2015 User Conference Best Practices for Genetic Family History April 24th, 2015 Presented by: Jen...

2015 User Conference

Best Practices for Genetic Family History April 24th, 2015

Presented by:

Jen NovakovichPM/EHR Trainer

EHR Session

BJ Bloom, RN, IBCLCTraining Specialist

2015 Office Practicum User Conference

Objectives

❏ Identify what your practice needs to do to prepare for using the new family history.

❏ See how current family history in Office Practicum will be converted to the new format

❏ Learn how to document history in OP14

❏ Understand the SNOMED-CT coding concepts associated with family history

2015 Office Practicum User Conference

Advantages of OP 14 Family History

❏ Reflects true genetic family

❏ Each entry associated with correct sibs

❏ Unique entry for each family member/problem

❏ Expanded family history questions

❏ SNOMED coding supports for clinical decision making

❏ Sort/Group/Filter for viewing data

❏ Meets 2014 Meaningful Use requirements

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How to look at Family History

❏ Current information about diseases/conditions which tend to “run in families”

❏ Some specific genetic information about patterns of inheritance for diseases/conditions

❏ Generally take information about what is known today and from the past

❏ Use frequency to predict likelihood of relevance in medical decision making today

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How is a Family defined in OP?

Financial Family:

People who are financially responsible for you

Insurance Guarantor

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How is a Family defined in OP?

Social Family:

People whom you live with/interact with

Register Contacts

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How is a Family defined in OP?

Genetic Family:

People with which you share genes

Register Contacts Role Family History

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Documenting Genetic Parents for New Patients❏ If you permit, front desk may be making this initial

decision, but be sure they understand the implications

❏ You can always fix it when you pull up the family history

❏ Exception: This question is not asked when adoption is already documented on perinatal history

2015 Office Practicum User Conference

Let’s See It!

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Merging Contacts

Does your office have duplicate contacts in your system?

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Merging Contacts

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Let’s See It!

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Pre-update History Checklist:

Patient Register:❏ Review contacts to ensure correct

relationships

❏ Confirm Resides With is correct for all Contacts

❏ Select Guarantors for each sibling on Insurance Tab

❏ Merge duplicate Contacts

Haven’t updated to OP 14 yet? Here are some things you can do in preparation:

2015 Office Practicum User Conference

2015 Office Practicum User Conference

Mapping Family Member Abbreviations

Mapping OP 11 Family Member Abbreviations in OP 14

❏ This list can be supplemented as you convert, so over the first few weeks your first-pass conversions should get cleaner

❏ Order is crucial when some abbreviations contain otherabbreviations - sort most complicated at top of list

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Post Update History Checklist

Map ICD-9 codes to SNOMED

In Chart--> History Tab:

❏ Confirm correct biological parents listed❏ Review acronyms for family members

and be consistent with naming❏ Convert Hx❏ Review for correct copying to sibs

complete hx entries with any updates

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Converting Family Histories

After updating to OP 14 you will notice:

❏ Re-arrangement of history tabs

❏ All neonatal history sections are grouped under a tab named “Perinatal”

❏ Two family history tabs (this is temporary)

Converting Old Family Histories from OP 11 to OP

14

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OP 14 Family History

2015 Office Practicum User Conference

OP 14 Family History

OP 14 Family History: Family Member AND

Condition❏ Family members are from a list of HL7 standards

❏ Medical problem defined by

❏ Problem description

❏ SNOMED (optional)

❏ Onset/Dx age range (optional)

❏ Notes/details (optional)

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OP 14 Family History

Maternal/Paternal Inheritance

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OP 14 Family History

Family History: Orienting to Maternal/Paternal

Inheritance❏ Choose patient’s GENETIC mother

❏ Natural mother❏ Birth mother (adoption)❏ Birth mother (other)❏ Egg Donor

❏ Pulldown includes anyone with “Mother” as role/reason on contact table in Patient Register (defaults to lowest sort number)

❏ Siblings with the same mother in this field imply they share maternal genes

❏ Do the same for paternal genetic lineage

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❏ If genetic mother and father are defined above grid AND correct siblings are associated with each side of the family:❏ When new data is added, most family members

have an inherent “side” (paternal grandmother, maternal aunt, etc.)

❏ OP intelligently defaults appropriate sibs to copy to, but you can override as needed

❏ Each row of data displays the list of siblings it has been copied to❏ You can edit to include/exclude siblings later on

OP 14 Family History

Sibling Mapping

2015 Office Practicum User Conference

OP 14 Family History

Sibling Mapping for Sibling Family Member

History❏ If sibling list is identical for genetic mother and

father, OP assumes same genetics (intact natural family)

❏ All siblings are pre-checked to copy-to

❏ Uncheck if inappropriate - “sib with asthma” except the sib who has asthma

❏ If sibling list is different for genetic mother and father, OP assumes genetics uncertain

❏ All siblings in common are pre-checked to copy-to

❏ You can manually specify additional appropriate siblings

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OP 14 Family History

Sibling Mapping - Manual

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Let’s See It!

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OP 14 Family History

OP 14 History Organization

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OP 14 Family History

OP 11 Family History to be Converted

❏ Several items refer to multiple family members; multiple conversions will be performed for those

❏ Name and location of family members in Comment is crucial - must be recognized, and must be either first word of Note, or first word on new line or after a comma

❏ [Map] buttonlets you tellOP about yourpreferredfamily memberabbreviations

2015 Office Practicum User Conference

OP 14 Family History

Initial Conversion to OP 14 Family History Format

❏ OP 11 records which referred to multiple family members might need to be cloned, depending on Note syntax

❏ May want to use SNOMED chooser in Problem field to provide a more precise definition of the condition

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OP 14 Family History

Converting Family History (continued)

❏ When you have cleaned up all your entries...

❏ Archive OP 11 history

❏ OP 11 family history tab will disappear

❏ Will only use OP 14 Family History moving forward

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OP 14 Family History

History Sections Before and After Archiving

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OP 14 Family History

Selecting Siblings to Convert Family History

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OP 14 Family History

Copying Family History to a New Family Member

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OP 14 Family History

Family History Grouped by Family Member

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OP 14 Family History

Family History Grouped by Problem

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Let’s See It!

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Questions?

2015 Office Practicum User Conference

We want your feedback!