National Reminders-National Reminders-Diabetic MicroalbuminDiabetic Microalbumin

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.

• Reminders should be installed by site manager and a CAC since some require the @ sign level of access

Preparation

• Document pxrm0150.1005o contains the setup of each reminder.

• Check the taxonomy

• Check for reminder terms

• Check for orders

Create 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

• LRZ MICROALBUMIN is the name the reminder will be looking for

Quick OrderSelect Order Menu Management Option: QO Enter/edit quick ordersSelect QUICK ORDER NAME: LRZ MICROALBUMIN 1 LRZ MICROALBUMIN 2 LRZ MICROALBUMIN TOMORROWCHOOSE 1-2: 1 LRZ MICROALBUMINNAME: LRZ MICROALBUMIN//DISPLAY TEXT: Microalbumin//VERIFY ORDER:DESCRIPTION: No existing text Edit? NO//ENTRY ACTION:

Quick OrderLab Test: MICROALBUMIN DEMO//Collected By: Send patient to lab//Collection Sample: URINE//Collection Date/Time: TODAY//How often: ONCE//Indication://Indication ICD9:// May decide to enter diabetes diagnosis here ------------------------------------------------------------------------------- Lab Test: MICROALBUMIN DEMO Collected By: Send patient to lab Collection Sample: URINE Specimen: URINE Collection Date/Time: TODAY How often: ONCE------------------------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE//Auto-accept this order? NO//

Reminder Exchange – Install Reminder

• Choose IHS-DIAB MICROALBUMIN 2007

Reminder Installation

• Select IFE to install the reminder

• Review the reminder• Select IA to install all

the components

Install the ComponentsREMINDER TAXONOMY entry IHS-DIABETES DX 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 entryThe update failed, UPDATE^DIE returned the following error

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

SELECTABLE DIAGNOSIS in SELECTABLE 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 CreationNAME: IHS-DIABETES DX 2007 ReplaceBRIEF DESCRIPTION: CLASS: LOCAL//SPONSOR:REVIEW DATE: PATIENT DATA SOURCE: EN,PL//USE INACTIVE PROBLEMS:INACTIVE FLAG: ICD0 Range of Coded ValuesSelect ICD0 LOW CODED VALUE: ICD9 Range of Coded ValuesSelect ICD9 LOW CODED VALUE: 250.00// ICD9 LOW CODED VALUE: 250.00// ICD9 HIGH CODED VALUE: 250.93//Select ICD9 LOW CODED VALUE:

Taxonomy Creation

• After the taxonomy is created

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

Renal Disease Taxonomy

REMINDER TAXONOMY entry IHS-END STAGE RENAL DISEASE 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

Install Reminder Term

• REMINDER TERM entry IHS-MICROALBUMIN already EXISTS,

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

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

Install the Reminder DefinitionREMINDER DEFINITION entry IHS-DIAB MICROALBUMIN 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 entryAre you sure you want to overwrite? N// Y

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-DIAB MICROALBUMIN 2007 is not linked to a reminder.

Select Reminder to Link: IHS-DIAB MICROALBUMIN 2007

Dialog Installation

• An X should be by all the pieces of 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-DIAB MICROALBUMIN 2007 Replace

DISABLE: DISABLED IN EXCHANGE Replace @

SURE YOU WANT TO DELETE? Y (Yes)

CLASS: LOCAL//

SPONSOR:

REVIEW DATE:

SOURCE REMINDER: IHS-DIAB MICROALBUMIN 2007//

Select SEQUENCE: 5//

SEQUENCE: 5//

DIALOG ELEMENT/GROUP: OI MICROALBUMIN//

Select SEQUENCE:

Activate Dialog

Edit the Reminder Term

• The reminder term cannot be populated with lab tests since each site has their own

• The microalbumin used at your site needs to be added to the reminder term.

• Use TE to edit the reminder 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

Edit Reminder Term

Select Reminder Term: IHS-MICROALBUMIN VISN ...OK? Yes// (Yes) NAME: IHS-MICROALBUMIN//CLASS: VISN//REVIEW DATE:DESCRIPTION:The lab tests used at a site to resolve the microalbumin

reminder Edit? NO//Select FINDING ITEM: LT.MICROALBUMIN

Edit Reminder Term Searching for a LABORATORY TEST 1 MICROALBUMIN MICROALBUMIN (retired) 2 MICROALBUMIN 24HR UR 3 MICROALBUMIN DEMO 4 MICROALBUMIN RANDOM MICROALBUMIN RANDOM (retired)CHOOSE 1-4: 3 MICROALBUMIN DEMO Are you adding 'MICROALBUMIN DEMO' 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:

Finding Items 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

• CACs need parameter access to edit

• RPMS-EHR configuration menu

• Select Reminders Configuration

• Then select PAR

Set the CFG

Set up GUI

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 – (non-diabetics)

• 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

• Is the correct data going into the note?

• Is the order there?• Are you presented

with the dialog to enter the order when you select Finish?

• Is it the correct Quick order?

Check the Dialog

Note

Order

Unable to add items to GUI

• If you consistently get a slash through the alarm clock and are unable to add items to the GUI, follow the following steps

• 1. Use ACT and make sure reminders are active

• 2. Set the NEW REMINDERS PARMETERS TO NO

• 3. Edit the cover sheet Reminder List and set up a very common reminder such as the tobacco screen

• 4. Pick a patient for whom this reminder will be due

• 5. The Slash in the alarm clock should now be gone and you can add your reminders in the GUI

• 6. Go back and reset the NEW REMINDER PARAMETERS to YES