National Reminders- Mammogram. Introduction The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at

National Reminders-Mammogram

National Reminders-Mammogram

Introduction

• The national reminders are in Patch 1005 of clinical reminders.

• The site manager should load this patch at your site.

• This will put all the national reminders into the Reminder Exchange file.

Preparation

• Document pxrm0150.1005 contains setup of each reminder.

• Check the taxonomy

• Check for reminder terms

• Check for orders

GUI Setup – First Time

• If your site has never setup reminders in the past, the following steps need to be undertaken to “turn on” the GUI reminders

• These steps do NOT make sense but they do need to be followed in the correct sequence

• DO NOT SKIP A STEP

First Time – Step 1

• Use the steps that follow to install 2 reminders or see the webex for installing the tobacco reminder

• The immunization forecaster and one other that is commonly used such as the tobacco reminder, weight, or blood pressure

First Time-Step 2

• Use the Parameters menu on the Reminder Setup menu to TURN ON the reminders

• Use the ACT (Reminder GUI Resolution Active) parameter and set to YES at the system level


• Set up the CAC to configure in the GUI

• Set the CFG- Allow EHR Configuration in GUI parameter from the same menu

• Set it by class for the CAC class


• Set the parameter CVR – EHR Cover Sheet reminder list

• This list will only have the 2 reminders you have installed

First Time –Step 5

• You should now be able to access the GUI

• Select a patient for whom the reminder will be due

• If the alarm clock is RED and the X is gone, you are ready to proceed

Add to GUI

• Click on the alarm clock

• Select the action drop down menu

• Choose Edit Cover Sheet Reminder List

• Select system level

Add to GUI –Step 6

• Select the 2 reminders making the Immunization forecaster the first

• Move them to the right

• Click apply and OK• Log out of the GUI


• Go back to the reminder parameters

• Select NEW – New reminder parameters

• Turn this on to YES for the system

• Log back into the GUI• For now, this will look the

same, but as you add more reminders to the GUI, they should appear

Mammogram Reminder

Create the Quick Order

• This reminder uses a quick order in the reminder dialog

• Section 5.4 page 40 in pxrm0150.1005o has list of quick orders to make

• RAZ BILATERAL MAMMOGRAM is the name the reminder will be looking for

Quick OrderQuick Order

• NAME: RAZ BILATERAL MAMMOGRAM Replace

• DISPLAY TEXT: Bilateral Mammogram//• VERIFY ORDER:• DESCRIPTION:• No existing text• Edit? NO//• ENTRY ACTION:• • Radiology Procedure: MAMMOGRAM BILAT//

Quick OrderQuick Order• Radiology Procedure: MAMMOGRAM BILAT//• Procedure Modifier:• History and Reason for Exam:• No existing text• Edit? No// (No)• Category: OUTPATIENT//• Is this patient scheduled for pre-op? NO//• Date Desired: TODAY//• Mode of Transport: AMBULATORY//• Is patient on isolation procedures?• Urgency: ROUTINE//• • -------------------------------------------------------------------------------• Radiology Procedure: MAMMOGRAM BILAT• Category: OUTPATIENT• Date Desired: TODAY• Mode of Transport: AMBULATORY• Urgency: ROUTINE• Submit request to: X-RAY• -------------------------------------------------------------------------------• • (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

• Radiology Procedure: MAMMOGRAM BILAT//• Procedure Modifier:• History and Reason for Exam:• No existing text• Edit? No// (No)• Category: OUTPATIENT//• Is this patient scheduled for pre-op? NO//• Date Desired: TODAY//• Mode of Transport: AMBULATORY//• Is patient on isolation procedures?• Urgency: ROUTINE//• • -------------------------------------------------------------------------------• Radiology Procedure: MAMMOGRAM BILAT• Category: OUTPATIENT• Date Desired: TODAY• Mode of Transport: AMBULATORY• Urgency: ROUTINE• Submit request to: X-RAY• -------------------------------------------------------------------------------• • (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Reminder Exchange – Install Reminder

• Choose IHS-MAMMOGRAM 2007

Reminder Installation

• Select IFE to install the reminder

• Review the reminder

Install the Computed Finding• Routine BPXRMWH already EXISTS,• but packed routine is different, what do you want to do?• (May need @ sign access to install routine for computed

findings)• Select one of the following:• • C Create a new entry by copying to a new name• I Install or Overwrite the current entry• Q Quit the install• S Skip, do not install this entry• • Enter response: S//

Computed FindingComputed Finding• REMINDER COMPUTED FINDINGS entry IHS-

MAMMOGRAM already EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new

name• I Install or Overwrite the current entry• Q Quit the install• S Skip, do not install this entry• • Enter response: S//

Refusal Type• REFUSAL TYPE entry MAMMOGRAM already EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new


Taxonomy• REMINDER TAXONOMY entry IHS-MAMMOGRAM

2007 already EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new


Error on Taxonomy• If there is an error in the

taxonomy, you need to build it manually

• The screen shows what this error would look like

• Use the pxrm0150.1005o document to determine what codes are in this taxonomy.

• REMINDER TAXONOMY entry IHS-ASTHMA 2007 is NEW,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new name• I Install or Overwrite the current entry• Q Quit the install• S Skip, do not install this entry• • Enter response: I// nstall or Overwrite the current entry• The update failed, UPDATE^DIE returned the following error

message:• MSG("DIERR")=1^1• MSG("DIERR",1)=701• MSG("DIERR",1,"PARAM",0)=3• MSG("DIERR",1,"PARAM",3)=493.02• MSG("DIERR",1,"PARAM","FIELD")=.01• MSG("DIERR",1,"PARAM","FILE")=811.23102• MSG("DIERR",1,"TEXT",1)=The value '493.02 ' for field

SELECTABLE DIAGNOSIS in SE• LECTABLE DIAGNOSIS SUB-FIELD in file REMINDER

TAXONOMY is not valid.• MSG("DIERR","E",701,1)=• • REMINDER TAXONOMY entry IHS-ASTHMA 2007 did not

get installed!• Examine the above error message for the reason.

Taxonomy Creation

Taxonomy Creation– Select Reminder Taxonomy: IHS-MAMMOGRAM 2007 Mammogram

codes LOCAL– ...OK? Yes// (Yes)– – – General Taxonomy Data– NAME: IHS-MAMMOGRAM 2007//– BRIEF DESCRIPTION: Mammogram codes//– – – CLASS: LOCAL//– SPONSOR:– REVIEW DATE:– – – PATIENT DATA SOURCE: EN,PL//– USE INACTIVE PROBLEMS:– INACTIVE FLAG:–

Taxonomy Creation• ICD9 Codes:• • Range V76.11-V76.12• • Code ICD Diagnosis• ---- -------------• V76.11 MAMMOGRAM HI-RISK MALIG BREAST• V76.12 OTH MAMMOGRAM MALIG BREAST• • ICD0 Codes:• • Range 87.37-87.37• • Code ICD Operation/Procedure• ---- -----------------------• 87.37 MAMMOGRAPHY NEC• • Range 87.36-87.36• • Code ICD Operation/Procedure• ---- -----------------------• 87.36 BREAST XEROGRAPHY

Taxonomy Creation• CPT Codes:• • Range 76090-76092• • Code CPT Short Name• ---- --------------• 76090 MAMMOGRAM, ONE

BREAST• 76091 MAMMOGRAM, BOTH

BREASTS• 76092 MAMMOGRAM, SCREENING• • Range G0204-G0204• • Code CPT Short Name• ---- --------------• G0204 DX MAMMO PRODUC DIR

DIGTL IMAG BIL• •

• CPT Codes:• • Range 76090-76092• • Code CPT Short Name• ---- --------------• 76090 MAMMOGRAM, ONE



DIGTL IMAG BIL•

• CPT Codes:• • Range 76090-76092• • Code CPT Short Name• ---- --------------• 76090 MAMMOGRAM, ONE



DIGTL IMAG BIL•

Taxonomy Creation

• After the taxonomy is created

• Re-load the reminder and use SKIP when you reach the taxonomy installation

Other Taxonomies• REMINDER TAXONOMY entry IHS-BILATERAL

MASTECTOMY already EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new


Other Taxonomies• ICD0 Codes:• • Range 85.42-85.42• • Code ICD Operation/Procedure• ---- -----------------------• 85.42 BILAT SIMPLE

MASTECTOMY• • Range 85.44-85.44• • Code ICD Operation/Procedure• ---- -----------------------• 85.44 BILAT EXTEND SIMP

MASTEC•

• Range 85.46-85.46• • Code ICD Operation/Procedure• ---- -----------------------• 85.46 BILAT RADICAL

MASTECTOMY• • Range 85.48-85.48• • Code ICD Operation/Procedure• ---- -----------------------• 85.48 BIL EXTEN RAD

MASTECTOMY•

Other Taxonomies• CPT Codes:• • Range 19180-19180• • Code CPT Short Name• ---- --------------• 19180 REMOVAL OF BREAST• • Range 19200-19200• • Code CPT Short Name• ---- --------------• 19200 REMOVAL OF BREAST• • Range 19220-19220• • Code CPT Short Name• ---- --------------• 19220 REMOVAL OF BREAST• • Range 19240-19240• • Code CPT Short Name• ---- --------------• 19240 REMOVAL OF BREAST

Reminder Term• REMINDER TERM entry IHS-MAMMOGRAM TERMS

already EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new


Reminder Definition• REMINDER DEFINITION entry IHS-MAMMOGRAM 2007 already

EXISTS,• what do you want to do?• • Select one of the following:• • C Create a new entry by copying to a new name• I Install or Overwrite the current entry• Q Quit the install• S Skip, do not install this entry• • Enter response: S// i Install or Overwrite the current entry• Are you sure you want to overwrite? N// y YES

Installing the Dialog

• Install the dialog after the reminder is installed

• It may appear that you are installing the reminder again

• Look to the upper left to see where you are

Installing the Dialog

Look here for directions

Select IA again for dialog pieces

Attach to the Reminder

• You are usually asked to attach the dialog to a reminder

• I have named the dialogs and the reminders the same

• If you are not asked during the install, you can manually attach them when you activate the dialog

• Install reminder dialog and all components with no further changes:Y// YES

• • Reminder Dialog IHS-

MAMMOGRAM 2007 is not linked to a reminder.

• • Select Reminder to Link:

IHS-MAMMOGRAM 2007

Dialog Installation

• An X should be by all the pieces of the dialog

Objects

• If TIU patch 1004 was installed, the objects needed in dialogs will be available

• If not, the user will be asked to replace or remove the object from the dialog

Activate the Dialog• All dialogs installed through reminder exchange

are disabled.• Exit out of Reminder Exchange and go to the

DM (Dialog Management)

• Select Reminder Managers Menu Option: DM Reminder Dialog Management

• DP Dialog Parameters ...• DI Reminder Dialogs• • Choose DI (Reminder Dialogs)

Activate the Dialog

• The initial View is of reminders, use CV and Select D to go to dialogs

Activate Dialogs

Activate the Dialog

• Choose the dialog by number then ED

Activate Dialog• NAME: IHS-MAMMOGRAM 2007//• DISABLE: DISABLED IN EXCHANGE Replace @• SURE YOU WANT TO DELETE? Y (Yes)• CLASS: LOCAL//• SPONSOR:• REVIEW DATE:• SOURCE REMINDER: IHS-MAMMOGRAM 2007//• Select SEQUENCE: 5//• SEQUENCE: 5//• DIALOG ELEMENT/GROUP: OI MAMMOGRAM//• Select SEQUENCE:

Activate Dialog

Add Radiology Tests to Reminder Term

Enter your radiology testsfor mammogram into thereminder term

• Select Reminder Managers Menu Option: trm Reminder Term Management

• • • TL List Reminder Terms• TI Inquire about Reminder• Term• TE Reminder Term Edit• TC Copy Reminder Term• •

Reminder Term• Select Reminder Term: IHS-MAMMOGRAM TERMS VISN• ...OK? Yes// (Yes)• • NAME: IHS-MAMMOGRAM TERMS//• CLASS: VISN//• REVIEW DATE:• DESCRIPTION:• No existing text• Edit? NO//• Select FINDING ITEM: RA.MAMMOGRAM• • Searching for a RADIOLOGY PROCEDURE, (pointed-to by FINDING

ITEM)• • •

Reminder Term• Searching for a RADIOLOGY PROCEDURE• • 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056• 2 MAMMOGRAM UNILAT (RAD Detailed) CPT:76090• CHOOSE 1-2: 1 MAMMOGRAM BILAT (RAD Detailed) CPT:77056• Are you adding 'MAMMOGRAM BILAT' as a new FINDINGS (the 1ST for this

REMINDER• TERM)? No// y (Yes)• EFFECTIVE PERIOD:• USE INACTIVE PROBLEMS:• WITHIN CATEGORY RANK:• EFFECTIVE DATE:• MH SCALE:• CONDITION:• CONDITION CASE SENSITIVE:• RX TYPE:• Select FINDING ITEM:

Reminder Term• You may enter a new FINDINGS, if you wish• Enter one of the following:• DR.EntryName to select a DRUG• ED.EntryName to select a EDUCATION TOPIC• EX.EntryName to select a EXAM• HF.EntryName to select a HEALTH FACTOR• IM.EntryName to select a IMMUNIZATION• LT.EntryName to select a LABORATORY TEST• MT.EntryName to select a MEASUREMENT TYPE• OI.EntryName to select a ORDERABLE ITEM• RP.EntryName to select a RADIOLOGY PROCEDURE• CF.EntryName to select a REMINDER COMPUTED FINDING• TX.EntryName to select a REMINDER TAXONOMY• ST.EntryName to select a SKIN TEST• DC.EntryName to select a VA DRUG CLASS• DG.EntryName to select a VA GENERIC• VM.EntryName to select a VITAL MEASUREMENT•

• You may enter a new FINDINGS, if you wish• Enter one of the following:• DR.EntryName to select a DRUG• ED.EntryName to select a EDUCATION TOPIC• EX.EntryName to select a EXAM• HF.EntryName to select a HEALTH FACTOR• IM.EntryName to select a IMMUNIZATION• LT.EntryName to select a LABORATORY TEST• MT.EntryName to select a MEASUREMENT TYPE• OI.EntryName to select a ORDERABLE ITEM• RP.EntryName to select a RADIOLOGY PROCEDURE• CF.EntryName to select a REMINDER COMPUTED FINDING• TX.EntryName to select a REMINDER TAXONOMY• ST.EntryName to select a SKIN TEST• DC.EntryName to select a VA DRUG CLASS• DG.EntryName to select a VA GENERIC• VM.EntryName to select a VITAL MEASUREMENT•

Add to GUI

• Click on the alarm clock

• Select the action drop down menu

Add to GUI

• Choose Edit Cover Sheet Reminder List

Add to GUI

• Select where you are going to add them.

• The choices are in the middle section

• The available reminders are on the bottom left.

• Move them over using the arrows

• Click apply when finished

Add to GUI

TEST,TEST,TEST

• Pick patients where the reminder is not applicable – (men, old or young women)

• Pick patients where the reminder is applicable but not due

• Pick patients where the reminder is applicable and due

• Is it correct??

Testing

• Use reminder maintenance to see what the computer found

• Right click on the reminder and choose clinical maintenance

Check the dialog

• Start a note

• Find the reminder in the reminders drawer

• Double click on the reminder and review the dialog

Check the Dialog

Check the dialog

Check Note

Check Order

Documents

National Reminders- Mammogram. Introduction The national reminders are in Patch 1005 of clinical reminders. The site manager should load this patch at