1. Notifications February 2008

2. Notification Management Menu This menu handles all the notifications. SYS Enable/Disable Notification System turns on the notification system for the facility. Until then NO notifications can be sent. However, once its turned on, all clinicians will receive any mandatory or enabled notifications, even if they are not using the EHR. When you turn notifications on, the package variables will become active immediately.

3. Notification Menu

4. Enable/Disable Notifications Turns specific notifications on or off –E (Enabled): notification enabled for entity unless entity of higher precedence has notification disabled (ex. Enabled at System level and Disabled at User level=user will not receive notification –D (Disabled): notification disabled for entity unless entity of higher precedence has notification enabled –M (Mandatory): Notification is mandatory and cannot be disabled

5.  NOTE: If a coordinator or IRMS person has answered “Yes” in the option Set Default Recipients for Notification, indicating that the user should always receive the notification, that Team or User will always receive the notification, regardless of the Enabled/Disabled settings.

6. Erase Notifications Erase all notifications for a User Erase all notifications for a Patient Erase all instances of a notification (regardless of Patient or User) Erase specific instances of a notification for a User Edit Erase All Notifications parameter for a User

7. Erase Notifications

8. Set Urgency for Notifications (GUI) Allows you to set the Urgency for a notification. Used mainly for sorting in GUI displays. The Urgencies include: Low –Medium –High –Info only All notifications come with a package value already set

9. Set Urgency for Notifications URG Set Urgency for Notifications

10. Set Urgency for Notifications

11. Notification Parameters PAR Notification Parameters

12. Set Deletion Parameters for Notifications Allows you to set parameters to determine deletion conditions. It uses a set of codes to determine how a notification will be deleted at a site. The codes include: –Individual Recipient –All Recipients

13. Deletion Parameters (continued) Individual-deletes the notification for an individual recipient when: –That individual completes the follow-up action –That individual reviews notifications that do not have follow-up action All recipients-deletes the notification for all recipients when: –Any recipient completes the follow-up action on notifications –Any recipient reviews notifications that do not have follow-up action

14. Deletion Parameters

15. Set Default Recipient(s) for Notifications Enter “Yes” if the recipient should always receive this notification. Recipients (users, teams) will receive the notification on a regular basis, despite settings in the option Enable/Disable Notifications. Example: Chaplain gets notification for all admissions

16. Set Default Recipient(s) for Notifications

17. Set Default Recipient Device(s) Enter “Yes” if the device (from the Device file) should always receive this notification. Recipient devices will receive the notification on a regular basis, despite settings in the option Enable/Disable Notifications.

18. Set Provider Recipients for Notifications Allows you to set any one or combination of a set of codes indicating default (provider) recipients of a notification by their title or relationship to the patient

19. Recipient Determination (continued) Each user on the potential recipient list is evaluated according to values set for entities identified in the parameter ORB PROCESSING FLAG. The parameter’s entity values are processed in a specific order to determine if that particular user should receive the notification/alert or not. If a user on the recipient list has the notification “ON”, they will receive the alert.

20. Set Provider Recipients for Notifications

21. Flag Orderable Item(s) to Send Notifications This option has two sub-options to flag specific orderable items to send notifications when they are ordered, resulted, or expiring

22. Archive (Delete) after Days Enter the number of days to archive a notification before deletion in the Alert Tracking file.

23. Forward Notifications This option lets you set the number of days to hold a notification before forwarding it to the recipient’s supervisor, surrogate, or a backup reviewer. Maximum 30 days If not set, the notification will not be forwarded

24. Set Delays for Unverified Orders Provides access to options that set up parameters for delaying unverified orders alert triggers –Set Delay for All Unverified Orders –Set Delay for Unverified Medication Orders

25. Set Delays for Unverified Orders

26. Set Notification Display Sort Method (GUI) Determines the order in which items of a notification are displayed in the GUI –By Patient –By Type –By Urgency

27. Set Notification Display Sort Method VA Only DO NOT USE

28. Set Notification Display Method - EHR The EHR uses the parameter CIAOXQ SORT BY Notification Sort Method for sorting. It works the same as the CPRS Parameter Sorting is by Patient, Type or Urgency

29. Notifications Pop-Up Window An instant message pop- up will appear by setting the parameter:CIAOXQ ALERT THRESHOLD Priority threshold for Popup Alert Priority is low, moderate or high If the notification meets the priority set, the pop- up will be generated Package value is High

30. Send Flagged Orders Bulletin Indicates whether to send a bulletin when an order is flagged for clarification.

31. Determine Recipients for a Notification Allows you to create a simulated notification recipient list, without sending the alert

32. Display Patient Alerts and Alert Recipients (continued) Produces a list of all OE/RR alerts for a specified patient for the dates you enter Produces detailed listing on specific alerts attached to the patient record Used mainly for troubleshooting purposes

33. Display Patient Alerts and Alert Recipients, cont. Select Notification Mgmt Menu Option: 15 Display Patient Alerts and Alert Recipients PATIENT (req'd): doe, WILLIAM C 9-12-44 243236572 YES SC VETERAN Enrollment Priority: GROUP 1 Category: IN PROCESS End Date: Start Date/Time (req'd): T-30// (JUL 22, 2000) End Date/Time (req'd): NOW// (AUG 21, 2000@14:27) Processing................................................................. ALERTS FOR PATIENT: DOE, WILLIAM C 1 [2B M] WARFARIN TAB ordered - adjust diet according 8/18/00@15:51 2 [2B M] New order(s) placed. [7094486] 8/18/00@10:00 3 [2B M] New order(s) placed. [7095466] 8/18/00@09:45 4 Lab order canceled: POTASSIUM BLOOD SERUM LC LB # [70954648/18/00@09:42 5 Lab order canceled: POTASSIUM BLOOD SERUM LC LB # [70954628/18/00@09:42 6 Lab order canceled: POTASSIUM BLOOD SERUM LC LB # [70954638/18/00@09:42 7 Lab order canceled: POTASSIUM BLOOD SERUM LC LB # [70954618/18/00@09:41 8 Lab order canceled: POTASSIUM BLOOD SERUM LC LB # [70954608/18/00@09:41 9 Lab order canceled: POTASSIUM BLOOD SERUM WC LB # [70954588/18/00@09:41 10 Lab order canceled: POTASSIUM BLOOD SERUM WC LB # [70954598/18/00@09:41 11 [2B MED] New DC order(s) placed. [7095457] 8/18/00@09:41 999 MORE... Enter alerts to display in detail:

34. Display Patient Alerts and Alert Recipients (continued) BUECHLER, MELANIE 1st displayed to recipient: 1st selected by recipient: Processed by recipient: Deleted via follow-up: Auto deleted: Forwarded by: Press RETURN to continue or '^' to exit: RECIPIENTS OF ALERTS FOR PATIENT: DOE, WILLIAM C. Page: 2 Forwarded to recipient: RUSSELL, JOEL 1st displayed to recipient: Nov 18, 1997@11:47:53 1st selected by recipient: Processed by recipient: Deleted via follow-up: Auto deleted: Forwarded by: Forwarded to recipient: - End of Report - Press RETURN to continue: Select Notification Mgmt Menu Option

35. Display the Notifications a User Can Receive Debugging tool to help determine why (or why not) notifications are being received by a particular individual. Lists each notification and its processing flag List reason for the processing flag value

36. Display the Notifications a User Can Receive (continued)

37. Example: Flagged Orderable Item Expiring - Inpatient [FLAGGED OI EXPIRING – INPT Trigger: TaskMan monitored process (currently every 15 minutes) Mechanism: The date range to search is based upon day of week and entries in the Holiday file. The range is extended to include all expiring med orders through the next working day (excluding holidays and weekends.) Alert is not triggered if patient is deceased or an outpatient.

38. Example (continued) Message: [ ] Order expiring: Follow-up: Display orders expiring through the next working day and allow renewal Recipients: Recipients for this notification are not based specifically on patient. They are based on orderable item.

39. Example (continued) Urgency: Determined by parameter ORB URGENCY. The exported value for this notification is High. Deletion: Determined by parameter ORB DELETE MECHANISM. The exported value for this notification is Individual Recipient (Individual review via View Alerts.)

40. GUI Personal Preferences From the Tools menu and “Options”, a user may: –Enable/disable notifications –Set a surrogate –Set the GUI display sorting: urgency, type, patient –Request Mailman bulletin be sent for flagged orders

41. Display on Notifications Tab By selecting the “Show All” box, notifications may be viewed across patients Notifications may be sorted by clicking on the column headings Notifications may be processed, either by processing all or by highlighting and selecting “process selected”, or “info only”

43. Processing Notifications Process All-use Next and Stop buttons in lower right corner of EHR to move to next notification Process Selected-select notifications to address

44. Processing Notifications Process Info Only Alerts

45. Notifications How do they really work?

46. Notifications Management Menu Notifications will be triggered by examining data in HL7 messages. In limited cases, they will be triggered within individual packages

47. Trigger Methods Notifications are triggered via six methods: –Hard coded triggers within packages; for example: Imaging Patient Examined –Time (TaskMan)-driven processes; for example: Medications Expiring –Expert system rules monitoring HL7 messages; for example: Critical Lab Results –Expert system rules monitoring DGPM Movement Events protocol; for example: Discharge –Expert system rules monitoring OE/RR Events; for example: Order Requires Electronic Signature –Order checking system; for example: Order Check

48. Recipient Determination CPRS Notifications determines recipients of a patient’s particular notification/alert in the following order. Check the value of the parameter ORB SYSTEM ENABLE/ DISABLE. If it is ‘D’isabled, do not process or send any notifications. If it is ‘E’nabled, process notifications as outlined below.  NOTE:You can check the value of this parameter via option “Enable or Disable Notification System.”

49. Recipient Determination (continued) Obtain the default/regular recipients for this notification regardless of patient from the parameter ORB DEFAULT RECIPIENTS.  NOTE:You can access this parameter via option “Set Default Recipients for Notifications.”

50. Recipient Determination (continued) Obtain the default/regular device recipients for this notification regardless of patient from the parameter ORB DEFAULT DEVICE RECIPIENTS.  NOTE:This parameter is accessed via option “Set Default Recipient Device(s) for Notifications.” One or more devices can be set up to automatically always receive a notification.

51. Recipient Determination (continued) After default recipients are determined, a list of potential alert recipients is obtained from: –Special, notification-specific recipients: If the notification processed is FLAGGED OI RESULTS - INPT/OUTPT (usually triggered by an HL7 result message from Lab, Imaging or Consults), the orderable item associated with the notification’s order number is found. The parameter ORB OI RESULTS – INPT/OUTPT is then evaluated to determine if users, teams or devices have flagged that orderable item.

52. Recipient Determination (continued)  NOTE:If a device is added to the potential recipient list, it will always receive the alert.  NOTE:You can check for users or teams linked to flagged orderable item results via option “Flag Orderable Item(s) to Send Notifications”

53. Recipient Determination (continued) If the notification processed is FLAGGED OI ORDER - INPT/OUTPT, the orderable item associated with the notification’s order number is found. The parameter ORB OI ORDERED – INPT/OUTPT is then evaluated to determine if users or teams have flagged that orderable item.

54. Recipient Determination (continued)  NOTE:If a patient is on an OE/RR team that has flagged an orderable item, all users on that team become potential alert recipients. Devices (printers, etc.) are linked to a patient if the device and patient are on the same OE/RR team.  NOTE:You can check for users or teams linked to flagged orderable item orders via option “Flag Orderable Item(s) to Send Notifications”.

55. Recipient Determination (continued) If the notification processed is FLAGGED OI EXPIRING - INPT/OUTPT, the orderable item associated with the notification’s order number is found. The parameter ORB OI EXPIRING – INPT/OUTPT is then evaluated to determine if users or teams have flagged that orderable item.

56. Recipient Determination (continued) If a lab results notification is processed (LAB RESULTS, ABNORMAL LAB RESULTS (ACTION), STAT RESULTS, CRITICAL LAB RESULTS (ACTION)), the unique lab id for the notification is obtained. The patient’s existing alerts are then reviewed for matching notifications and unique lab ids. If a matching alert is found, that alert’s recipients are added to the potential recipient list. In addition, the matching alert’s message text is prefixed to the current alert’s message text and the matching alert is deleted.

57. Recipient Determination (continued) The optional recipient list identified by the service triggering the alert. For example, Radiology sends Notifications a list of potential recipients when its STAT Imaging Request notification is triggered.

58. Questions and Discussion