1. EHR Reminders - Copying and Customizing National Reminders LCDR Susan Pierce-Richards, MSN, ARNP

2. Introduction National Reminder logic is based on the default logic in the Health Maintenance Reminders (HMR). Like the HMR, the logic can be customized for your site. National Reminders cannot be edited but may be copied as a Local Reminder. Local Reminders MAY be edited. If you still display the HMR on the Health Summary, consider making the same logic changes so the Clinical (EHR) Reminders and HMR display the same information.

3. Objectives At the end of this presentation, the CAC will be able to: Copy a National Reminder to a local name Make basic changes to the reminder logic for use at the local site –Change age in baseline frequency age range set –Change reminder frequency and effective period in a reminder finding –Change the condition of a refusal finding –Change how far back to look for a diagnosis in a cohort –Add refusal finding to a reminder

4. Overview You will need to copy the National Reminder. Use consistent naming conventions Examples: –Change prefix to local site (Yak-Mammogram) –Append name (IHS-Mammogram_Yakama) You will need to change any text to reflect the logic changes You can link the National Reminder to your local dialog

5. Scenario 1 – Mammogram Reminder National Reminder logic: –Due yearly for women 50-70 years of age who do not have a history of a bilateral mastectomy –Refusal turns off reminder for 1 year Your Medical Staff wants the Mammogram reminder to: –Begin at 40 years of age –Refusal to turn off Reminder only for 1 day so other clinicians can encourage patient to have service done

6. Script for Mammogram COPY National Reminder YAKAMA HEALTH CENTER IHS RPMS-EHR Management Version 1.1 Reminder Configuration CFM Reminder Computed Finding Management... DEF Reminder Definition Management... DLG Reminder Dialog Management... EXC Reminder Exchange INF Reminder Information Only Menu... PAR Reminder Parameters... RPT Reminder Reports... SPO Reminder Sponsor Management... TAX Reminder Taxonomy Management... TRM Reminder Term Management... TST Reminder Test YAKAMA HEALTH CENTER IHS RPMS-EHR Management Version 1.1 Reminder Definition Management CPY Copy Reminder Definition EDT Add/Edit Reminder Definition INQ Inquire about Reminder Definition LST List Reminder Definitions

7. Select the reminder item to copy: IHS-MAMMOGRAM 2007 NATIONAL PLEASE ENTER A UNIQUE NAME: YAK-MAMMOGRAM 2007 The original reminder IHS-MAMMOGRAM 2007 has been copied into YAK- MAMMOGRAM 2007 Do you want to edit it now? y YES Select one of the following A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web Addresses Select section to edit: a All reminder details

8. NAME: YAK-MAMMOGRAM 2007// PRINT NAME: Mammogram// CLASS: LOCAL// SPONSOR: REVIEW DATE: USAGE: *// RELATED REMINDER GUIDELINE: INACTIVE FLAG: REMINDER DESCRIPTION: Females 50 to 70 should have yearly mammograms. Mammograms are found by CPT code, radiology exam or from the women's health pack age ==[ 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 <=======T=======T=======T=======T=======T=======T=======T=======T=======T TECHNICAL DESCRIPTION: No existing text Edit? NO// Change the age in description to 40 to 70

9. PRIORITY: Baseline Frequency DO IN ADVANCE TIME FRAME: 3M// SEX SPECIFIC: FEMALE// IGNORE ON N/A: Baseline frequency age range set Select REMINDER FREQUENCY: 1Y// REMINDER FREQUENCY: 1Y// MINIMUM AGE: 50Y//40Y MAXIMUM AGE: 70Y// AGE MATCH TEXT: No existing text Edit? NO// AGE NO MATCH TEXT: No existing text Edit? NO// Select REMINDER FREQUENCY: Enter new Min Age of 40Y

10. Findings Choose from: CF IHS-MAMMOGRAM REF MAMMOGRAM RT IHS-MAMMOGRAM TERMS TX IHS-BILATERAL MASTECTOMY TX IHS-MAMMOGRAM 2007 Select FINDING: ref.ma Searching for a REFUSAL TYPE, (pointed-to by FINDING ITEM) MAMMOGRAM...OK? Yes// y (Yes) FINDING ITEM: MAMMOGRAM// MINIMUM AGE: MAXIMUM AGE: REMINDER FREQUENCY: 1D RANK FREQUENCY: USE IN RESOLUTION LOGIC: OR// USE IN PATIENT COHORT LOGIC: EFFECTIVE PERIOD: 1Y// 1D EFFECTIVE DATE: CONDITION: I V="MAMMOGRAM"//I V=“MAMMOGRAM BILAT” CONDITION CASE SENSITIVE: FOUND TEXT: No existing text Edit? NO// NOT FOUND TEXT: No existing text Edit? NO// Change this to 1 day so the reminder is due again tomorrow if refused Refusals must point to local term Edit if needed (see next page – look at Health Summary to see local term) Change this to 1 day so refusal expires tomorrow

11. Health Summary Display of Refusal ---------------- PATIENT REFUSALS FOR SERVICE (max 2 years) ---------------- Sep 08, 2008 MAMMOGRAM BILAT (MAMMOGRAM) Refusal Type: REFUSED SERVICE This is local term to use for condition

12. Select REMINDER FREQUENCY: Findings Choose from: CF IHS-MAMMOGRAM REF MAMMOGRAM RT IHS-MAMMOGRAM TERMS TX IHS-BILATERAL MASTECTOMY TX IHS-MAMMOGRAM 2007 Select FINDING: Patient Cohort and Resolution Logic CUSTOMIZED PATIENT COHORT LOGIC (OPTIONAL): GENERAL PATIENT COHORT FOUND TEXT: Patient is in age (50 to 70) for yearly mammograms unless bilateral mastectomy Edit? NO// YES ==[ WRAP ]==[ INSERT ]=== ==[ H=Help ]==== Patient is in age (40 to 70) for yearly mammograms unless bilateral mastectomy == Change the age in description to 40 to 70

13. GENERAL RESOLUTION FOUND TEXT: No existing text Edit? NO// GENERAL RESOLUTION NOT FOUND TEXT: Mammogram results have not been found in the computer Edit? NO// Reminder Dialog LINKED REMINDER DIALOG: IHS-MAMMOGRAM 2007// Web Addresses for Reminder Information Select URL: It is still linked to the national dialog. If you wanted to link it to your own, you could change this here

14. Now you are done editing the reminder. Now go to your Cover Sheet, remove the National and add the Local Reminder

15. Local Mammogram Reminder display Now you can see the service was refused, but the reminder stays due

16. TEST…TEST…TEST…TEST…TEST

17. Scenario 2 – DM HGB A1C Reminder National Reminder logic: –Due yearly patients with a visit diagnosis of Diabetes or problem list entry in the past 2 years Your Medical Staff wants the DM HGBA1C reminder to be applicable for patients who have EVER had a diabetes diagnosis

18. Script for DM HBGA1C COPY National Reminder Select Reminder Definition Management Option: rc Copy Reminder Definition Select the reminder item to copy: IHS-DIAB HGBA1C 2007 PLEASE ENTER A UNIQUE NAME: YAK-DIAB HGBA1C 2007 The original reminder IHS-DIAB HGBA1C 2007 has been copied into YAK-DIAB HGBA1C2007. Do you want to edit it now? y YES

19. Select one of the following: A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web Addresses Select section to edit: f Findings Findings Choose from: RT IHS-HGBA1C TX IHS-DIABETES DX 2007 Select FINDING: tx.ihs-dia Searching for a REMINDER TAXONOMY, (pointed-to by FINDING ITEM) IHS-DIABETES DX 2007 LOCAL...OK? Yes// y (Yes)

20. FINDING ITEM: IHS-DIABETES DX 2007// MINIMUM AGE: MAXIMUM AGE: REMINDER FREQUENCY: RANK FREQUENCY: USE IN RESOLUTION LOGIC: USE IN PATIENT COHORT LOGIC: AND// EFFECTIVE PERIOD: 2Y// @ SURE YOU WANT TO DELETE? y (Yes) EFFECTIVE DATE: USE INACTIVE PROBLEMS: CONDITION: CONDITION CASE SENSITIVE: FOUND TEXT: Edit? NO// NOT FOUND TEXT: No existing text Edit? NO// The effective period tells the reminder how long the finding is valid. If blank, the reminder looks at ALL available data. So if you wanted to patients with dx in past 5 years, put 5Y here.

21. Now go into the Reminders Cover sheet Remove IHS-DIAB HGBA1C 2007 Add YAK-DIAB HGBA1C 2007 (the local one you just made) TEST…TEST…TEST…TEST…TEST

22. Scenario 3 – DM Dental Exam Reminder National Reminder logic: –Due yearly patients with diabetes Your Medical Staff wants the DM Dental reminder to: –Turn off for 1 year if refusal documented

23. Script for DM Dental Exam Find exact term for “condition” Enter a refusal for Dental Exam on a Test Patient Look at the Health Summary ---------------- PATIENT REFUSALS FOR SERVICE (max 2 years) ------------- Sep 08, 2008 DENTAL EXAM (EXAM) Refusal Type: REFUSED SERVICE Here is the term you will use for “condition”

24. COPY National Reminder Select Reminder Definition Management Option: rc Copy Reminder Definition Select the reminder item to copy: IHS-DIAB DENTAL EXAM 2007 NATIONAL PLEASE ENTER A UNIQUE NAME: YAK-DIAB DENTAL EXAM 2007 The original reminder IHS-DIAB DENTAL EXAM 2007 has been copied into YAK-DIAB DE NTAL EXAM 2007. Do you want to edit it now? y YES Select one of the following: A All reminder details G General B Baseline Frequency F Findings L Logic D Reminder Dialog W Web Addresses Select section to edit: f Findings Findings Choose from: CF IHS-DENTAL EX DENTAL EXAM TX IHS-DENTAL CODE TX IHS-DIABETES DX 2007

25. Select FINDING: REF.EXAM Searching for a REFUSAL TYPE, (pointed-to by FINDING ITEM) Searching for a REFUSAL TYPE EXAM...OK? Yes// y (Yes) Are you adding 'EXAM' as a new FINDINGS (the 5TH for this REMINDER DEFINITION) ? No// y (Yes) FINDING ITEM: EXAM// MINIMUM AGE: MAXIMUM AGE: REMINDER FREQUENCY: RANK FREQUENCY: USE IN RESOLUTION LOGIC: OR 1 OR 2 OR NOT Choose 1-2: 1 OR USE IN PATIENT COHORT LOGIC: EFFECTIVE PERIOD: 1Y EFFECTIVE DATE: CONDITION: I V="DENTAL EXAM" CONDITION CASE SENSITIVE: FOUND TEXT: No existing text Edit? NO// NOT FOUND TEXT: No existing text Edit? NO// Findings Enter the item exactly as displayed on Refusal section on health summary (prior slide)

26. Now go into the Reminders Cover sheet Remove IHS-DIAB DENTAL EXAM 2007 Add YAK-DIAB DENTAL EXAM 2007 (the local one you just made) TEST…TEST…TEST…TEST…TEST

27. Reminder is now turned off for 1 year if refusal is documented

28. 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/