Neehr Perfect Activity: Introduction to Clinical Reminders

This activity is intended for the intermediate to advanced EHR student user. In this activity, students will be introduced to the Clinical Reminder system of the EHR.

Prerequisites

Completion of Scavenger Hunts Level I - III

Student instructions

If you have questions about this activity, please contact your instructor for assistance.

Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS).

Screen displays are provided as a guide and some data (e.g. dates and times) may vary.

Additional resources

Review the associated power point slides, Introduction to Clinical Reminders. You should receive this from your instructor.

Review the Breast Cancer Screening Guidelines document. You should receive this from your instructor.

Objectives

Describe the purpose and use of the Clinical Reminder system in thenEHR.

Utilize technology, for data collection, storage, analysis, and reporting of information.

Explain analytics and decision support. Analyze systems designed to collect statistical data for decision making.

Create a Clinical Decision Support query to support an evidence based practice body of knowledge.

Select patient-centered health information materials for the EHR. Identify applicable codes to be used in the evaluation of a Clinical Decision Support query.

Evaluate enterprise-wide CDI strategic and operational methods

Apply project management techniques to ensure efficient workflow and appropriate outcomes.

Glossary

Clinical Reminders: The Clinical Reminder system is a built-in Clinical Decision Support (CDS) system that allows the care team to track and improve preventive healthcare and disease treatment for patients and ensure that timely clinical interventions are initiated. Clinical Reminders perform automatic chart audits and schedule events based on pre-programmed criteria. In other words, Clinical Reminders do a chart review and tell clinicians what the patient needs or which patients need something.

Reminder Cohort: Patients included in a group who need an intervention, e.g. “This patient needs a flu shot” or patients to include on a report, “Show all patients who need flu shots.”

Applicable Reminder: A reminder is “Applicable” to a patient if they meet the definition of the cohort.

Not Applicable Reminder: A reminder is considered to be “Not Applicable” for a patient if no findings are present in the patient’s chart.

Reminder Resolution: What will turn this reminder OFF? The findings necessary to resolve the Reminder

Reminder Frequency: How often should this reminder or selected intervention be due for the cohort?

Reminder Finding: A FINDING is a piece of information that the reminder searches for in the EHR. A FINDING is binary: It’s there or it’s not. A finding must be coded data in order for the EHR to recognize it.

Due Reminder: A reminder is DUE for a patient if they are in the cohort (applicable) and have not had the need (frequency) for the intervention (finding) that the reminder is seeking.

Resolved Reminder: A reminder is considered RESOLVED if the intervention (finding) and frequency defined by the reminder has been met/found.

Reminder Dialogue: Reminder Dialogues are templates linked to reminders that can place orders, enter encounter information, and enter vitals and mental health data. Reminder dialogues facilitate documentation and enable the clinician to resolve or impact Reminders for the patient at the same time as writing a note in EHR.

Clinical Decision Support (CDS)

Clinical Decision Support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools.

The activity

Imagine you work in the Quality Assurance department of a busy HMO healthcare facility. Part of your job is to ensure patients receive timely and appropriate care to reduce complications, admissions and readmissions. When the facility used a paper documentation system, your team would audit charts, record and analyze data, and help create clinical roadmaps and policies, but it was a completely manual process. You constantly worried about the patients who inevitably “fell through the cracks.” Now your facility has implemented an electronic health record system and you are excited to hear about the built-in tools for clinical decision support called Clinical Reminders.

In this activity, you will learn about the Clinical Reminder system, evaluate potential uses and create an example clinical reminder to solve a current healthcare problem.

To get started, read through the Glossary and terminology section above and the power point slides titled Introduction to Clinical Reminders, then answer the following questions.

1. What is the Clinical Reminder system?

2. Give at least two examples of what Clinical Reminders could be used for.

3. What is the “Cohort” of a Reminder

4. What is the Reminder “Resolution?”

5. What is the Reminder “Frequency?”

6. What is a “Finding” in relation to Reminders? Give an example of a “Finding.”

7. What makes a Reminder “due” for a patient?

8. When is a Reminder considered to be “resolved?”

9. When is a Reminder considered to be “Not Applicable?”

10. Based on your knowledge of how Clinical Reminders work with “Cohorts,” “Findings,” and “Frequencies,” come up with three potential risks of relying on Clinical Reminders for clinical decision support. Log into the EHR and open the Roy Gallant patient chart.

11. List the active Clinical Reminders found in Roy Gallant’s chart.

BMI Mass Index

Lipid Measurement (Cholesterol)

NP Influenza

NP BMI

12. Click once on the Lipid Measurement (Cholesterol) Clinical Reminder and answer the following questions about the Clinical Maintenance report.

a. What is the status and due date of this reminder for Mr. Gallant?

DUE NOW

b. What is the recommended frequency for Mr. Gallant to have a Lipid Measurement and for what ages?

Due every 5 years for ages 35 to 50

C. What does this test measure?

The test measures four types of lipids: total cholesterol, LDL cholesterol, HDL cholesterol, and Triglycerides.

13. Right click on the Lipid Measurement (Cholesterol) Clinical Reminder. Under Reference Information, click on the link for, “What Makes Coronary Artery Disease More Likely?” Paste the URL found below and describe the purpose of linking this site to the Lipid Measurement (Cholesterol) Clinical Reminder.

https://www.nhlbi.nih.gov/health/health-topics/topics/cad/

Show the risk of not controlling your cholesterol.

14. Right click on the Lipid Measurement (Cholesterol) Clinical Reminder again. Choose the Reminder Inquiry and answer the following questions.

a. Mr. Gallant has this reminder due on the frequency of every 5 years because he is a man between the ages of 35 and 50. How frequently would this reminder be due if this patient was a 40 year old female?

No indicated for ages 18 to 44

b. How frequently will Mr. Gallant need a lipid measurement when he turns 51?

Every two years for ages 35 to 50

c. What patient characteristics, aside from age and gender, could impact the frequency of the Lipid Measurement?

Patient with diabetes will have a reminder due every 2 years and patients with IHD or atherosclerosis will have it due every 2 years.

15. A “finding” must be coded data. What types of findings are important to the evaluation of the Lipid Measurement (Cholesterol) Clinical Reminder?

VA-Diabetes and VA-MHV IHD and atherosclerosis

Click on the Reminder Icon clock in the upper right-hand corner of the EHR, as shown below, to open the Available Reminders window.

Click on the plus sign next to All Evaluated to open the folder and scroll down to find a Reminder titled DM-4: Lipid Measurement.

Right click on the DM-4: Lipid Measurement

Reminder and access the Reminder Inquiry to answer the following questions.

16. What is the difference between Lipid Measurement (Cholesterol) and DM-4: Lipid Measurement?

17. Why isn’t the DM-4: Lipid Measurement Reminder applicable for Roy Gallant?

Breast Cancer is the most frequently diagnosed non-cutaneous (non-skin) cancer and the second leading cause of cancer deaths among women in the United States. In an attempt to diagnosis breast cancer early, historically, women were taught to perform self-breast exam (SBE) on a monthly basis at home and to have annual mammograms beginning at the age of 40. New research has shown this type of routine screening is not the best approach.

The healthcare facility where you work would like to update breast cancer screening using the 2009 recommendations from AHRQ, the Agency for Healthcare Research and Quality. The EHR will be used to initiate Clinical Decision Support (CDS) to identify women needing breast cancer screening within recommended intervals. Read the accompanying Clinical Summary of 2009 U.S. Preventive Services Task Force Recommendation and outline a Clinical Reminder to help guide clinicians in when to screen for breast cancer.

Hint: Refer to the Glossary and Terminology section at the beginning of this activity if needed.

18. What will you name this Reminder?

Breast Cancer Screening

19. Describe who the “Cohort” of this Reminder includes.

This cohort includes all the patients who need a mammogram.

20. What will the “Resolution” for this Reminder be?

To schedule a mammogram and record the findings in the EHR

21. What is the “Frequency” for this Reminder?

The “frequency” for this Reminder is women of ages 40-49 to begin biennial screening according to individual patient’s context and values.

22. Give examples of the “Findings” for this Reminder.

Dense breast tissues, women of age 40 and above

23. What makes this Reminder “due” for a patient?

The Reminder becomes “due” for a patient if she is 40 years and older and has not scheduled a mammogram.

24. When is the Reminder considered to be “resolved?”

The Reminder is considered to be “resolved” when the EHR has recorded a mammogram

25. For whom is this Reminder considered to be “Not Applicable?”

The Reminder is considered “Not Applicable” for males and women below 40 years of age.

26. Cite three Reference Information resources to associate with this Reminder, and provide the rationale for including each. (i.e. Three web resources to support this Reminder.)

27. http://www.breastcancer.org/ -Describes breast cancer, its signs, and symptoms. It also describes treatment and side effects

28. https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm -Defines a mammogram and explains how its use in screening.

29. https://www.emedicinehealth.com/mammogram/article_em.htm -Outlines the procedure guidelines and ages for breast cancer screening.

Reminder Dialogues enable a clinician to resolve a Reminder through clinical documentation in the patient’s EHR, over-riding the need for a particular procedure to be documented in the record. Why might a Reminder Dialogue be important to include for this Reminder? A Reminder Dialogue might be essential for this reminder because it enables the mammogram to generate orders. Also, it enables information to be entered on the mammogram.

31. The new Reminder has now been in place for six months and the healthcare organizational board wants to know if it has improved the rate of breast cancer screening at the facility. How can this Reminder be used to help the facility determine whether the rate of breast cancer screening has improved?

It enables the facility to track the number of patients with a cohort for breast cancer screening. Besides, it allows for comparison between the number of patients with a cohort for breast cancer screening and those who are already seen or scheduled mammograms before the new Reminder.

Submit your work

Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.