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EHR Reminders - Customizing National Dialogs

EHR Reminders - Customizing National Dialogs. LCDR Susan Pierce-Richards, MSN, ARNP. Introduction. A Reminder Dialog is a documentation tool that creates note text at the same time as entering information into the RPMS.

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EHR Reminders - Customizing National Dialogs

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  1. EHR Reminders -Customizing National Dialogs LCDR Susan Pierce-Richards, MSN, ARNP

  2. Introduction A Reminder Dialog is a documentation tool that creates note text at the same time as entering information into the RPMS. PXRM 1.5 Patch 1005 delivers National Reminder Dialogs with the National Reminders. Because many fields used to “resolve” reminders (medications, labs, quick orders) and many objects used to display data (TIU objects) are site specific, many National Dialogs are delivered in a very basic form. These dialogs can be edited and customized. ***Please refer to the Clinical Reminders manual (link provided at the end of this presentation) for detailed information on this topic***

  3. Objectives At the end of this presentation, the CAC will be able to: • Understand the basic components of a dialog • Element • Prompt • Group • Edit dialog text • Edit dialog finding item • Create display text (element) and add to a dialog • Add additional finding • Create element and add to dialog • Quick order • Historical service • Education code

  4. Dialog Structure Elementsare the basic structure and include: • Dialog text • Progress note text (or can be display only) • Finding items (if it is entering data – pt ed, ICD9 code, quick order, etc.) • Prompts (if the finding item has fields the user needs to enter, such as results, level of understanding) Groupsare 1 or more elements (or groups) that are placed together. • Allows you to create check boxes, radio buttons • Allows you to hide groups from display until activated Unlike TIU Templates, the Reminder Dialogs are built in the RPMS.

  5. Let’s Examine a Dialog – EHR View Text only Element Group Element Prompts All the words in the grey box are “Dialog Text.” This is Progress note text. Usually the same as Dialog text. Can use Alternate text. This is what goes into RPMS… the “Finding Item” and “Additional Findings”

  6. RPMS View of Same Dialog Display only element REMINDER DIALOG NAME: IHS-TD IMMUNIZATION Sequence Dialog Details 1 Dialog element: HD TD TEXT 5 Dialog group: GRP TD IMM Dialog elements: 1 IM TD-ADULT DONE 5 IM TD-ADULT DONE ELSEWHERE 10 IM TD-ADULT REFUSED 15 Dialog group: GRP IMMUNIZATION EDUCATION Dialog elements: 5 ED IMMUNIZATION PATIENT LITERATURE 10 ED IMMUNIZATION INFORMATION 15 ED IMMUNIZATION SCHEDULE 20 ED IMMUNIZATION DEFICIENCY 25 ED IMMUNIZATION PREVENTION 30 ED IMMUNIZATION COMPLICATIONS 35 ED IMMUNIZATION FOLLOW-UP + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Quit// Group Elements Group Elements

  7. Dialog Text View Display only element Dialog Edit List Sep 08, 2008 19:55:43 Page: 1 of 4 REMINDER DIALOG NAME: IHS-TD IMMUNIZATION Sequence Dialog Text 1 |IMMUNIZATIONS DUE| 5 Check to document immunization information. [no caption for this group] 5.1 Patient received TD immunization at this encounter Imm Site: Lot Number: Injection Volume: Vacc Info Sheet Date: Comment: 5.5 Patient indicated TD immunization was received at another facility Date: Location: Comment:+ + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Next Screen// Group “GRP TD IMM” – see next slide for details Element Prompts

  8. Dialog Group Element “IM-TD ADULT DONE” Dialog Edit List Sep 08, 2008 20:04:38 Page: 1 of 2 DIALOG GROUP NAME: GRP TD IMM Sequence Dialog Details Disabled 1 Dialog element: IM TD-ADULT DONE Resolution: DONE AT ENCOUNTER Finding type: IMMUNIZATION Finding item: TD (ADULT) [IM(102)] Additional prompts: PXRM IMM SITE PXRM LOT NUMBER PXRM VOLUME PXRM IMM VIS DATE PXRM COMMENT 5 Dialog element: IM TD-ADULT DONE ELSEWHERE Resolution: DONE ELSEWHERE (HISTORICAL) Finding type: IMMUNIZATION Finding item: TD (ADULT) [IM(102)] Additional prompts: PXRM VISIT DATE PXRM OUTSIDE LOCATION PXRM COMMENT 10 Dialog element: IM TD-ADULT REFUSED Resolution: PATIENT REFUSED Finding type: IMMUNIZATION Finding item: TD (ADULT) [IM(102)] Additional prompts: PXRM COMMENT PXRM IMM REFUSED

  9. Naming Conventions It is important to use consistent naming conventions for dialogs, elements, prompts, groups Review the existing nomenclature. Local dialogs – Use local prefix or append name (YAK-MAMMOGRAM or Mammogram-Yakama Elements – use naming conventions based on what is in the element: HD for text OI for orderable item CPT for CPT code ICD9 for ICD9 code IM or IMM for immunization LAB or LT for lab test TX for taxonomy etc Groups – need to follow similar conventions GP IM ED TOPICS GP TO HF etc Prompts – PR

  10. Now we’ll take two dialogs and make some changes:

  11. Scenario 1 –Mammogram Dialog The National Dialog is delivered with a radiology quick order for mammography. Your site does not have mammography, rather, you refer your patients to a local hospital through Contract Health. You are the CAC and you are asked to: ADD info only header to display eligibility EDIT dialog element text EDIT dialog element finding item

  12. Current Mammogram Dialog We will: Add a text to display CHS eligibility Change text on the element Change the finding item to a Mammogram consult

  13. Now – go and look at Dialog in RPMS Go to the Reminder Dialog menu: BEH → REM → DLG → DLG You will be in the main Dialog menu. Always look at the upper left area of the screen to see where you are in the menus. • The menus for Dialogs, Groups, Elements, Prompts all look very similar. • Look for the menu at the bottom of the screen – use “CHANGE VIEW” to move to the Prompt, Element, Group, Dialog menus SEE NEXT PAGE

  14. This tells you what menu you are in Dialog List Sep 09, 2008 11:02:04 Page: 1 of 7 REMINDER VIEW (ALL REMINDERS BY NAME) Item Reminder Name Linked Dialog Name & Dialog Status 1 BLANK for TO Dialogue Test-Tobacco Screen 2007 2 IHS-ALCOHOL SCREEN IHS ALCOHOL SCREEN 3 IHS-ALCOHOL SCREEN 2007 IHS-ALCOHOL SCREEN 2007 4 IHS-ALLERGY 5 IHS-ASTHMA PLAN 2007 IHS-ASTHMA PLAN 6 IHS-ASTHMA PRIM PROV 2007 IHS-ASTHMA PRIM PROV 7 IHS-ASTHMA SEVERITY 2007 IHS-ASTHMA SEVERITY 8 IHS-ASTHMA STEROID 2007 IHS-ASTHMA STEROIDS 9 IHS-BLOOD PRESSURE IHS-BLOOD PRESSURE 10 IHS-COLON CANCER 11 IHS-COLON CANCER 2007 IHS-COLON CANCER 2007 12 IHS-DEPRESSION SCREEN 13 IHS-DEPRESSION SCREEN 2007 IHS-DEPRESSION SCREEN 2007 14 IHS-DIAB ACE/ARB 15 IHS-DIAB ACE/ARB 2007 IHS-DIAB ACE/ARB 2007 16 IHS-DIAB ASPIRIN + + Next Screen - Prev Screen ?? More Actions >>> AR All reminders LR Linked Reminders QU Quit CV Change View RN Name/Print Name Select Item: Next Screen// CV Use this to change “view” to another menu (element, prompt, etc)

  15. Select one of the following: D Reminder Dialogs E Dialog Elements F Forced Values G Dialog Groups P Additional Prompts R Reminders RG Result Group (Mental Health) RE Result Element (Mental Health) TYPE OF VIEW: R// D

  16. Dialog List Sep 09, 2008 11:16:05 Page: 2 of 6 DIALOG VIEW (REMINDER DIALOGS - SOURCE REMINDER NAME) +Item Reminder Dialog Name Source Reminder Status 17 IHS-DOMESTIC VIOLENCE 2007 IHS-DOMESTIC VIOLENCE 200 Linked 18 IHS-HCT/HGB IHS-HCT/HGB Linked 19 IHS-HEAD CIRCUMFERENCE *NONE* Linked 20 IHS-HEARING TEST IHS-HEARING TEST Linked 21 IHS-HEIGHT *NONE* Linked 22 IHS-HEIGHT 2Y-18Y IHS-HEIGHT 23 IHS-HEP A ADULT IHS-HEP A ADULT Linked 24 IHS-HEP B ADULT IHS-HEP B ADULT Linked 25 IHS-HIGH RISK FLU 2007 IHS-HIGH RISK FLU 2007 Linked 26 IHS-HIGH RISK PNEUMO IHS-HIGH RISK PNEUMO 2007 Linked 27 IHS-HPV IMMUNIZATION IHS-HPV IMMUNIZATION Linked 28 IHS-INFLUENZA IMMUNIZATION 2007 IHS-INFLUENZA IMMUNIZATIO Linked 29 IHS-LIPID FEMALE IHS-LIPID FEMALE Linked 30 IHS-LIPID MALE IHS-LIPID MALE Linked 31 IHS-MAMMOGRAM 2007 IHS-MAMMOGRAM 2007 Linked 32 IHS-PAP SMEAR 2007 IHS-PAP SMEAR 2007 Linked + + Next Screen - Prev Screen ?? More Actions >>> AD Add Reminder Dialog PT List/Print All QU Quit CV Change View RN Name/Print Name Select Item: Next Screen// 31

  17. Mammogram Dialog Dialog Edit List Sep 09, 2008 11:24:03 Page: 1 of 1 REMINDER DIALOG NAME: IHS-MAMMOGRAM 2007 Sequence Dialog Details Disabled 1 Dialog element: HD MAMMOGRAM 5 Dialog element: OI MAMMOGRAM Resolution: ORDERED Orderable item: ??? Finding type: QUICK ORDER Finding item: LRZ MAMMOGRAM + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Quit// This shows the structure of this dialog. We now know we need EDIT the OI MAMMOGRAM element We are going to ADD a display header to add Eligibility

  18. SCRIPT for Mammogram Dialog Changes From the main menu, CHANGE VIEW, then select E Element Dialog List Sep 09, 2008 11:16:05 Page: 2 of 6 DIALOG VIEW (REMINDER DIALOGS - SOURCE REMINDER NAME) +Item Reminder Dialog Name Source Reminder Status 17 IHS-DOMESTIC VIOLENCE 2007 IHS-DOMESTIC VIOLENCE 200 Linked 18 IHS-HCT/HGB IHS-HCT/HGB Linked 19 IHS-HEAD CIRCUMFERENCE *NONE* Linked 20 IHS-HEARING TEST IHS-HEARING TEST Linked 21 IHS-HEIGHT *NONE* Linked 22 IHS-HEIGHT 2Y-18Y IHS-HEIGHT 23 IHS-HEP A ADULT IHS-HEP A ADULT Linked 24 IHS-HEP B ADULT IHS-HEP B ADULT Linked 25 IHS-HIGH RISK FLU 2007 IHS-HIGH RISK FLU 2007 Linked 26 IHS-HIGH RISK PNEUMO IHS-HIGH RISK PNEUMO 2007 Linked 27 IHS-HPV IMMUNIZATION IHS-HPV IMMUNIZATION Linked 28 IHS-INFLUENZA IMMUNIZATION 2007 IHS-INFLUENZA IMMUNIZATIO Linked 29 IHS-LIPID FEMALE IHS-LIPID FEMALE Linked 30 IHS-LIPID MALE IHS-LIPID MALE Linked 31 IHS-MAMMOGRAM 2007 IHS-MAMMOGRAM 2007 Linked 32 IHS-PAP SMEAR 2007 IHS-PAP SMEAR 2007 Linked + + Next Screen - Prev Screen ?? More Actions >>> AD Add Reminder Dialog PT List/Print All QU Quit CV Change View RN Name/Print Name Select Item: Next Screen// CV

  19. Select one of the following: D Reminder Dialogs E Dialog Elements F Forced Values G Dialog Groups P Additional Prompts R Reminders RG Result Group (Mental Health) RE Result Element (Mental Health) TYPE OF VIEW: R// E

  20. ADD a Display Header Dialog List Sep 09, 2008 11:37:04 Page: 1 of 27 DIALOG VIEW (DIALOG ELEMENTS) Item Dialog Name Dialog type Status 1 CPT 92002 Dialog Element 2 CPT 92004 Dialog Element 3 CPT 92012 Dialog Element 4 CPT 92014 Dialog Element 5 CPT 92015 Dialog Element 6 CPT 92250 Dialog Element 7 CPT 99202 Dialog Element 8 CPT 99203 Dialog Element 9 CPT 99204 Dialog Element 10 CPT 99205 Dialog Element 11 CPT 99212 Dialog Element 12 CPT 99213 Dialog Element 13 CPT 99214 Dialog Element 14 CPT 99215 Dialog Element 15 CPT BREAST PELVIC G0101 Dialog Element 16 CPT COLONOSCOPY Dialog Element + + Next Screen - Prev Screen ?? More Actions >>> AD Add CV Change View INQ Inquiry/Print CO Copy Dialog PT List/Print All QU Quit Select Item: Next Screen// AD Select DIALOG to add: HD ELIGIBILITY Are you adding 'HD ELIGIBILITY' as a new REMINDER DIALOG (the 507TH)? No//Y

  21. NAME: HD ELIGIBILITY// DISABLE: CLASS: L LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE: ORDERABLE ITEM: FINDING ITEM: DIALOG/PROGRESS NOTE TEXT: No existing text Edit? NO// YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== |PATIENT ELIGIBILITY STATUS|← Put in the TIU object <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: Y YES← This makes the element display only SUPPRESS CHECKBOX: 1 SUPPRESS← Now it displays without a leading check box Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: Input your edit comments. Edit? NO// Select DIALOG to add:

  22. Now edit the OI MAMMOGRAM element • Make sure you are in the ELEMENTS menu • Select the OI MAMMOGRAM element to edit Dialog List Sep 09, 2008 12:06:04 Page: 23 of 27 DIALOG VIEW (DIALOG ELEMENTS) +Item Dialog Name Dialog type Status 353 OI CONSULT SMOKING CESSATION Dialog Element 354 OI CONSULT SOCIAL SERVICES Dialog Element 355 OI HGB/HCT Dialog Element 356 OI HGBA1C Dialog Element 357 OI LAB DM PANEL FAST Dialog Element 358 OI LAB DM PANEL NONFAST Dialog Element 359 OI LAB FOBT Dialog Element 360 OI LAB HGA1C Dialog Element 361 OI LAB LIPID Dialog Element 362 OI LAB MICROALBUMIN/CREAT RATIO Dialog Element 363 OI LAB PAP ONLY Dialog Element 364 OI LAB PAP WITH STD Dialog Element 365 OI LIPID Dialog Element 366 OI MAMMOGRAM Dialog Element 367 OI MED ASPIRIN Dialog Element 368 OI MED CARDIOLOGY ACE/ARB Dialog Element + + Next Screen - Prev Screen ?? More Actions >>> AD Add CV Change View INQ Inquiry/Print CO Copy Dialog PT List/Print All QU Quit Select Item: Next Screen// 366

  23. Now you can EDIT CURRENT DIALOG ELEMENT/GROUP NAME: OI MAMMOGRAM Used by: IHS-MAMMOGRAM 2007 (Reminder Dialog) NAME: OI MAMMOGRAM// DISABLE: CLASS: VISN// SPONSOR: REVIEW DATE: RESOLUTION TYPE: ORDERED// ORDERABLE ITEM: FINDING ITEM: LRZ MAMMOGRAM// ??

  24. FINDING ITEM: ?? This is the finding item that should be created if the dialog element/group is checked in CPRS. Additional findings may be entered into the additional findings field. Enter one of the following: ED.EntryName to select a EDUCATION TOPICS IM.EntryName to select a IMMUNIZATION ST.EntryName to select a SKIN TEST EX.EntryName to select a EXAM HF.EntryName to select a HEALTH FACTOR CPT.EntryName to select a PROCEDURE ICD9.EntryName to select a ICD9 DIAGNOSIS VM.EntryName to select a VITAL TYPE TX.EntryName to select a TAXONOMY Q.EntryName to select a ORDER DIALOG MT.EntryName to select a MEASUREMENT TYPE

  25. FINDING ITEM: Q.GMRQO CHS Mammogram GMRQO CHS Mammogram ...OK? Yes// (Yes) DIALOG/PROGRESS NOTE TEXT: Check to order mammogram from radiology Edit? NO// YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== Check to order mammogram referral← change text – this is the text in your reminder dialog <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: Mammogram ordered Edit? NO// y YES ==[ WRAP ]==[ INSERT ]====< ALTERNATE PROGRESS NOTE TEXT >===[ <PF1>H=Help ]==== Mammogram referral done← change text – this is the text in the note that is created <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX: Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: Input your edit comments. Edit? NO//

  26. Now your “OI MAMMOGRAM” is updated. You need to ADD “HD ELIGIBILITY” Change View to the Dialog menu. Dialog List Sep 09, 2008 13:08:29 Page: 2 of 6 DIALOG VIEW (REMINDER DIALOGS - SOURCE REMINDER NAME) +Item Reminder Dialog Name Source Reminder Status 17 IHS-DOMESTIC VIOLENCE 2007 IHS-DOMESTIC VIOLENCE 200 Linked 18 IHS-HCT/HGB IHS-HCT/HGB Linked 19 IHS-HEAD CIRCUMFERENCE *NONE* Linked 20 IHS-HEARING TEST IHS-HEARING TEST Linked 21 IHS-HEIGHT *NONE* Linked 22 IHS-HEIGHT 2Y-18Y IHS-HEIGHT 23 IHS-HEP A ADULT IHS-HEP A ADULT Linked 24 IHS-HEP B ADULT IHS-HEP B ADULT Linked 25 IHS-HIGH RISK FLU 2007 IHS-HIGH RISK FLU 2007 Linked 26 IHS-HIGH RISK PNEUMO IHS-HIGH RISK PNEUMO 2007 Linked 27 IHS-HPV IMMUNIZATION IHS-HPV IMMUNIZATION Linked 28 IHS-INFLUENZA IMMUNIZATION 2007 IHS-INFLUENZA IMMUNIZATIO Linked 29 IHS-LIPID FEMALE IHS-LIPID FEMALE Linked 30 IHS-LIPID MALE IHS-LIPID MALE Linked 31 IHS-MAMMOGRAM 2007 IHS-MAMMOGRAM 2007 Linked 32 IHS-PAP SMEAR 2007 IHS-PAP SMEAR 2007 Linked + + Next Screen - Prev Screen ?? More Actions >>> AD Add Reminder Dialog PT List/Print All QU Quit CV Change View RN Name/Print Name Select Item: Next Screen// 31 ← select dialog to edit

  27. Add the HD ELIGIBILITY element to the Mammogram dialog Dialog Edit List Sep 09, 2008 13:15:18 Page: 1 of 1 REMINDER DIALOG NAME: IHS-MAMMOGRAM 2007 Sequence Dialog Details Disabled 1 Dialog element: HD MAMMOGRAM 5 Dialog element: OI MAMMOGRAM Resolution: ORDERED Orderable item: ??? Finding type: QUICK ORDER Finding item: CHS Mammogram Referral [2396] + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Quit// ED NAME: IHS-MAMMOGRAM 2007// DISABLE: CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-MAMMOGRAM 2007// Select SEQUENCE: 5// ?

  28. Select SEQUENCE: 5// ? Answer with COMPONENTS SEQUENCE, or ITEM Choose from: 1 HD MAMMOGRAM 5 OI MAMMOGRAM You may enter a new COMPONENTS, if you wish Type a Number between .1 and 999.9, 1 Decimal Digit Select SEQUENCE: 5// 3 DIALOG ELEMENT/GROUP: HD ELIGIBILITY dialog element LOCAL ...OK? Yes// (Yes) Select SEQUENCE: Dialog Edit List Sep 09, 2008 13:15:18 Page: 1 of 1 REMINDER DIALOG NAME: IHS-MAMMOGRAM 2007 Sequence Dialog Details Disabled 1 Dialog element: HD MAMMOGRAM 3 Dialog element: HD ELIGIBILITY 5 Dialog element: OI MAMMOGRAM Resolution: ORDERED Orderable item: ??? Finding type: QUICK ORDER Finding item: CHS Mammogram Referral [2396] + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Quit//

  29. Log out and log back into see your new Dialog

  30. Scenario 1 –Colon Cancer Screen Dialog The National Dialog is delivered with text only describing where the user can enter screening results. Your Medical Staff wants you to: REPLACE Informational Header ADD FOBT order with education ADD Colonoscopy referral with education ADD ability to enter historical colonoscopy

  31. Current Dialog We will: Replace the display text Add FOBT order and education Add Colonoscopy referral order and education Add ability to enter a historical Colonoscopy

  32. Element 1New Informational Header Dialog List Sep 09, 2008 19:42:58 Page: 1 of 27 DIALOG VIEW (DIALOG ELEMENTS) Item Dialog Name Dialog type Status Item Dialog Name Dialog type Status 1 CPT 45378 HISTORICAL Dialog Element 2 CPT 92002 Dialog Element 3 CPT 92004 Dialog Element 4 CPT 92012 Dialog Element 5 CPT 92014 Dialog Element 6 CPT 92015 Dialog Element 7 CPT 92250 Dialog Element 8 CPT 99202 Dialog Element 9 CPT 99203 Dialog Element 10 CPT 99204 Dialog Element 11 CPT 99205 Dialog Element 12 CPT 99212 Dialog Element 13 CPT 99213 Dialog Element 14 CPT 99214 Dialog Element 15 CPT 99215 Dialog Element 16 CPT BREAST PELVIC G0101 Dialog Element + + Next Screen - Prev Screen ?? More Actions >>> AD Add CV Change View INQ Inquiry/Print CO Copy Dialog PT List/Print All QU Quit Select Item: Next Screen//AD Select DIALOG to add: HD COLON CA TEXT YAK Are you adding 'HD COLON CA TEXT YAK' as a new REMINDER DIALOG (the 515TH)? No//YES Not used by any other dialog

  33. NAME: HD COLON CA TEXT YAK Replace DISABLE: CLASS: L LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE: ORDERABLE ITEM: FINDING ITEM: DIALOG/PROGRESS NOTE TEXT: No existing text Edit? NO//YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== Order FOBT or Colonoscopy below. Document Historical Colonoscopy below. Formatting is tricky in the dialogs, you may need to include extra lines for readable format Document Historical Sigmoidoscopy on the Services tab. <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: y YES SUPPRESS CHECKBOX: 1 SUPPRESS Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: Input your edit comments. Edit? NO//

  34. Element 2Colonoscopy Consult Order with Education Select DIALOG to add:OI COLONOSCOPY REFERRAL YAK Are you adding 'OI COLONOSCOPY REFERRAL YAK' as a new REMINDER DIALOG (the 516TH)? No//YES Not used by any other dialog NAME: OI COLONOSCOPY REFERRAL YAK Replace DISABLE: CLASS: l LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE: OrDERED ...OK? Yes// (Yes) ORDERABLE ITEM: FINDING ITEM: Q.GMRQO CHS Col GMRQO CHS Colonoscopy ...OK? Yes// (Yes) DIALOG/PROGRESS NOTE TEXT: No existing text Edit? NO//YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== Colonoscopy referral ordered. Counseled on importance of test. <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX:

  35. Select ADDITIONAL FINDINGS: ED.CA-TEST Searching for a EDUCATION TOPICS, (pointed-to by ADDITIONAL FINDINGS) Searching for a EDUCATION TOPICS CA-TESTS CA-TESTS CA-TE ...OK? Yes// (Yes) Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: 5← This is where you add the appropriate Prompts for the findings you entered ADDITIONAL PROMPT/FORCED VALUE: PXRM LEVEL OF UNDERSTANDING prompt NATIONAL OVERRIDE PROMPT CAPTION: START NEW LINE: y YES ← YES places each prompt on a separate line, NO they will be side by side EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCED VALUE: PXRM PED LENGTH prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE: 15 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE: Input your edit comments. Edit? NO//

  36. Element 3FOBT Order with Education Select DIALOG to add:OI FOBT YAK Are you adding 'OI FOBT YAK' as a new REMINDER DIALOG (the 517TH)? No//YES Not used by any other dialog NAME: OI FOBT YAK Replace DISABLE: CLASS: l LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE: OrDERED ...OK? Yes// (Yes) ORDERABLE ITEM: FINDING ITEM: Q.LROQO FOBT LROQO FOBT ...OK? Yes// (Yes) DIALOG/PROGRESS NOTE TEXT: No existing text Edit? NO//YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== FOBT ordered. Counseled on importance of test. <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX:

  37. Select ADDITIONAL FINDINGS: ED.CA-TEST Searching for a EDUCATION TOPICS, (pointed-to by ADDITIONAL FINDINGS) Searching for a EDUCATION TOPICS CA-TESTS CA-TESTS CA-TE ...OK? Yes// (Yes) Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: 5← This is where you add the appropriate Prompts for the findings you entered ADDITIONAL PROMPT/FORCED VALUE: PXRM LEVEL OF UNDERSTANDING prompt NATIONAL OVERRIDE PROMPT CAPTION: START NEW LINE: y YES ← YES places each prompt on a separate line, NO they will be side by side EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCED VALUE: PXRM PED LENGTH prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE: 15 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: Select SEQUENCE: Input your edit comments. Edit? NO//

  38. Element 4Historical Colonoscopy Entry Select DIALOG to add: CPT COLONOSCOPY HISTORICAL YAK Are you adding 'CPT COLONOSCOPY HISTORICAL YAK' as' as a new REMINDER DIALOG (the 518TH)? No//YES Not used by any other dialog NAME: CPT COLONOSCOPY HISTORICAL YAK Replace DISABLE: CLASS: l LOCAL SPONSOR: REVIEW DATE: RESOLUTION TYPE: done elseWHERE (HISTORICAL) ...OK? Yes// (Yes) ORDERABLE ITEM: ITEM: CPT.45378 45378 DIAGNOSTIC COLONOSCOPY COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR ...OK? Yes// y (Yes) DIALOG/PROGRESS NOTE TEXT: No existing text Edit? NO//YES ==[ WRAP ]==[ INSERT ]======< DIALOG/PROGRESS NOTE TEXT >====[ <PF1>H=Help ]==== Historical Colonoscopy reported <=======T=======T=======T=======T=======T=======T=======T=======T=======T>====== ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX:

  39. ALTERNATE PROGRESS NOTE TEXT: No existing text Edit? NO// EXCLUDE FROM PROGRESS NOTE: SUPPRESS CHECKBOX: Select ADDITIONAL FINDINGS: RESULT GROUP/ELEMENT: Select SEQUENCE: 5← This is where you add the appropriate Prompts for the findings you entered ADDITIONAL PROMPT/FORCED VALUE: PXRM VISIT DATE prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCED VALUE: PXRM OUTSIDE LOCATION prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: 15 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT prompt NATIONAL ...OK? Yes// (Yes) OVERRIDE PROMPT CAPTION: Results and source of info: ← This is where you can provide guidance for user START NEW LINE: y YES EXCLUDE FROM PN TEXT: REQUIRED: y YES Select SEQUENCE: Input your edit comments. Edit? NO//

  40. Now Edit the Colon Cancer Screen Dialog Return to DIALOG VIEW Dialog List Sep 09, 2008 19:52:03 Page: 1 of 6 DIALOG VIEW (REMINDER DIALOGS - SOURCE REMINDER NAME) Item Reminder Dialog Name Source Reminder Status Item Reminder Dialog Name Source Reminder Status 1 IHS PED HEPB IMMUN IHS-PED HEPB IMMUN 2 IHS-ALCOHOL SCREEN 2007 IHS-ALCOHOL SCREEN 2007 Linked 3 IHS-ASTHMA PLAN IHS-ASTHMA PLAN 2007 Linked 4 IHS-ASTHMA PRIM PROV IHS-ASTHMA PRIM PROV 2007 Linked 5 IHS-ASTHMA SEVERITY IHS-ASTHMA SEVERITY 2007 Linked 6 IHS-ASTHMA STEROIDS IHS-ASTHMA STEROID 2007 Linked 7 IHS-BLOOD PRESSURE IHS-BLOOD PRESSURE Linked 8 IHS-COLON CANCER 2007 IHS-COLON CANCER 2007 Linked 9 IHS-DEPRESSION SCREEN 2007 IHS-DEPRESSION SCREEN 200 Linked 10 IHS-DIAB ACE/ARB 2007 IHS-DIAB ACE/ARB 2007 Linked 11 IHS-DIAB ASPIRIN 2007 IHS-DIAB ASPIRIN 2007 Linked 12 IHS-DIAB DENTAL EXAM 2007 IHS-DIAB DENTAL EXAM 2007 Linked 13 IHS-DIAB EYE EXAM 2007 IHS-DIAB EYE EXAM 2007 Linked 14 IHS-DIAB FOOT EXAM 2007 IHS-DIAB FOOT EXAM 2007 Linked 15 IHS-DIAB HGBA1C 2007 IHS-DIAB HGBA1C 2007 Linked 16 IHS-DIAB MICROALBUMIN 2007 IHS-DIAB MICROALBUMIN 200 Linked + + Next Screen - Prev Screen ?? More Actions >>> AD Add Reminder Dialog PT List/Print All QU Quit CV Change View RN Name/Print Name Select Item: Next Screen// 8 ← select dialog to edit

  41. Dialog Edit List Sep 10, 2008 14:16:09 Page: 1 of 2 REMINDER DIALOG NAME: IHS-COLON CANCER 2007 Sequence Dialog Details Disabled 5 Dialog element: HD COLON CANCER SCREENING + + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Dialog QU Quit DP Progress Note Text INQ Inquiry/Print Select Sequence: Next Screen// ED NAME: IHS-COLON CANCER 2007 Replace DISABLE: CLASS: LOCAL// SPONSOR: REVIEW DATE: SOURCE REMINDER: IHS-COLON CANCER 2007// Select SEQUENCE: 5// SEQUENCE: 5// DIALOG ELEMENT/GROUP: HD COLON CANCER SCREENING // HD COLON TEXT YAK dialog element LOCAL ← Replace with the new element ...OK? Yes// (Yes) Select SEQUENCE: 10 ← Now add the new elements DIALOG ELEMENT/GROUP: OI FECAL OCCULT BLOOD dialog element LOCAL ...OK? Yes// (Yes) Select SEQUENCE: 15 DIALOG ELEMENT/GROUP: OI COLONOSCOPY REFERRAL YAK dialog element LOCAL ...OK? Yes// (Yes) Select SEQUENCE: 20 DIALOG ELEMENT/GROUP: CPT COLONOSCOPY HISTORICAL YAK dialog element LOCAL ...OK? Yes// (Yes)

  42. New Colon Cancer Dialog Dialog Edit List Sep 09, 2008 19:53:23 Page: 1 of 2 REMINDER DIALOG NAME: IHS-COLON CANCER 2007 Sequence Dialog Details Disabled Sequence Dialog Details Disabled 5 Dialog element: HD COLON CA TEXT YAK 10 Dialog element: OI FECAL OCCULT BLOOD Resolution: ORDERED Orderable item: ??? Finding type: QUICK ORDER Finding item: Fecal Occult Blood x 3 [2179] Additional Finding: CA-TESTS [ED(718)] Additional prompts: PXRM LEVEL OF UNDERSTANDING PXRM PED LENGTH PXRM COMMENT 15 Dialog element: OI COLONOSCOPY REFERRAL YAK Resolution: ORDERED Orderable item: ??? Finding type: QUICK ORDER + + Next Screen - Prev Screen ?? More Actions >>> Finding type: QUICK ORDER + + Next Screen - Prev Screen ?? More Actions >>> CO Copy Dialog DT Dialog Text RI Reminder Inquiry DD Detailed Display ED Edit/Delete Di

  43. New Colon Cancer Dialog

  44. Summary During this presentation we: • Reviewed the construction of a basic dialog • Created new elements and added them to National Dialogs • Edited existing dialogs • Created elements with additional findings and added Prompts

  45. Resources Clinical (EHR) Reminders Manual ftp://ftp.ihs.gov/pubs/EHR/Training/Guides/EHR Reminders Guide.doc Clinical (EHR) Reminders Patch 1005 National Reminder Set Up guide will be released with the patch and patch notes. Other reminders resources: ftp://ftp.ihs.gov/pubs/EHR/Training/Guides/EHR%20Reminders/

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