1. National Reminders- Diabetic Microalbumin

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. Reminders should be installed by site manager and a CAC since some require the @ sign level of access

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

4. Create 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 LRZ MICROALBUMIN is the name the reminder will be looking for

5. Quick Order Select Order Menu Management Option: QO Enter/edit quick orders Select QUICK ORDER NAME: LRZ MICROALBUMIN 1 LRZ MICROALBUMIN 2 LRZ MICROALBUMIN TOMORROW CHOOSE 1-2: 1 LRZ MICROALBUMIN NAME: LRZ MICROALBUMIN// DISPLAY TEXT: Microalbumin// VERIFY ORDER: DESCRIPTION: No existing text Edit? NO// ENTRY ACTION:

6. Quick Order Lab Test: MICROALBUMIN DEMO// Collected By: Send patient to lab// Collection Sample: URINE// Collection Date/Time: TODAY// How often: ONCE// Indication:// Indication ICD9://  May decide to enter diabetes diagnosis here ------------------------------------------------------------------------------- Lab Test: MICROALBUMIN DEMO Collected By: Send patient to lab Collection Sample: URINE Specimen: URINE Collection Date/Time: TODAY How often: ONCE ------------------------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

7. Reminder Exchange – Install Reminder Choose IHS-DIAB MICROALBUMIN 2007

8. Reminder Installation Select IFE to install the reminder Review the reminder Select IA to install all the components

9. Install the Components REMINDER TAXONOMY entry IHS-DIABETES DX 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//

10. 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. 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.

11. Taxonomy Creation

12. NAME: IHS-DIABETES DX 2007 Replace BRIEF DESCRIPTION: CLASS: LOCAL// SPONSOR: REVIEW DATE: 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: 250.00// ICD9 LOW CODED VALUE: 250.00// ICD9 HIGH CODED VALUE: 250.93// Select ICD9 LOW CODED VALUE:

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

14. Renal Disease Taxonomy REMINDER TAXONOMY entry IHS-END STAGE RENAL DISEASE 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

15. Install Reminder Term REMINDER TERM entry IHS-MICROALBUMIN 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

16. Install the Reminder Definition REMINDER DEFINITION entry IHS-DIAB MICROALBUMIN 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

17. 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

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

19. 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 Install reminder dialog and all components with no further changes:Y// YES Reminder Dialog IHS-DIAB MICROALBUMIN 2007 is not linked to a reminder. Select Reminder to Link: IHS-DIAB MICROALBUMIN 2007

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

21. 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)

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

23. Activate Dialogs

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

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

26. Activate Dialog

27. Edit the Reminder Term The reminder term cannot be populated with lab tests since each site has their own The microalbumin used at your site needs to be added to the reminder term. Use TE to edit 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

28. Edit Reminder Term Select Reminder Term: IHS-MICROALBUMIN VISN...OK? Yes// (Yes) NAME: IHS-MICROALBUMIN// CLASS: VISN// REVIEW DATE: DESCRIPTION: The lab tests used at a site to resolve the microalbumin reminder Edit? NO// Select FINDING ITEM: LT.MICROALBUMIN

29. Edit Reminder Term Searching for a LABORATORY TEST 1 MICROALBUMIN MICROALBUMIN (retired) 2 MICROALBUMIN 24HR UR 3 MICROALBUMIN DEMO 4 MICROALBUMIN RANDOM MICROALBUMIN RANDOM (retired) CHOOSE 1-4: 3 MICROALBUMIN DEMO Are you adding 'MICROALBUMIN DEMO' as a new FINDINGS (the 1ST for this REMINDE R 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:

30. Finding Items 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

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

32. Add to GUI Choose Edit Cover Sheet Reminder List

33. 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

34. Add to GUI

35. TEST,TEST,TEST Pick patients where the reminder is not applicable – (non-diabetics) Pick patients where the reminder is applicable but not due Pick patients where the reminder is applicable and due Is it correct??

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

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

38. Check the Dialog Is the correct data going into the note? Is the order there? Are you presented with the dialog to enter the order when you select Finish? Is it the correct Quick order?

39. Check the Dialog

40. Note

41. Order