National Reminders -Colon Cancer Screening

National Reminders -Colon Cancer Screening

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

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

Colon Cancer ScreenColon Cancer Screen

Reminder Exchange – Install Reminder

• Choose the Colon Cancer 2007 reminder

Reminder Installation

• Select IFE to install the reminder

• Review the reminder

Install the Components

• REMINDER TAXONOMY entry IHS-SIGMOIDOSCOPY 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

• General Taxonomy Data• NAME: IHS-SIGMOIDOSCOPY//• BRIEF DESCRIPTION: Sigmoidoscopy

codes// • CLASS: VISN//• SPONSOR:• REVIEW DATE: • PATIENT DATA SOURCE: EN,PL,IN//• USE INACTIVE PROBLEMS:• INACTIVE FLAG:

Taxonomy Creation• ICD0 Range of Coded Values• Select ICD0 LOW CODED VALUE: 45.42// ?• Answer with ICD0 RANGE OF CODED VALUES ICD0 LOW

CODED VALUE• You may enter a new ICD0 RANGE OF CODED VALUES, if you

wish• Answer must be 3-7 characters in length.• • Select ICD0 LOW CODED VALUE: 45.42//• ICD0 LOW CODED VALUE: 45.42//• ICD0 HIGH CODED VALUE: 45.42//• Select ICD0 LOW CODED VALUE: 45.42• ICD0 LOW CODED VALUE: 45.42//• ICD0 HIGH CODED VALUE: 45.42//• Select ICD0 LOW CODED VALUE:

Taxonomy Creation

• Select CPT LOW CODED VALUE: G0104//• CPT LOW CODED VALUE: G0104//• CPT HIGH CODED VALUE: G0104//• Select CPT LOW CODED VALUE: 45330• CPT LOW CODED VALUE: 45330//• CPT HIGH CODED VALUE: 45345//• Select CPT LOW CODED VALUE:•

Taxonomy Creation

• After the taxonomy is created

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

Other Taxonomies – Colorectal cancer

• REMINDER TAXONOMY entry IHS-COLORECTAL CANCER 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//

Colorectal Cancer• ICD9 Codes:• • Range 153.0-153.9• • Code ICD Diagnosis• ---- -------------• 153.0 MAL NEO HEPATIC

FLEXURE• 153.1 MAL NEO TRANSVERSE

COLON• 153.2 MAL NEO DESCEND COLON• 153.3 MAL NEO SIGMOID COLON• 153.4 MALIGNANT NEOPLASM

CECUM• 153.5 MALIGNANT NEO APPENDIX• 153.6 MALIG NEO ASCEND COLON• 153.7 MAL NEO SPLENIC

FLEXURE• 153.8 MALIGNANT NEO COLON

NEC• 153.9 MALIGNANT NEO COLON

NOS

• • Range 154.0-154.1• • Code ICD Diagnosis• ---- -------------• 154.0 MAL NEO RECTOSIGMOID

JCT• 154.1 MALIGNANT NEOPL

RECTUM• • Range 197.5-197.5• • Code ICD Diagnosis• ---- -------------• 197.5 SEC MALIG NEO LG BOWEL• • Range V10.05-V10.05• • Code ICD Diagnosis• ---- -------------• V10.05 HX OF COLONIC

MALIGNANCY

Colorectal Cancer• CPT Codes:• • Range 44150-44153• • Code CPT Short Name• ---- --------------• 44150 REMOVAL OF COLON• 44151 REMOVAL OF COLON/ILEOSTOMY• 44152 REMOVAL OF COLON/ILEOSTOMY• 44153 REMOVAL OF COLON/ILEOSTOMY• • Range 44155-44156• • Code CPT Short Name• ---- --------------• 44155 REMOVAL OF COLON/ILEOSTOMY• 44156 REMOVAL OF COLON/ILEOSTOMY• • Range 44210-44212• • Code CPT Short Name• ---- --------------• 44210 LAPARO TOTAL PROCTOCOLECTOMY• 44211 LAP COLECTOMY W/PROCTECTOMY• 44212 LAPARO TOTAL PROCTOCOLECTOMY•

Other Taxonomies - Colonoscopy

• REMINDER TAXONOMY entry IHS-COLONOSCOPY 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//

Other Taxonomies- Colonoscopy• ICD0 Codes: • Range 45.22-45.22 • Code ICD Operation/Procedure• ---- -----------------------• 45.22 ENDOSC LG BOWEL THRU ST• • Range 45.23-45.23• Code ICD Operation/Procedure• ---- -----------------------• 45.23 FLEX FIBEROPTIC COLONOSC• • Range 45.25-45.25• Code ICD Operation/Procedure• ---- -----------------------• 45.25 CLOSED BX OF LARGE INTESTINE• • Range 76.51-76.51• Code ICD Operation/Procedure• ---- -----------------------• 76.51 CONDYLECTOMY•

Other Taxonomies- Colonoscopy• CPT Codes: • Range 45355-45355• Code CPT Short Name• ---- --------------• 45355 SURGICAL COLONOSCOPY• Range 45378-45387• • Code CPT Short Name• ---- --------------• 45378 DIAGNOSTIC COLONOSCOPY• 45379 COLONOSCOPY W/FB REMOVAL• 45380 COLONOSCOPY AND BIOPSY• 45381 COLONOSCOPY, SUBMUCOUS INJ• 45382 COLONOSCOPY/CONTROL BLEEDING• 45383 LESION REMOVAL COLONOSCOPY• 45384 LESION REMOVE COLONOSCOPY• 45385 LESION REMOVAL COLONOSCOPY• 45386 COLONOSCOPY DILATE STRICTURE• 45387 COLONOSCOPY W/STENT• • Range G0105-G0105• • Code CPT Short Name• ---- --------------• G0105 COLOREC CANCR SCR; COLNSCPY HI RIS

Other Taxonomies- Colonoscopy• Range G0121-G0121• • Code CPT Short Name• ---- --------------• G0121 COLOREC CNCR SCR;COLNSCPY NO HI RS• • Range 44388-44394• • Code CPT Short Name• ---- --------------• 44388 COLONOSCOPY• 44389 COLONOSCOPY WITH BIOPSY• 44390 COLONOSCOPY FOR FOREIGN BODY• 44391 COLONOSCOPY FOR BLEEDING• 44392 COLONOSCOPY & POLYPECTOMY• 44393 COLONOSCOPY, LESION REMOVAL• 44394 COLONOSCOPY W/SNARE• •

Other Taxonomies- Colonoscopy• Range 44397-44397• • Code CPT Short Name• ---- --------------• 44397 COLONOSCOPY W/STENT• Range 44394-44394• • Code CPT Short Name• ---- --------------• 44394 COLONOSCOPY W/SNARE• • Range 45391-45391• • Code CPT Short Name• ---- --------------• 45391 COLONOSCOPY W/ENDOSCOPE US

Other Taxonomies – Barium Enema

• REMINDER TAXONOMY entry IHS-BARIUM ENEMA 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- Barium Enema

• CPT Codes:• Range 74270-74280• • Code CPT Short Name• ---- --------------• 74270 CONTRAST X-RAY EXAM OF COLON• 74280 CONTRAST X-RAY EXAM OF COLON• Range G0106-G0106• • Code CPT Short Name• ---- --------------• G0106 COLOREC CANCR SCR; SIGMOIDSCOPY• • Range G0120-G0120• • Code CPT Short Name• ---- --------------• G0120 COLOREC CANCR SCR;COLNSCPY BA ENEM

Other Taxonomies -Fecal Occult Lab Test

• REMINDER TAXONOMY entry IHS-FECAL OCCULT LAB TEST 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//

Fecal Occult Lab Test• CPT Codes:• • Range 82270-82270• • Code CPT Short Name• ---- --------------• 82270 OCCULT BLOOD, FECES• • Range 82274-82274• • Code CPT Short Name• ---- --------------• 82274 ASSAY TEST FOR BLOOD, FECAL• • Range G0107-G0107• • Code CPT Short Name• ---- --------------• G0107 COLOREC CNCR SCR;FECL-OCCLT BLD TS• • Range 89205-89205• • Code CPT Short Name• ---- --------------• 89205 OCCULT BLOOD TEST•

Reminder Term• REMINDER TERM entry IHS-FECAL OCCULT BLOOD

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// kip, do not install this entry

Reminder Definition• REMINDER DEFINITION entry IHS-COLON CANCER 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// kip, do not install this entry•

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

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-COLON CANCER 2007 Replace• DISABLE: DISABLED IN EXCHANGE Replace @• SURE YOU WANT TO DELETE? Y (Yes)• CLASS: LOCAL//• SPONSOR:• REVIEW DATE:• SOURCE REMINDER: IHS-COLON CANCER 2007//

Activate Dialog

Add Lab Tests to Reminder Term

• Reminder Term Management

• CPY Copy Reminder Term

• EDT Reminder Term Edit

• INQ Inquire about Reminder Term

•

Add Lab Tests to Reminder Term

• If you have a fecal occult blood test in the lab (not a micro test) you should add it to the reminder term IHS-FECAL OCCULT BLOOD

• All Lab reminder terms need to be set up at the site

• NAME: IHS-FECAL OCCULT BLOOD Replace• CLASS: VISN//• REVIEW DATE:• DESCRIPTION:• No existing text• Edit? NO//• Select FINDING ITEM: LT.FECAL• Searching for a LABORATORY TEST, (pointed-

to by FINDING ITEM) • Searching for a LABORATORY TEST• • 1 FECAL BLOOD GUIAC retired 6/99• 2 FECAL BLOOD FECAL OCCULT BLOOD• 3 FECAL FAT RANDOM FAT, QUAL.• 4 FECAL GLUCOSE FECAL REDUCING

SUBSTANCE• 5 FECAL LACTOFERRIN FECAL WBC-

LATEX TEST• Press <RETURN> to see more, '^' to exit this list,

OR• CHOOSE 1-5: 2 FECAL OCCULT BLOOD• Are you adding 'FECAL OCCULT BLOOD ' as a

new FINDINGS (the 1ST for this REMIN• DER TERM)? No// Y (Yes)• EFFECTIVE PERIOD:

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 – (Age)

• 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

Reminder InquiryReminder Inquiry

• Default PATIENT COHORT LOGIC to see if the Reminder applies to a patient:

• (SEX)&(AGE)&'FI(6)

• Expanded Patient Cohort Logic:

• (SEX)&(AGE)&'FI(IHS-COLORECTAL CANCER)

• Default PATIENT COHORT LOGIC to see if the Reminder applies to a patient:

• (SEX)&(AGE)&'FI(6)

• Expanded Patient Cohort Logic:

• (SEX)&(AGE)&'FI(IHS-COLORECTAL CANCER)

• Default RESOLUTION LOGIC defines findings that resolve the Reminder:

• FI(1)!FI(2)!FI(3)!FI(4)!FI(5)

• Expanded Resolution Logic:• FI(IHS-SIGMOIDOSCOPY)!FI(IHS-

COLONOSCOPY 2007)!FI(IHS-FECAL OCCULT BLOOD)!

• FI(IHS-BARIUM ENEMA)!FI(IHS-FECAL OCCULT LAB TEST)

• Default RESOLUTION LOGIC defines findings that resolve the Reminder:

• FI(1)!FI(2)!FI(3)!FI(4)!FI(5)

• Expanded Resolution Logic:• FI(IHS-SIGMOIDOSCOPY)!FI(IHS-

COLONOSCOPY 2007)!FI(IHS-FECAL OCCULT BLOOD)!

• FI(IHS-BARIUM ENEMA)!FI(IHS-FECAL OCCULT LAB TEST)

Logic- Reminder InquiryLogic- Reminder Inquiry

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

• If you wished, you could add a quick order for the lab test.

• Since this reminder is generally resolved through procedures, they are not in the dialog