RPMS EHR 2014 Text Integration Utilities 1.0 P1011/1012

AFTRPMS EHR 2014Text Integration Utilities 1.0 p1011/1012DRTeresa Chasteen, RHITBemidji Area Clinical Applications Coordinator1

TAFRDCONTENTS OF PATCH

Content of *225TIU*1.0*213DRAFVA patchesTTIU 1011 – Mega-patchIHS 34TIU*1.0*231TIU*1.0*238TIU*1.0*224

Content of patchRAFBTIULO5 - Updated for SNOMED narrativesBTIULO7 - For CLIA info on labsBTIUMED9 - For suspended med objectBTIUPCC1 - Updated for SNOMED narrativesBTIUPDD - New objects for Integrated problem listBTIUPRVI - New objects for visit dataBTIUSTSC - New object for Stroke ScoresBTIUVAMI - New object for V AMI fileBTIUVSTR - New object for V Stroke fileD-TTIU 1012 – New routines and objects to supportchanges for Meaningful Use Stage 2 changes

TIU 1011/1012 in a Nutshell This primarily will impact existing rules that allow expected cosigner to edit a signednote prior to cosigning (such as for student)Training issue – cosigners would write amendment rather than edit noteAF TSigned note will no longer honor business rules that allow users to edit themexcept for Chief MISNew objects for IPL and other Meaningful Use 2014 software changes Review and update templates if needed prior to deployment but not essential for GoLive Review and have basic understandingNot required to do anything for Go Live but after install you will need to map NEWnote titlesSchedule clean up and mapping over next few monthsForm letters D RNote title clean up and mapping to VHA Enterprise DocumentNew functionalityDeploy routinely if desired

TAFRDNATIONAL NOTE TITLECLEAN-UP AND MAPPING

National Note title CleanupRTIU VHA ENTERPRISE STANDARD TITLETIU LOINC SUBJECT MATTER DOMAINTIU LOINC ROLETIU LOINC SETTINGTIU LOINC SERVICETIU LOINC DOCUMENT TYPED8926.18926.28926.38926.48926.58926.6AFT Introduces the VHA Enterprise Document TypeOntology and mapping utility Assists CACs with mapping local TIU note titles toVHA Enterprise Standard Titles New files introduced

TAFRDWHY MAP TO STANDARD TITLESThe following slides are excerpted from CPRS National Call February2006, Veterans Health Administration, Office of Information, Health Dataand Informatics

TWhy Standardize Clinical DocumentTitles?DRAF Share meaningful titles across systems Create searchable, retrievable, comparable,and computable data Capture complete health information9

How were Note Title StandardsDetermined?DRAFT Researched existing Standard DevelopmentOrganizations (SDO) for existing clinical documentstandards. (LOINC and HL7) Extracted all TIU document titles from 128databases [in the VA] (156,000) Analyzed every term within the extracted Titles. Categorized the title terms to follow LOINC and HL7standards.10

Local Title Examples -- the Need forStandardizationRAFTAUDIO/REEVAL/HA CHECK (T)(CI)CH-SARP NOTECIH/STAR II CONSULTDME CLINIC (T)IC/ID/VSOCIAL WORK BOMH DISPOSITION NOTE (O) (T)UR 67CD (T)(K)BLDG 85 CAFFEINE CLASSBED STY NURSING NOTEBUDGET GROUP, PHASE I (CI)DIVERSIONAL ACTIVITY - KPATIENT HEALTH EDU POINT AND CLICKRAP NOTE (K)STARDOM EVALUATIOND-11

What TIU Data will be Standardizedand When?TTIU Document Definition file 8925.1AF Name field .01 (note title name)TIU Document file 8925R Status Field .05D Keeping current statuses.When: Installation of TIUv1.0 Patch101112

LOINC Standards - LOINC document namingnomenclature contains five axes: DR T Subject Matter Domain – Characterizes the subject matter of a note.Role - Characterizes the training or professional level of the author ofthe document, but does not breakdown to specialty or subspecialty.Setting – Characterizes the general setting of the health care beingprovided. Setting is not equivalent to location, which typically hasmore locally defined meanings.Service - Characterizes the kind of service or activity that wasprovided to/for the patient as described in the note. Commonsubclasses of service would be examinations, evaluations, andmanagement.Document Type - Characterizes the general structure of thedocument at a macro level.AF 13

Standard Title TermsA standard note title is created by combining terms from each axis intoa composite ntOutpatientHome Health CareServiceCounselingDiagnostic StudyEvaluation andManagementDocument TypeNoteConsultReportAFSubject Matter Domain (SMD)Primary CareCardiologySurgery14

Order of Title TermsThe order of combining terms within a Title is as follows:-Not all axes are required to create a valid document title; some axes maybe blank.For example if we took "Cardiology" from the SMD axis and "Consult"from the Document Type axis, the following title could be created:AF-TSubject Matter Domain : Role : Setting : Service : Document TypeDResult:Cardiology ConsultRCardiology : No Author/Role : No Setting : No Service: Consult15

More Examples of Standard TitlesTReport of Contact (Document Type only)AFPhysical Therapy Note (SMD, Document Type)RPrimary Care Nursing Outpatient Note ( SMD, Role, Setting,Document Type)DAdvance Directive (Document Type )Audiology Inpatient Diagnostic Study Report (SMD, Setting,Service, Document Type)16

Important FactsAFTNo delimited characters in standard titles with the exception of“&”. HL7 specifications use delimited characters for messagetransmission. Examples of delimited characters: ; : RSites will maintain their local titles in the Text Integrated UtilityDocument Definition file 8925.1DThe VA sends these documents to the “Health Data Repository”– we do not yet but this will prepare for future exchange ofdata.17

Implementation -- MappingNUTRITION CLINIC FIRST VISIT NOTETLocalnotetitleAFSUBJECT MATTERDOMAINSETTINGDOCUMENT TYPERNutrition DieteticsSERVICEDOutpatientInitial evaluationStandardized note title“Nutrition Dietetics outpatient initial evaluation noteNote18

TAFRDMAPPING PROCESS

Mapping to National Titles1. Perform Active Title CleanupInactivate unused note titles (except National titles)T AF2. Print a list of Active Note Titles (BEH – TIU – HIS – LAD)3. Review of VHA Enterprise Standard itleStandards-1.xlsDirect mapD R4. Review and identify which standard titles your local titlesmay be mapped to5. Add Synonyms (optional)6. Use mapping tools to map remaining titles

TAFRDSTEP 1: ACTIVE TITLE CLEANUPREPORT/UTILITY

Active Title Cleanup ReportR Cleanup report should be run and inactive notesprocessed prior to using mapping optionsNational Note titles such as Crisis Note, AdvancedDirective and Patient Record flag note titles should NOTbe inactivatedD AFT Delivers a report “Active Title Cleanup Report” andautomated cleanup utility to assist the DataStandardization’s efforts and standardize DocumentTitles.

Active Title Cleanup Report When running reportAFT Users may be on system Run at time that does not conflict with system back up Processing times will varyDR The report will display all currently ACTIVE titles along withthe number of instances that title has been used in theprevious 365 days, the last day that title has been used,along with the last AUTHOR/DICTATOR of that entry.

Active Title Cleanup ReportDRAFT INACTIVE titles will only appear on the report if that titlehas been used in the previous 365 days. ACTIVE titles that have a document type field that pointsto a document (in 8925.1) of type DOCUMENT CLASS orCLASS will have a *[DOCUMENT CLASS]* or *[CLASS]* tagappended to the title respectively. ACTIVE titles that contain a 0 (zero) or NULL documenttype field will be displayed as UNKNOWN *[missing]* onthe report and the document IENs for these titles will belisted at the end of the report.

Active Title Cleanup ReportDRAFT All ACTIVE titles with a count of 0 (zero) will be selected forautomatic inactivation ONLY AFTER USER INTERVENTIONDURING THE REPORT PROCESS. No changes will be madeto file #8925.1 without consent from the user. Specific titles may be selected that will NOT beINACTIVATED even if their usage count for the last year is0.

Active Title Cleanup ReportT You will run the utility twiceDRAF The first time you will select NO when promptedto inactivate note titles. This allows you toreview your system. The second time you will inactivate selectively

Active Title Cleanup report-REVIEWBEH TIU HIS TMM CLN# of Total Titles :8760---------84D# of Docs :29# of Docs Incorrect .01 Field : 0# of Docs Zero/Null .01 Field : 0---------# of Total Docs Searched :29R# of Used Titles :# of Unused Titles :# of Invalid Titles :AFTInactivate the unused Document Titles at this time? NO// NODEVICE: HOME//The sample shown below was on a test database and is not indicative of the results at any actual site.Review ScreenElapsed Time: 0 minute(s) 1 second(s)Current User: USER,DEMOCurrent Date: Jan 04, 2013@11:52:38Date range searched: Jan 05, 2012 - Jan 04, 2013

DRAFTActive Title Cleanup report-REVIEW

DRAFTActive Title Cleanup report-REVIEW

Active Title Cleanup reportDRAFTReview the list. Select the titles you wish toinactivate.Remember do not inactivate National Note titlesor Patient Record Flag note titles.

Active Title Cleanup reportNational Document ClassesDRAFTADDENDUMADDICTION SEVERITY INDEXADVANCE DIRECTIVEADVERSE REACTION/ALLERGYANESTHESIA REPORTSC & P EXAMINATION REPORTSCLINICAL WARNINGCRISIS NOTEDISCHARGE SUMMARIESHISTORICAL PROCEDURESLR ANATOMIC PATHOLOGYNURSE INTEROPERATIVE REPORTSPATIENT RECORD FLAG CAT IPATIENT RECORD FLAG CAT IIPROCEDURE REPORT (NON-O.R.)OPERATION REPORTSREQUEST FOR CORRECTION/AMENDMENT OF PHISCI OUTCOMES

Active Title Cleanup ReportNational Document TitlesADDENDUMADVANCE DIRECTIVEADVERSE REACTION/ALLERGYANESTHESIA REPORTANNOTATION ***APPROVED REQUEST FOR CORRECTION/AMENDMENT OF PHIASI-ADDICTION SEVERITY INDEXCLINICAL WARNINGDENIED REQUEST FOR CORRECTION/AMENDMENT OF PHIDISCLOSURE OF ADVERSE EVENT NOTECRISIS NOTEDISCHARGE SUMMARYE-COPY DISCHARGE INSTR NOT RECEIVED ***E-COPY DISCHARGE INSTR RECEIVED ***HISTORICAL CARDIAC CATHETERIZATION PROCEDUREHISTORICAL ECHOCARDIOGRAM PROCEDUREHISTORICAL ELECTROCARDIOGRAM PROCEDUREHISTORICAL ELECTROPHYSIOLOGY PROCEDUREHISTORICAL ENDOSCOPIC PROCEDUREHISTORICAL EXERCISE TOLERANCE TEST PROCEDUREHISTORICAL HEMATOLOGY PROCEDUREHISTORICAL HOLTER PROCEDUREHISTORICAL PACEMAKER IMPLANTATION PROCEDUREHISTORICAL PRE/POST SURGERY RISK NOTEHISTORICAL PULMONARY FUNCTION TEST PROCEDUREHISTORICAL RHEUMATOLOGY PROCEDURELR AUTOPSY REPORTLR CYTOPATHOLOGY REPORTLR ELECTRON MICROSCOPY REPORTLR SURGICAL PATHOLOGY REPORTNURSE INTERPRETATIVE REPORTOPERATION REPORTSPATIENT RECORD FLAG CATEGORY IPATIENT RECORD FLAG CATEGORY I - HIGH RISK FOR SUICIDERISK OF CJDSCI CRAIG HANDICAP ASSESSMENT&REPORTING TECHNIQUE-SHORT FORMSCI DIENER SATISFACTION WITH LIFE SCALESCI GENERAL NOTESCI FUNCTIONAL INDEPENDENCE MEASUREWRIISC ASSESSMENT NOTEPROCEDURE REPORTDRAFTNational Document Titles*** IHS addition

Active Title Cleanup reportINACTIVATEBEH TIU HIS TMM CLNTInactivate the unused Document Titles at this time? NO// YESAFAll active titles that have not been used in the previous 365 dayswill be set to INACTIVE.You may select individual DOCUMENT TITLES that will NOT be setto INACTIVE by this cleanup.RAre you sure you want to change their status to INACTIVE? NO// YESDEnter the DOCUMENT TITLE(S) that will NOT be INACTIVATEDduring the cleanup process.Enter RETURN or ' ' to finish selections.Enter DOCUMENT TITLE: ADVANCE DIRECTIVETITLE TITLE******Enter your list of titles that you wish to keep active one at a time *********

Active Title Cleanup reportINACTIVATETThe list will be presented to you before you being the inactivation processThe following DOCUMENT TITLES will NOT be INACTIVATED:DRAFADVANCE DIRECTIVECLINICAL WARNINGADVERSE REACTION/ALLERGYCRISIS NOTEAMH BH INDIVIDUALPRENATAL VISITANNOTATIONPATIENT RECORD FLAG CATEGORY IPATIENT RECORD FLAG CATEGORY II - RISK, FALLPATIENT RECORD FLAG CATEGORY II - RISK, WANDERINGPATIENT RECORD FLAG CATEGORY II - RESEARCH STUDYPATIENT RECORD FLAG CATEGORY II - INFECTIOUS DISEASEIs this correct? YES//