2015 User Conference Best Practices for Genetic Family History April 24th, 2015 Presented by: Jen Novakovich PM/EHR Trainer EHR Session BJ Bloom, RN, IBCLC

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

Rena Lefkowitz

I shortened slide 3 to slide 4- let me know your thoughts.

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


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


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


How is a Family defined in OP?

Financial Family:

People who are financially responsible for you

Insurance Guarantor



Social Family:

People whom you live with/interact with

Register Contacts



Genetic Family:

People with which you share genes

Register Contacts Role Family History


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


Let’s See It!


Merging Contacts

Does your office have duplicate contacts in your system?


Merging Contacts


Let’s See It!


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:



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

Rena Lefkowitz

ask BJ


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


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


OP 14 Family History

BobbyJo Bloom

why are positives listed in green?

Jen Novakovich

I didn't even notice...weird...I will retake those screen shots



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)



Maternal/Paternal Inheritance



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


❏ 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


Sibling Mapping



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



Sibling Mapping - Manual


Let’s See It!



OP 14 History Organization



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



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



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



History Sections Before and After Archiving



Selecting Siblings to Convert Family History



Copying Family History to a New Family Member



Family History Grouped by Family Member



Family History Grouped by Problem


Let’s See It!


Questions?


We want your feedback!

Documents

2015 User Conference Best Practices for Genetic Family History April 24th, 2015 Presented by: Jen Novakovich PM/EHR Trainer EHR Session BJ Bloom, RN, IBCLC