RPMS-EHR New FeaturesRPMS-EHR New FeaturesVersion 1.1 Patch 1Version 1.1 Patch 1

Jim Gemelas

CAC/RPh

Warm Springs

Set-up guide available with patch release

Featured new features:

• ICD Codes Captured for Lab Clinical Indicators√ Lab patch 22 is a pre-requisite. LR*5.2*1022 should be installed.

This enables clinical indicator prompt for lab orders.

• Adverse Reaction Data Entry from Cover Sheet√ The RPMS Adverse Reaction Tracking manuals can be

downloaded from: http://www.ihs.gov/Cio/RPMS/index.cfm?module=home&option=documents (and/or EHR 1.1 patch 1 New Features guide)

• Displaying Patient Record Flags√ The Patient Record Flag Implementation Instructions are

included in the PIMS0530.1007o.zip file. This can be downloaded from: ftp://ftp.ihs.gov/rpms/patches/

ICD Codes Lab Clinical Indicators

Options for “Other” indicationSearch for code or enter free text

Options for “Other” indicationSearch for code or enter free text

Free text entries

Order Details

Adverse Reaction Data Entry

• This is a new component that may be invoked from the adverse reaction cover sheet popup menu.

• It permits authorized users to enter, edit, and verify adverse reaction information into RPMS-EHR.

• The data is stored and managed through the RPMS Adverse Reaction Tracking application

Adverse Reaction Entry:– Instruct providers on coversheet adverse reaction data

entry and to sign those BEFORE leaving the Cover sheet– Educate providers that allergy ordering and display will

no longer be available on the orders tab.– Train pharmacist or whomever verifies your allergies

currently on adverse reaction verification– VERIFIERS can verify in EHR (new) or RPMS (old)– Verify that staff who enter/verify allergies have electronic

signatures– Disable allergy ordering on Orders tab– Disable allergy display on Orders tab.– Configure permissions for adverse reaction data entry– Review permissions for adverse reaction verification – Review mail group membership

Important:• The new adverse reaction must be signed to be available for

order checks and display throughout RPMS-EHR. Providers can delete their own unsigned adverse reactions that have entered in error.

• What happens if allergies are not signed off? – i.e. a session hangs up or is killed?– Adverse Reaction Tracking Verifier Menu Option: 3 Reports Menu

“Patient Allergies Not Signed Off report”– report not working for allergies not signed in EHR

• KNOWN PROBLEM-Fix is in development

– Consider- “RECALL LAST PATIENT SELECTED” parameter– Train providers to sign allergies before leaving the cover sheet AND

NOT to wait to sign ADR with medication orders for proper order checking to occur

Disable Allergy Ordering on the Orders Tab

• Allergy Ordering can be disabled by removing the GMRAOR ALLERGY ENTER/EDIT (generic order) from the Write Orders List

• This needs to be done for all users• ORWDX WRITE ORDERS LIST (parameter)

– Menu for Write Orders List • Setting ORWDX WRITE ORDERS LIST for System: W-

SPRINGS-HC.PORTLAND.IHS.GOV - • Order Dialog: ORZM MAIN MD ORDERS//

• Order Dialog: ORZM MAIN MD ORDERS//

Disable Allergy Display on the Orders Tab

• Needs to be done in Fileman. • File called “DISPLAY GROUP.” There is an

entry in this file called “ALL SERVICES”

• Remove ALLERGIES from the MEMBER field of this file:

• 12 ALLERGIES This one

Allergy removed from orders display list

Configure Permissions for Adverse Reaction Data Entry

• RPMS-EHR Configuration Menu • Adverse Reaction Tracking Configuration (ART)

• Enable Adverse Reaction Data Entry (ENT) • Setting Allow entry of adverse reaction data for

Division: --Allow entry of adverse reaction data?: YES//– Verify that staff who enter/verify allergies have

electronic signatures

Review Permissions for Adverse Reaction Verification

• This allows those with the GMRA ALLERGY-VERIFY key to verify the correctness of data (both in EHR and RPMS)

• It is recommended that all adverse reactions are verified

• Usually the pharmacist or designated verifier will already have the existing security keys

• VER Allow Adverse Reaction Verification

Mail Bulletin Setup

• Automated mail bulletins will be sent to the ART verifiers when an allergy/adverse reaction has been entered and signed (completed) by a user

• Review the membership of the following mail groups to ensure that the verifiers are included:

– GMRA VERIFY DRUG ALLERGY– GMRA VERIFY FOOD ALLERGY– GMRA VERIFY OTHER ALLERGY

Method

• Manage Mailman Option– GDM Group/Distribution Management– Mail Group Edit– Select MAIL GROUP NAME: << enter group

(i.e. GMRA VERIFY DRUG ALLERGY)– Select MEMBER: <<< enter user here

Allergy Entry Overview

• Enter new adverse reactions

• Providers can delete their own unsigned adverse reactions which have been entered in error.

• Edit existing adverse reactions- not verified

• Enter no-known-allergies (NKA) assessments

Verifier options– Verify “on the fly” when a patient is encountered with

an unverified allergy – “Pop up” will occur when switching patients

Verify options

– “Don’t sign” option and use:

“List by Location Not Verified Reactions” report

List by Location Not Verified Reactions Report

Other causative agents

• Food or other unmatched allergies• Check Auto-verify settings• Select Adverse Reaction Tracking Verifier Menu

Option:

1 Enter/Edit Site Configurable Files ...

3 Enter/Edit Site Parameters • AUTOVERIFY FOOD/DRUG/OTHER:

“0” NO AUTOVERIFY

Other causative agents

Patient Record Flags

• PIMS 0530 1007 should be installed to enable entry of patient flags into RPMS

• Allocate key: DGPF 1 DGPF LOCAL FLAG EDIT 2 DGPF PRF ACCESS 3 DGPF PRF CONFIG 4 DGPF RECORD FLAG ASSIGNMENT

• “Patient Record Flags alert the staff of patients whose behavior or characteristics might pose a threat either to the safety of the employee, the safety of other patients, or compromise the delivery of quality healthcare”

• Sites may create local flags (i.e. clinical) or use national flag (behavioral)

Patient Record Flags Main Menu ... [DGPF RECORD FLAGS MAIN MENU]

RPMS: Patient Record Flags Main Menu

RM Record Flag Reports Menu ...

FA Record Flag Assignment

FM Record Flag Management

• Category I – National Flag (Behavioral)

• Category II – Local Flags

Category I (National)Add New Record Flag' action not allowed for Category I (National) Flags. Only Category II (Local) Flags may be

created at the local site

Record Flag Management –Category II (Local)

FA Record Flag Assignment

Assign a flag• Select Action: AF Assign Flag • Select a flag for this assignment: BEH• Searching for a National Flag • BEHAVIORAL ACTIVE BEHAVIORAL

...OK? Yes// (Yes) • Enter Narrative Text for this record flag assignment:

==========Assignment Narrative Text ========Patient has a record of disruptive behavior requiring

Security intervention at VAMC in Portland.

Category I

Set “POPUPFLAGS” to TRUE

VA policy

• http://www.va.gov/vdl/application.asp?appid=156

Thank you