PRAPARE TOOL (Protocol to Respond to and Assess Patient ......Standardized Patient Risk Assessment...

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PRAPARE TOOL (Protocol to Respond to and Assess Patient Assets, Risks, and Experiences)

eClinicalWorks Data Definition and Configuration Guide

Disclaimer:

eClinicalWorks and the eClinicalWorks logo are registered trademarks of eClinicalWorks LLC. The Health Center Network of New York (HCNNY) is the author of this guide is not affiliated with eClinicalWorks LLC. This configuration guide is provided by the author “as is” and any express or implied warranties, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose, are disclaimed. The information contained in this document is subject to change without notice. HCNNY shall not be liable for technical or editorial errors or omissions. The use of eClinicalWorks system and configuration manuals from the vendor’s support portal is recommended.

Revised 9/6/2016

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Table of Contents

Section Title Page

I Overview 1

II How to Use this Guide 1

III PRAPARE Smart Form (Optional) 2

IV Manual Configuration 2

Demographics 2

Progress Note 5

Create Social History Structured Data 6

Appendix A ‐ Demographics Screen 14

Appendix B ‐ Progress Note Social History 18

Appendix C – PRAPARE Smart Form 22

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I. Overview NACHC, Kaiser Permanente, AAPCHO, Oregon Primary Care Association, Blue Shield of California Foundation and the Institute for Alternative Futures developed a project to develop a National Standardized Patient Risk Assessment Protocol for Electronic Health Record Systems. The Protocol to Respond to and Assess Patient Assets, Risks, and Experiences (PRAPARE) tool was developed to provide the assessment. The components of the PRAPARE tool were based on evidenced based guidelines to assess the patient’s socioeconomic and psychosocial characteristics, as well as clinical characteristics to make appropriate and informed care decisions based on the patient complexity. The tool was initially developed as a paper document to be completed by the patient. The Health Center Network of New York (HCNNY) and the project team has developed a best practice protocol to capture the PRAPARE tool in the eClinicalWorks EHR using existing fields and established protocols as well as creating structured data. The information from the paper tool is typically captured by different staff in the practice management and progress note sections of eCW. This information is intended to be combined. The intent of this guide is to provide a standardized process to allow the data to be aggregated across organizations. The demographics related information in PRAPARE is currently captured by the front end staff and the data will continue to reside in this section to avoid duplication of effort and data integrity issues. This data is currently captured by most FQHCs for Meaningful Use incentives and UDS reporting to HRSA. Non FQHC’s wishing to utilize this tool can add the additional structured data to demographics. The other information is best captured by clinical staff, patient navigators and social workers in Social History of the Progress Note. This information identifies needs that the organization may be able to provide information about resources, referrals or additional services.

II. How to use this Guide The intent of this document is to provide guidance on setting up the PRAPARE tool to identify the Social Determinants of Health for our patients. Organizations can either use a split view of PRAPARE questions accessed through Demographics and Social History or they can install the eCW PRAPARE Smart Form. Organizations that elect to use the Smart Form will have the comprehensive view of PRAPARE plus additional enhancements. The PRAPARE Smart Form functions like other eCW Smart Forms that are accessed through the Progress Note. The PRAPARE Smart Form combines the information captured in demographics, structured Social History questions and responses, a simple tally score* and documents Enabling Services provided using structured data*. (* Items added beyond the scope of PRAPARE). Linked dummy CPT Codes and ICD10 Codes for enabling Services can be added manually or using an Order Set. eCW Support will create and map data as part of the PRAPARE Smart Form install fee. The questions and responses will follow this guide but will be completed by eCW. Organizations that do not elect to utilize the Smart Form can manually configure PRAPARE following the directions in this guide for demographics and Social History. It is important to enter the questions and

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responses as indicated in this document using the format specified. These questions can be mapped in Community Mapping to facilitate reporting across organizations. Screenshots of each item are contained in the appendices.

III. PRAPARE Smart Form (Optional)

Contact eCW Support to request installation of the PRAPARE Smart Form if desired. Practices will not be required to pay for the development of this form, however, they will need to pay a reduced cost installation fee. The installation fee covers the cost of eCW adding structured data, community mapping and installation of the Smart Form on a test and production environment. As of July 2016, the installation cost from eCW is $1,000.

eCW is unable to add Assessments, Problems or Enabling Service CPT Codes based on the Smart Form, however, they will include the enabling services selected as structured data in Social History. eCW recommends creating Procedures with custom/dummy CPT codes attached for enabling services and adding these to an Order Set with the relevant Linked ICD10 Codes. The custom/dummy CPT codes can be configured with the appropriate charge and non‐billable option selected. Although outside the scope of the current PRAPARE tool, a separate guide for documenting enabling services in eCW using an Order Set is being developed and will be made available.

Once the Smart Form in installed, staff can access the Smart Form from the Smart Form (SF) drop down menu at the top of the progress note, or by clicking on the detail field in Social History.

IV. Manual Configuration

A. Demographics

The demographics questions required for PRAPARE follow the Uniform Data Set (UDS) eCW UDS Reference Guide and Sliding Fee Set Up that Federally Qualified Health Centers (FQHCs) use for standard reporting. FQHC and non‐FQHC organizations should follow the eCW UDS Reference Guide and Sliding Fee Set Up available on the eCW Support Portal under the Health Center documentation section for directions in configuring the PRAPARE demographics questions. Step by Step directions are not provided in this section in order to avoid to duplicating their documentation and potential version conflicts. The information below explains the alignment and end user requirements.

1. Are you Hispanic or Latino?

Yes

No

I choose not to answer this question

eCW Patient Information Screen, Additional Info tab, Ethnicity field

Utilizes the drop down list in V10

Map eCW Unreported/Refused to Report to “I choose not to answer this question”.

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2. Which race(s) are you? Check all that apply

Asian Native‐Hawaiian

Pacific Islander Black/African American

American Indian/Alaskan Native White

Other I choose not to answer this question

eCW Patient Information Screen, Additional Info tab, Race Field

Utilizes the drop down list in V10

The races preconfigured in eCW may be different than the paper tool ‐ map to UDS race for reporting purposes.

Recommend cleaning up non UDS races that may have been added in V9 free text or in error to V10. Map “More than One Race” to “Other” on reports.

See Diagram A demographics screen shots

Map eCW “Unreported/Refused to Report” to “I choose not to answer this question”.

3. At any point in the past 2 years, has seasonal or migrant farm work been you or your family’s main source of income?

Yes No I choose not to answer this question

eCW Patient Information Screen, Additional Info tab, Structured Data Tab, Structured data names: “Seasonal” and “Migrant”

Set up structured data as Boolean following the eCW UDS guidelines. This should not be modified to avoid creating errors on UDS reports.

Map Seasonal “Yes” response or Migrant “Yes” response to Yes for reporting purposes

Map the “null” response to “I choose not to answer this question”. Note: This requires manual configuration by the practice following the FQHC set up.

See Diagram A demographics screen

Definitions (According to section 330(g) of the Public Health Service Act):

Migratory agricultural worker: is an individual whose principal employment is in agriculture and who establishes a temporary home for the purposes of such employment. Migratory agricultural workers are usually hired laborers who are paid piecework, hourly, or daily wages. The family members may or may not move with the worker or establish a temporary home.

Seasonal agricultural workers: individuals whose principal employment is in agriculture on a seasonal basis (e.g. picking fruit during the limited months of a picking season) but who do not establish a temporary home for purposes of employment. Seasonal agricultural workers are usually hired laborers who are paid piecework, hourly, or daily wages.

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4. Have you been discharged from the armed forces of the United States?


eCW Patient Information Screen, Additional Info tab, Structured Data Tab, Structured data name “Veteran”.

Set up structured data as Boolean following the eCW UDS guidelines. This should not be modified to avoid creating errors on UDS reports.

Map the “null” response to “I choose not to answer this question”. Note: This is a manual configuration by the practice following the FQHC set up.

See Diagram A demographics screen

5. What language are you most comfortable speaking?

English Language other than English I choose not to answer this question

eCW Patient Information Screen, Additional Info tab, Language field

Utilizes the Drop down and selection list in V10. These will vary by organization and should be mapped to the ISO codes as part of the Meaningful Use configuration for Version 10.

Mapped to ISO codes in eCW Community Mapping

Map all languages other than English to “Language other than English” and Null to “I choose not to answer this question” on any reporting tool.

6. How many family members, including yourself, do you currently live with?

eCW Patient Information Screen, Sliding Fee, Dependents field

Numerical response entered by staff

Map Null value to I choose not to answer this question if sliding fee field is blank

eCW Patient Information Screen, Sliding Fee, Gross Income field

Any reporting tool used will need to convert to Annual income based on the type

7. During the past year, what was the total combined income for you and your family members you live with? This information will help us determine if you are eligible for any benefits.

PRAPARE uses this information to determine the percent of patients by Federal Poverty (FPL) for reporting purposes. Use the calculated Poverty Level for Reporting.

eCW Patient Information Screen, Sliding Fee Scale Screen Total Gross Amount field (eCW automatically calculates based on entry)

8. What is your main insurance?

eCW Patient Information Screen, Insurance field

Use primary insurance field, Insurance 1, and map to insurance group, or map using the UDS mapping for any reporting tool

9. What address do you live at?

eCW Patient Information Screen Address line 1, 2, city, state, zip

Use Street Address if different than mailing on additional info screen if completed.

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B. Progress Note Section

All of the information in this section is built in the Social History Section and intended for clinical staff, patient advocates or social workers to complete. Create a custom category named Social Determinants of Health and a custom Item called Social Determinants of Health. The questions are built as custom structured data using the same text as the paper PRAPARE Tool unless indicated otherwise. The choices from the paper tool should be added to each structured data as structured text using the same text as the paper PRAPARE tool unless indicated otherwise.

Important Note: Most of the questions are set up as structured text and not Boolean to allow the option for “I choose not to answer the question”. An example of the completed output from the Social History is shown below. Screen shots of the actual configuration are contained in Appendix B.

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1. Create Structured Data in Social History

Please note that structured data will be visible to the end users as soon as they are created and is available for immediate use. Once a structured item is used in Social History you will not be able to delete it. We recommend that you create the items in a test environment and then recreate them in the production environment. You will also need security in order to customize structured data.

a. Create Social Determinants of Health Category

1. From an unlocked progress note, open Social History.

2. Click on the “Custom” button and select “New Category”

3. Enter the category name that you want to display on the folder.

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b. Create Structured Item 1. While in the Social Determinants of Health Category, repeat the same steps as above but

select New Item 2. Enter the Item Name of Social Determinants of Health and check the structured box.

c. Create the Questions using Structured Data 1. Open the structured item created above by clicking in the details field for the item.

a. The Social History Structured Notes window should appear. 2. Click on the Custom button to open the Structured Data window 3. Click the Add button to create a new structured data element (Questions).

4. The Structured data window will open

5. Enter question in the name field 6. Select type of structured text, numeric, date, Boolean (yes/no), Date (mm/yyyy) or Date

(yyyy) based on the configuration needed. 7. Select mandatory if desired 8. Select a default value if desired 9. Click OK.

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d. Create structured text Responses for each structured data questions

1. Click on the structured data name and click the “Customize Structured Text” button

2. The Structured text window opens

a. Click the Add button and type one response on each line for structured text b. Use the arrow buttons to change the order c. Select any item you want to be the default response if desired and click ok

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C. Progress Note/Social History Questions and Responses

1. SDH Entered/Updated*

Added structured question with date field to the beginning of the PRAPARE tool to capture the date the information was updated or completed in social history.

Staff should complete this field anytime they add or edit information

2. What is your housing situation today?

I have housing I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, or in a park)


Create the question as custom structured data under Social History/Social Determinants of Health/Social Determinants of Health Item.

Add custom structured text with each of the responses.

See Appendix B

I do not have housing/homeless definitions (Based on UDS Reporting):

Shelter: Shelters for homeless persons are seen as temporary and generally provide for meals as well as a place to sleep for a limited number of days and hours of the day that a resident may stay at the shelter.

Transitional Housing: Transitional housing units are generally small units (six persons is common) where persons who leave a shelter are provided extended housing stays—generally between 6 months and 2 years—in a service rich environment. Transitional housing provides for a greater level of independence than traditional shelters, and may require that the resident pay some or all of the rent, participate in the maintenance of the facility and/or cook their own meals. Count only those persons who are “transitioning” from a homeless environment. Do not include those who are transitioning from jail, an institutional treatment program, the military, schools or other institutions.

Doubled Up: Patients who are living with others; the arrangement is generally considered to be temporary and unstable, though a patient may live in a succession of such arrangements over a protracted period of time.

Street: This category includes patients who are living outdoors, in a car, in an encampment, in makeshift housing/shelter, or in other places generally not deemed safe or fit for human occupancy.

Other: This category may be used to report previously homeless patients who were housed when first seen, but who were still eligible for the Health Care for the Homeless program. Patients who reside in SRO (single room occupancy) hotels or motels, other day‐to‐day paid housing, as well as residents of permanent supportive housing or other housing programs that are targeted to homeless populations should also be classified as “other”.

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3. Are you worried about losing your housing?




See Appendix B

4. What is the highest level of school that you have finished?

Less than high school degree High school diploma or GED

More than high school I choose not to answer this question



See Appendix B

5. What is your current work situation?

Unemployed and seeking work Part time work Full time work

Otherwise unemployed but not seeking work. Please write. (Ex: student, retired, disabled, unpaid primary care giver)




See Appendix B

6. In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? Check all that apply.

I do not have problems meeting my needs

Food Clothing

Utilities Child care

Medicine or any health care (medical, dental, mental, health or vision)

Phone

Other (please write in notes) I choose not to answer this question


Added “I do not have problems meeting my needs” to the eCW PRAPARE tool.

Add custom structured text that is multi‐select with each of the responses.

See Appendix B

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7. How often do you see or talk to people that you care about and feel close to? (For example: talking to friends on the phone, visiting friends or family, attending church or meetings)

Less than once a week 1 or 2 times a week 3‐5 times a week

More than 5 times a week I choose not to answer this question



See Appendix B 8. How stressed are you? Stress is when someone feels tense, nervous, anxious, or can’t sleep at

night because their mind is troubled.

Not at all A little bit Somewhat

Quite a bit Very much I choose not to answer this question


NOTE: Reversed the two sentences from the paper tool so it starts with the question “How stressed are you” so the staff will see it.


Staff can enter additional information in the notes section about who they usually see or talk to that relate to the optional feature. You cannot add this as structured text.

See Appendix B 9. Has lack of transportation kept you from medical appointments, meetings, work or from

getting things needed for daily living?

Yes, it has kept me from medical appointments or from getting my medications

Yes, it has kept me from non‐medical meetings, appointments, work, or getting things needed for daily living

No I choose not to answer this question



See Appendix B

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Optional Questions 10. In the past year have you spent more than 2 nights in a row in a jail, prison, detention center,

or juvenile correctional facility?


Release Date – child question for “Yes” response



Create child question if response is Yes as a date field to capture the release date with mm/yyyy

See Appendix B

11. Are you a refugee?




See Appendix B

12. What country are you from? This question has been removed from the current version of the PRAPARE tool. Organizations that utilize the PRAPARE Smart form can un‐map this question in Community Mapping to remove it from the PRAPARE Smart Form.

13. Do you feel physically and emotionally safe where you currently live?

Yes No

Unsure I choose not to answer this question



See Appendix B

14. In the past year, have you been afraid of your partner or ex‐partner? Yes No

Unsure I have not had a partner in the past year




See Appendix B

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Appendix A – Post Configuration Demographics Screen The following screenshots reflect the PRAPARE demographics questions once they are configured in eCW. End users will need to capture this information to provide PRAPARE data.

Patient Information Screen

What is your main insurance? Utilizes the Self Pay box if checked

or Insurance Class from the Primary Insurance.

What address do you live at?

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Sliding Fee Screen

During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.

How many family members, including yourself, do you currently live with? Poverty Level calculated by

system. Note: Currently checking “Non Proof of Income” will change this to 100%

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Additional Info Screen

Which race(s) are you? Use Race List and select all that apply

Are you Hispanic of Latino?

What language are you most comfortable speaking? Use Language List to select.

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Demographics Additional Information Screen, Structured Data Tab Note: The Structured Demographic Data configuration is provided in the eCW UDS Manual and must be manually configured if you have not previously set it up. These questions can be made mandatory in order to ensure staff capture the information consistently.

At any point in the past 2 years, has seasonal or migrant farm work been you or your family’s main source of income?

Have you been discharged from the armed forces of the United States?

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Appendix B ‐ Progress Note Social History 1. SDH Entered/Updated

2. What is your housing situation today?

3. Are you worried about losing your housing?

4. What is the highest level of school that you have finished?

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5. What is your current work situation?

6. In the past year, have you or any family members you live with been unable to get any of the

following when it was really needed? Check all that apply.

7. How often do you see or talk to people that you care about and feel close to? (For example:

talking to friends on the phone, visiting friends or family, attending church or meetings)

8. How stressed are you? Stress is when someone feels tense, nervous, anxious, or can’t sleep at

night because their mind is troubled.

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9. Has lack of transportation kept you from medical appointments or from getting your medications?

Optional Questions

10. In the past year have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?

Add Child Question to above Jail question for Release Date Trigger on YES

11. Are you a refugee?

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12. What country are you from? Removed from PRAPARE 13. Do you feel physically and emotionally safe where you currently live?

14. In the past year, have you been afraid of your partner or ex‐partner?

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Appendix C – Smart Form

PRAPARE:ProtocolforRespondingtoandAssessingPatientAssets,Risks,andExperiences

Date Completed/Updated: Patient Name: Test, Sam Address: 123 Happy Lane, Overtherainbow, NY, 12345 Race: White Ethnicity: Hispanic Language: Spanish Insurance: Self Pay Insurance Class: None Income Level: 40% Migrant: Yes Seasonal: No Veteran: No

Money & Resources What is your current housing situation?

I have housing

I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on

a beach, or in a park)


Are you worried about losing your housing?

Yes

No


What is the highest level of school that you have finished?

Less than a high school degree

High school diploma or GED

More than high school


10/15/15

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What is your current work situation?

Unemployed and seeking work

Part time work

Full time work

Otherwise unemployed but not seeking work (ex. student, retired, disabled, unpaid primary

care giver)

I choose not to answer this question In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? Check all that apply. o Food

o Clothing

Utilities o Child care

o Medicine or any health care (medical, dental, mental health or vision)

o Phone

o Other (please write in notes)

o I do not have problems meeting my needs

o I choose not to answer this question

Social and Emotional Health How often do you see or talk to people that you care about and feel close to? (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)

Less than once a week

1 or 2 times a week

3 to 5 times a week

More than 5 times a week


How stressed are you? Stress is when someone feels tense, nervous, anxious, or can’t sleep at night because their mind is troubled.

Not at all

A little bit

Somewhat

Quite a bit

Very much


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Additional Questions In the past year have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?

Yes

No


What was your release date? ( Has lack of transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?

Yes, it has kept me from medical appointments or from getting my medications

Yes, it has kept me from non‐medical meetings, appointments, work, or getting things needed

for daily living

No


Are you a refugee?

Yes

No


Do you feel physically and emotionally safe where you currently live?

Yes

No

Unsure


In the past year, have you been afraid of your partner or ex‐partner?

Yes

No

Unsure

I have not had a partner in the past year


PRAPARE Score: 19

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Enabling Services Provided?

o Case Management Assessment First Visit

o Case Management Follow‐up

o Case Management Home Visit

o Emergency Intervention/Phone Non‐Medical

o Emergency Intervention/Encounter Non‐Medical)

o Phone and Walk‐in Triage

o Pharmaceutical Case Management

o Case Management Appointment Made

o Case Management Chronic Disease Management

o Follow‐up for Compliance/Phone

o Case Management Field Visit

o Referral for Food Services

o Referral for Housing Services

o Financial Counseling/Eligibility Assistance

o Health Education/Supportive Counseling

o Interpretation Services

o Language Assistance in Completing forms

o Outreach Services

o Transportation to/from Health Center

o Transportation to/from Referral Appointment

o Other Services

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