protocols 1
Protocols are located within the Guidelines tab of the Intake Template.
The red dot next to the Protocol indicates that there is an item “due” for that protocol.
Protocols can be activated by using the Add Protocols button.
Individual care guideline items can up updated by highlighting the item, fill out the edit fields below the grid and then select the Update Button. 2 3

3. Adding Risk Indicators1
Click on the Risk Indicators Health Maintenance link.

4. Documenting Risk Factors
Select a risk factor by clicking on the checkbox corresponding to the risk indicator.
Select a diagnosis. Clicking in the Diagnosis field for a risk indicator will launch a picklist of high-risk diagnosis codes that can be selected for the patient.
A status can be selected for the diagnosis. Click in the Status field and select from the picklist.
High risk diagnosis codes selected on the Risk popup can be added to the Diagnosis module using the Add button. 4 1 2 3

5. Activating Protocols
Using the Add Protocols button (shown on page 2), users can open the Activate Protocols popup.
1. Select a protocol.
Protocols can be selected for the patient by clicking in the Protocols field above the grid and selecting from the picklist.
2. Select a diagnosis (a diagnosis is not required for Health Maintenance). 
A diagnosis can be added by clicking in the Diagnosis field above the grid and selecting from the picklist, which will display a list of current diagnoses for the patient.Clicking on Cancel to close the picklist will cause the diagnosis search popup to open automatically.
- Or -
3. After selecting a protocol and a diagnosis, click the Add button. The order items that make up the selected protocol will be added to the grid.
4. Click Save & Close to return to the Clinical Guidelines template. 1 2 3 3 3
will appear
after clicking on OK 4

6. Modifying Protocols
Individual guidelines that are Protocol items can be modified using the Clinical Guideline Update popup. This popup is opened from the Clinical Guidelines grid:
Highlighting the appropriate protocol row in the grid and select the Edit button found below the grid.
Modifications made this way are made to individual protocol items for an individual patient and will not affect the protocol for other patients.
The Edit button will only become enabled when you highlight a protocol item. When you click the Edit button, the Clinical Guideline Update popup will open, and users can make modifications to the protocol guideline item. 1

7. Modifying Protocols, cont.
Modifications to the protocol item can include:
Changes to testing time Interval
Start/Stop Ages and Start/Stop Dates which define when the guideline item is to be active for the patient
Hold/Resume Dates for temporarily suspending a protocol item
Document when the test/exam was Last addressed
Ability to Exclude or Decline the test/exam and to document the reason, including when the item is excluded from the protocol or declined by the patient 3 4 1 2 5

8. Using the Clinical Guideline Update
• Interval – the time interval for testing can be modified along with noting the reason for interval change   • Hold date – the testing can be put on hold so the test/exam does not show as due.   • Resume date – the date the test/exam is to be resumed. (For example, the patient is leaving to go to Florida for 3 months; the test/exam can be placed on hold and then resumed 3 months later.)   • Next due – this calculates the next due date based on last completed date and the interval.   • Start age – if the test/exam needs a start age the start age can be modified.
The start and stop ages entered must include units, month, year. when you click in the Start Age and Stop Age fields, a time-frame entry popup will open. After selecting or manually typing a number in the Years field and clicking OK to close the popup, the number will be displayed in the Start Age or Stop Age field with units.
• Stop age – if the test/exam should stop at a certain age the stop age can be modified.   • Start date – the date the protocol was activated.

9. Using the Clinical Guideline Update, Cont.
 • Stop date – the date the test/exam should be discontinued. You can discontinue a specific test/exam on a per patient basis. If a test/exam is discontinued, it will not be shown.   • Excluded/declined – if the test/exam is excluded or declined, this is where the reason for doing so should be documented. The test/exam will still show as due with the following exceptions:   If breast exam and mammograms are excluded due to a bilateral mastectomy, these items will not be shown as due.   If colon cancer screening (FOBT, sigmoidoscopy, or colonoscopy) are excluded due to a total colectomy, these items will not be shown as due.
• Last addressed – can be used to document that the test/exam has been completed by entering the date that the test/exam was completed.   **It is recommended that users not modify the Next Due date. The Next Due date is automatically calculated when a new encounter is created using the Interval and the Last Completed date.

10. Deleting vs. Excluding Guidelines
Individual items cannot be deleted, but can be excluded.
To exclude or decline a test/exam, select the Excluded/declined check box .
Select the reason for exclusion or decline from the Reason picklist that will automatically open to document medical, patient, or system.
Make a selection to document a reason detail from the second picklist that appears, or select the top blank line in the picklist in order to manually type in the reason using free text.
Medical reasons:
allergic reaction
contraindicated
not indicated at this time
preference
previously ineffective
Patient reasons:
financial
refused
religious
social
System reasons:
equipment malfunction
equipment not available
medication not available
** Note that some items will also have diagnosis or procedure and allergy to select from. **

11. Deleting a Protocol Set
We have the ability to delete a protocol set. For example, you have added a protocol set by mistake and want to delete it and all the associated items/tests.
To delete a Protocol Set:
Highlight the protocol you want to delete
Click on the Delete button. 1 2
Individual items cannot be deleted. For example, Lipid cannot be deleted from Health Maintenance. Individual items should be excluded (see page 9) so that there is a record in the chart why the item/test is not being monitored