1. How to Make a Reminder

2. Start with the Pieces Who is this reminder for? –Sex related? –Age related? –Disease related? How often should this reminder be due? –One time only? –Every time patient is seen?

3. Pieces of a Reminder What will turn this reminder off? –One type of item – a particular lab test –Multiple types of the same item –many different lab tests –Multiple types of different items – lab tests or CPT codes or education codes –Is this data already available as a reminder type or do you need a computed finding?

4. Create the Pieces - Taxonomies If you need a COHORT of diseases for a reminder If you need ICD9, ICD0 or CPT codes to resolve a reminder

5. Create the Pieces – Reminder Terms Multiple similar items satisfy the reminder – tobacco health factors Reminder logic would become if A or B or C or D or E or F How can you add a new one if it’s a national reminder? Put them into reminder terms. The first one found satisfies the reminder

6. Create the Pieces – Reminder Terms DR.EntryName to select a DRUG ED.EntryName to select a EDUCATION TOPIC EX.EntryName to select a EXAM HF.EntryName to select a HEALTH FACTOR IM.EntryName to select a IMMUNIZATION LT.EntryName to select a LABORATORY TEST MT.EntryName to select a MEASUREMENT TYPE OI.EntryName to select a ORDERABLE ITEM RP.EntryName to select a RADIOLOGY PROCEDURE CF.EntryName to select a REMINDER COMPUTED FINDING TX.EntryName to select a REMINDER TAXONOMY ST.EntryName to select a SKIN TEST DC.EntryName to select a VA DRUG CLASS DG.EntryName to select a VA GENERIC VM.EntryName to select a VITAL MEASUREMENT VA only, do not use MT.EntryName to select a MEASUREMENT TYPE

7. Reminder to Create Diabetes Screening Done every 2 years on pts over 40 Exclude those with DX of diabetes Done yearly on those pts with pre-diabetes Resulted by glucose lab tests or GTT

8. Taxonomies Need Taxonomy for Diabetes In the Taxonomy menu, choose Edit Taxonomy Item PXRM Tax Mngt Menu TL List Taxonomy Definitions TI Inquire about Taxonomy Item TE Edit Taxonomy Item TC Copy Taxonomy Item BEHORM Tax Mngt Menu CPY Copy Taxonomy Item EDT Edit Taxonomy Item INQ Inquire about Taxonomy Item

9. Taxonomy – Diabetes Codes Select Reminder Taxonomy: DEMO DIABETES Are you adding 'DEMO DIABETES' as a new REMINDER TAXONOMY? No// Y (Yes) REMINDER TAXONOMY BRIEF DESCRIPTION: Diabetes DX REMINDER TAXONOMY CLASS: l LOCAL General Taxonomy Data NAME: DEMO DIABETES//

10. Diabetes Codes SPONSOR: REVIEW DATE: PATIENT DATA SOURCE: ? Answer must be 1-40 characters in length. This is a list of comma separated patient data sources. You may use any combination of valid entries. Valid entries are: IN - inpatient from PTF INDXLS - inpatient DXLS diagnosis only INPR - inpatient primary diagnosis only EN - encounter PCE data ENPR - encounter PCE data primary diagnosis only PL - Problem List RA - radiology CPT only PATIENT DATA SOURCE:EN,PL

11. Diabetes Codes USE INACTIVE PROBLEMS: INACTIVE FLAG: ICD0 Range of Coded Values Select ICD0 LOW CODED VALUE: ICD9 Range of Coded Values Select ICD9 LOW CODED VALUE: 250.00 Are you adding '250.00' as a new ICD9 LOW CODED VALUE (the 1ST for this REMINDER TAXONOMY)? No// Y (Yes) ICD9 HIGH CODED VALUE: 250.90 Select ICD9 LOW CODED VALUE: CPT Range of Coded Values Select CPT LOW CODED VALUE: Input your edit comments. Edit? NO//

12. Taxonomy – Prediabetes Codes Select Reminder Taxonomy: PRE-DIABETES CODES Are you adding 'PRE-DIABETES CODES' as a new REMINDER TAXONOMY? No// Y (Yes) REMINDER TAXONOMY BRIEF DESCRIPTION: Codes for Pre-diabetes REMINDER TAXONOMY CLASS: l LOCAL General Taxonomy Data NAME: PRE-DIABETES CODES// BRIEF DESCRIPTION: Codes for Pre-diabetes Replace CLASS: LOCAL// SPONSOR:

13. Pre-diabetes Codes PATIENT DATA SOURCE: EN,PL USE INACTIVE PROBLEMS: INACTIVE FLAG: ICD0 Range of Coded Values Select ICD0 LOW CODED VALUE: ICD9 Range of Coded Values Select ICD9 LOW CODED VALUE: 790.21 Are you adding '790.21' as a new ICD9 LOW CODED VALUE (the 1ST for this REMINDER TAXONOMY)? No// Y (Yes) ICD9 HIGH CODED VALUE: 790.29 Select ICD9 LOW CODED VALUE: 277.7 Are you adding '277.7' as a new ICD9 LOW CODED VALUE (the 2ND for this REMINDER TAXONOMY)? No// Y (Yes) ICD9 HIGH CODED VALUE: 277.7 Select ICD9 LOW CODED VALUE: CPT Range of Coded Values Select CPT LOW CODED VALUE: Input your edit comments. Edit? NO//

14. Reminder Term- Glucose Tests Most sites have multiple glucose tests to satisfy this reminder Use the Reminder Term Options to create a reminder term BEHORM Term Mngt Menu CPY Copy Reminder Term EDT Reminder Term Edit INQ Inquire about Reminder Term PXRM Term Mngt Menu TL List Reminder Terms TI Inquire about Reminder Term TE Reminder Term Edit TC Copy Reminder Term

15. Glucose Tests Select Reminder Term: GLUCOSE TESTS Are you adding 'GLUCOSE TESTS' as a new REMINDER TERM (the 81ST)? No// Y (Yes) REMINDER TERM CLASS: L LOCAL NAME: GLUCOSE TESTS// CLASS: LOCAL// REVIEW DATE: DESCRIPTION: No existing text Edit? NO//

16. Glucose Tests Select FINDING ITEM: LT.GLUCOSE Searching for a LABORATORY TEST, (pointed-to by FINDING ITEM) Searching for a LABORATORY TEST 1 GLUCOSE GLUCOSE, RANDOM URINE 2 GLUCOSE 3 GLUCOSE FASTING GLUCOSE 4 GLUCOSE FLUID GLUCOSE 5 GLUCOSE 24 HR URINE GLUCOSE Press to see more, '^' to exit this list, OR CHOOSE 1-5: 6 GLUCOSE 2 HR POST PARANDIAL GLUCOSE 7 GLUCOSE BLOOD GLUCOSE 8 GLUCOSE-6-PHOS DEHYDROGENASE GLUCOSE-6-PHOS DEHYDROGENASE retired 9 GLUCOSE-6-PHOSPHATE DEHYDROGENASE (2000)

17. Glucose Tests CHOOSE 1-5: 1 GLUCOSE, RANDOM URINE Are you adding 'GLUCOSE, RANDOM URINE' as a new FINDINGS (the 1ST for this REMINDER TERM)? No// Y (Yes) EFFECTIVE PERIOD: USE INACTIVE PROBLEMS: WITHIN CATEGORY RANK: EFFECTIVE DATE: MH SCALE: CONDITION: CONDITION CASE SENSITIVE: RX TYPE:

18. Repeat adding all the glucose tests. What about GTT tests? Use the resources of your lab What happens if the lab changes tests?

19. Put the reminder together Menu is Reminder Definition Menu RE is the choice to make a new reminder National reminders must be copied and edited Inactivate old reminders BEHORM Reminder Def Mngt CPY Copy Reminder Definition EDT Add/Edit Reminder Definition INQ Inquire about Reminder Definition LST List Reminder Definitions PXRM Reminder Def Mngt RL List Reminder Definitions RI Inquire about Reminder Definition RE Add/Edit Reminder Definition RC Copy Reminder Definitio RA Activate/Inactivate Reminders

20. Basic Fields Select Reminder Definition: DIABETES SCREEN Are you adding 'DIABETES SCREEN' as a new REMINDER DEFINITION? No// Y (Yes) REMINDER DEFINITION CLASS: L LOCAL NAME: DIABETES SCREEN// PRINT NAME: Diabetes Screen CLASS: LOCAL// SPONSOR: REVIEW DATE:

21. Basic Fields USAGE: ?? The USAGE field describes how the reminder definition will be used. This field must contain C if the reminder is to be selected in CPRS. This is free text field and can contain any combination of the following codes: Code Usage C CPRS R Reminder Reports X Reminder Extracts * All of the above

22. Basic Fields RELATED REMINDER GUIDELINE: INACTIVE FLAG: REMINDER DESCRIPTION: No existing text Edit? NO// TECHNICAL DESCRIPTION: No existing text Edit? NO// PRIORITY: ? Enter the reminder priority. Choose from: 1 HIGH 2 MEDIUM 3 LOW PRIORITY:

23. Reminder - Frequency Baseline Frequency DO IN ADVANCE TIME FRAME: 3m SEX SPECIFIC: IGNORE ON N/A: Baseline frequency age range set Select REMINDER FREQUENCY: 2Y Are you adding '2Y' as a new REMINDER FREQUENCY (the 1ST for this REMINDER DEFINITION)? No// Y (Yes) MINIMUM AGE:40Y MAXIMUM AGE:110Y AGE MATCH TEXT: Patient is in range to be screened for diabetes Edit? NO// AGE NO MATCH TEXT: No existing text Edit? NO// Select REMINDER FREQUENCY:

24. Findings -1 Reminder has no findings Select FINDING: TX.DIAB Searching for a REMINDER TAXONOMY, (pointed-to by FINDING ITEM) Searching for a REMINDER TAXONOMY DIABETES DX Codes for diabetes LOCAL...OK? Yes// Y (Yes) Are you adding 'DIABETES DX' as a new FINDINGS (the 1ST for this REMINDER DEFINITION)? No// Y (Yes) FINDING ITEM: DIABETES DX// MINIMUM AGE: MAXIMUM AGE: REMINDER FREQUENCY: RANK FREQUENCY: USE IN RESOLUTION LOGIC: USE IN PATIENT COHORT LOGIC: AND 1 AND 2 AND NOT Choose 1-2: 1 AND EFFECTIVE PERIOD: 2Y EFFECTIVE DATE:

25. Findings 1 USE INACTIVE PROBLEMS: CONDITION: CONDITION CASE SENSITIVE: FOUND TEXT: Patient has diabetes and does not need to be screened Edit? NO// NOT FOUND TEXT: No existing text Edit? NO//

26. Findings 2 Are you adding 'PRE-DIABETES CODES' as a new FINDINGS (the 2ND for this REMINDER DEFINITION)? No// Y(Yes) FINDING ITEM: PRE-DIABETES CODES// MINIMUM AGE: MAXIMUM AGE: REMINDER FREQUENCY: 1Y RANK FREQUENCY: USE IN RESOLUTION LOGIC: USE IN PATIENT COHORT LOGIC: AND 1 OR 2 OR NOT Choose 1-2: 1 OR EFFECTIVE PERIOD: EFFECTIVE DATE: USE INACTIVE PROBLEMS: CONDITION: CONDITION CASE SENSITIVE:

27. Findings 2 FOUND TEXT: Patient has pre-diabetes and should be screened yearly Edit? NO// NOT FOUND TEXT: No existing text Edit? NO// Findings Choose from: TX DIABETES DX TX PRE-DIABETES CODES Select FINDING:

28. Findings 3 Select FINDING: RT.GLUCOSE TESTS Searching for a REMINDER TERM, (pointed-to by FINDING ITEM) Searching for a REMINDER TERM GLUCOSE TESTS LOCAL...OK? Yes// Y (Yes) Are you adding 'GLUCOSE TESTS' as a new FINDINGS (the 3RD for this REMINDER DEFINITION)? No// Y (Yes) FINDING ITEM: GLUCOSE TESTS// 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:

29. Conditions CONDITION: Drug None Education Topic Level of understanding I V=3 Exam Result I V="N" Health Factor Level/severity I V="H" Immunization IHS doesn’t use Laboratory Test Result Value I V>130 Mental Health Instrument IHS doesn’t use this function Orderable Item Status I V="complete" Radiology Procedure None Reminder Taxonomy None Skin Test Result I V="N“ VA Drug Class None VA Generic None Vital Measurement Rate I V>27

30. Findings 3 CONDITION CASE SENSITIVE: FOUND TEXT: Glucose Screening test was found Edit? NO// NOT FOUND TEXT: Glucose screening test was not found. Patients should be screened every 1-2 years for diabetes Edit? NO// Findings Choose from: RT GLUCOSE TESTS TX DIABETES DX TX PRE-DIABETES CODES Select FINDING:

31. Logic Cohort AGE AND NOT DIABETES OR PRE- DIABETES Resolution GLUCOSE TEST

32. Finishing Touches Patient Cohort and Resolution Logic CUSTOMIZED PATIENT COHORT LOGIC (OPTIONAL): GENERAL PATIENT COHORT FOUND TEXT: Patient should be screened for diabetes Edit? NO// GENERAL PATIENT COHORT NOT FOUND TEXT: No existing text Edit? NO// CUSTOMIZED RESOLUTION LOGIC (OPTIONAL): GENERAL RESOLUTION FOUND TEXT: No existing text Edit? NO// GENERAL RESOLUTION NOT FOUND TEXT: No glucose test was found in the computer in the past year Edit? NO// Reminder Dialog LINKED REMINDER DIALOG: Web Addresses for Reminder Information Select URL:

33. A word about found/not found text There is found/not found text for: Findings General Cohort General Resolution This is the text that returns to your Clinical Maintenance box. Be VERY careful what you put where. Look at all scenarios with your reminders to make sure that the returned text makes sense in all circumstances (users may look at this when the reminder is due, not due AND when not applicable) Consider just using general cohort found/not found with a good solid description of what should/should not be there. Too much returned text can be very confusing. Other sections of text make sense when used very judiciously.