RPMS-EHR New Features Version 1.1 Patch 1

1. RPMS-EHR New FeaturesVersion 1.1 Patch 1 Jim Gemelas CAC/RPh Warm Springs

2. Set-up guide available with patch release

3. Featured new features: • ICD Codes Captured for Lab Clinical Indicators • Lab patch 22 is a pre-requisite. LR*5.2*1022 should be installed. This enables clinical indicator prompt for lab orders. • Adverse Reaction Data Entry from Cover Sheet • The RPMS Adverse Reaction Tracking manuals can be downloaded from: http://www.ihs.gov/Cio/RPMS/index.cfm?module=home&option=documents (and/or EHR 1.1 patch 1 New Features guide) • Displaying Patient Record Flags • The Patient Record Flag Implementation Instructions are included in the PIMS0530.1007o.zip file. This can be downloaded from: ftp://ftp.ihs.gov/rpms/patches/

4. ICD Codes Lab Clinical Indicators

5. Options for “Other” indicationSearch for code or enter free text

6. Options for “Other” indicationSearch for code or enter free text

8. Free text entries

11. Order Details

12. Adverse Reaction Data Entry • This is a new component that may be invoked from the adverse reaction cover sheet popup menu. • It permits authorized users to enter, edit, and verify adverse reaction information into RPMS-EHR. • The data is stored and managed through the RPMS Adverse Reaction Tracking application

14. Adverse Reaction Entry: • Instruct providers on coversheet adverse reaction data entry and to sign those BEFORE leaving the Cover sheet • Educate providers that allergy ordering and display will no longer be available on the orders tab. • Train pharmacist or whomever verifies your allergies currently on adverse reaction verification • VERIFIERS can verify in EHR (new) or RPMS (old) • Verify that staff who enter/verify allergies have electronic signatures • Disable allergy ordering on Orders tab • Disable allergy display on Orders tab. • Configure permissions for adverse reaction data entry • Review permissions for adverse reaction verification • Review mail group membership

15. Important: • The new adverse reaction must be signed to be available for order checks and display throughout RPMS-EHR. Providers can delete their own unsignedadverse reactions that have entered in error. • What happens if allergies are not signed off? • i.e. a session hangs up or is killed? • Adverse Reaction Tracking Verifier Menu Option: 3 Reports Menu “Patient Allergies Not Signed Off report” • report not working for allergies not signed in EHR • KNOWN PROBLEM-Fix is in development • Consider- “RECALL LAST PATIENT SELECTED” parameter • Train providers to sign allergies before leaving the cover sheet AND NOT to wait to sign ADR with medication orders for proper order checking to occur

16. Disable Allergy Ordering on the Orders Tab • Allergy Ordering can be disabled by removing the GMRAOR ALLERGY ENTER/EDIT (generic order) from the Write Orders List • This needs to be done for all users • ORWDX WRITE ORDERS LIST (parameter) • Menu for Write Orders List • Setting ORWDX WRITE ORDERS LIST for System: W-SPRINGS-HC.PORTLAND.IHS.GOV - • Order Dialog: ORZM MAIN MD ORDERS//

17. Order Dialog: ORZM MAIN MD ORDERS//

18. Disable Allergy Display on the Orders Tab • Needs to be done in Fileman. • File called “DISPLAY GROUP.” There is an entry in this file called “ALL SERVICES” • Remove ALLERGIES from the MEMBER field of this file: • 12 ALLERGIES This one

19. Allergy removed from orders display list

20. Configure Permissions for Adverse Reaction Data Entry • RPMS-EHR Configuration Menu  • Adverse Reaction Tracking Configuration (ART)  • Enable Adverse Reaction Data Entry (ENT) • Setting Allow entry of adverse reaction data for Division: --Allow entry of adverse reaction data?: YES// • Verify that staff who enter/verify allergies have electronic signatures

21. Review Permissions for Adverse Reaction Verification • This allows those with the GMRA ALLERGY-VERIFY key to verify the correctness of data (both in EHR and RPMS) • It is recommended that all adverse reactions are verified • Usually the pharmacist or designated verifier will already have the existing security keys • VER Allow Adverse Reaction Verification

22. Mail Bulletin Setup • Automated mail bulletins will be sent to the ART verifiers when an allergy/adverse reaction has been entered and signed (completed) by a user • Review the membership of the following mail groups to ensure that the verifiers are included: • GMRA VERIFY DRUG ALLERGY • GMRA VERIFY FOOD ALLERGY • GMRA VERIFY OTHER ALLERGY

23. Method • Manage Mailman Option • GDM Group/Distribution Management • Mail Group Edit • Select MAIL GROUP NAME: << enter group (i.e. GMRA VERIFY DRUG ALLERGY) • Select MEMBER: <<< enter user here

24. Allergy Entry Overview • Enter new adverse reactions • Providers can delete their own unsigned adverse reactions which have been entered in error. • Edit existing adverse reactions- not verified • Enter no-known-allergies (NKA) assessments

25. Verifier options • Verify “on the fly” when a patient is encountered with an unverified allergy • “Pop up” will occur when switching patients

26. Verify options • “Don’t sign” option and use: “List by Location Not Verified Reactions” report

27. List by Location Not Verified Reactions Report

28. Other causative agents • Food or other unmatched allergies • Check Auto-verify settings • Select Adverse Reaction Tracking Verifier Menu Option: 1 Enter/Edit Site Configurable Files ... 3 Enter/Edit Site Parameters • AUTOVERIFY FOOD/DRUG/OTHER: “0” NO AUTOVERIFY

29. Other causative agents

31. Patient Record Flags • PIMS 0530 1007 should be installed to enable entry of patient flags into RPMS • Allocate key: DGPF 1 DGPF LOCAL FLAG EDIT 2 DGPF PRF ACCESS 3 DGPF PRF CONFIG 4 DGPF RECORD FLAG ASSIGNMENT • “Patient Record Flags alert the staff of patients whose behavior or characteristics might pose a threat either to the safety of the employee, the safety of other patients, or compromise the delivery of quality healthcare” • Sites may create local flags (i.e. clinical) or use national flag (behavioral)

32. Patient Record Flags Main Menu ... [DGPF RECORD FLAGS MAIN MENU] RPMS: Patient Record Flags Main Menu RM Record Flag Reports Menu ... FA Record Flag Assignment FM Record Flag Management • Category I – National Flag (Behavioral) • Category II – Local Flags

33. Category I (National)Add New Record Flag' action not allowed for Category I (National) Flags. Only Category II (Local) Flags may be created at the local site

34. Record Flag Management –Category II (Local)

35. FA Record Flag Assignment

36. Assign a flag • Select Action: AF Assign Flag • Select a flag for this assignment: BEH • Searching for a National Flag • BEHAVIORAL ACTIVE BEHAVIORAL ...OK? Yes// (Yes) • Enter Narrative Text for this record flag assignment: ==========Assignment Narrative Text ======== Patient has a record of disruptive behavior requiring Security intervention at VAMC in Portland.

37. Category I

38. Set “POPUPFLAGS” to TRUE

39. VA policy • http://www.va.gov/vdl/application.asp?appid=156

40. Thank you