356H Clinical Reminder Report for Pharmacy

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356H Clinical Reminder Report for Pharmacy

• Tom Fagan, Richmond, Virginia VAMC [phone]

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LEARNING OBJECTIVES

• Understand basic clinical reminder for use in
  reports and patient list.
• Utilize clinical reminder report to extract data.
• Utilize clinical reminder patient list
  functionality to extract data.
• Understand the role of Clinical Application
  Coordinator Staff assigned to Reminders
• Compare and contrast Clinical Reminder reports,
  patient list function and VA FileMan reports.

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TERMINOLOGY

• Reminder
• Cohort and Resolution Logic
• Dialog
• Reminder Term
• Findings
• Due Reports
• Patient List
• Fileman Reports

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CLINICAL REMINDER SYSTEM

• The Clinical Reminders system allows caregivers
  to track and improve preventive healthcare and
  disease treatment for  patients and to ensure
  that timely clinical interventions are initiated.
  The clinical reminder system is now the VA's
  preferred mechanism for implementing clinical
  practice guidelines, and facilitates linking the
  evidence with the real-time clinical reminder,
  with the action, and with the automatically
  generated documentation, as well as with a trail
  of standardized performance data. 

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COHORT

• If the cohort logic evaluates to true, then the
  reminder is applicable to the patient
• A group of patients to be evaluated
• Patients with HDL gt40
• Patients with HDL gt 40 and ACTIVE order for
  SIMVASTATIN TAB
• Patients with Diabetes Diagnosis according to
  Health Factors, ICD or CPT code

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APPLICABLE

• A reminder is APPLICABLE to a patient if they
  meet the definition of the cohort group (FINDINGS
  are true).
• Patient is considered in the cohort.

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DUE

• A reminder is DUE for a patient if they are in
  the cohort, and have not yet had the RESOLUTION
  (FINDINGS), examples
• Treatment
• Medication
• Education
• LAB

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RESOLVED

• A reminder is considered RESOLVED ( SATISFIED)
  if the FINDINGS conditions defined by the
  reminder RESOLUTION have been met.

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FINDING

• FINDINGS comprise logic for COHORT and RESOLUTION
• A FINDING is a piece of patient information that
  can be evaluated by the reminder
• It is either there or it isnt.
• Its FOUND or NOT FOUND
• Common Examples include
• drugs or drug classes
• laboratory tests
• diagnosis codes (ICD-9 or CPT)
• immunization records (Health Factors)

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REMINDER TERM

• A TERM is a collection of findings grouped
  together to make one concept.
• Terms may contain more than one different kind of
  finding.
• For example, a term called LDL CHOLESTEROL may
  include your sites tests for LDL (Calculated)
  and LDL (Direct)
• Terms are useful because they make defining a
  reminder more straightforward.

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TAXONOMY

• A TAXONOMY is a collection of ICD-9 (diagnosis)
  codes and/or CPT (procedure) codes that defines a
  condition or treatment.
• The taxonomy that defines DIABETES, for example,
  will have all of the ICD-9 codes in the 250.xx
  series.
• Like terms, taxonomies are helpful to define a
  single clinical concept.

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HEALTH FACTOR

• HEALTH FACTORS are findings created for
  information about a patient that does not exist
  elsewhere in VistA or CPRS
• Health factors tell you some fact about a
  patient, such as the following examples
• Diabetes Patient Education Completed
• Tobacco- Alcohol user (from screening)
• Declined/Refused FOBT testing
• Life expectancy lt 6 months

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REMINDER DUE REPORTS

• For a selected reminder the report lists any
  reminders which are currently due.
• Options to select patients to process report
• Individual Patient
• Reminder Patient List
• Hospital Location
• OE/RR Team (all patients in team)
• PCMM Provider (all practitioner patients)
• PCMM Team (all patients in team)
• Type of Display for Results
• SUMMARY
• DETAILED may be saved as a local patient list

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DUE REPORTS CREATION

• Created by Clinical Application Coordinator (CAC)
  assigned to reminders
• Due Report Option and Template and can be
  assigned to NON-CAC staff without intense
  training
• Template Created by CAC from existing reminders
  or create REPORT only reminder definition

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REPORT ONLY REMINDER

• Findings contain logic to determine COHORT
• If RESOLUTION is blank or net met then all
  patients in cohort will appear on DUE report

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REMINDER DUE REPORTS USES

• Practical uses Display patients on 2 active
  medications quickly for all outpatient or
  inpatient locations.
• Finding logic use orderable item or drug
• VISTA Due Report Menu and Templates can be
  assigned to NON CAC staff process reports at any
  time
• NON DUE REPORT Provider reminder for
  Bisphosphonate Rx waring for dental tooth
  extraction

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PATIENT LIST

• Incredibly fast due to the reminder index files
• Local patient lists may be created from list
  rules, copied to OE/RR teams, copied to other
  patient lists or deleted.
• Individual lists may be displayed or printed or
  used to run health summaries.
• Demographics may be displayed
• Reminder term can be inserted in output
• Conditions can be set for any findings with
  variables, example lab result threshold

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PATIENT LIST CREATION

• PATIENT LIST RULE defines an existing patient
  list to identify patients.
• FINDING RULE defines reminder term
  findings to identify patients.
• REMINDER RULE defines a reminder, where the
  patient cohort logic is used to identify
  applicable patients.
• LIST RULE SET combines multiple list rule
  criteria (Patient List, Finding Rule, and
  Reminder Rule) in a specified sequence, where
  each sequence has an operation (Add, Remove,
  Select) to create/modify a patient list.
• Lists display Demographics and Health Summaries

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PATIENT LIST GENERATION

• Generated in one of 3 ways
• Reminder Due Reports
• Extracts
• Using a reminder term to create a finding rule
  and rule set

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PATIENT LIST DETAILS

• Stored in the Reminder Patient List file
• File 810.5 can be designated public or private
• Separate menu options to manage and use lists NOT
  usually assigned to NON CAC Staff (requires
  intense training)
• Display lists with patient IEN
• Can be copied to OE/RR lists for use by NON CAC
  STAFF
• Demographics
• Health summaries
• Can display value of finding with INSERT finding
• Can display the origin and rules that were used
  to create the list

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DELIMITED REPORTS

• Make sure that there is no wrapping of individual
  lines
• (Excel carriage return end of a line)
• Paste into Excel
• Use Excel Data menu
• Text to Columns command
• Determine the format of columns as needed
• Or Capture Screen Display as Text (.txt) file

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DELIMITED FORMAT EXCEL

• The delimited output is consistent in format
• Once a Excel file is set up for calculations
  and/or with links, then it can be reused for
  weekly or monthly updates very easily

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REMINDER ITEMS NOT DISCUSSED

• Extracts- used to transmit DATA to national
• Reminder Dialogs not used for reports

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EFFECTIVE DATE RULES REMINDER REPORTS

• Use of dates at multiple levels has a hierarchy
• The rules for overriding date ranges can be
  defined with the following equation, where "lt"
  should be interpreted as "is overridden
  by"Terms finding gt List Rule gt Rule Set
  Sequence gt List Build
• Use of relative dates (T-1y to T) are
  interpreted based on the end dates entered at run
  time (List build)
• Term T-2Y to T, Run T-2Y to T-1Y ? T-3Y to T-1Y
• There are begin and end dates associated with
  each level term, finding rule, rule set, and at
  run time

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OUTPATIENT PRESCRIPTIONS

• Must be released to be evaluated by finding
• Effective Date of reminder may change results
  when using ACTIVE status
• (calculates and compares based on days supply
  and refills)

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HANDS ON

• Access VEHU
• Verify VEHU
• Select Training Menu Option
• PCE Basic PCE Hands-On ...
• AICS Encounter Forms ...
• OE CPRS Manager Menu ...
• PX Reminder Managers Menu ...
• XX General Parameter Tools ...

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REMINDERS REFERENCES

• Reminders page
• http//vista.med.va.gov/reminders/index.html
• Vista Document Library
• http//www.va.gov/vdl/
• Past VEHU presentations

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DATA VALIDATION

• Does Your Output Make Sense?
• Random Sample
• Other DATA SOURCES
• CPRS QUERY TOOLS
• VISTA REPORTS
• FILEMAN REPORT

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CONTRAST FILEMAN REPORTS

• Fileman
• Search and Display Any FILE or FIELD
• Need Access
• Complicated Commands
• Slow to Search large file
• Reminder Reports
• Incredibly fast due to the reminder index files
• Due Report template and menu can be assigned to
  non-CAC staff
• ( Reminders Due Report (User) PXRM REMINDERS DUE
  (USER))
• Display ALL inpatient or outpatient locations
  (limited by encounter)
• Limited output- use insert finding and Need CAC
  staff to create
• Patient list requires access to reminders menu
• Results are sometimes different due to evaluation
  of dates
• Need for VALIDATION

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Contact Information

• Phone Tom Fagan [phone]
• EMAIL THOMAS.FAGAN_at_VA.GOV

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QUESTIONS
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