Using Telin Mediplan to Support Patient s Medical Home

Transcription

1 EMR TIP SHEET JANUARY 2017 Using Telin Mediplan t Supprt Patient s Medical Hme Cntents Intrductin... 3 Patient s Medical Hme... 3 Fundatin fr Success - Cmmitment t Standardizatin in the EMR... 4 Help Files... 5 References... 6 Panel Identificatin... 7 Patient Panel Definitin... 7 Demgraphics... 7 Basic Demgraphic Infrmatin... 7 Dcumenting Status Changes... 9 Managing Patient Type by Physician # Verificatin Cnfiguring Type (Status) Prducing a Prvider s Panel List Initial Panel Clean-Up Bulk/Batch Actins Panel Maintenance Panel Management Appraches t Panel Management Opprtunistic Outreach Panel Management: Hw t Get Started Preventive Screening Care Disease Management Management f Cmplex Patients Panel Management Examples Preventive Screening Searches POEM Template... 36

2 Registries Disease Management Tls fr Panel Management Clinical dcumentatin s that data may be searched Scanned Dcuments Searches Getting Started Opprtunistic Screening Tls Measurement Verificatin Rate Screening Rate Based n Cmpleted Screens Appendix A: High Value Efficiency Tips frm Alberta Peers Appendix B: Other Searching Tls Analyzer Tl Patient Management Tl Quick Reprt/Exprt Appendix C: Finding Lab Cdes Appendix D: Ntes/Buttns Tl Appendix E: Creating Templates Appendix F: List f Scanned Dcument Index Wrds/Keywrds

3 Intrductin Patient s Medical Hme When an EMR is used in a meaningful way within the Patient s Medical Hme (PHM) mdel it supprts effective patient panel identificatin, panel maintenance, panel management and will enable practive panel-based care fr patients in a practice. Meaningful use f the EMR will enable Panel & Cntinuity ; knwing which patients are active with each prvider and using this infrmatin fr scheduling purpses and t mnitr supply, demand and cntinuity with the prvider. This wrk is fundatinal fr success, and must be discussed with the entire practice, arriving at agreed-upn plicies and prcedures n what, why and hw data is t be captured and maintained with the EMR. Organized Evidence Based Care fr preventive screening is a lgical place t start t learn hw t use the EMR fr panel management, r in ther wrds, practive panel-based care. 3

4 Fundatin fr Success - Cmmitment t Standardizatin in the EMR Successful standardizatin f data entry fr imprvement r change, apart frm leveraging the inherent functinality f the EMR, relies heavily n three peple and prcess principles in cnjunctin with the EMR functinality fr adptin and use. These are: 1. Team Includes having engaged leadership and inclusive team representatin within each clinic r rganizatin; A clinic champin fr EMR standardizatin can be named EMR imprvements r changes d nt happen in islatin, and require cmmitment f time and resurces fr imprvement t happen Cmbining EMR imprvement with enhanced use f team, prcess imprvement and practice facilitatin is the ideal strategy in wrking tward adptin f the PMH Leverage PCN supprts where they exist (i.e. Imprvement Facilitatrs, Panel Crdinatrs, etc.) 2. Data Quality Data Standardizatin fr the main areas f data input, the entire clinic team shuld discuss and agree upn: use f fields in a standardized way, create structured exam frms r templates fr the cnsistent capture f patient infrmatin utilizing standardized text r macrs (cmmnly repeated text) whenever pssible instead f free text develp verificatin prcesses t ensure ver time that data recrding is reliable (e.g., BP is always in the BP field and nt in a text bx) develp and prvide staff educatin with assciated jb aids fr cnsistent patient data chart entry (e.g. scanning and attaching dcuments t patient charts) prcesses t recrd patient prblems with the apprpriate ICD9 identifier (highly recmmended) where apprpriate, t mre clearly identify wh dcumented the infrmatin in the chart, it is recmmended t use the individual initials in areas utside f chart ntes (e.g., in demgraphic ntes r while prviding a reasn fr a bulk/batch change) It is advised that ne persn, r a small grup, prvide directin fr patient data entry t ensure high quality in the clinic and minimize data incnsistency. Create Gd in / Gd ut prcesses at the practice Dcumentatin f Standard Operating Prcedures (Plicies, Prcedures and Prcesses) assists a clinic team in having a cmmn understanding f wrkflw; these shuld be reviewed peridically Cmmunicate with the practice team the linkage between data entry and the ability fr a pintf-care reminder t functin and infrm reprting 4

5 3. Incremental Change A key recmmendatin is t take baby steps in EMR changes, especially when it cncerns practice-wide pint-f-care reminders. These can be managed t make the changes small and sustainable fr the practice team Use the simple but effective Mdel fr Imprvement methd including applying plan-d-studyact (PDSA) cycles t identify and test small incremental changes tward the desired and clearly identified imprvement gal When a new pint-f-care reminder is put in place an assciated, dcumented peple prcess needs t be develped and implemented; thus, making the change effective and sustainable, by embedding it int the wrk prcess and clinic culture Help Files Alng with the EMR tip sheet and vides made available n the TOP website, the embedded EMR Help Files frm the vendr can be a great untapped resurce with detailed instructins n hw t ptimize EMR functinality. Telin Mediplan has the Knwledge Base: 5

6 References Patient s Medical Hme Patient s Medical Hme Implementatin Field Kit Patient s Medical Hme Assessments: Readiness Phase 1 Phase 2 6

7 Panel Identificatin Patient Panel Definitin A patient panel, r rster, lists the unique patients that have established relatinships with a prvider. There is an implicit agreement that the identified physician will prvide primary care services. Relatinal cntinuity, r an nging relatinship between a physician and a patient, is a key bjective f establishing a patient identificatin prcess. Demgraphics Basic Demgraphic Infrmatin In the demgraphic area f the patient chart the basic infrmatin that is needed fr patient panel identificatin is: Full Name Date f Birth Sex (Gender) Cmplete address Phne number(s) Primary prvider Althugh there are tw fields that appear apprpriate fr this purpse, using the Phys # field is mst frequently used within queries t shw attachment t a physician. The Phys # shuld cntain the name f the physician that the patient is paneled t. The Family Dr field is ptinal. While it is gd practice t cmplete this field as well and have it match the Phys # field, panel lists and queries fr patient care can be cmpleted withut the use f this field. NOTE: Ensure that the fllwing check bx in yur system settings is checked in rder t ensure that the Phys # desn t get changed when a physician, ther than the assigned family dctr, bills (sign in as administratr, and g t Other/System Settings/Billings). 7

8 Use the belw radi buttns t indicate inactive/deceased patients. NOTE: if yu deactivate a patient, it will cancel all future appintments, s ensure nt t deactivate patient names that yu use t reserve spts in the schedule (i.e. Lunch, *, Reserved, Test etc.). Creating a chart type r assigning these fake patients t a fake physician is a gd wrk-arund. Patient status (Active r Inactive) (Chart) Type Alberta Patient Healthcare Number (PHN) Belw is an example f a full demgraphic page in Mediplan. If yu are n the Reg tab, yu can duble click, r click Mdify t enter the full versin shwn belw. Make sure t click Save! 8

9 Other demgraphic fields exist depending n the versin f Mediplan yu are using. These ther fields may als supprt patient panel identificatin and maintenance prcesses. TIP: In rder t ensure that all changes are saved within the REG tab, it is imprtant t duble-click r click Mdify in rder t reach the abve separate windw. If yu simply mdify the summary page that appears within the chart, changes may nt save within certain fields. Dcumenting Status Changes When changing a patient chart type r listing an inactive status, it is advisable t recrd the reasn and the date that the status was changed. If anther staff member at the clinic questins the status change, r if the patient cntacts the clinic, a recrd will make it clear t all when and why this was dne. There are tw areas f the chart where this can be recrded: Flagged Cmments and the REC tab. 9

10 Flagged Cmments Flagged cmments will pp-up any time a particular patient is searched. T mdify the flagged cmments sectin, pen the REG windw and enter cmments in the bttm left bx. Nte in the example belw, the status has been changed t inactive, and a nte within Flagged cmments fr Appts lists the reasn why. REC Ntes Tab The REC ntes tab can be used as an alternative t flagged cmments fr recrding status changes, but is als helpful fr recrding cntact with existing patients. Fr example, this tab can shw a running lg f interactins with a patient that include ffers f screening. 10

11 This free ntes area can be fund by clicking the REC tab in the chart. T write ntes, free type within the New Ntes bx and then click Add t Office Recrd. Newer ntes will appear at the tp. T learn hw t create a buttn that psts a standard nte within this sectin, see Appendix D. Managing Patient Type by Physician # Instead f classifying patients by assigning them a Type, yu can create a series f physician numbers (Phys #) instead. This is a particularly useful strategy fr differentiating between walk-in patients and primary care practice patients. This prcess achieves the same end as managing by using the (chart) Type drp-dwn, but because there is a different clur attached t each physician type, it can be easier t initiate a change f practice within a clinic, and it guarantees that these walk-in patients will nt be included within a physician panel. Ensure that if yu use this strategy that the D nt change patient physician bx is checked within system settings, r else yu risk having the walk-in physician listed as the default physician if a patient cmes in casually, even if the patient is attached t a different physician. T create a new physician: G t Other/Sign-On 11

12 Select an existing physician, and click Duplicate, t create a new physician and cpy existing settings. Within the next windw, enter the physician s name, and click the clured bx next t Resurce Clur Cde t select a distinct clur fr this physician. 12

13 The walk-in physician is used exclusively t stratify the patient ppulatin by type. Each patient will still be billed by whichever physician they see that day. Because f this, it is nt necessary t fill ut all f the detailed settings within the newly created Dr. Walk-In prfile. Verificatin Mediplan has a designated field fr patient demgraphic data verificatin. Marking this field/bx indicates that the address, phne, patient status and prvider attachment are up t date. The field als applies a date stamp and indicates wh stamped it, s that all knw when it was last dne and by whm. This is a searchable field s that yu may d a search fr quality imprvement purpses t see hw well yu are ding with verificatin prcesses. This search can be fund in a later sectin, Verificatin Rate. Cnfiguring Type (Status) In rder t cnfigure the chart Type in Mediplan, yu must have the apprpriate administrative privileges. Select Other frm the main menu then select System Settings frm this drp dwn. Select the Lists tab and the Chart Type frm the drp dwn. 13

14 Examples f Patient Status Used in Primary Care Status Status Name Additinal Infrmatin Active Office Patient Active ffice patient attached t a prvider in the practice Specialty Service Temprary New Orphaned/unassigned Emergency Department Lng term care This patient may be active in the practice but nly fr a given service (e.g., vasectmy, aesthetic, maternity care, aviatin medical, circumcisin, IUD). Sme clinics give a status t each type f specialty service. Applied t a patient seeking walk-in care. These patients are nt cnsidered part f the prvider s panel. When a practice is still accepting new patients, a patient may nt be cnfirmed as an ffice patient until after a first r secnd appintment. When a prvider leaves a practice resulting in an unassigned panel, these patients may be identified. Mainly in rural centres, where a patient recrd exists fr a visit that ccurred in ER f a nn-clinic patient. Fr a grup f patients seen in a lng-term care site but 14

15 Lapsed r Drmant nt the practice. Sme clinics prefer t use this term fr patients that are inactive, with n clinic visit within a specified perid f time (e.g., 3 years). They will be given this term during panel clean up r maintenance. Inactive Inactive Includes frmerly active patients with n clinic visits in a perid f time defined by the practice, (e.g. 3 years.) Deceased Nn-clinic patient / Nt Our Patient Duplicate r Archive Patient is deceased. When a patient chart is created fr lab wrk received at the practice r fr a patient never seen at the practice (may apply t a new patient that made an appintment but never visited the practice). When a patient has accidentally been registered mre than nce and the EMR des nt have the ability t merge duplicate recrds; the archived recrd has this unique status. Add, delete and change the list as desired fr yur clinic. Save yur changes and Save yur System Settings. Prducing a Prvider s Panel List During the panel identificatin prcess the first step is t prduce a list f all active patients attached t a prvider using the reprt/search functinality f the clinic EMR. Last Visit Date (LVdate) may assist with determinatin f which patients are active. (Fr infrmatin n getting started with searches, please see the sectin n Getting started with searches in Mediplan. Patients with a visit in clinic during an agreed-upn, predetermined perid (e.g. last 3 years) These lists usually create awareness fr initial panel clean up. Verificatin f the data prduced n the lists with the primary prvider and team will help t determine validity f the infrmatin. Further panel clean-up is assisted by additinal searches in the EMR. 15

16 Once the panel clean-up is cmplete, this search can be saved and laded again at a future date. Once a patient verificatin prcess has been in place fr sme time, the LVdate field can be replaced by FamilyDR_Cnfirmed is within last 3 years. TIP: Many EMRs will prduce the list with the EMR reprt/search functinality but als ffer exprting the list fr further srting and analysis in Micrsft Excel r Open Office Calc. Basic spreadsheet training is recmmended. Initial Panel Clean-Up Searches/reprts that assist initial panel clean up include prducing a list f active patients attached t a prvider, with the additinal search parameters f: Last visit date and n future appintments Age Srting the list f active patients by age is valuable. In viewing the list f active patients ver the age f 95 years, a prvider is usually able t indicate if there are patients n the list wh shuld be marked as deceased. Mediplan des nt have a field fr age s yu instead must search by the birthdate being befre a certain date. 16

17 Appintment Type/Reasn If the practice uses the appintment type r reasn when scheduling visits, searching by this infrmatin may prduce lists f patients that are nt family practice panel patients such as aviatin medical r Btx injectin. Billing (Fee/Health Services) Cde If the clinic ffers specialty services t patients wh are nt a part f the physician s family practice, they may be identifiable by billing cde frm the Schedule f Medical Benefits. Ask the prviders if there are any billing cdes that they rutinely use fr patients that are nt members f their family practice panel. Prcedure cdes E.g., searching by prcedures ffered at the practice, but all the patients may nt belng t the practice, such as vasectmy (75.64) Lng term care patients are billed with an 03.03E billing cde Yu can search billing cdes thrugh the Query Builder r yu can use the Search Editr. If yu have n need t save yur search, the Query Builder is a mre efficient way t search. Belw, we shw hw t search fr the 03.03E cde under the Billing tab. 17

18 Address r Pstal Cde Srting f active patients by the address r pstal cde searches can be valuable in identifying grups that may nt be part f the family practice panel due t their place f residence; temprary wrkers t an area may be identified this way. This example is limiting by pstal cde r city. Area cde is anther field that can searched in Mediplan that is a similar idea t the address/pstal cde ptin. Last Name is Test Mst clinics have test patients that were created fr training r practice purpses; fr reprting and analysis they shuld nt be included in the family practice panels. Verify each patient in the event there is a real patient with the last name Test. IMPORTANT: The primary prvider and/r the practice team need t review the data frm reprts t ensure that the crrect infrmatin is being pulled int them. Due t unique prtcl at a practice, fields may be used in a specific way and this may impact the accuracy f reprts. 18

19 Bulk/Batch Actins Once a list is prduced and srted, mst EMRs are capable f applying a bulk change t the entire list r a grup within the list. Making bulk changes makes the prcess f initial clean-up and nging panel maintenance faster and easier. Fr Mediplan, the clinic needs t prduce the list and then cntact the vendr t supprt the bulk change. TIP: Carefully verify data with the primary prvider and/r care team befre making a bulk change. Example Panel Search fr Clinics Verifying FamilyDR at Every Visit If clinics are rutinely using the family dr cnfirmed field each time the patient presents at the clinic, then they can use that as their criteria t search their panel list. The example belw will prvide the list f patients cnfirmed within the last 3 years. Panel Maintenance Once an initial clean-up is cmplete there are several prcesses that supprt maintaining a clean patient panel list fr each prvider. These prcesses include: 1. Onging phne/address data, physician attachment and status verificatin at patient check in. Develping and mnitring a prcess fr all staff that wrks the frnt desk with expectatins fr data verificatin is required. This prcess can be checked using the EMR reprting. Run a search t prduce a list f patients with visits in a given perid f time and determine what percentage f patients was verified during that time frame. Standard perating prcedures shuld be in place fr frnt desk staff fr: 19

20 Patients n lnger part f the clinic Patients nt seen in the clinic (e.g., recrds created fr patients where lab wrk was received r seen at anther facility, like the lcal ER) Patients seen at yur clinic but nt yur family practice patients (e.g., walk-in r temprary patients) Patients scheduled fr a meet and greet appintment 2. Cnducting searches at regular intervals and applying bulk actins t patients that are n lnger active at the practice. The regularity f the intervals varies by practice. It may be mnthly fr the first year and then every six mnths thereafter. Reprts that assist identifying these patients include searches by: Last visit date (and n future appintments) Age Appintment Type/Reasn Billing cde Address r pstal cde Last Name is Test (first be sure there are n actual practice patients with the surname Test) Examples f these reprts can be fund in the previus sectin. 3. Patient utreach: Sme practices identify active patients with n visits in the past 3 years (and n future appintments), priritizing thse verdue fr preventive screening care, then reaching ut practively t determine if they are still members f the practice. The utcmes f the utreach invlve updating the patient demgraphics, physician attachment and ffers f preventive screening care. Panel Management Panel management, als knwn as ppulatin management, is a practive apprach t health care. Ppulatin means the panel f patients assciated with a prvider r care team. Ppulatin-based care (r panel-based care) means that the practice team is cncerned with the health f the entire active ppulatin f attached patients at the practice, nt just thse wh cme in fr visits. 1 The Patient s Medical Hme implementatin element f Organized Evidence Base Care invlves embedding evidence-based guidelines int daily clinical practice where each encunter is designed t meet the patient s preventive and chrnic illness needs. Setting up ppulatin-wide pint-f-care reminders supprts these planned interactins and EMR functinality supprts apprpriate fllw-up care. 1 Mdule 20. Facilitating Panel Management. May Agency fr Healthcare Research and Quality, Rckville, MD. 20

21 Appraches t Panel Management Opprtunistic When appraching panel management pprtunistically, it means catching a patient while they are in the practice r n the phne with a team member, t ffer care. Fr example, a 52-year-ld female is in the practice fr an appintment t inquire abut the vaccine fr shingles. While in the ffice her bld pressure is taken and she is ffered requisitins fr a FIT test, plasma lipid prfile, fasting glucse and mammgram because they are all verdue. Methds t identify patients that are verdue fr clinical services may invlve: Setting up ppulatin wide pint-f care reminders that alert a team member that a patient is due fr a clinical service, where available in yur EMR Setting fllw-up r anther type f alert at the individual patient chart t practively set up fr the next interventin A team member that cmbs thrugh the charts f patients meeting certain criteria wh have an appintment, t identify clinical services that are due and marking the chart as due Outreach An utreach methd t panel management invlves identifying active, paneled patients verdue fr clinical services that d nt have appintments and reaching ut t ffer care. This prcess invlves using the search/reprting tl in the EMR t prduce lists f patients. Fr example, a 58-year-ld male was last in the clinic 2.5 years ag fr a knee injury. The panel care crdinatr (PCC) at the practice has run a reprt that shws this patient is verdue fr a plasma lipid prfile, a FIT test and a fasting glucse. The PCC phnes the patient and verifies that he is still a patient in the practice attached t his paneled physician. * As per clinic prtcl, the PCC makes an ffer that the patient can cme by the clinic and just pick up the lab requisitin t get the verdue screening dne and the clinic will fllw-up if/as necessary. The patient agrees. *Nte: such prtcls vary frm practice t practice. It is an imprtant prcess that must have prvider agreement befre implementatin. TIP: It is recmmended that a practice initiating utreach begin with patients that have been verified as attached, active patients. This will prevent the experience f cntacting patients that are deceased r n lnger active at the practice. 21

22 Panel Management: Hw t Get Started Once patient panel identificatin and maintenance prcesses are in place, it is recmmended t begin practive panel-base care with the fllwing apprach: Panel Identificatin & Maintenance Panel Lists Patient Verificatin Preventive Screening Care Fundatinal Learning Simple t Cmplex Pint-f-Care Reminders Reprting Disease Management Disease Registries Practive Panelbased Care Mre Cmplex Pint-f-Care Reminders Cmplex Patients Autmated prcesses t supprt uncmmn care requirements With ICD-9 cdes in place identify cmplex patients fr systematic care Preventive Screening Care Preventive screening care invlves a smaller number f data elements than disease management There is benefit t starting with sme clean surces f data like electrnic lab feeds Clinic team will learn: the imprtance f, and begin, standardizatin f naming prtcls fr scanned dcuments (e.g., mammgrams and clnscpy reprts) frm this experience abut patterns in their data entry and can make crrectin fr future meaningful use f EMR practice standard perating prcedures that enable practive panel-based care The searches and ppulatin-wide pint f care reminders start simple and can build t the mre cmplex Practices can build n: the number f screening maneuvers they are addressing, and/r; the ppulatin f patients at the practice that pint-f-care reminders are set fr (e.g., gender and age) Prvides a fundatinal experience fr prcess imprvement 22

23 Disease Management Clinic team take lessns learned frm less cmplex preventive screening care prcesses that can then be applied t disease management Invlves mre cmplex searches with mre data elements than screening A dependency exists n reliable registries f patients with a given disease Prviders will learn the imprtance f cnsistent cding in the prblem list f the EMR Clinic team will build n the benefits f standardized data entry Building f mre cmplex pint-f-care reminders with increased reliability f planned priritized care Management f Cmplex Patients With a slid fundatin in preventive screening care and disease management, patients with cmplexities and multiple, c-existing cnditins will have visits that address many predictable health issues by using available resurces mre efficiently t reliably meet patient s mst imprtant needs 23

24 Panel Management Examples Preventive Screening Searches As per the Alberta Screening and Preventin (ASaP) Prgram 24

25 Lading the physician panel t begin a screening search T search fr patients due fr a particular screening maneuver, yu must first lad the physician panel in the query builder (data/query builder/use search editr/lad). By lading this pre-defined search, yu will nt have t re-create it fr each search. Preventive Screening Searches Find Patients Due fr Bldwrk r DI Due fr Pap Tests Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: female Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click LAB tab and enter apprpriate infrmatin Enter the apprpriate lab cde fr Pap Ensure the cmparisn equals 0 Enter lab test date (three years frm tday) Click Search Only in selectin belw Click Remve these Patients 25

26 Return t the Patients tab, the remaining patients are due fr a pap test Due fr Lipid Panel Lad yur saved physician panel search within query builder Insert age and gender criteria Male Age Female Age Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click LAB tab and enter apprpriate infrmatin Enter the apprpriate lab cde fr chlesterl Ensure the cmparisn is greater than 0 Enter lab test date (five years frm tday) Click Search Only in selectin belw Click Remve these Patients Return t the Patients tab, the remaining patients are due fr a lipid panel 26

27 Due fr Diabetic Screening Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates) Click LAB tab and enter apprpriate infrmatin Enter the apprpriate lab cde fr fasting glucse Ensure the cmparisn is greater than 0 Enter lab test date (five years frm tday) Click Search Only in selectin belw Click Remve these Patients Re-enter the apprpriate lab cde fr Hemglbin A1C Ensure the cmparisn is greater than 0 Enter lab test date (five years frm tday) Click Search Only in selectin belw Click Remve these Patients Return t the Patient tab, the remaining patients are due fr a diabetic screen Due fr Mammgram Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Female Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates) Click Reprts/DI tab and enter apprpriate infrmatin 27

28 Reprts date = 2 years frm tday Reprts type = Mammgram (ensure that the apprpriate standardized reprt type is selected frm the drp-dwn and appears in the bx t the left) Click Search Only in selectin belw Click Remve these Patients Return t the Patients tab, the remaining patients are due fr a mammgram. Due fr FIT Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click Reprts/DI tab and enter apprpriate infrmatin Reprts date = 10 years frm tday Reprts type = Clnscpy Click Search Only in selectin belw Click Remve these Patients Click LAB tab and enter apprpriate infrmatin Enter the apprpriate lab cde fr Fecal Immunchemical Test Ensure the cmparisn is equal t 0 28

29 Enter lab test date (tw years frm tday) Click Search Only in selectin belw Click Remve these Patients Return t the Patients tab, the remaining patients are due fr a FIT test Preventive Screening Searches Find Patients Due fr Vitals These searches assume that vitals are entered in the apprpriate bxes within the encunter nte Nte the ptin t specify which arm the BP was taken n Left B/P Right R Helpful trick: nce the vitals have been entered in the Charts/Vitals tab, yu can return t the Nte tab and cpy them directly int the nte by clicking Paste and then Vitals 29

30 Due fr BP Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click Encunter tab Click use search editr Search within default table Clinical Data Systlic is strictly greater than 0 OR Systlic_R is strictly greater than 0 Click Query NOTE: We include bth Systlic and Systlic_R t ensure that all BPs are captured if the clinic specifies Left/Right BP within encunters Within the Encunter Tab, nw enter the date f encunter (ne year frm tday) Click Search Only in selectin belw Click Remve these Patients Return t the Patients tab, the remaining patients are due fr BP Due fr Height Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Bth 30

31 Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates) Click Encunter tab Click use search editr Search within default table Clinical Data Height is strictly greater than 0 Click query Click Remve these Patients Return t the Patients tab, the remaining patients are due fr height Due fr Weight Lad yur saved physician panel search within query builder Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click Encunter tab Click use search editr Search within default table Clinical Data Weight is strictly greater than 0 AND date is within the last 3 years Click query Click Remve these Patients NOTE: all vitals searches can be saved Return t the Patients tab, the remaining patients are due fr weight Preventive Screening Searches Find Patients Due fr a Scial Histry Screen These searches assume that scial histry infrmatin is entered in the apprpriate bxes within the Hx tab It is nt pssible within Telin t search whether an individual has had a smking r exercise assessment by date, because the date is attached t the last day that the histry was mdified, nt the last time that the individual field was mdified. 31

32 Nte: In rder t ensure that the histry menu is always up t date and includes previus ntes, always click Mdify rather than New t edit the histry. Due fr Smking Assessment Lad yur saved physician panel search within query builder Click Hx tab Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click use search editr Search within default table Patient_Hx Smking Status is different frm 0 AND Smking_c is nt empty Click Query 32

33 Click Remve these Patients Return t the Patients tab, the remaining patients are due fr a smking assessment Due fr Exercise Assessment Lad yur saved physician panel search within Query builder Click Hx tab Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click use search editr Search within default table Patient_Hx Exercise is nt empty Click Query Click Remve these Patients Return t the Patients tab, the remaining patients are due fr an exercise assessment Preventive Screening Searches Find Patients Due fr Immunizatins These searches assume that immunizatin histry is saved in the apprpriate menu accessed frm the Hx tab. 33

34 Due fr Flu Sht Lad yur saved physician panel search within query builder Click Hx tab Insert age and gender criteria Age: Gender: Bth Click Search Only in selectin belw (the resulting number is yur denminatr when calculating screening rates). Click use search editr Click the drpdwn menu and scrll dwn t pen the Immunizatin table flu_viral_last_date is within the last 1 years Click Query Click Remve these Patients Return t the Patients tab, the remaining patients are due fr a flu sht CV Risk Calculatin This is a highly valuable tl t assess risk in patients with n previus cardivascular disease (e.g., NOT taking a statin class f medicatin) Cnduct n males r females every 5 years Requires ther data held in the EMR: gender, tbacc use, BP, nn-fasting lipid data and diabetes diagnsis (fr sme CV Risk calculatrs) May use an internal EMR CV Risk Calculatr r an external calculatr such as: Hw t search fr CV Risk cmpletins depends n where the prvider recrds the result r if it is aut created frm the internal calculatr in the EMR Mediplan has the Framingham Risk Calculatr as its built-in CV Risk functin. It can be accessed frm 2 places in the chart. 34

35 1. Frm the Chart/Vitals tab 2. It can als be accessed via a buttn fund n the POEM template. Mre infrmatin n the POEM Template can be fund in the sectin, POEM Template. When yu click n the Framingham buttn frm within this sectin, it will pull in all f the values required fr the calculatin if they already exist in the system, therwise, it will be left blank and the user needs t fill it in. If accessed frm the POEM, nce all f the infrmatin is entered, the scre will appear in the bx in the POEM belw the Framingham buttn. The query functin is limited as it cannt search the date the Framingham was cmpleted. Searching wrk-arunds fr date f Framingham: 1. Find the date f the last POEM the scre is in and search fr this date 35

36 2. Print ut either a cpy f the POEM n the date that the Framingham is dne, r print ut a different Cardivascular Risk Assessment and link it as a reprt that includes a standardized name (e.g. Framingham r CV Risk) and the date it was cnducted. POEM Template The POEM is a tl that prvides a snapsht f the mst recent lab data, reprts, scial histry assessments, and vitals fr a particular patient Lcatins f access t POEM tl: 1. Chart: 2. Encunter: 36

37 Yu can cnfigure the system settings t either lad a brandnew POEM every time yu click the POEM buttn, r t lad the last POEM template that was generated. As lng as yu have a system t ensure that a panel manager updates the POEM regularly, it may be useful t use the latter setting s that there is n lag-time pening the POEM when the physician wishes t check the template. Lg-in as administratr Other/System Settings/LAB Cnfiguring yur POEM If yu have nt used the POEM befre it needs t be cnfigured fr yur clinic. T d this cnfiguratin: 1. Open the POEM fr any patient. 2. Select the Settings buttn. 3. Select yur lab regin at the tp. If yu get yur labs frm a different regin nt listed, yu will need t cntact Telin fr supprt. 4. Reprts are searched based n reprt type. If yu label scanned mammgram reprts mamm, then list mamm in the settings s that the POEM will find it. symbl is a wild-card symbl and will enable the POEM t pick up any text r pen space - the space befre/after where it is placed. 5. Select Save - this will clse the POEM and it will be cnfigured fr all patients. 6. Settings can be changed/updated if cdes frm a lab service are changed. 37

38 The Telin Knwledgebase cntains a page updated t May 2016 with the POEM cnfiguratins fr Edmntn, Calgary and Red Deer fund at the fllwing link: 38

39 See an example f the POEM template belw: The data (e.g., dates and values) is pulled int the POEM, hwever data entered int the POEM is nt pushed back t the ther areas f the chart. 39

40 Registries A disease registry identifying patients with a cded disease cnditin is the first step in preparing fr panel management f patients f a given cnditin. Ideally, all patients with a cnditin will have the cnditin nted in their Prblem List in a cnsistent way. Fr example, Diabetes is always called Diabetes Mellitus and will have the 250 ICD-9 cde attached t it. It is imprtant that an entire practice agree n terms fr the cnditins t create registries. In this example diabetes is nt named with ther incnsistent terms such as Diabetes, DMII, DM2, Diabet M, etc. TIP: Free typing in the prblem list is NOT recmmended. Physicians shuld use the drp-dwn list when cding prblems. In sme cases, a clean-up f the list may be needed t enable cnsistent cding mving frward. Cding a Prblem List T add a new diagnsis t the patient s chart, g t the Prblem tab. There are three ways t cde a prblem frm the Prblem tab: 1. The first ptin yu have is t enter a new prblem that des nt have an ICD-9 cde attached. Select the New Prblem (text/n ICD) buttn and yu can enter free text int the field. Althugh this is a searchable field and there may be circumstances where yu wish t enter this infrmatin withut a cde attached, if yu wish t search by cde r a typ is made, the patient will nt shw up in the search. 2. The next feature allws a clinic t determine a standard list fr entering cmmn diagnses. Select the Prblem Lkup (Picklist) buttn. This favurite list can be cnfigured t include ICD- 9 cdes r free text. T add a new prblem t the pick list, click Add New, enter a heading, the physician wh requested this t be added t their pick list (r 0 fr all physicians), and the ICD cde which will ppulate the Prblem sectin. T pick a prblem frm the pick list t add t the patient s diagnstic list, select the prblem yu wish t add and select Dne. 40

41 The picture belw shws the diabetes prblem listed twice. The first entry shws it entered using the text/n ICD buttn. In the secnd entry, it is cded with the ICD-9 (using the pick list shwn abve). 3. If yu d nt have a pick list cnfigured, yu wish t cde a prblem nt n the list, r yu d nt knw the ICD cde, yu can use the ICD cntains this text ptin. Fr this example, we wish t cde the prblem multiple sclersis. We enter all r part f this text in the bx and enter n ur keybard. It will give us a selectin f related wrds and cdes frm the ICD-9 table. In this case, the example is specific s we get just ne chice. Click n the rw with the ptin yu wish t 41

42 chse and select Clse/Select at the bttm f the pp-up bx. Yu will be asked t cnfirm if yu want t add this t the prblem list. Select YES t add the prblem. Creating a Registry: Search by Prblem If yu add the ICD-9 cde t each prblem yu enter then yu can create reliable searches. Yu can add the criteria t yur search using the example belw. This example shws the ICD-9 cde f 250 fr diabetes mellitus. Nte that it will pick up any prblem that has the cde 250 in it. Lad yur saved physician panel search within Query Builder Click Diagnses tab Enter the apprpriate ICD-9 cde OR enter the prblem descriptin, depending n whether r nt yu cde yur prblems based n the ICD-9 cde r based n free text Click Search Only in selectin belw Click Select Patients 42

43 Return t the Patients tab, the remaining patients have diabetes in their prblem list Services Cdes & Searches t Find Patients t add t registry While the Service Cdes used in claims r billing are useful searches t infrm the practice when frming registries, it is nt in itself accurate enugh t be used when creating pint f care reminders. An accurate prblem list shuld be the trigger fr the pint f care reminders. The fllwing are useful searches that will supprt creatin f disease registries. By lking in the fllwing areas f the EMR, patients withut the apprpriate prblem in their Prblem List can be identified, and the apprpriate diagnsis added fr future searches. Feature f EMR Example 1 Data that wuld infrm Diabetes Mellitus Registry Example 2 Data that wuld infrm Hypertensin registry Billing Diagnstic cde 250 Diagnstic cde 401 Medicatins Currently taking metfrmin r insulin Currently taking an antihypertensive Lab HbA1c ver 7 % BP > value specified by clinic MDs Disease Management Practive panel-based care f a chrt f patients with a given cnditin (e.g., diabetes r hypertensin) is enabled by ntable EMR features. Belw are a few suggestins fr tls and searches that can be used t best enable disease management within Mediplan. Chrnic Disease Mdule (CDM) Tl This is a helpful tl t enhance yur disease registry in additin t identifying a diagnsis using the prblem list is the Chrnic Disease Mdule tl. This tl has disease-specific templates fr prvisin f care, and pulls lab data and vitals frm ther parts f the chart. First, ensure that use f the CDM tl is enabled. Lg-in as administratr/ Other/System Settings/Envirnment/ Enable chrnic disease mdule (CDM) 43

44 The tl is accessible frm the main page f the patient s chart 44

45 Clicking n the CDM buttn will bring up a windw that includes a drpdwn menu f chrnic disease care templates, as well as the ptin t create a Chrnic Care Plan. Once a cnditin is selected, click create new, and anther windw will pp-up. Yu can either fill ut the template r simply click Save, t keep a recrd that the patient has this cnditin. 45

46 Searches t Enhance Care fr Patients with Diabetes Keep in mind that this search, used t keep track f patients with uncntrlled diabetes, is mst effective nce a diabetes registry has already been frmed, and searches have already been run t add the diagnstic cde fr diabetes t the prblem list f patients previusly unidentified as having diabetes. Search fr patients with A1C > 7 Lad yur diabetes registry by running a search fr all patients attached t a particular physician wh have a particular ICD-9 cde Click the LAB tab Enter the apprpriate lab cde fr Hemglbin A1C Enter cmparisn is greater than 7.0 Click Search Only in selectin belw Click Select Patients Return t the Patients tab. These patients culd be cnsidered as having uncntrlled diabetes. Search fr patients with diabetes verdue fr an A1C Lad yur diabetes registry by running a search fr all patients attached t a particular physician wh have a particular ICD-9 cde Click the LAB tab Enter the apprpriate lab cde fr Hemglbin A1C Enter cmparisn is greater than 0 Enter the desired date range (say, t lk fr anyne wh hasn t had an A1C > 6 mnths, enter the date f 6 mnths ag) Click Search Only in selectin belw Click Remve these Patients Return t the Patients tab. These are patients with diabetes that are verdue fr an A1C. The Diabetes Tl The diabetes tl prvides a snapsht f the bldwrk and vitals relevant t mst patients with diabetes; althugh, unlike the CDM tl, infrmatin is nly pulled int the tl, yu cannt manually enter any data. 46

47 First, ensure that use f the diabetes tl is enabled. Lg-in as administratr/ Other/System Settings/Scheduler/ Shw Diabetes Buttn n Chart Access the diabetes tl either frm the main chart r frm the CDM Diabetes Template. 47

48 Tls fr Panel Management Clinical dcumentatin s that data may be searched EMR users need t be aware f the search capabilities f their EMR. Where infrmatin is entered matters! In general, fields that can infrm a search r reprt include: Drp dwn lists Radi buttns Bxes nly designed t recrd certain infrmatin like bld pressure r weight Templated fields in an exam template Even in an area where free text can be entered, if certain infrmatin is entered with a cnsistent term, it may be searched. When cmmn repeated text (macrs r aut-replace) is used, it may be uniquely searched. Scanned Dcuments Every clinic receives electrnic faxed dcuments which get linked t individual patient recrds. The naming r indexing f these dcuments as they are attached shuld enable tw prcesses: 1. When a prvider is viewing the patient chart they shuld easily identify the infrmatin and be able t find it quickly. Sme EMRs have the ability t search fr a dcument name at the individual patient level. 2. In the EMR search / reprts it is pssible t prduce a list f patients that have a type f linked dcument within a perid f time. These same dcument names can be used t create a ppulatin-wide pint-f-care reminder r a flwsheet. Custmizing a Dcument List A dcument list can be custmized fr each physician. Because f the way in which the list is entered, it may make the prcess easier t prepare a list in a text dcument first and then type the labels int the system. Access the physician settings menu by clicking ther/sign-n Duble-click the name f the physician fr whm a standardized dcument list is being generated Click page 3 at the tp f the windw Under the Reprt Types drpdwn, yu can custmize the list: Select a reprt type and then click clear t remve it frm the list Click add, type in a new label, and hit enter t add an item t the list 48

49 Key principles fr linking scanned dcuments Create a list f acceptable dcument wrds that can be used at the practice that is agreed upn by the clinic team (clinicians and team members). See Appendix F fr examples. Use the drp-dwn list in the EMR; avid free typing Certain clinical reprts need t be distinguished t enable panel management Distinguish mammgram results frm all diagnstic imaging Sme cnsult reprts need cnsistent naming: Clnscpy reprts Flex sigmidscpy reprt Clpscpy reprt Prvide training t staff and place a printed list f acceptable keywrds with indexing tips at every wrkstatin where dcuments get linked t patient charts Name based n type f cnsultatin rather than the name f the cnsultant E.g., If a referral is fr gastrenterlgist cnsult, name the letter Gastrenterlgy cnsult nt Dr. Black cnsult Only central clinic EMR administratr(s) shuld be allwed t add, delete r mdify the main list 49

50 Searches Getting Started When learning t create searches the fllwing tips will assist in btaining accurate data: Be infrmed n hw data is recrded at the clinic; this will prvide directin n which fields t search Build the search ne parameter at a time Validate, as each line f the search is created, that the results are crrect befre adding anther parameter t the search Search fr the psitive first then search fr the negative E.g., If yu are searching fr female patients y that have nt had a mammgram in the past 2 years first identify all patients that have HAD a mammgram in the past 2 years. Once yu have validated that yur search criteria are crrect it is easy t search fr patients that have NOT had a mammgram. Verify that yur results are crrect by cmpleting sme chart reviews frm the patients fund in yur search Getting Started with Searches in Mediplan Query Builder Overview There are a few different built-in features t cmplete yur searches in Mediplan. This sectin, and all previus example searches, fcus n the Query Builder tl. See Appendix B fr a summary f the ther tls, including Analyser, the Panel Management Tl, and Quick Reprt. Select the Query Builder tl under the Data drpdwn n the main menu. 50

51 This will pen up a blank Query Builder screen. Frm this screen, yu can define certain search criteria including age, gender, last visit date, and physician, as well as custmizing yur wn searches r lading previusly saved nes. Since fr mst f yur searches yu will want t exclude inactive and deceased patients, the first step after lading query builder is typically t lad yur patient panel by clicking Use Search Editr. Use the screensht and list belw t learn abut the different parts f the main Query Builder windw. Nte that each tab has a different functin, but reprts are mst useful when generated frm the Patients tab, s we will discuss this tab the mst. 1. Selecting New Search all Patients will perfrm a search based n whatever parameters are listed abve within Sectin 3. Fr example, if the gender selected is Female, and the Include in Search Belw bx is checked, clicking New Search all Patients will generate a list f every single female patient in the clinic, regardless f physician, age, r status. Pressing this buttn will always replace whatever search was laded befre. 2. The Use Search Editr buttn (discussed in greater detail belw) allws yu t lad a custmized search f patients. Fr example, a cmmn saved search is a panel search that will prduce a list f all patients attached t a particular physician, excluding deceased r inactive patients. Nte that much like the New Search all Patients buttn, using this tl will verride whatever search had been laded previusly. 3. Any f these parameters can be applied either t create a brand-new search (Sectin 1: New Search All Patients) r t an existing search (Sectin 4: Search Only in selectin belw). Nte that in rder fr the parameter t be included in the search, the crrespnding include in search belw bx must be checked. 4. Search Only in selectin belw allws yu t narrw dwn an existing grup f patients based n the parameters in sectin 3. Fr example, say that after lading a panel search, yu wanted t find all patients aged After lading the panel search, yu wuld enter the apprpriate age, ensure that the crrespnding include in search belw bx was checked, and then click Search Only in selectin belw. This search wuld nly list the paneled patients that fit within this age range. 51

52 5. The tabs listed at the tp f the windw allw yu t run additinal searches related t ther areas f the EMR, and then apply the searches t the first Patients tab shwn abve. See belw fr an verview f the functinality f the tabs and their relatinship with the Patients tab. 6. The Reprts buttn pens anther windw that allws yu t specify what infrmatin yu wuld like t be included in a generated list f patients. See belw fr mre infrmatin. Additinal Tabs Each tab within query builder pertains t a different Table that stres data within the EMR. T search fr lab infrmatin, yu need t select the LAB tab, t search fr billing cdes, yu need t select the Billing tab, etc. In additin t searching fr values applicable t a particular tab, yu can als apply the data frm the search t the Patients tab in rder t include nly patients that meet a particular parameter, r t include nly patients that d nt meet a particular parameter. Running a brand new search within an additinal tab will nly change the patients listed in the Patients tab if ne f the ptins n the right are selected (i.e. Select Patients, Add Patients, r Remve Patients). See the belw screensht f the LAB tab as an example t learn mre abut hw these additinal tabs wrk and their relatinship t the Patients tab. Nte that prir t any searches, there is already a list f labs this is because a panel f 23 patients had already been laded within the Patients tab, s nce switching t the lab tab, all the labs that have ever been attached t thse 23 patients are autmatically laded as well. 52

53 1. The New Search all Lab Tests buttn functins very similarly t the New Search All Patients buttn. The results f this search fr a particular lab test will include lab results frm all patients within the system, nt nly the data frm patients laded frm the patients tab. 2. Use Search Editr will allw yu t custmize a search related t any specific parameter related t the tab. Fr example, within the Encunter tab, yu can use the search editr t specify searches fr vitals, and within the Hx tab, yu can use the search editr t specify searches fr scial histry. Nte that like the New Search all Lab Tests (r equivalent) buttn, this search will verride all previus searches and search data frm all patients in the system. 3. Search Only in selectin belw will apply the search fr lab results t the patients already selected. 4. This area allws yu t specify a search based n a particular lab cde. Nte that if the lab result prvides a numerical value, yu can select greater than 0 t find all patients wh have had the test dne. If the lab result des nt have an attached numerical value (e.g. pap test r FIT test), ensure that the cmparisn and bservatin value is equal t 0. T find the apprpriate lab cde, see Appendix C. 5. The Select Patients buttn allws yu t apply the search frm the additinal tab (ensure that ne f the search buttns n the left has already been used) t narrw dwn the list f patients n the Patients tab t nly include the patient that nly meet the searched parameters frm the additinal tab. 6. The Add these patients buttn will add all patients that meet the parameters frm the additinal tab search t the Patients tab list, regardless f whether r nt they already exist n the Patients tab list. 7. The Remve these Patients buttn will remve all patients that meet the parameters frm the additinal tab search frm the patients listed in the Patients tab list. This search is useful fr finding patients that are due fr a particular lab test, DI test, r billing cde by remving thse that have already met the criteria. 8. This Reprt buttn will generate an infrmatin reprt based n the tab selected. That means that if yu search fr a particular lab result, it will include every instance that each patient has had this lab result. This is ne f the nly ways t exprt lab data (the value and date), but will require sme wrk in excel t uncver nly the mst recent values. In mst instances, the mst useful reprts t generate are based n the patient, which can be dne by returning t the Patient tab. Search Editr Building Searches Regardless f the tab, the Use Search Editr query functins the same way. There are a number f fields t wrk with t refine yur search. See the example belw t guide yu: 53

54 1. This allws yu t specify between: And, Or, Except 2. Generally speaking, when yu select the dwn arrw next t the main Find field, it will prduce a list f parameters that are specifically related t the Tab yu are searching within. With very few exceptins, this is the list t select frm when develping a custmized search. If yu scrll dwn further; hwever, yu will see a list f every table that exists within Mediplan, and if yu pen the tables, yu can see each field within it. Only certain tables can be searched frm within a nn-matching tab. 3. This drp-dwn will include custmized cmparisns based n the field selected. 4. Enter the particular data yu are searching fr nte that depending n the icn next t the field, the data required changes. each f these icns indicates the value is numerical indicates that the value is true r false indicates that the value is a date (in mnth/day/year frmat) 54

55 each f these icns indicate that the value is in a text frmat (lng/shrt text, respectively). Yu can search a field that cntains a particular phrase r wrd 5. Use the +/- signs t add anther line r remve a line 6. This icn brings up a menu t lad/save a search. Nte that all searches are saved t the cmputer that yu are using, and is nt attached t the user s lgin r a system-wide database f files. Generating Reprts Selecting the Reprt ptin within the Patient tab will bring up the Quick Reprt menu that allws yu t custmize the utput f the reprt by selecting preferred clumns. 55

56 Much like the Query Builder, the listed ptins are thse that are relevant t the selected table/tab, and are indicated in the Master Table. If yu select that drpdwn, yu can select additinal tables, but given that the patients tab typically nly searches within the Patient Table, nt all fields selected frm ther tables will actually generate data when yu click t generate the reprt. Select a desired clumn by duble clicking the field listed belw Master Table, r by clicking the green arrw t the right f it. These keys are used t select clumns and rearrange them farther t the left r right frm hw they appear in the generated table. Nte that in this example, [Patients] ULI is selected, and the buttn n the left culd be used t mve the clumn t the left. When yu have selected the parameters that yu wuld like, yu can save this particular template by using the Save as... ptin. Nte that the template is saved t the cmputer that yu are using, nt t the user s lgin r a system-wide database f files. T generate the reprt t a list and print it directly, click File/Generate and yur default printer windw will pen T generate the reprt t MS Excel/Open Office, select File/Destinatin/Disk File, and then File/Generate It will ask yu t save the file as a.txt file. T pen this file in Excel (r ther spreadsheet sftware), pen the prgram and click Open. Ensure that the drpdwn All Files is selected ( All Excel Files will be the default ), and select the saved.txt file. Click Finish and Open and re-save yur new Excel spreadsheet as a wrkbk r.csv files. 56

57 Opprtunistic Screening Tls Althugh this EMR des nt have a clinical decisin supprt tl that will search the database fr specified criteria t identify patients due fr clinical service, there are a number f strategies that can be used fr pprtunistically identifying patients that are due fr particular services. 1. Patients can be identified either thrugh regularly run screening searches, r by checking the POEM in advance f a patient s visit. Once a patient has been identified as due fr a particular screening maneuver, a panel manager can mdify the encunter nte in advance f an appintment t indicate t the physician, r ther apprpriate team member, that the patient is due; even changing the text clur if desired. 2. The panel manager culd als print a requisitin in advance f the appintment by selecting the apprpriate req. frm the Frms drpdwn in the chart. T custmize the frms included within the Frms drpdwn list (custmized by physician), g t Other/Sign-On/select physician/custmize Integrated Frms List and ensure that all required frms are checked ff. 57

58 Measurement While mving tward the Patient s Medical Hme, a practice r team will nt knw hw they are ding unless they measure fr imprvement. Prcess measures reflect the things that are dne in the practice and hw the systems are perating. Example measures are: Verificatin Rate One tl that can be useful is t measure hw ften the team is verifying the patient demgraphic infrmatin (address and phne) and physician attachment. When a clinic is new t patient verificatin it can be measured in the query builder. Fr example, a team that wants t measure hw they did in a week: # patients verified this week x 100 = verificatin rate (%) # patient visits this week 58

59 A clinic may als have an expectatin ver a perid f time and can determine if they are meeting their gals. Fr example, if a practice has an expectatin that their verificatin rate in the last three mnths shuld be 95% the frmula wuld be: # patients verified in the three mnths (screensht 1) x 100 = verificatin rate (%) # patient visits in the last three mnths (screensht 2) Screensht 1: 1. Screensht 2: Screening Rate Based n Cmpleted Screens A practice will als find that they are able t measure rates fr preventive screening care. Measuring cmpleted screens lks fr cmpleted results. The generic equatin is: # patients in eligible ppulatin with screening result within screening interval x100 = % # patients in the eligible ppulatin The % represents the screening rate The screening interval is the time frame during which the screening maneuver shuld be dne 59

60 The eligible ppulatin wuld include all the active, paneled patients fr a prvider that wuld als qualify fr a particular screening based n age/gender Example 1: Dr. Brwn wishes t calculate the cmpleted bld pressure screening rate fr her active paneled adult patients. Bld pressure shuld be measured annually (ASaP) # active adult patients* (18 +) with a BP result in last year x 100 = BP screening rate (%) # active adult patients* (18 +) *Attached t Dr. Brwn in the EMR Example 2: Dr. Brwn wishes t calculate the cmpleted diabetes screening rate fr her active adult paneled patients. Diabetes screening is: apprpriate fr adults 40 + recmmended nce every 5 years cmpleted with a fasting glucse, hemglbin A1c result r a diabetes risk calculatr scre # active adult patients* (40 +) with a fasting glucse OR HBA1c OR Diab. Risk Calculatin in last 5 years x 100 = % # active adult patients* (40+) The % refers t the diabetic screening rate. * Attached t Dr. Brwn in the EMR Calculating a Screening Rate Based n Offers f Screening Care Practitiners participating in the Alberta Screening and Preventin imprvement prject will include bth cmpleted screens and ffers f the screen. In this case, t measure with the EMR there must be a place that declined, deferred and exemptins fr screening are reliably recrded. In this case the generic equatin is: #active adult patients with an ffer f screen + #patients with cmpleted screen x 100 =% #active eligible adult patients It is recmmended t use the chart audit methdlgy 2 instead f EMR measures if the ffers f screening care are unable t be searched in the EMR. 2 See ASaP EMR Chart Review Instructins: 60

61 Appendix A: High Value Efficiency Tips frm Alberta Peers A grup f Alberta Mediplan peer leaders brainstrmed sme tips and shared them belw. Messaging and Task Manager Task Manager vs Messaging take the time t learn hw t ptimize each f these functins and cmmunicate prcesses with all users in the clinic Messaging Highly recmmend use f Referrals bx fr referrals Task Manager: Create task grups accrding t yur clinic prcesses (e.g., fllw ups, referrals, etc.) Nte that alerts cme up in yur task manager Patient Management Panel Tl like a dashbard-at-a-glance fr utreach and pprtunistic Lads mre quickly than the POEM Template Pastes int an encunter Integrates immediately int Excel In Calgary, it currently pulls labs incnsistently (Paps) It s view nly; yu can t enter infrmatin in (pull data nly, nt push) Frm POEM yu have the view all feature which is useful fr clinicians and POETs In POEM, yu miss exceptins, (e.g. patients wh had hysterectmy exempt frm paps) Templates Yu can duplicate templates acrss a clinic, but yu cannt share them utside f yur clinic Make it a 0 in the set-up s it s nt physician specific Scheduler Right click n an appintment day t see the day s remaining appintments Dn t mess with the asterisk Make appintments lnger by using shift click Yu can remve the default prmpt is this yur family dctr? when arriving a patient; use the date stamp n registratin page when demgraphics are verified. Assigning Patients Mark patients deceased using available deceased tick bx In every search, yu will need t exclude deceased patients Chart Type Create a Dr. Inactive t classify inactive patients. It will create a list f inactive patients but in the Family Dr field, the patient s physician remains fr future reference 61

62 Whever changes a patient status shuld put their initials in the file fr reference Dcumenting Exceptins Mediplan des nt have a designated sectin t dcument surgical histries Recmmended t nte hysterectmies and mastectmies in Other Ntes sectin in Histry Opprtunistic Screening When ding pprtunistic screening, create a template that is cpied and pasted int encunter and custmize per patient. Use a different fnt clur and initial wh applied it. Outreach Screening Recmmend using the birthday mnth apprach fr utreach screening, it means creating and maintaining fewer spreadsheets. Final Tip! If there is a field t enter int, use it! Nt the SOAP nte! 62

63 Appendix B: Other Searching Tls Analyzer Tl Lcatin: Data/Analyzer Useful fr: running multiple patient searches requiring cmplex use f And/Or/Except Patient Management Tl Lcatin: Data/Patient Management (fr searching) Prvides spreadsheet view f POEM infrmatin based n query f patients icn will autmatically exprt spreadsheet t excel Similar query frmat t query builder with different terms (blded term is used in patient management tl): Use 4D Editr = Use Search Editr Further Search based n This Result (checkbx) + Shw results/refresh = Search Only in selectin belw 63

64 Shw results/refresh = New Search all patients Add the result t the patient list = Add these patients Remve the result frm patient list = Remve these Patients Shw nly the result frm patient list = Select these patients Output Result t Panel will push query t spreadsheet view See belw example search and example spreadsheet: 64

65 Quick Reprt/Exprt Lcatin: Data/Quick Reprt/Exprt Mre easily apply Chart Type exclusin Prvides lnger list f search tables frm the main windw 65

66 Appendix C: Finding Lab Cdes 1. Telin Knwledge Base: (shws the default lab cdes fr the POEM template depending n the regin f Alberta) 2. Panel Management Tl: Data/Panel Management Tl/Query/Lab/Test Cdes Lkup (will prvide alphabetized list f lab cdes fr yur regin) 66

67 Appendix D: Ntes/Buttns Tl The Tasks Ntes Tl Setup functin allws yu t custmize buttns and drp-dwns t create templates fr tasks and ther messages within the EMR. Lcatin: Other/Tasks Ntes Tl Setup Click Add t create a new buttn r drp-dwn menu ptin Unless the ntestl checkbx is selected, each buttn r drpdwn ptin will refer t a new template fr a task. Clicking a buttn that des nt cntain a sub-list will lad the saved task template. T create a buttn, type the name f the new buttn, select a number between 1-32, and list the header, message, and urgency that yu wuld like t appear fr each task. 67

68 Clicking a buttn that cntains sub-lists will prduce a drpdwn menu, each f which with a crrespnding list f task templates. T create an item n a sub-list, select an existing buttn name and list the header, message, and urgency that yu wuld like t appear fr each task. Clicking the ntestl checkbx allws yu t save similar buttns/drpdwn lists fr templates f text t be used in ther parts f the EMR. Fr example, if yu create a buttn and assign it the number 37, 38, r 39, yu can create a template fr the text used within the REC ntes area f the chart. 68

69 Appendix E: Creating Templates T pen the windw t create templates fr encunter ntes, letters, r reprts, g t Data/Cdes and Lkups/Obj Under Templates, select which type f template yu wuld like t create, and then click New. 69