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
First Time – Step 3
• 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
First Time – Step 4
• 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
 First Time – Step 7
• 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 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 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//
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 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
name
• I Install or Overwrite the current entry
• Q Quit the install
• S Skip, do not install this entry
•
• Enter response: S//
 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
name
• I Install or Overwrite the current entry
• Q Quit the install
• S Skip, do not install this entry
•
• Enter response: S//
 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: • CPT Codes:
• •
• Range 76090-76092 • Range 76090-76092
• •
• Code CPT Short Name • Code CPT Short Name
• ---- -------------- • ---- --------------
• 76090 MAMMOGRAM, ONE • 76090 MAMMOGRAM, ONE
BREAST BREAST
• 76091 MAMMOGRAM, BOTH • 76091 MAMMOGRAM, BOTH
BREASTS BREASTS
• 76092 MAMMOGRAM, SCREENING • 76092 MAMMOGRAM, SCREENING
• •
• Range G0204-G0204 • Range G0204-G0204
• •
• Code CPT Short Name • Code CPT Short Name
• ---- -------------- • ---- --------------
• G0204 DX MAMMO PRODUC DIR • G0204 DX MAMMO PRODUC DIR
DIGTL IMAG BIL 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
name
• I Install or Overwrite the current entry
• Q Quit the install
• S Skip, do not install this entry
•
• Enter response: S//
 Other Taxonomies
• ICD0 Codes: • Range 85.46-85.46
• •
• Range 85.42-85.42 • Code ICD Operation/Procedure
• • ---- -----------------------
• Code ICD Operation/Procedure • 85.46 BILAT RADICAL
• ---- ----------------------- MASTECTOMY
• 85.42 BILAT SIMPLE •
MASTECTOMY • Range 85.48-85.48
• •
• Range 85.44-85.44 • Code ICD Operation/Procedure
• • ---- -----------------------
• Code ICD Operation/Procedure • 85.48 BIL EXTEN RAD
• ---- ----------------------- MASTECTOMY
• 85.44 BILAT EXTEND SIMP •
MASTEC
•
 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
name
• I Install or Overwrite the current entry
• Q Quit the install
• S Skip, do not install this entry
•
• Enter response: S//
 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 • Install reminder dialog
to attach the dialog to a and all components with
no further changes:Y//
reminder
YES
• I have named the •
dialogs and the • Reminder Dialog IHS-
reminders the same MAMMOGRAM 2007 is
• If you are not asked not linked to a reminder.
during the install, you •
can manually attach • Select Reminder to Link:
IHS-MAMMOGRAM
them when you activate
2007
the dialog
 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 tests • Select Reminder Managers
Menu Option: trm Reminder
for mammogram into the Term Management
reminder term •
•
• 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
•
 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