Clinical (EHR) Reminders – More Than Just A Memory Jogger
RPMS-EHRElectronic Health RecordOriginally developed by :Susan Pierce-Richards, MSN, ARNP, FNP-BC, ANP-BCCDR, US Public Health ServiceOIT National Programs – EHR TestingFederal Lead – EHR, Clinical (EHR) Reminders
Session ObjectivesAt the end of this session, participants should be able to: Understand the basic end user functionality of ClinicalRemindersPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC2
What are Clinical (EHR)Reminders? “The Clinical Reminders system allows caregivers to track andimprove preventive healthcare and disease treatment forpatients and to ensure that timely clinical interventions areinitiated.” (VA Vista Website) Interactive decision support tools that can provide patientspecific screening or treatment recommendations on the basisof the most recent available data within the RPMS (InformationTechnology as a Tool to Improve the Quality of AmericanIndian Health Care. Thomas D. Sequist, MD MPH, TheresaCullen, MD, MS and John Z. Ayanian, MD, MPP).Simple terms:Clinical Reminders chart reviews for you and tells you what thepatient needsPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC3
Where are Clinical (EHR)Reminders? They are visible from 4 places in HER:1- “Alarm clock” icon on the toolbarPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC4
Where are Clinical (EHR)Reminders?2- Reminders list on the Cover Sheet display DUEremindersPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC5
Where are Clinical (EHR)Reminders?3-“Reminders drawer” on the Notes tabPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC6
Where are Clinical (EHR) Reminders?Reports tab (requires configuration):Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC7
Where are Clinical (EHR) Reminders?able by right-clicking on a reminderDetails are avaiPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC8
What are Clinical ReminderDialogs? Clinical Reminder Dialogs facilitate documentation- Looks like a Template- Resolves the reminder (enters info into EHR/PCC)- Creates the note all at the same time!!! Generates order- Meds- Labs- Consults Supports treatment algorithmsPresented by Emmanuel Y. Yennyemb, MBA, CSAP,CAC9
Hands-onThe following reminders are due forthis patientPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC10
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Why do we need remindersystems? Improve preventive health care tracking Improve disease treatment monitoring Assist in clinical guideline implementation Improve patient safety Improve capture of GPRA and other reporting measuredata (MU/IPC/)Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC12
Why can’t we just use the HealthSummary reminder system with EHR? The Health Summary reminder system is not highlyvisible in EHR The Health Summary reminder system does not have adocumentation tool for EHR No longer using PCC Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC13
Do we need Clinical (EHR)Reminders?YES Clinical (EHR) Reminders restores: A visible reminder system A streamlined documentation toolClinical (EHR) Reminders additionallydelivers:- Locally configurable tools to solve local problems- Reports tool to extract real time data on specific reminderPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC14
Types of Clinical (EHR)Reminders National Reminders Delivered to all sites Based on same logic as Health Maintenance reminders Many have associated ‘dialogs’ for data entry/note generation Local Reminders Written at a local site to solve a particular clinical problem Can be shared between sites Dialogs can also be shared Reminder Reports Can quickly extract data by provider Very helpful for local reminders in identifying and tracking sitespecific issuesPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC15
A little “Reminders” lingo Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC16
Finding A FINDING is a piece of information that the remindersearches for in the computer FINDINGS are used to determine: Who needs an intervention (cohort) What resolves the reminderFindings include individual or groups of Labs, Pt EdTopics, Taxonomies of codes (ICD9, ICD0, CPT), Exam,Measurements, Health Factors, Medications Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC17
Applicable The Cohort is the “who needs the intervention” A reminder is APPLICABLE to a patient if they are in thecohortCohort IdentifiedAge 50Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CACNO h/oColon ca18
Resolution What will turn this reminder OFF?DM HgbA1C Lab test DM ACE/ARB Current & filled rx for ACEI or ARB A reminder is considered RESOLVED if the intervention(finding) defined by the reminder has been met/foundPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC19
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Due A reminder is DUE for patient if they are in the cohort(applicable) and have not yet had the intervention(finding) that the reminder is seeking.Presented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC21
Basic Reminder LogicNoDoes Patient meet cohort criteria?Reminder not applicable(white clock)Any Exclusions?Reminder not applicable(white clock)Reminder ResolvedApplicable (blue clock)CACFulfills resolution criteria?Reminder DueDue (red clock)22
National Reminder – Dialogtools Screening bundle Alcohol Screening and Brief Intervention (ASBI) Tobacco counseling and interventionPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC23
The future Reminders can be locally created and used for bothproblem identification and interventions Dialogs can be used to resolve reminder Dialogs can stand along and be used as documentationtools like PCC Reminders and Dialogs can be SHARED between sitesPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC24
CAC Resources FTP HR%20Reminders/ Sharepoint site for those with D1 default.aspx Recorded webex trainings Reminders start to finish (several done by Mary Hager) Getting started series (several done by Susan Richards) Road map to deployment Reminders – copy and customize Dialogs – customize Importing/Exporting remindersPresented by Emmanuel Y. Yennyemb, MBA, CSAP, CAC25
Clinical (EHR) Reminders – More than just a memory jogger Author: Emmanuel Yennyemb Subject: Clinical (EHR) Reminders More than just a memory jogger Keywords: Clinical (EHR) Reminders – More than just a memory jogger
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EHR Implementation Status, 2018 5%. 18%. 19%. 28%. 13%. 16%. 2018 EHR Implementation Status. Not yet implemented. Fully implemented EHR. Less than 6 months. 6-12 months. 12-18 months. More than 18 months Of behavioral health provider organizations who purchased an EHR, 77% describe the EHR as fully implemented The majority (37%) of EHR
In Medscape's 2009 Reader's Choice EHR survey, only 38% of respondents were using an EHR. At that time, more than a third said they didn't have an EHR and didn't plan to get one. Famous . the EHR product itself vs satisfaction with the vendor. "The doctor purchased the EHR through a salesperson, and the salesperson asked all the right .
with this EHR. 9. This EHR enables me to practice higher quality medicine than I could with paper charts. 10. I have a good idea how much this EHR system is costing my practice. 11. This EHR is worth the expense. 12. Our EHR vendor provides excellent training and support. Survey overview: 13. I a
genomics in the EHR? Non-exceptionalist perspective: Any genetic or genomic test can be ordered from an EHR via CPOE Any genetic test report can be included in the EHR as a text document Some EHR systems (or LIS modules within an EHR): Support storage of discrete genetic findings (variants, quantitative
7 The EHR's Impact on Professional Satisfaction and Work-Life Balance 2 hours administrative work for every hour of direct patient care Distracted Doctoring in Exam Room 53% of time on direct clinical face time 37% on EHR and desk work Work after work Average 1- 2 hours of EHR time at home o Pajama time o Saturday night date with EHR Decreased Interaction with Colleagues in the .
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