1. National Reminders- Mammogram

2. Introduction The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at your site. This will put all the national reminders into the Reminder Exchange file. The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at your site. This will put all the national reminders into the Reminder Exchange file.

3. Preparation Document pxrm0150.1005 contains setup of each reminder. Check the taxonomy Check for reminder terms Check for orders Document pxrm0150.1005 contains setup of each reminder. Check the taxonomy Check for reminder terms Check for orders

4. GUI Setup – First Time If your site has never setup reminders in the past, the following steps need to be undertaken to “turn on” the GUI reminders These steps do NOT make sense but they do need to be followed in the correct sequence DO NOT SKIP A STEP If your site has never setup reminders in the past, the following steps need to be undertaken to “turn on” the GUI reminders These steps do NOT make sense but they do need to be followed in the correct sequence DO NOT SKIP A STEP

5. First Time – Step 1 Use the steps that follow to install 2 reminders or see the webex for installing the tobacco reminder The immunization forecaster and one other that is commonly used such as the tobacco reminder, weight, or blood pressure Use the steps that follow to install 2 reminders or see the webex for installing the tobacco reminder The immunization forecaster and one other that is commonly used such as the tobacco reminder, weight, or blood pressure

6. First Time-Step 2 Use the Parameters menu on the Reminder Setup menu to TURN ON the reminders Use the ACT (Reminder GUI Resolution Active) parameter and set to YES at the system level Use the Parameters menu on the Reminder Setup menu to TURN ON the reminders Use the ACT (Reminder GUI Resolution Active) parameter and set to YES at the system level

7. First Time – Step 3 Set up the CAC to configure in the GUI Set the CFG- Allow EHR Configuration in GUI parameter from the same menu Set it by class for the CAC class

8. First Time – Step 4 Set the parameter CVR – EHR Cover Sheet reminder list This list will only have the 2 reminders you have installed

9. First Time –Step 5 You should now be able to access the GUI Select a patient for whom the reminder will be due If the alarm clock is RED and the X is gone, you are ready to proceed You should now be able to access the GUI Select a patient for whom the reminder will be due If the alarm clock is RED and the X is gone, you are ready to proceed

10. Add to GUI Click on the alarm clock Select the action drop down menu Choose Edit Cover Sheet Reminder List Select system level Click on the alarm clock Select the action drop down menu Choose Edit Cover Sheet Reminder List Select system level

11. Add to GUI –Step 6 Select the 2 reminders making the Immunization forecaster the first Move them to the right Click apply and OK Log out of the GUI

12. First Time – Step 7 Go back to the reminder parameters Select NEW – New reminder parameters Turn this on to YES for the system Log back into the GUI For now, this will look the same, but as you add more reminders to the GUI, they should appear Go back to the reminder parameters Select NEW – New reminder parameters Turn this on to YES for the system Log back into the GUI For now, this will look the same, but as you add more reminders to the GUI, they should appear

13. Mammogram Reminder

14. Create the Quick Order This reminder uses a quick order in the reminder dialog Section 5.4 page 40 in pxrm0150.1005o has list of quick orders to make RAZ BILATERAL MAMMOGRAM is the name the reminder will be looking for This reminder uses a quick order in the reminder dialog Section 5.4 page 40 in pxrm0150.1005o has list of quick orders to make RAZ BILATERAL MAMMOGRAM is the name the reminder will be looking for

15. Quick Order NAME: RAZ BILATERAL MAMMOGRAM Replace DISPLAY TEXT: Bilateral Mammogram// VERIFY ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Radiology Procedure: MAMMOGRAM BILAT// NAME: RAZ BILATERAL MAMMOGRAM Replace DISPLAY TEXT: Bilateral Mammogram// VERIFY ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Radiology Procedure: MAMMOGRAM BILAT//

16. Quick Order Radiology Procedure: MAMMOGRAM BILAT// Procedure Modifier: History and Reason for Exam: No existing text Edit? No// (No) Category: OUTPATIENT// Is this patient scheduled for pre-op? NO// Date Desired: TODAY// Mode of Transport: AMBULATORY// Is patient on isolation procedures? Urgency: ROUTINE// ------------------------------------------------------------------------------- Radiology Procedure: MAMMOGRAM BILAT Category: OUTPATIENT Date Desired: TODAY Mode of Transport: AMBULATORY Urgency: ROUTINE Submit request to: X-RAY ------------------------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Radiology Procedure: MAMMOGRAM BILAT// Procedure Modifier: History and Reason for Exam: No existing text Edit? No// (No) Category: OUTPATIENT// Is this patient scheduled for pre-op? NO// Date Desired: TODAY// Mode of Transport: AMBULATORY// Is patient on isolation procedures? Urgency: ROUTINE// ------------------------------------------------------------------------------- Radiology Procedure: MAMMOGRAM BILAT Category: OUTPATIENT Date Desired: TODAY Mode of Transport: AMBULATORY Urgency: ROUTINE Submit request to: X-RAY ------------------------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

17. Reminder Exchange – Install Reminder Choose IHS-MAMMOGRAM 2007

18. Reminder Installation Select IFE to install the reminder Review the reminder Select IFE to install the reminder Review the reminder

19. Install the Computed Finding Routine BPXRMWH already EXISTS, but packed routine is different, what do you want to do? (May need @ sign access to install routine for computed findings) Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// Routine BPXRMWH already EXISTS, but packed routine is different, what do you want to do? (May need @ sign access to install routine for computed findings) Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

20. Computed Finding REMINDER COMPUTED FINDINGS entry IHS- MAMMOGRAM already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER COMPUTED FINDINGS entry IHS- MAMMOGRAM already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

21. Refusal Type REFUSAL TYPE entry MAMMOGRAM already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REFUSAL TYPE entry MAMMOGRAM already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

22. Taxonomy REMINDER TAXONOMY entry IHS-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

23. Error on Taxonomy If there is an error in the taxonomy, you need to build it manually The screen shows what this error would look like Use the pxrm0150.1005o document to determine what codes are in this taxonomy. If there is an error in the taxonomy, you need to build it manually The screen shows what this error would look like Use the pxrm0150.1005o document to determine what codes are in this taxonomy. REMINDER TAXONOMY entry IHS-ASTHMA 2007 is NEW, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: I// nstall or Overwrite the current entry The update failed, UPDATE^DIE returned the following error message: MSG("DIERR")=1^1 MSG("DIERR",1)=701 MSG("DIERR",1,"PARAM",0)=3 MSG("DIERR",1,"PARAM",3)=493.02 MSG("DIERR",1,"PARAM","FIELD")=.01 MSG("DIERR",1,"PARAM","FILE")=811.23102 MSG("DIERR",1,"TEXT",1)=The value '493.02 ' for field SELECTABLE DIAGNOSIS in SE LECTABLE DIAGNOSIS SUB-FIELD in file REMINDER TAXONOMY is not valid. MSG("DIERR","E",701,1)= REMINDER TAXONOMY entry IHS-ASTHMA 2007 did not get installed! Examine the above error message for the reason.

24. Taxonomy Creation

25. –Select Reminder Taxonomy: IHS-MAMMOGRAM 2007 Mammogram codes LOCAL –...OK? Yes// (Yes) – –General Taxonomy Data –NAME: IHS-MAMMOGRAM 2007// –BRIEF DESCRIPTION: Mammogram codes// – –CLASS: LOCAL// –SPONSOR: –REVIEW DATE: – –PATIENT DATA SOURCE: EN,PL// –USE INACTIVE PROBLEMS: –INACTIVE FLAG: – –Select Reminder Taxonomy: IHS-MAMMOGRAM 2007 Mammogram codes LOCAL –...OK? Yes// (Yes) – –General Taxonomy Data –NAME: IHS-MAMMOGRAM 2007// –BRIEF DESCRIPTION: Mammogram codes// – –CLASS: LOCAL// –SPONSOR: –REVIEW DATE: – –PATIENT DATA SOURCE: EN,PL// –USE INACTIVE PROBLEMS: –INACTIVE FLAG: –

26. Taxonomy Creation ICD9 Codes: Range V76.11-V76.12 Code ICD Diagnosis ---- ------------- V76.11 MAMMOGRAM HI-RISK MALIG BREAST V76.12 OTH MAMMOGRAM MALIG BREAST ICD0 Codes: Range 87.37-87.37 Code ICD Operation/Procedure ---- ----------------------- 87.37 MAMMOGRAPHY NEC Range 87.36-87.36 Code ICD Operation/Procedure ---- ----------------------- 87.36 BREAST XEROGRAPHY ICD9 Codes: Range V76.11-V76.12 Code ICD Diagnosis ---- ------------- V76.11 MAMMOGRAM HI-RISK MALIG BREAST V76.12 OTH MAMMOGRAM MALIG BREAST ICD0 Codes: Range 87.37-87.37 Code ICD Operation/Procedure ---- ----------------------- 87.37 MAMMOGRAPHY NEC Range 87.36-87.36 Code ICD Operation/Procedure ---- ----------------------- 87.36 BREAST XEROGRAPHY

27. Taxonomy Creation CPT Codes: Range 76090-76092 Code CPT Short Name ---- -------------- 76090 MAMMOGRAM, ONE BREAST 76091 MAMMOGRAM, BOTH BREASTS 76092 MAMMOGRAM, SCREENING Range G0204-G0204 Code CPT Short Name ---- -------------- G0204 DX MAMMO PRODUC DIR DIGTL IMAG BIL CPT Codes: Range 76090-76092 Code CPT Short Name ---- -------------- 76090 MAMMOGRAM, ONE BREAST 76091 MAMMOGRAM, BOTH BREASTS 76092 MAMMOGRAM, SCREENING Range G0204-G0204 Code CPT Short Name ---- -------------- G0204 DX MAMMO PRODUC DIR DIGTL IMAG BIL CPT Codes: Range 76090-76092 Code CPT Short Name ---- -------------- 76090 MAMMOGRAM, ONE BREAST 76091 MAMMOGRAM, BOTH BREASTS 76092 MAMMOGRAM, SCREENING Range G0204-G0204 Code CPT Short Name ---- -------------- G0204 DX MAMMO PRODUC DIR DIGTL IMAG BIL

28. Taxonomy Creation After the taxonomy is created Re-load the reminder and use SKIP when you reach the taxonomy installation After the taxonomy is created Re-load the reminder and use SKIP when you reach the taxonomy installation

29. Other Taxonomies REMINDER TAXONOMY entry IHS-BILATERAL MASTECTOMY already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TAXONOMY entry IHS-BILATERAL MASTECTOMY already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

30. Other Taxonomies ICD0 Codes: Range 85.42-85.42 Code ICD Operation/Procedure ---- ----------------------- 85.42 BILAT SIMPLE MASTECTOMY Range 85.44-85.44 Code ICD Operation/Procedure ---- ----------------------- 85.44 BILAT EXTEND SIMP MASTEC ICD0 Codes: Range 85.42-85.42 Code ICD Operation/Procedure ---- ----------------------- 85.42 BILAT SIMPLE MASTECTOMY Range 85.44-85.44 Code ICD Operation/Procedure ---- ----------------------- 85.44 BILAT EXTEND SIMP MASTEC Range 85.46-85.46 Code ICD Operation/Procedure ---- ----------------------- 85.46 BILAT RADICAL MASTECTOMY Range 85.48-85.48 Code ICD Operation/Procedure ---- ----------------------- 85.48 BIL EXTEN RAD MASTECTOMY

31. Other Taxonomies CPT Codes: Range 19180-19180 Code CPT Short Name ---- -------------- 19180 REMOVAL OF BREAST Range 19200-19200 Code CPT Short Name ---- -------------- 19200 REMOVAL OF BREAST Range 19220-19220 Code CPT Short Name ---- -------------- 19220 REMOVAL OF BREAST Range 19240-19240 Code CPT Short Name ---- -------------- 19240 REMOVAL OF BREAST CPT Codes: Range 19180-19180 Code CPT Short Name ---- -------------- 19180 REMOVAL OF BREAST Range 19200-19200 Code CPT Short Name ---- -------------- 19200 REMOVAL OF BREAST Range 19220-19220 Code CPT Short Name ---- -------------- 19220 REMOVAL OF BREAST Range 19240-19240 Code CPT Short Name ---- -------------- 19240 REMOVAL OF BREAST

32. Reminder Term REMINDER TERM entry IHS-MAMMOGRAM TERMS already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// REMINDER TERM entry IHS-MAMMOGRAM TERMS already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S//

33. Reminder Definition REMINDER DEFINITION entry IHS-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// i Install or Overwrite the current entry Are you sure you want to overwrite? N// y YES REMINDER DEFINITION entry IHS-MAMMOGRAM 2007 already EXISTS, what do you want to do? Select one of the following: C Create a new entry by copying to a new name I Install or Overwrite the current entry Q Quit the install S Skip, do not install this entry Enter response: S// i Install or Overwrite the current entry Are you sure you want to overwrite? N// y YES

34. Installing the Dialog Install the dialog after the reminder is installed It may appear that you are installing the reminder again Look to the upper left to see where you are Install the dialog after the reminder is installed It may appear that you are installing the reminder again Look to the upper left to see where you are

35. Installing the Dialog Look here for directions Select IA again for dialog pieces

36. Attach to the Reminder You are usually asked to attach the dialog to a reminder I have named the dialogs and the reminders the same If you are not asked during the install, you can manually attach them when you activate the dialog You are usually asked to attach the dialog to a reminder I have named the dialogs and the reminders the same If you are not asked during the install, you can manually attach them when you activate the dialog Install reminder dialog and all components with no further changes:Y// YES Reminder Dialog IHS- MAMMOGRAM 2007 is not linked to a reminder. Select Reminder to Link: IHS-MAMMOGRAM 2007

37. Dialog Installation An X should be by all the pieces of the dialog

38. Objects If TIU patch 1004 was installed, the objects needed in dialogs will be available If not, the user will be asked to replace or remove the object from the dialog If TIU patch 1004 was installed, the objects needed in dialogs will be available If not, the user will be asked to replace or remove the object from the dialog

39. Activate the Dialog All dialogs installed through reminder exchange are disabled. Exit out of Reminder Exchange and go to the DM (Dialog Management) Select Reminder Managers Menu Option: DM Reminder Dialog Management DP Dialog Parameters... DI Reminder Dialogs Choose DI (Reminder Dialogs) All dialogs installed through reminder exchange are disabled. Exit out of Reminder Exchange and go to the DM (Dialog Management) Select Reminder Managers Menu Option: DM Reminder Dialog Management DP Dialog Parameters... DI Reminder Dialogs Choose DI (Reminder Dialogs)

40. Activate the Dialog The initial View is of reminders, use CV and Select D to go to dialogs

41. Activate Dialogs

42. Activate the Dialog Choose the dialog by number then ED

43. Activate Dialog NAME: IHS-MAMMOGRAM 2007// DISABLE: DISABLED IN EXCHANGE Replace @ SURE YOU WANT TO DELETE? Y (Yes) CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-MAMMOGRAM 2007// Select SEQUENCE: 5// SEQUENCE: 5// DIALOG ELEMENT/GROUP: OI MAMMOGRAM// Select SEQUENCE: NAME: IHS-MAMMOGRAM 2007// DISABLE: DISABLED IN EXCHANGE Replace @ SURE YOU WANT TO DELETE? Y (Yes) CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-MAMMOGRAM 2007// Select SEQUENCE: 5// SEQUENCE: 5// DIALOG ELEMENT/GROUP: OI MAMMOGRAM// Select SEQUENCE:

44. Activate Dialog

45. Add Radiology Tests to Reminder Term Enter your radiology tests for mammogram into the reminder term Enter your radiology tests for mammogram into the reminder term Select Reminder Managers Menu Option: trm Reminder Term Management TL List Reminder Terms TI Inquire about Reminder Term TE Reminder Term Edit TC Copy Reminder Term

46. Reminder Term Select Reminder Term: IHS-MAMMOGRAM TERMS VISN...OK? Yes// (Yes) NAME: IHS-MAMMOGRAM TERMS// CLASS: VISN// REVIEW DATE: DESCRIPTION: No existing text Edit? NO// Select FINDING ITEM: RA.MAMMOGRAM Searching for a RADIOLOGY PROCEDURE, (pointed-to by FINDING ITEM) Select Reminder Term: IHS-MAMMOGRAM TERMS VISN...OK? Yes// (Yes) NAME: IHS-MAMMOGRAM TERMS// CLASS: VISN// REVIEW DATE: DESCRIPTION: No existing text Edit? NO// Select FINDING ITEM: RA.MAMMOGRAM Searching for a RADIOLOGY PROCEDURE, (pointed-to by FINDING ITEM)

47. Reminder Term Searching for a RADIOLOGY PROCEDURE 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056 2 MAMMOGRAM UNILAT (RAD Detailed) CPT:76090 CHOOSE 1-2: 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056 Are you adding 'MAMMOGRAM BILAT' 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: Select FINDING ITEM: Searching for a RADIOLOGY PROCEDURE 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056 2 MAMMOGRAM UNILAT (RAD Detailed) CPT:76090 CHOOSE 1-2: 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056 Are you adding 'MAMMOGRAM BILAT' 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: Select FINDING ITEM:

48. Reminder Term You may enter a new FINDINGS, if you wish Enter one of the following: 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 You may enter a new FINDINGS, if you wish Enter one of the following: 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

49. Add to GUI Click on the alarm clock Select the action drop down menu Click on the alarm clock Select the action drop down menu

50. Add to GUI Choose Edit Cover Sheet Reminder List

51. Add to GUI Select where you are going to add them. The choices are in the middle section The available reminders are on the bottom left. Move them over using the arrows Click apply when finished Select where you are going to add them. The choices are in the middle section The available reminders are on the bottom left. Move them over using the arrows Click apply when finished

52. Add to GUI

53. TEST,TEST,TEST Pick patients where the reminder is not applicable – (men, old or young women) Pick patients where the reminder is applicable but not due Pick patients where the reminder is applicable and due Is it correct?? Pick patients where the reminder is not applicable – (men, old or young women) Pick patients where the reminder is applicable but not due Pick patients where the reminder is applicable and due Is it correct??

54. Testing Use reminder maintenance to see what the computer found Right click on the reminder and choose clinical maintenance Use reminder maintenance to see what the computer found Right click on the reminder and choose clinical maintenance

55. Check the dialog Start a note Find the reminder in the reminders drawer Double click on the reminder and review the dialog Start a note Find the reminder in the reminders drawer Double click on the reminder and review the dialog

56. Check the Dialog

57. Check the dialog

58. Check Note

59. Check Order