pop! pop! pop! smash! how to stop unwanted clinical decision support for good!

Pop! Pop! Pop!

SMASH!

How to stop unwanted Clinical Decision Support

for good!

Laurie DrennanProduct Readiness Manager

Kelly Gentry Director, Professional Services

"The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at Work

are trademarks of General Electric Company."

Clinical Decision Support

• Agenda– CDS and CPOE A&P CCC in general– Tx Deficiency Editor– Tx Protocol Editor– Finding GPI codes– Q&A


• The Clinical Decision Support (CDS) included in the CCC Basic package triggers automatic alerts in the CPOE A&P-CCC form.


• Per the CCC Basic Release Notes, alerts are built in CCC Basic for the following problems:– Diabetes Mellitus (ICD 250) M/F–Myocardial Infarction, Acute (ICD-410)– Prenatal Care, delayed (ICD-V23.7)– CHF (ICD- 428.0) M/F– ASA Prophylaxis (ICD-410, ICD-250)– Hypercholesterolemia (ICD-272.0)*– Screening PSA (ICD-V76.44)*


• Only users with the appropriate privileges are able to access Clinical Decision Support

• The privilege is activated by being a member of the CDS Access group in Administration and having access to Access Clinical Decision Support in the Chart Folder


• If a user does not have (or want) access to see the CDS prompts, the user will see this message


• Remember CDS is a Meaningful Use measure, so use caution when choosing to turn off CDS prompts from the CPOE A&P form (i.e. be sure you are capturing CDS in another way sufficient for your stage of Meaningful Use)


• If you do have CDS access, and you do select one of the 7 supported problems for CDS with CCC Basic, you will see a number of pop-ups that differ by problem.

• Here are some examples of the pop-ups from the simple to the complex …


• Simple = Prenatal Care, delayed


• Complex = Diabetes Mellitus


• You have options!1. You can edit what comes “out of the

box”2. You can create your own CDS options

for the CPOE A&P CCC form


• There are two main editors controlling the pop ups you see for CDS– Tx Deficiency Editor– Tx Protocol Editor

Tx Deficiency Editor

• Tx Deficiency Editor controls the first pop ups you see

• The prompts are designed to remind providers of possible treatments that may be due based on the patients – Sex– Problem–Medication


• An example of the Tx Deficiency pop-ups we’ve looked at already

Tx Deficiency Editor• You access the Tx Deficiency Editor

from within CPS/EMR from a test patient chart and an update

• The form is in the CCC folder, TFE subfolder and is called Tx Deficiency Editor-CCC

CCC Basic Editor

• You must have access to edit forms• If you see this yellow message, you

don’t have access to the editor:

CCC Basic Editor

• Access is granted in the CCCQE-User-Edit-Setup file

• This file lives in the CCC folder on your computer/network

• Access should only be given to users who are technically savvy, and users should only use these editors if they take the TFE training class

CCC Basic Editor

• Open the file, and replace kstarr with your login to the Authorized TFE users section. The login is case sensitive. Do not remove the quotes.

CCC Basic Editor

• Save the file, log out of Centricity and back in and you should no longer see the yellow Unauthorized error message.

• You are ready to begin using the editor.


• Again access the Tx Deficiency Editor from within CPS/EMR from a test patient chart and an update


• Select Family Practice, and click Insert Prior Protocol to see the existing options from the Choose Existing Protocol dropdown


• Select Prenatal Care, delayed• Click Insert Values for Editing


• Each of the buttons is also a clickable field with additional information/instruction about what it is looking for

• Click any of the buttons to learn what to put in that field


• Dx Description = Enter Dx Description, This is a label only and used for identification purposes.

• Dx Codes = Enter in a comma delimited string of ICD-9 codes to trigger prompt. The codes should be prefaced with “ICD-”.

• Yes/Not = Enter one or the other from the drop down. Enter in “not” to mean the patient’s medication list does not contain the following medication. Enter in “yes” to mean the patient’s medication list does contain the medication.


• Rx category # = Enter in category of medication class (click the list button to refer to the CPOE medication call list). Note this is NOT the GPCI.

• Kill-Switch Obs= The kills switch obs contains an obs term that, when populated, will turn off the pop up notice for a given patient.

• Yes/No Message = Enter message to appear in the yes/no pop-up.

• If Yes to Message above … = If user says yes to message, should they get a prompt for a custom med list or an encounter form? Select from drop down. Enter in name of custom list or encounter form path.


• If No to Message above … = Enter in the message to appear if “No” is selected above

• If Yes to 2nd Message, then load encounter form = Load EF is default and points to CDSS-Contraindications-CCC Form. The form and path can be changed by clicking Edit EF Path Name from radio buttons on top of Tx Deficiency Editor form.


• This is what actually saves any changes you make to the file on your computer


• Don’t like an existing option?– Deactivate– Commit changes to text file– Sign all the way out and back in– You won’t see again

• Change your mind and want it back?– Reactivate– Commit changes to text file– Sign all the way out and back in– It will be there again


• Want to make a new option?

• Chose Create New Protocol option and all the fields will be blank for you to create as you wish


• I created a new protocol for Migraines


• I signed out of CPS and back in • I added Migraines as a problem to a

test patient chart• I accessed the CPOE A&P form• I crossed my fingers I did it right …


• If you are on a thick or fat client that runs a local copy of CCC forms, that change is only on your workstation and needs to be copied or pushed to other workstations

• Jobs.txt is a program that can do that


• The CCCQE-User-Edit-PSIA-Adult is the text file that is being updated from this editor

• That text file lives in your CCC folder • Once converted to text, the Prenatal,

delayed reads like this:

Tx Protocol Editor

• Tx Protocol Editor controls the second pop ups you see

• The prompts are designed to remind providers of laboratory or diagnostic testing that may be due based on the patients– Age– Sex– Problem–Medication

Tx Protocol Editor

• An example of the Tx Protocol pop-ups we’ve looked at already

Tx Protocol Editor• You access the Tx Protocol Editor

from within CPS/EMR from a test patient chart and an update

• The form is in the CCC folder, TFE subfolder and is called Tx Protocol Editor-CCC

Tx Protocol Editor

• Select Specialty of Family Practice, and click Insert Prior Protocol to see the existing options from the Prior Protocol dropdown

Tx Protocol Editor

• Select ICD-250 – Age range (months) 0-999

• Click Insert Prior Protocol

Tx Protocol Editor

Tx Protocol Editor

• Each of the buttons is also a clickable field with additional information/instruction about what it is looking for

• Click any of the buttons to learn what to put in that field

Tx Protocol Editor

Tx Protocol Editor

• Dx Description = This is the Dx Description. If this field is used, then the problem list must contain this string for the protocol to be activated.

• Dx Codes = If this field is used, then the Problem list must contain this string for the protocol to be activated. This value must contain an “ICD-” prefix. You can use more than one diagnosis in this field, separated by a comma.

• And/or = This field allows you to add a condition to your protocol. If “and” is chosen, then both the dx and the medication conditions must be true to activate the protocol. If “or” is chosen, then either the problem or the medication must be true to activate the protocol.

Tx Protocol Editor

• Med Name = This field sets the name of the medication or medication group which is to be used as a condition to activate the protocol. It is used for identification purposes and for the protocol pop up message.

• GPI code = This field contains the GPI code for the Medication. Use only the 1st 10 Characters (see end slide on how to find GPI code)

• Genders = Select which genders this protocol is specific to. Leave blank if for both.

• Age Range – months =This field sets the age range (in months) for the patient population this protocol should apply to. Separate values with a single hyphen (-).

Tx Protocol Editor

• Order Category = This field sets the order category the order to be applied belongs to. It must be the exact name of the order category from Administration. This field is space and case sensitive.

• Test or Service = Select T if order is Test and Procedure or S if order is Service. This field cannot be blank.

• Order Description = This field sets the order description of the order to be applied. It must be the exact name of the order from Administration. This field is space and case sensitive.

Tx Protocol Editor

• Test Name = This is the name of the order as it will display in the pop up. It can be the same as the description or different.

• Obs Term = This is the Obs Term for the value which will be evaluated for the given protocol. This is used to check for last value to trigger the protocol. This should be the value where the results are entered (manually or via interface).

Tx Protocol Editor

• Range Symbol = The range sets the limits for the value in the obs field which is being evaluated.– > (greater than)– < (less than)– Between (between and including)

• If between is chosen, you must include a minimum limit (range 1) and maximum limit (range 2).

• If < or > is chosen, then you must include a single value (range 1).

• If nothing is selected, then range 1 and range 2 will be ignored

Tx Protocol Editor

• Range 1 = Whenever a value is chosen in the Range Symbol field, then this field must also contain a value.

• Range 2 = Whenever Between is chosen from the Range Symbol field, this field represents the high end of the range.

• Frequency in days = Enter in how often the test result value in the obs tem should be evaluated in days. This field must be populated.

Tx Protocol Editor

Tx Protocol Editor

• This is what actually saves any changes you make to the file on your computer

Tx Protocol Editor

• Don’t like an existing option?– Deactivate– Commit changes to text file– Sign all the way out and back in– You won’t see again

• Change your mind and want it back?– Reactivate– Commit changes to text file– Sign all the way out and back in– It will be there again

Tx Protocol Editor

• Want to make a new option?

• Chose Create New Protocol option and all the fields will be blank for you to create as you wish

Tx Protocol Editor

• I created a new protocol for ICD-V70 for women only over 40 for a mammogram yearly

Tx Protocol Editor

• I signed out of CPS and back in • I added V70 as a problem to a female

test patient who was over 40• I accessed the CPOE A&P form• I pulled in the V70 problem• I crossed my fingers I did it right …

Tx Protocol Editor

Tx Protocol Editor

• If you are on a thick or fat client that runs a local copy of CCC forms, that change is only on your workstation and needs to be copied or pushed to other workstations

• Jobs.txt is a program that can do that

Tx Protocol Editor

• The CCCQE-User-Edit-PSIA-Adult is the text file that is being updated from this editor

• That text file lives in your CCC folder

Finding GPI Code

• How do you find the GPI of a Medication?– Place the medication on a test patient’s

chart– Access the Drug Code Look-Up letter – The 4th position is the GPI number which

is a 14 digit code• Only use 1st 10 digits, last 4 are dose specific

Finding GPI Code

Finding GPI Code

4th position, use 1st 10 characters (rest is dose specific)


• Wrap Up– CDS and CPOE A&P CCC in general– Tx Deficiency Editor– Tx Protocol Editor– Finding GPI codes– Q&A

Questions?

• "The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric Company."

Pop! Pop! Pop!

SMASH!

How to stop unwanted Clinical Decision Support

for good!

pop! pop! pop! smash! how to stop unwanted clinical decision support for good!

Documents

clinical decision supportper

ccc folder

ccc basic editoraccess

cds access group

cpoe apccc form

cds prompts

ccc basic release notes

cds options