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
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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
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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
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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
2015 Office Practicum User Conference
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?
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We want your feedback!