1. 1 Interdisciplinary Notes Setup Patricia Mauseth Margy McClenahan Jeanie Scott

2. 2 ID Notes Team  Pat Mauseth—TIU Project Manager  Margy McClenahan—ID Notes Developer  Rich Vertigan—GUI Developer  Joel Russell—Lead TIU Developer  Robin Ostrander—TIU Developer  Jean Krieg—TIU Developer  Ruth Markham—Functional Analyst  Sue Gohlinghorst—Functional Analyst  Charles Arceneaux—Technical Writer  Jeanie Scott—Release Manager  Sheri Kreuz—Release Manager

3. 3 Topics  Titles  User Classes  Business Rules  TIU Document Parameters  Example Interdisciplinary Note  Business Rule Context  Additional Considerations  Implementation Issues

4. 4 Titles  Overview  Nomenclature

5. 5 Titles: Overview—Sample note  ENTRY TITLE: REHAB TREATMENT PLAN  DATE OF NOTE: JAN 31,2001@08:32  ENTRY DATE: JAN 31,2001@08:32:46  AUTHOR:...   ENTRY TITLE: REHAB INITIAL ASSESSMENT NOTE  DATE OF NOTE: JAN 31,2001@09:10  ENTRY DATE: JAN 31,2001@09:16  AUTHOR: Dr. Whatshisname...   ENTRY TITLE: REHAB NURSE NOTE  DATE OF NOTE: JAN 31,2001@10:39:57  ENTRY DATE: JAN 31,2001@10:47:49  AUTHOR: Nurse Smith...   ENTRY TITLE: REHAB PHYSICAL THERAPY NOTE  DATE OF NOTE: JAN 23,2001@11:00  ENTRY DATE: JAN 23,2001@11:22  AUTHOR: Physical Therapist...   ENTRY TITLE: REHAB OCCUPATIONAL THERAPY NOTE  DATE OF NOTE: JAN 31,2001@15:14  ENTRY DATE: JAN 31,2001@15:37  AUTHOR: A Therapist... 

6. 6 Titles: Nomenclature  Note:  Decide on a nomenclature prior to implementation and remain consistent throughout the facility.

7. 7 Titles: Nomenclature  Our Example:  REHAB Parent Treatment Plan  REHAB Child Initial Assessment Note  REHAB Child Nurse Note  REHAB Child Physical Therapy Note  REHAB Child Occupational Therapy Note  REHAB Child Pharmacy Note  REHAB Child Psychology Note  REHAB Child Discharge Planning Note

8. 8 Titles: Nomenclature  Other possible terms for parent titles:  ER Cover Note  Discharge Planning Cover Note  ER ID Parent Note  Rehab IDP Note  Pain Clinic IN Parent Note  Rehab Routing Note  Mental Health Team Note  Same-day Surgery Team Note  End-of-Life Team Note  Choose one term

9. 9 Titles: Create a new Parent Title   Create Document Definitions Apr 12, 2001@10:27:55 Page: 1 of 1  BASICS   + Name Type  2 PROGRESS NOTES CL  3 REHAB SERVICE DC  4 REHAB PARENT TREATMENT PLAN TL   ?Help >ScrollRight PS/PL PrintScrn/List +/- >>>  (Class/DocumentClass) Next Level Detailed Display/Edit  Title Restart Status...  (Component) Boilerplate Text Delete  Select Action: Title// 

10. 10 Titles: Create new Child Titles   Create Document Definitions Apr 12, 2001@10:27:55 Page: 1 of 1  BASICS   + Name Type  2 PROGRESS NOTES CL  3 INTERDISC CHILD DOCUMENT DC  4 REHAB CHILD DISCHARGE PLANNING NOTE TL  5 REHAB CHILD INITIAL ASSESSMENT NOTE TL  6 REHAB CHILD NURSE NOTE TL  7 REHAB CHILD OCCUPATIONAL THERAPY NOTE TL  8 REHAB CHILD PHARMACY NOTE TL  9 REHAB CHILD PHYSICAL THERAPY NOTE TL  10 REHAB CHILD PSYCHOLOGY NOTE TL   ?Help >ScrollRight PS/PL PrintScrn/List +/- >>>  (Class/DocumentClass) Next Level Detailed Display/Edit  Title Restart Status...  (Component) Boilerplate Text Delete  Select Action: Title// 

11. 11 User Classes  REHAB TEAM MEMBER  CHIEF, MIS  IN MANAGEMENT TEAM

12. 12 Business Rules  New Actions  Parent Business Rules  Child Business Rules  New role: COMPLETER

13. 13 New Actions Find Edit Rule Change View Add Rule Delete Rule Quit Select Action: Next Screen// AD Add Rule Please Enter a New Business Rule: Select DOCUMENT DEFINITION: REHAB PARENT TREATMENT PLAN// TITLE DOCUMENT DEFINITION: REHAB PARENT TREATMENT PLAN// STATUS: COMPLETED ACTION: ATT 1 ATTACH ID ENTRY Rule applies to interdisciplinary PARENT notes 2 ATTACH TO ID NOTE Rule applies to individual ID CHILD entries CHOOSE 1-2: 1 ATTACH ID ENTRY Rule applies to interdisciplinary PARENT notes This rule authorizes users to ATTACH AN ID ENTRY TO a note of type: REHAB PARENT TREATMENT PLAN. WARNING: Notes used as ID PARENTS may NOT be used as ID children. Rules such as this one which permit notes to be ID PARENTS OVERRIDE any existing rules permitting them to be children.... A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER

14. 14 New Actions  Attach and detach are symmetrical: If you can attach, you can detach.

15. 15 Parent Business Rules  Basics  Parent Business Rules for Managers

16. 16 Parent Business Rules: Basics A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER

17. 17 Parent Business Rules: Basics A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER

18. 18 Parent Business Rules for Managers A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS An AMENDED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS

19. 19 Parent Business Rules for Managers A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM An AMENDED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM

20. 20 Child Business Rules  Basics  Unsigned Child Notes  Child Business Rules for Managers

21. 21 Child Business Rules: Basics A COMPLETED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a COMPLETER

22. 22 Child Business Rules: Basics An COMPLETED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an AUTHOR/DICTATOR An UNCOSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an EXPECTED COSIGNER An UNCOSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an AUTHOR/DICTATOR

23. 23 Child Business Rules: Basics NOTE: Child business rules must be created for each required combination of note status and user role.

24. 24 Child Business Rules: Unsigned Child Notes We do not recommend permitting users to attach unsigned notes to Interdisciplinary Notes.

25. 25 Child Business Rules: Unsigned Child Notes If you do not write a business rule specifically allowing the attachment of unsigned child notes, then users cannot attach pre-existing unsigned notes.

26. 26 Child Business Rules: Unsigned Child Notes But, it can happen by: In the CPRS GUI Notes tab, you select a parent title. Next you select the menu action Add New Entry to ID Note. Then you select a title and start writing the note. Finally, the process is interrupted and the note is saved without a signature. In this case, the new note remains attached even though it is not signed.

27. 27 Child Business Rules: For Managers A COMPLETED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS An UNCOSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS An AMENDED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS An UNSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS

28. 28 Child Business Rules: For Managers A COMPLETED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM An UNCOSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM An AMENDED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM An UNSIGNED (TITLE) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM

29. 29 TIU Document Parameters  ORDER ID ENTRIES BY TITLE  SEND ALERTS ON NEW ID ENTRY These parameters apply only to Interdisciplinary parent titles.

30. 30 TIU Document Parameters ORDER ID ENTRIES BY TITLE Lists child notes alphabetically by title. By default, child notes are listed by date of note.

31. 31 TIU Document Parameters SEND ALERTS ON NEW ID ENTRY Allows originator to review additions to the Interdisciplinary Note. By default, alerts are not sent.

32. 32 Example Interdisciplinary Note  Parent Title Hierarchy  Parent Business Rules  Child Title Hierarchy  Child Business Rules  Parameter Settings  Summary

33. 33 Example Interdisciplinary Note: Parent Title Hierarchy   Create Document Definitions Apr 12, 2001@10:27:55 Page: 1 of 1  BASICS   + Name Type  2 PROGRESS NOTES CL  3 REHAB SERVICE DC  4 REHAB PARENT TREATMENT PLAN TL   ?Help >ScrollRight PS/PL PrintScrn/List +/- >>>  (Class/DocumentClass) Next Level Detailed Display/Edit  Title Restart Status...  (Component) Boilerplate Text Delete  Select Action: Title// 

34. 34 Example Interdisciplinary Note Parent Business Rules ASU Rule Browser Apr 12, 2001@10:46:59 Page: 1 of 2 List Business Rules by DOCUMENT DEFINITION 9 Rules for TITLE REHAB PARENT TREATMENT PLAN _ 1 A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER 2 An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a REHAB TEAM MEMBER 3 A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS 4 An AMENDED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS 5 An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by a CHIEF, MIS

35. 35 Example Interdisciplinary Note Parent Business Rules (cont.) 6 A COMPLETED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM 7 An AMENDED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM 8 An UNCOSIGNED (TITLE) REHAB PARENT TREATMENT PLAN may BE GIVEN AN ID ATTACHMENT by an IN MANAGEMENT TEAM + + Next Screen - Prev Screen ?? More Actions Find Edit Rule Change View Add Rule Delete Rule Quit Select Action: Next Screen//

36. 36 Example Interdisciplinary Note Child Title Hierarchy   Create Document Definitions Apr 12, 2001@10:27:55 Page: 1 of 1  BASICS   + Name Type  2 PROGRESS NOTES CL  3 INTERDISC CHILD DOCUMENT DC  4 REHAB CHILD DISCHARGE PLANNING NOTE TL  5 REHAB CHILD INITIAL ASSESSMENT NOTE TL  6 REHAB CHILD NURSE NOTE TL  7 REHAB CHILD OCCUPATIONAL THERAPY NOTE TL  8 REHAB CHILD PHARMACY NOTE TL  9 REHAB CHILD PHYSICAL THERAPY NOTE TL  10 REHAB CHILD PSYCHOLOGY NOTE TL   ?Help >ScrollRight PS/PL PrintScrn/List +/- >>>  (Class/DocumentClass) Next Level Detailed Display/Edit  Title Restart Status...  (Component) Boilerplate Text Delete  Select Action: Title// 

37. 37 Example Interdisciplinary Note: Child Business Rules ASU Rule Browser Apr 12, 2001@12:48:02 Page: 1 of 2 List Business Rules by DOCUMENT DEFINITION 12 Rules for DOCUMENT CLASS INTERDISC CHILD DOCUMENT _ 1 A COMPLETED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a COMPLETER 2 A COMPLETED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an AUTHOR/DICTATOR 3 An UNCOSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an EXPECTED COSIGNER 4 An UNCOSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a AUTHOR/DICTATOR 5 A COMPLETED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS 6 An UNCOSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS

38. 38 Example Interdisciplinary Note: Child Business Rules (cont.) 7 An AMENDED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS 8 An UNSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a CHIEF, MIS 9 A COMPLETED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM 10 An UNCOSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM 11 An AMENDED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM 12 An UNSIGNED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by an IN MANAGEMENT TEAM + + Next Screen - Prev Screen ?? More Actions Find Edit Rule Change View Add Rule Delete Rule Quit Select Action: Next Screen//

39. 39 Example Interdisciplinary Note: Parameter Settings Select TIU Parameters Menu Option: ? 1 Basic TIU Parameters 2 Modify Upload Parameters 3 Document Parameter Edit 4 Progress Notes Batch Print Locations 5 Division - Progress Notes Print Params Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text. Select TIU Parameters Menu Option: 3 Document Parameter Edit First edit Institution-wide parameters: Select DOCUMENT DEFINITION: REHAB PARENT TREATMENT PLAN TITLE Are you adding 'REHAB PARENT TREATMENT PLAN' as a new TIU DOCUMENT PARAMETERS (the 34TH)? No// Y (Yes) DOCUMENT DEFINITION: REHAB PARENT TREATMENT PLAN//

40. 40 Example Interdisciplinary Note: Parameter Settings (cont.) REQUIRE RELEASE: REQUIRE MAS VERIFICATION: REQUIRE AUTHOR TO SIGN: Y YES ROUTINE PRINT EVENT(S): STAT PRINT EVENT(S): MANUAL PRINT AFTER ENTRY: ALLOW CHART PRINT OUTSIDE MAS: ALLOW >1 RECORDS PER VISIT: Y YES ENABLE IRT INTERFACE: SUPPRESS DX/CPT ON ENTRY: n NO FORCE RESPONSE TO EXPOSURES: ASK DX/CPT ON ALL OPT VISITS: SEND ALERTS ON ADDENDA: ORDER ID ENTRIES BY TITLE: SEND ALERTS ON NEW ID ENTRY: Y YES EDITOR SET-UP CODE:

41. 41 Example Interdisciplinary Note: Parameter Settings (cont.) If document is to be uploaded, specify Filing Alert Recipients: Select FILING ERROR ALERT RECIPIENTS: Now enter the USER CLASSES for which cosignature will be required: Select USERS REQUIRING COSIGNATURE: Now enter the DIVISIONAL parameters: Select DIVISION: Select TIU Parameters Menu Option:

42. 42 Example Interdisciplinary Note: Summary 1.Select one Interdisciplinary Note to implement. 2.Decide on a nomenclature to use for parent/child titles. 3.Create new titles. 4.Create new user classes (if necessary). 5.Create new Interdisciplinary Note business rules. 6.Set parameters if needed.

43. 43 Business Rule Context:  Parent ID notes must have the status of at least uncosigned in order to receive children.  Child ID notes must have status at least unsigned in order to be attached to parent notes.  CWADs, Discharge Summaries, and Consults may not be ID parents or children.

44. 44 Business Rule Context:  Child ID Notes may be detached only by those users who may ATTACH them.  If a title has rules permitting it to be an ID parent, any existing child rules for that title are overruled.  The software rules out actions which would result in ID grandchildren.

45. 45 Additional Considerations  Mandatory Business Rule  Not Recommended:  Single Interdisciplinary Document Class  Using class USER  Writing Rules for Class Progress Notes  Using Existing Titles  Parameter Settings

46. 46 Additional Considerations: Mandatory Business Rule A COMPLETED (DOCUMENT CLASS) INTERDISC CHILD DOCUMENT may BE ATTACHED to an ID note by a COMPLETER  This rule enables TIU to properly list Interdisciplinary Note titles when creating a child note. Additional child business rules for document status, user class, and/or user role are created using a site’s discretion.

47. 47 Not Recommended: Single Interdisciplinary Document Class What if you created one document class for all Interdisciplinary Note titles?  If rules permit a title to be both a parent and a child, the parent rule takes precedence. Therefore, keep your child titles in a separate document class from your parent titles.

48. 48 Not Recommended: Using class USER What if you wrote parent rules for the user class USER?  If you create rules with the user class USER, then anyone with access to TIU can create and attach entries. This may lead to erroneous attachments. Therefore, create rules restricting Interdisciplinary Note privileges to users from the service areas involved.

49. 49 Not Recommended: Writing Rules for Class Progress Notes What if you wrote child rules for Class Progress Notes?  This would enable any Progress Note to be an interdisciplinary entry. In such a case, there would be no way to distinguish unattached interdisciplinary children from other notes. Therefore, create a document class for child titles and write the child rules for that document class.

50. 50 Not Recommended: Using Existing Titles What if you have existing titles you are using to simulate Interdisciplinary Notes?  Do not use these titles as Interdisciplinary Note titles. It will result in the existing titles having new behaviors.

51. 51 Parameter Settings  ORDER ID ENTRIES BY TITLE  SEND ALERTS ON NEW ID ENTRY  The parameters are set at the document definition level. The parameters may be set at the Progress Notes class level.  Users cannot disable the alert or individually change the sort order of child titles.

52. 52 Implementation Issues  Terminology  List Manager vs. CPRS GUI  Quality Assurance

53. 53 Implementation Issues:  Terminology  Parent vs. child – suggests a primary and secondary status. Washington VAMC created the terms of “team” and “team member” to represent parent and child entries.  ID Note – suggests Infectious Disease title. IDN or IN may be used as alternate abbreviations.

54. 54 Implementation Issues:  TIU List Manager vs. CPRS GUI  CPRS List Manager & CPRS GUI v14 provide limited Interdisciplinary Note functionality.  CPRS GUI v15 executable supports complete functionality. Interdisciplinary notes are easily created using drag and drop, right click or action menu.  TIU List Manager also provides complete Interdisciplinary Note functionality.

55. 55 Implementation Issues:  Quality Assurance of Interdisciplinary notes  Business rules regulate action of a title for use as an interdisciplinary entry (parent or child).  No fields exist in 8925.1 to distinguish an Interdisciplinary title from another title.  E3Rs

56. 56 Questions & Answers Thank you for your attention— from the TIU Interdisciplinary Notes Team.