# Presentation: 759578

## VEHU PRESENTATION# 238

- Tangy Report Recipes

## Overview

- Collecting raw data from Clinical Reminders and Health Factors.
- Compiling and presenting an attractive final product which presents valuable information used in decision making for performance improvement purposes.

## Objectives

- Extract data using ACRP and Clinical Reminders Due Reports
- Import and format raw data to MS Excel
- Use pivot tables to manipulate data
- Use histograms to display data
- Identify optimal methods to convey data succinctly

## Presenters*

*Cathy Harrity*
- Clinical Applications Coordinator, Altoona PA
*Raymond Tavera*
-  Program Analyst, Bronx NY
*Michael Ingino*
- Management Analyst, Bronx NY
*Irene Adames*
- Clinical Reminder Coordinator, San Juan PR
- *In order of appearance

## Using the ACRP menu to run Health Factor reportsCathy HarrityCAC, Altoona PA

## James E. Van Zandt VAMC

- Altoona, PA
- 1 CAC
- 1 Clinical Information Specialist
- 182,763 Visits
- 1003 Discharges
- FY 2006 data

## Creating reminders with HF

- Make the HF as descriptive/meaningful as possible
- Use a standard naming convention

## ACRP Menu

- Ad Hoc menu
-  ACRP Ad Hoc Report [SCRPW AD HOC REPORT]
-  Delete an Ad Hoc Report Template [SCRPW AD HOC TEMPLATE DELETE]
-     **> Locked with SC AD HOC TEMPLATE
-  Display Ad Hoc Report Template Parameters [SCRPW AD HOC DISPLAY TEMPLATE]
-  Print from Ad Hoc Template [SCRPW AD HOC TEMPLATE PRINT]

## V Files

- Store information from PCE
- Encounter forms
- Clinical Reminders

## V File Elements

- EXAMINATION
- HEALTH FACTOR
- IMMUNIZATION
- PATIENT EDUCATION
- TREATMENTS
- SKIN TEST

## AdHoc report functions

- Run reports based on the reminder health factors
- Compare health factors from different reminders

## Example

- Influenza vaccine
- We have 2 reminders
- Nursing reminder that contains health factor REFUSED INFLUENZA IMMUNIZATION
- Provider reminder that is triggered when the patient refuses
- Provider discusses benefits of immunization
- If patient still refuses, new health factor called REFUSED FLU VACCINE POST PROVIDER VISIT

## Immunization refused

## Provider reminder

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## Findings

- Refusals at nursing visit:  2945 (uniques)
- Refusals post provider visit:  1796
- Difference: 1149 more veterans received the flu vaccine who would not have because we have a second reminder for providers.
- 39 percent of the initial refusals received the flu vaccine after talking to their PCP.

## Another Example

- MUE (medication use evaluation) Reminder dialog method for approving non-formulary drugs.
- Search for requests for Plavix that were not approved.

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## Findings

- I can run an additional report looking for the “MUE Plavix” progress note for the same date range.
- I can subtract the number of request not approved from the number of notes and end up with the number approved.
- (Ideally, I should have set up 2 health factors: approved and not approved.)

## USING CLINICAL REMINDERS DUE REPORTS FOR PERFROMANCE MONITORINGRaymond Tavera Program Analyst, Bronx NYMichael InginoManagement Analyst, Bronx NY

## James J Peters VAMC

- Bronx, New York
- 3 CACs
- 53 PCPs
- 35 Clinical Reminders (EPRP)

## How to run a Clinical Reminders Due Report Raymond Tavera Program Analyst, Bronx NY

## Once you initiate your VistA session, choose to view your available Service Packages:

## A list of you available Service Menus will show. Type the one that says “Reminder Due Report”

- * Note there are two Reminders Due Report options. The other option will have the added (User) part at the end.

## With or Without (USER)

- Reminders Due Report- Option will enable the user to view all created templates and have the option to run and edit them.
- Reminders Due Report (USER)- Option will restrict user to only templates that are assigned to them by an administrator.

## Reminders Due Report (User) will restrict the user to see only templates that are assigned to them. To view any additional templates, the user must have them assigned to them by an administrator with higher level access.

- “??” Will enable the user to see what templates he/she has access to

## A prompt will ask for a report Template: templates can be created for local facilities by CAC’s or just hit enter to create your own.

## Running the Reports

- There are more than one way to run a report.
- Conventionally we run our reports based on a sample size based on patient locations.
- Another way to run it is by a provider’s panel.

## Running Report by Location

- Creating a report using the Location option will run the selected reminder against patients who have visited a specific clinic location during a specific time frame.

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## The next few prompts are the ones to finalize and run the report

- Create a new report template: N// O ****** No will not save your search into a report. Type yes if you wish to save the report to run on a later time.**
- Print delimited output only: N// Y ** ******** Should be only used for summary reports**
- Include deceased patients on the list? N// O ****** Type no in order not to includes deceased patients**
- Include test patients on the list? N// O  ****** Type no in order not to include test patients**
- Save due patients to a patient list: N// O  ****** Yes to save your results to a list. Only useful if you want to compare the list you get with another reminder or when running the same reminder at a later time.**
- DEVICE: HOME//  ****** this will run the report**
**Note: You can also type P-MESSAGE in the Device prompt in order to store the results into an VistA email message.**

## Running Report by PCMM Provider

- Creating a report using the PCMM Provider option will run the selected reminder against all patients in the providers primary care panel.

## In the Patient Sample prompt type “P” for PCMM Provider.

- Type in the name(s) of the Provider and hit enter
-  These are the following steps to generate the report:

## 
   You will be asked:

          P         Primary care assigned patients only
          A         All patients on list

PRIMARY CARE ONLY OR ALL: P// All patients on list  <- - to get 100% patient capture

-    **You will be asked:**
-           P         Primary care assigned patients only
-           A         All patients on list
- PRIMARY CARE ONLY OR ALL: P// **All patients on list  <- - to get 100% patient capture**

## 

Enter EFFECTIVE DUE DATE: Mar 08, 2007//   (MAR 08, 2007)  reminders being run will have the effective due date of the one being entered. Default will yield the present date

     Select one of the following:*

          D         Detailed
          S         Summary

TYPE OF REPORT: S// Detailed    get patient names for the reminder

Display All Future Appointments: N// NO  to avoid a report that pulls up ALL future appts

Sort by Next Appointment date: N// NO  say no and it will default to an alphabetical sort by pt name

Print full SSN: N// NO  say no unless you want full 9 digit SSN if not you will get just the last 4

Select individual REMINDER:

- Enter EFFECTIVE DUE DATE: Mar 08, 2007//   (MAR 08, 2007) ****** reminders being run will have the effective due date of the one being entered. Default will yield the present date**
-      Select one of the following:*
-           D         Detailed
-           S         Summary
- TYPE OF REPORT: S// **Detailed   ******** get patient names for the reminder**
- Display All Future Appointments: N// **NO ******** to avoid a report that pulls up ALL future appts**
- Sort by Next Appointment date: N// **NO ******** say no and it will default to an alphabetical sort by pt name**
- Print full SSN: N// **NO ******** say no unless you want full 9 digit SSN if not you will get just the last 4**
- Select individual REMINDER:

- *Note:
- Detailed reports can only extract information for one reminder and provide patient information.
- Summary reports can have multiple reminders but no patient information.

## Select Reminder Category 
(For summary reports only)
This prompt will only be available by running a summary   report. It will allow you to run a custom created reminder category.

Select Individual Reminder
Bronx Primary Care Clinical Reminders are reflective of EPRP standards

- (For summary reports only)
- This prompt will only be available by running a summary   report. It will allow you to run a custom created reminder category.
- Select Individual Reminder
- Bronx Primary Care Clinical Reminders are reflective of EPRP standards

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## Add will give you the option to create a Reminder Category
When creating one you will be prompted to enter the reminders that will make up the category one at a time.
Categories can always be edited to reflect any changes.

- When creating one you will be prompted to enter the reminders that will make up the category one at a time.
- Categories can always be edited to reflect any changes.

- Creating a Reminder Category

## Why Create a Template

- Templates are useful in running routine reports in a quick and easier way.
- Performance Measures monitoring which utilize reports that contain and abundant amount of data.
- Reminders that are used constantly to generate specific data.

## Retrieving Clinical Reminder Reports from VISTA

- Retrieve your reminder due reports from VISTA
- Reports can either be run live or sent to a mail message to be retrieved at a later time or to archive
- Capture each run on a text document

## Delimited Text Ready for Excel Import

**TITLE:PHE INPATIENT MONITOR^TEMPLATE:PHE INPATIENT MONITOR**
**^RUN:7/13/2007 3:30:10 pmEffective Date:7/13/2007 4:30 pm**
**^^INDIVIDUAL TEAMS PLUS TOTALS BY FACILITY**
**0^1D ALL^^**
**1^Inpatient Medication Education^24^0^1D ALL**
**2^Inpatient Nutrition Education^24^0^1D ALL**
**3^Inpatient Supplies/Equip Education^5^1^1D ALL**
**4^Inpatient Pain Education^13^0^1D ALL**
**5^Advance Directives Education^24^3^1D ALL**
**0^PATIENTS^24^^1D ALL**
**0^1E ALL^^**
**1^Inpatient Medication Education^16^0^1E ALL**
**2^Inpatient Nutrition Education^15^0^1E ALL**
**3^Inpatient Supplies/Equip Education^2^0^1E ALL**
**4^Inpatient Pain Education^5^0^1E ALL**
**5^Advance Directives Education^16^2^1E ALL**
**0^PATIENTS^16^^1E ALL**
**0^6B ALL^^**
**1^Inpatient Medication Education^23^3^6B ALL**
**2^Inpatient Nutrition Education^20^0^6B ALL**
**3^Inpatient Supplies/Equip Education^0^0^6B ALL**
**4^Inpatient Pain Education^9^2^6B ALL**
**5^Advance Directives Education^23^12^6B ALL**
**0^PATIENTS^23^^6B ALL**

## Creating the report using MS Excel Pivot Table and Conditional Formatting Functionality

Michael InginoManagement Analyst, Bronx NY

*Michael Ingino*Management Analyst, Bronx NY

## Excel Pivot Table

- Defaults to open .xls files, need to change to All files.

- Opening text files

## Opening text files

- Excel automatically recognizes text files and starts a wizard or you can choose the “Text to Column” option to initiate the process.

## Opening text files

## Delimited Text

## Delimited Text

## Opening text files

**Note: Column A contains all the data.**

**Opening text files**

## Opening text files

**Opening text files**

- The same wizard appears when
- T_e_xt to Columns... is chosen

## Formatting for Pivot Function

**Formatting for Pivot Function**

## Formatting for Pivot Function

**Formatting for Pivot Function**

## Pivot Function

## Pivot Function

## Pivot Function

## Pivot Function

## Pivot Function

## Slide 72

## Pivot Function

## Pivot Function

## Pivot Function

## Pivot Function

## Pivot Function

## Pivot Function

## Hyperlinks

## Hyperlinks

## Hyperlinks

## Hyperlinks

## Highlight with Formatting

- Conditional formatting
- Success
- Deficits
- Accentuate the positive
- Accentuate the negative

## Highlight with Formatting

## Highlight with Formatting

## Highlight with Formatting

## Highlight with Formatting

## Highlight with Formatting

## Pivot Graph

- Graphs are fundamental to conveying voluminous data in a concise format
- A bar graph for each measure, service, or provider can be created using pivot graph drop down arrows.

- Graphing

## Link on intranet

- Put it where they’ll use it!

- On the Web

## Results

- Transparent reporting process
- Buy-in to use in other areas, i.e. P4P
- Timely feedback on provider’s performance
- Ease of Comparison
- Increase used by providers and management
- Improved patient care

## Use of Histograms to Display Provider’s Cumulative Monthly Report Data

***Irene Adames***
- Clinical Reminder Coordinator,
- San Juan PR

##  VA Caribbean Healthcare System

**San Juan, PR**
**Four Clinical Reminder  Coordinators**
**62 Providers**
**25 Reminders (providers) **
**Based on performance measures**

## Main Goal:

***To allow comparison among PC providers (at medical center, satellites, and community-based clinics) on their compliance with the Performance Measures and  to release monthly reports (each provider has a specific code), through Outlook for PI (Performance Improvement) purposes.***

## Histogram is a powerful tool.

***The Histogram clearly portrays information***
***Helps the user to perceive process ***
***It is visually strong!***
***Suggest areas of possible improvement***
***Can be compared to a normal curve***
***Enables a team to recognize and analyze patterns in data that are not apparent simply by looking at a table of data, or by finding the average or median ***

## Steps 

***1.  Calculate the average cumulative compliance percentage of 25 performance measures for each of the 62 Primary Care Providers (including MDs and NPs for the Medical Center, Satellites, and Community-Based Clinics) monthly, from October to September.***
***2. The cumulative data of Provider-Specific Reminder Reports is documented in an Excel spread sheet monthly from October to September.***
***3.  A Histogram is constructed monthly based on two (2)  Standard Deviations (below and above mean) for all 62 providers.***

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## Concepts Added to the Histogram

**                 ****Incentive Award**
**      ****(Locally Established ~ Target = 85%)           **
-        **Underperforming   00.00% - 84.99%**
**       ****Meeting                   85.00% - 89.99%**
**       ****Exceeding              90.00% - 99.00%**

## Why Two Standard Deviations?

**Within these two levels (upper/lower) are 95% of providers, then the graph will show: **
***	***_***Low Outliers & High Outliers***_
**Once we have the limits of the total 62 providers we give feedback on low/high outliers of the two standard deviations, how they are spread and how they compare with the mean.**
_**Benefit of identifying LOW OUTLIERS:**_*** ******Performance Improvement***
_**Benefit of identifying HIGH OUTLIERS**__***:***_** **
**	*****Incentive Awards***

## What is shown in the GRAPH?

**We actually generate three reports because not all PC providers can be shown in a graph (SJ-PCs Teams, Satellites Teams, and CBOCs Teams)**
**The 1****st**** report compares the cumulative data of PC providers at the San Juan Clinics  *****(see next slide)***
**Second and third reports contain the data of the CBOCs & Satellite providers**

## Slide 123

## TURNING DATA INTO INFORMATION

## TURNING DATA INTO INFORMATION

- ACRP-
- Identified specific numerical value
- Need to put value into context
- e.g. Is lower better?

## Clinical Reminders Due Report
captured data to a specific location
individuals and groups are easily identified 

- captured data to a specific location
- individuals and groups are easily identified

_***TURNING DATA INTO INFORMATION***_

## Histogram
compares performance to the normal distribution
quickly identifies outliers

- compares performance to the normal distribution
- quickly identifies outliers

_***TURNING DATA INTO INFORMATION***_

## TURNING DATA INTO INFORMATION

- Suggestion: adjust the axis

## TURNING DATA INTO INFORMATION

_***TURNING DATA INTO INFORMATION***_

## For additional information e-mail:

- ACRP Reports
- _[ ](mailto:%20Catherine.Harrity@va.gov)__[C](mailto:%20Catherine.Harrity@va.gov)__[atherine.Harrity@va.gov](mailto:%20Catherine.Harrity@va.gov)__[ ](mailto:%20Catherine.Harrity@va.gov)_
- Clinical Reminders Due Reports_[Raymond.Tavera@va.gov](mailto:Raymond.Tavera@va.gov)_
- MS Excel Pivot tables/formatting
- _[Michael.Ingino@va.gov](mailto:Michael.Ingino@va.gov)_
- Histograms
- _[Irene.Adames@va.gov](mailto:Irene.Adames@va.gov)_