# Presentation: 564577

## 261H CPRS Graphing – not just for the Dow Jones and Stock Market 

- Harnessing the Power of Graphs
- Kevin Meldrum – Salt Lake City, Utah
- Sabrina L. Schrader, DO - Oklahoma City VAMC

## Dr. Schrader’s family

## Dr. Schrader’s family

## Dr. Schrader’s family

## Course Objectives

- By the end of this course, get ready to:
- View your patient’s entire history within a few minutes using graphs, to improve patient care
- Create your own personal graphs to improve retrieval of pertinent disease related data
- Request Pre-set Graphs on Reports tab from your CACs, so new docs can utilize graphs immediately

**Notes:**
Let me start off by asking all of you to turn your cell phones and pagers off. We are going to be moving quickly through this material, and you will not want to be interrupted. You will be able to check your voice mails later! 

## Course overview	

- Introduction
- Graphing
- Old graph function
- New graphs – On the fly:
- CTRL button;shift button; right click mouse
- Views, Settings, Sources
- Creating Personal pre-defined graphs
- Setting your defaults
- Use of on the fly graph functions to hone view

**Notes:**
Introduction –
-the graphing function is to CPRS what CPRS was to VISTA – except that where CPRS collected Vista data from a dos like format to a graphic user interface (GUI),  the graphing function collects all the data that is present in the pages and pages of the GUI,  and makes them available in coordinated picture graphs. These pictures can tell you in seconds what used to take minutes or longer to surmise. It also communicates to patients in a powerful visual way, since they are able to see patterns such as missed med refills, lab changes when meds not refilled in a timely way, or improvement in labs or BP with addition of medications or loss of weight. Our goal is for you to begin to Use this tool to the fullest extent in improving and simplifying care of our veterans. I personally would love to see that, eventually , every VA has reports tab graphs so that even the newest and least experienced VA doc could tap into the power of graphs on day one.

The new graphing function rolled out with vesion 26 of CPRS. It was placed in the lab tab, so I initially though ti would be like the old graph tool,
which I had finally started using after being in VA for over 5 years. In fact, when the new graphing function first rolled out, I was quite disgruntled and though that it did not work right. I did not know how to use it until I came to this course one year ago. Since that time, I fell into my own habits of using the function, and most often used it “on the fly” so to speak, basically using the control button to pick and choose among the patients meds, labs, etc, until I had created a picture I could communicate with the vet.

I had learned, in this course last year, how to make some Pre-defined graphs, and made a couple of them, but they seemed clunky, and I was too lazy to try to remember how to change them so that they would work for me.

So today, we will go hands on, and see how grphing works, “on the fly”. Then, we will create several pre-defined graphs, so you will go away with lots of hands on experience in this function. We will also get practice in how to hone your pre-defined graphs down so they work for you better. Your ultimate goal could be to create some personal graphs that work SO WELL, that your CAC will be happy to just copy your graphs and use them to hang off the reports tab (more on that later)

 examples
Behaves slightly differently – show example of the lab tab graph, and how it works. For thos of you who are new, this is the only graph we used to have. NOW< we have Mega Graphing available, as long as you now how to use it.

## Course Overview- continued	

- Sneak Peak at v. 27 coming out this month
- Considerations for Report Tab Graphs
- Perfecting Public Graphs
- Fileman stuff

**Notes:**
This will be Kevin’s domain, and will let him consider wheter to keep or changes this slide

The following is from Rick’s minutes, not sure if it is really what Kevin will be covering......
Kevin:Setting graph DEFAULTS
            Tools >>  Options >>  Graph
            PUBLIC graphs explanation
            How to add Public onto REPORTS tab

            CPRS parameters that control graphing  (public) etc

            How a users  PERSONAL graph could be converted (by IRM)  to Public behind the scenes
            powerpoint:
                        A few slides showing parameters involved for Public
                        Future enhancements

## If you remember nothing else:	

- Ctrl G
- Control G will get you into the graphing function from any tab in the CPRS chart -

**Notes:**
Again, there are a couple of ways to get into graphs in CPRS – but the easiest, and most versatile, is CTRL-G!

## Considerations

- Naming of templates
- Easy to rename!
- Completeness – e.g. Antibiotics
- Easy to add anything missing!
- Scale – Y-axis
- E.g. creatinine
- E.g. if comparing trigl vs. CRP!

## Clinical Examples

- Create a view for Lipid labs
- LDL, Trigl, HDL, Chol, SGOT, SGPT
- Create a view for Lipid meds
- Niacin, fish oil, lipid ‘drug class’
- Changing a ‘Public’ view
- Rx: HTN   (find what is missing)

**Notes:**

Sabrina 
GRAPHING ON THE FLY: TOOLS:
LAUNCHING GRAPHING: 
	TOOLS –graphing vs. Lab Tab  graphing vs. CTRL-G from anywhere in the CPRS chart
- Clinical graphing examples
          INDIVIDUAL – CHECKED VS. UNCHECKED and the difference it can make
	TIMELINE/DATE RANGE – All results is the default          
		1 month vs. 2 mos vs. 6 mos vs. 1 year vs. 2 years – the graph should change with you as you change timeline on X axis 
	 SPLIT VIEW -  creates two different graphs, although they will be linked with timeline - 
	SETTINGS – you can select the sources of information you will automatically pull when graphing launched            
		Admissions, allergies, exams (diabetic foot exam), tests, radiology, pathology, medications (BCMA< Inpatient<Outpatient<Non-VA), immunizations
	ON THE FLY HONING AND ADJUSTMENT –
            -right clicking options – values, gradient vs. clear, 
            -double click   values or bars  vs graph points
            -double click can show an AD HOC health summary on some data elements
	- SELECT/DEFINE  BUTTON
            Chooes what will be contained in a predifined graph
		all options vs. patient specific options – e.g. diabetic foot exam
	SAVING A PERSONAL GRAPH – 
		example #1 – Medications used for hyperlipidemia

            save  a personal graph  touch on PUBLIC
Renaming graphs, Deleting graphs, adding data to graphs

- SETTINGS button
Changing your default settings

## Lets Graph!   SIGN ON TO CPRS

**Find your student number ****##**** by your computer****                                   Click this Icon:  **** **
**Access Code: ****##****VEHU****	**
**Verify Code: ****VEHU****##****example 1: eleven,patient (P11)****example 2: fifteen,patient (P15)**

## Slide 13

**Notes:**
Before we get started on the hands on, I wanted to go through a few screen captures from the talk last year, giving some examples that are clinically relavent.
Here is a comparison of ALT vs. hepatitis testing vs. Peg-interferon and  Ribaviron (two separate courses). Bear in mind that when you are live, these mouse cab be hovered over any of these elements for more details about them. E.g. ferritin results, Hep C RNA results, etc. – make sure this is true

## Slide 14

**Notes:**
Here is another screen scrape from Dr. Volppe, which stuck in my mind last year. It compares white count results with cultures drawn (middle) vs. antibiotcs administration (bottom). This could be and incredibly powerful tool in the hospital setting to see in a glance if you are making progress.

**Notes:**
Points to consider: when you choose a pre-defined graph, those elements will jump to the top. It is therefore easy to remove any elements you do not want to see, e.g. in this example, I removed the total cholesterol, both plasma and blood, and in the lower graph I removed the BCMA and inpatient choices. This is another example of combining the pre-defined option with the CTRL button to get the results that you want.
In this example, notice that the LDL went up to 166- and the last fill on the simvastatin was a few months ago. It is simple, using grphs, to point this out to patients, and encourage compliance!

**Notes:**
Points to make: Lab: Lipids vs. Drug: hyperlipidemia – if you keep the individual button checked, the scale is not as impressive. See next slide for comparison
The time line of the bottom graph in the split view is going to stretch out to be the same X axis as the view above [for comparisons in time]
Also, if graphing drugs, and it is only a few, individual might be fine [see next page]

Even though on the fly you do not need to use the split screen view, it becomes very useful when using two different pre-defined graph sets, as above.

**Notes:**
Points to make about this slide: Compared with previous slide, this shows scale differently, because several items graphed together. Take care when graphing things together that had dfferent scales, e.g. triglycerides and hemoglobin A1c.
Below, this can sometimes happen when the ‘Individual graphs” button is unchecked. This is an intermittent problem, and they are working on it.

## Making a list of Antimicrobials

**Notes:**
Select Define –
This box will give you the different sources of objects to be pulled by a pre-defined graph. In this example, choose drug class from the list on the left, and then select the drug classes one by one – when your list is populated the way you want, save it as a personal or public graph, remembering that if you save something as a public graph, it should be as complete as possible. We are going to apply the public graph called Drug Class: Antimicrobials to Patient 15.
Which drug is missing?

Now, choose that public graph, and all of its source elements will be in the middle column. Assume that you want to keep all of those elements. Click on the ‘>>’, and all of them will go into the column on the right. Then, choose “drug Class” again from the “Source” column on the left. Go back through and try to find any drug classes related to oral antimicrobials that might not be present in the “Items for graphing” column.  

Another way to populate a predefined graph would be from the “Patient Items” – click on that now. 

**Notes:**
Here is another slide pirated from Dr. Volppe’s presentation. You might recognize this as the reports tab. On the right, he has enlarged a detail of some preset graphs used at his site in Northern California. Imagine you are a new doctor at VA, and you knew about this function. You can, on your first patient encounter, click on these reorts and instantly see pictures giving a history of your patient’s treatment for these disease states. Isn’t that exciting? Then all you need to know is some of the detail we are about to go over in this talk, to hone down your views, your default settings and your timelines.
SO let’s begin.

## Graphing: Technical Detour

- Kevin Meldrum
- CPRS Developer

## Personal & Public Views

- Views that have been saved show in this drop-down list.

- A View has items (tests, drug classes, etc.).
- A Saved View has a _Name_.

## Technical Detour:  Which Settings?

- Are there settings saved specifically for me?

- yes

- Are there settings saved specifically for my site?

- yes

- Use Those

- Use Those

- Use Nationally Exported Defaults

## Technical Detour:  Namespace

- Namespaces organize the system.

- Cprspatient, One

- ORWG GRAPH PUBLIC EDITOR CLASS

- Family Name

- Given Name

- Family Name

- Given Name

## Graphs on the Reports Tab

- Graph Report Menu:  ORZ GRAPHS

- Graph Report:  ORZ LIPIDS

- OE/RR REPORT file

- Public Views

- _Graph Report_ turns a view into a report.
- 1 or two view may be in a single report.
- _Graph Report Menu_ allows multiple graph reports.
- _Available Reports_ contains the full list of reports shown on the reports tab.

## Going Public

- Choose an appropriate User Class
- Clinical Coordinators, for example
- Use the Parameter Editor to assign the User Class to the parameter:
- ORWG GRAPH PUBLIC EDITOR CLASS
- This set of users will now have the “Save Public” button

## Graphing “Cheat”: Personal to Public

- Edit the Parameter file (8989.5)
- Select the user of the personal graph
- Select Parameters Entity:  USR.PROVIDER,ABC
- Find the ORWG GRAPH VIEW parameter with the correct name and choose it
- (You may have a lot of scrolling)
- Change the entity of that entry to your domain name
- ENTITY: PROVIDER,ABC// SYS.LOCALDOMAIN.MED.VA.GOV

- (...or wait for version 27 – much easier...)

## Future Enhancements

- Performance Improvements (v27)
- Usability Improvements (v27)
- Merge – Treat Multiple Items as One
- Remote Data

## Display of Free Text Comments

## Export to a Spreadsheet

## Items, Views & Lab Groups

- Items, Views on Separate Tabs

- Lab Groups are Available

## Exchange Personal Views

- Personal Views & Lab Groups Available to Others

## Display Definition of a View

## Default Date Ranges

- Dr. Schrader’s family

## QUESTIONS?