# Presentation: 108224

## Habitat for Health SummaryClass 231

- Judy Hollander DNS, RN CAC, Bronx NY
- Tamara Diltz-Andary, IRM Clinical Software Spc, Cincinnati, OH
- John Reiffenberger, CAC, Black Hills Health Care Sys.

## Habitat for Health Summary

- Health Summary originated as an Indian Health Service software package in the early 1990s. The first widespread use of health summary within the VA was with the release of version 2.5 in 1993.
- Current version 2.7 released in 1994

## Habitat for Health Summary

- Health Summary is a package that was designed to create customized reports from data stored in various different software programs. To pull the data from the different software packages Health Summary Components were made that can be controlled using:
- Time Limits
- Number of Occurrences
- Selection of items within component

## Habitat for Health Summary

**Health Summary**
- Software package data pulled in national components
- Automated Med Info Exchange (AMIE) C&P
- Allergy Tracking
- Clinical Reminders
- Consults
- Dietetics
- Laboratory
- Medicine/Clinical Procedures
- Mental Health
- Nursing (Vital Signs) Order Entry/Results Reporting (OE/RR)

## Habitat for Health Summary

- Health Summary
- Software packages (cont)
- Patient Care Encounter (PCE)/Visit Files
- Pharmacy - Inpatient/Outpatient/IV
- Problem List
- Radiology/Vista Imaging
- Registration
- Scheduling – Appointments
- Social Work
- Surgery
- TIU – Discharge Summary & Progress Notes

## Habitat for Health Summary

- Health Summary
- Local health summaries can be created using the various national components. Some sites may also have local components created with class III software. Health summaries can be created using the Health Summary Coordinator menu or the Health Summary Enhanced menu.

## Habitat for Health Summary

- Health Summary
- Originally were printed in paper format and could be batch by locations such as by clinic or ward. When encounter forms software was introduced health summaries could be added as a form to print in batches with other forms.

## Habitat for Health Summary

- Health Summary
- Using List Manager OE/RR version 2.5 health summaries were added as a type of report that could be viewed or printed from the Reports tab. When OE/RR 3.0 known as the Computerized Patient Record System (CPRS) released a GUI version health summaries were now a click away.

## Habitat for Health Summary

- Health Summary
- Clinical Reminders was originally installed as part of the Patient Care Encounter (PCE) software. There were health summary components created to bring in reminder data such as Due, History and Summary. The only way to show someone that a reminder was due was to add that component to the health summary back in the List Manager days.

## Habitat for Health Summary

- Health Summary Objects
- In January 2003 Health Summary Released patch GMTS*2.7*58 to prepare for the use of health summary and components to create health summary objects.
- In May 2003 Text Integrated Utilities (TIU) released patch TIU*1.0*135 that provided a simplified way to create these health summary objects.

## Habitat for Health Summary

- Health Summary
- The CPRS we have today in a way has it’s roots in the way that health summary brought data together in a customized format so that users could more easily review.

## HEALTH SUMMARY TIU OBJECTS

**Judy Hollander DNS, RN**
**Clinical Applications Coordinator**
**JJ Peters VA**
**Bronx, New York**

**Notes:**
Good afternoon, I am going to show you how to make tiu objects from health summaries. You can make them from either existing health summaries or a health summary that you create on the fly.
The health summary object that I have created for this PowerPoint  used the health summary component CRS or Clinical Reminder Summary. I wanted the nurses to know when the opened their notes whether or not the patient was due for a Braden Scale Assessment. I did not want them to have to depend on looking at the Clinical Reminders themselves because they often ignored that button.

For purposes of this presentation I will not create the clinical reminder but I will create the health summary and the object. 

Remember, that an object can be made from any health summary component—so you can pull in lab tests over a date range, demographics, surgery documentation, anything for which you have a health summary component.

The down side of using this form of object is that you have very little control over how it actually looks in the note whereas if you have a traditional object your programmer can tweak it so it comes out the way you want it. 

## CREATION OF HEALTH SUMMARY TIU OBJECTS

**Access menu option: Create TIU/Health Summary Objects**

**Notes:**
Access the menu option Create TIU/Health Summary Objects.

## Slide 14

**Notes:**
Select: Create New TIU Object

## Slide 15

**Notes:**
Today I am going to call my object BRADEN SCALE BRX1. Name it according to your naming conventions. This object is just created for this presentation and I did not adhere to any existing conventions.

Follow the prompts.

## Enter the name of the health summary.

- In this case it is
**BRADEN SCALE BRX1**

**Notes:**
Today I am going to call my object BRADEN SCALE BRX1. Name it according to your naming conventions. This object is just created for this presentation and I did not adhere to any existing conventions.

Follow the prompts.

## Enter the name of the health summary.

- In this case it is
**BRADEN SCALE BRX1**

- Suppress Print of Components without Data

**Notes:**
Today I am going to call my object BRADEN SCALE BRX1. Name it according to your naming conventions. This object is just created for this presentation and I did not adhere to any existing conventions.

Follow the prompts.

## Select the Health Summary Component—

- CRS-- Reminders Summary

**Notes:**
I am now prompted to enter a component. As mentioned in the beginning of my talk, I select CRS or CLINICAL REMINDERS SUMMARY. 

## Delete Header Name for cosmetic reasons

**Notes:**
At the prompt, HEADER NAME, I deleted the words “Reminders Summary” solely for cosmetic reasons.

## Add the “Selection Item.” Here it is the specific clinical reminder you are interested in. 

- Add the “Selection Item.” Here it is the specific clinical reminder you are interested in.
- I selected “BRADEN SCALE ACUTE SETTINGS

**Notes:**
At the “SELECTION ITEM”  I enter the clinical reminder of interest, in this case BRADEN SCALE ACUTE SETTINGS

## Yeah !!!!

**Yeah !!!!**

**Notes:**
Continue to follow the prompts. Your object has been created successfully.

## To Test the Object:

- Go to Notes Tab.
- Click on Options.
- Click on Edit Templates

**Notes:**
To test the object:
Go to notes tab (or consults or discharge summary tab)
Click on Options.
Click on Edit Templates

## Click on New Template button

**Notes:**
Click on New Template button

## Name your new template with a name that has at least 3 characters

**Notes:**
Name the new template with a name that has at least 3 characters

## Slide 25

**Notes:**
Click Edit, then click on Insert Patient Data.

## Slide 26

**Notes:**
Find the object you just made, in this instance, Braden Scale BRX1
Click on “Insert Object” button.

## Slide 27

**Notes:**
Object is deposited in the template

## Slide 28

**Notes:**
Click on Edit, Preview/Print Template

## Slide 29

**Notes:**
Here is what our object looks like in a progress note.

## I add some text to the template to make it more understandable for the nurse/user

**Notes:**
I add some text to the template to make it more understandable for the nurse/user.

## Slide 31

**Notes:**
Here is what it looks like.

## Slide 32

**Notes:**
Here is what it looks like for a real inpatient whose Braden was done.

## What it looks like in the note template

## Other Uses of HS Objects

- VANOD PRESSURE ULCER History
- Demographics in Intake Note
- TBI symptoms in Consult Completion Note

**Notes:**
Other Uses of HS Objects
Vanod Pressure Ulcer History
Demographics
TBI symptoms

## VANOD PRESSURE ULCER HISTORY HEALTH SUMMARY OBJECT

- Enter the name of the object.
- In this case it is
**PRESSURE ULCER**

- Enter the name of the object.
- In this case it is
**PRESSURE ULCER**

**Notes:**
Go to Create TIU/Health Summary Object option.
Enter the name of the new TIU Object.
In this case it is PRESSURE ULCER.

## Slide 37

**Notes:**
Respond to prompts as before.

## Continue to respond to prompts...

- You will be prompted to create a new Health Summary Type

**Notes:**
Enter the name of the new health summary; JH Pressure Ulcer

## Select Component: 

- Select Component:
**SHF PCE HEALTH FACTORS SELECTED**

**OCCURRENCE LIMIT: 2**
**TIME LIMIT: 1M**

**Notes:**
Instead of choosing Clinical Reminder Summary Component here we select “SHF PCE HEALTH FACTORS SELECTED”
Enter the occurrence and time parameters.

## SELECTION ITEMS: 

- SELECTION ITEMS:
**PRESSURE ULCER STAGE**
**PRESSURE ULCER REASSESSMENT**

**Notes:**
Enter the SELECTION ITEM: PRESSURE ULCER STAGE and PRESSURE ULCER REASSESSMENT. These are health factor categories.
What will show up is a health factor in each category that describes the condition and stage of a pressure ulcer. 

## Slide 41

**Notes:**
Follow prompts

## Done

**Notes:**
Successfully completed.

## Slide 43

**Notes:**
In the note where this object is the Stage of the ulcer and location.

## Demographics in Intake Note

**Notes:**
Patient demographics deposited in the text of an intake note.

## Health Summary Inquiry

**Notes:**
In the health summary choose the Component DEM Demographics
This component does not have occurrence and time parameters.

## Progress Note View of Demographics

**Notes:**
How this object looks in a progress note.

## TBI Symptoms in Consult Completion Note

**Notes:**
TBI symptoms in Consult Completion Note

## TBI Health Summary Inquiry

**TBI Health Summary Inquiry**

**Notes:**
Using Selected Health Factors, the for Health Factor Categories were used to create the object:
TBI CURRENT SYMPTOMS; TBI SYMPTOMS, TBI SOURCE, and TBI RESULTS. 

## Slide 49

**Notes:**
This information is deposited in a note and it viewable to the person completing the consult. Gives the responder a heads up.

## Summary

## Summary

- Detailed description of how to create a health summary object that pulled into a progress note the status of the clinical reminder “Do Braden Scale.”

## Summary

- Detailed description of how to create a health summary object that pulled into a progress note the status of the clinical reminder “Do Braden Scale.”
- Gave three other examples using other health summary components:
- Health factors that pulled in Pressure Ulcer history

## Summary

- Detailed description of how to create a health summary object that pulled into a progress note the status of the clinical reminder “Do Braden Scale.”
- Gave three other examples using other health summary components:
- Health factors that pulled in Pressure Ulcer history
- Demographics

## Summary

- Detailed description of how to create a health summary object that pulled into a progress note the status of the clinical reminder “Do Braden Scale.”
- Gave three other examples using other health summary components:
- Health factors that pulled in Pressure Ulcer history
- Demographics
- Health factors that pulled in TBI situation

## Reports Tab--Health Summaries

- REMOTE V03 CONSULTS

## Health Summary Inquiry

*Component developed in VISN 2*

**Notes:**
Here is a view of the Health Summary Type. By using the component “CONSULTS COMPLETE” all details about all consults. This is a component that was developed in VISN 2 by Andreas Mergner. 

## PLACING THE HEALTH SUMMARY ON THE REPORTS TAB

## Slide 58

## Slide 59

## Select System Level

## Slide 61

## View from the Reports Tab

## Remote V03 Consults

- Contains total history of the consult as well as reason for request and associated progress note

## Patient Safety B-K Look Back Program

- Tamara Diltz-Andary
- Cincinnati VAMC
- Information Technology Specialist

## Patient Safety Alert

- In April 2006 VHA identified a patient safety alert regarding prostate biopsies procedures done by 21 VAMCs nationwide, using a particular vendor’s equipment and cleaning technique. There were over 27,000 veterans nation wide that were identified as having potential exposure. The Cincinnati VAMC was one of the sites affected.

## Identify Patients involved in Patient Safety Look Back

- Listing of patients with procedure (FileMan search) of Surgery file with Diagnosis/CPT
- Identification of all patients within the electronic medical record who should have look back done using same search criteria (Clinical Reminder)
- Results of search for patients
- 1450 patients with the procedure
- 261 deceased at time of look back
- 1189 patients living patients to be notified

## Using Reminder Dialogs with Health Summary Objects (cont)

- One reminder dialog was linked to the reminder and three additional reminder dialogs were used in the final review process. These reminder dialogs each had health summary objects so that date of surgery could be compared with labs order prior to the surgery, labs done after surgery and labs done as part of patient safety look back.

##  Health Summary (cont)

- A total of 11 health summaries were created. We used the “(TIU)” in the title so that we could separate those converted to health summary objects. The "B-K Look Back Program" was built as a VISN health summary to look for all the lab needed to be reviewed at all sites in the VISN. Our site is a large facility referral site so many of these patients had data at the other facilities in our VISN.

##  Health Summary

- Health summary obstacles: Some of the Hepatitis and HIV lab tests were marked as Output only. Any lab marked as Output only can not be used by the lab package so those type of labs could not be pulled in to the health summary. Fortunately for our site those tests were not needed for the providers review.
- Due to the various differences in the Lab package at each site the VISN health summary had to be customized for each sites specific labs.

## B-K Reminder Dialog Education

## Reminder Dialog HS Components

## Reminder Dialog Recommendations

## Reminder Dialog Health Factors

## Progress Note Text with Object Data

## Progress Notes Text (cont)

## Slide 76

**Notes:**
Even though we like to do a lot of things on monumental proportions, we also like to keep things easy to use just like everyone else does. Today, I am going to show a few examples of health summaries that we use to help staff be as efficient as possible. Some of our access points – CBOC’s – are located in some pretty rural areas. Whenever we establish an access point, we make sure they have computer access in the clinic because  not all private clinics have implemented electronic records. It is not always possible to have computer access in every exam room because the clinic may be privately owned and may not be wired for computer access. To help them out, we have created a health summary they can print for a reference about things they need to do during the visit. 

##                        HEALTH SUMMARY TYPE INQUIRY

- Title:  CBOC pre-visit
-              Max        Hos  ICD   Pro  CPT
- Abb   Ord    Component Name        Occ  Time  Loc  Text  Nar  Mod  Selection
- ------------------------------------------------------------------------------
- DEM   5       Demographics
- BADR  10    Brief Adv React/All
- OD    15       Outpatient Diagnosis 4
- RXOP  20    Outpatient Pharmacy       6M
- IM    25        Immunizations
- CR    30       Reminders Due
-                                                                    BASELINE MEDICAL EVALUATION/V2
-                                                                    AMIODARONE FOLLOWUP
-                                                                    ASCVD/LDL>100
-                                                                    BREAST CANCER DETECTION/V13
-                                                                    CERVICAL CANCER DETECTION/V13
-                                                                    POS DEPRESSION SCREEN FOLLOWUP
-                                                                    DM BP>160/100/V13
-                                                                    DM MICROALBUMINURIA/V13
-                                                                    HEMOGLOBIN A1C/V13
-                                                                    HTN BP>160/100/V13
-                                                                    HYPERLIPIDEMIA SCREEN/BHH-FEMA
-                                                                    HYPERLIPIDEMIA SCREEN/BHH-MALE
-                                                                    ALLERGY ASSESSMENT

**Notes:**
The CBOC health summary includes demographics, allergies, OPT Pharmacy, and immunizations. This is pretty basic information that everyone should have access to. Where the CBOC’s had a rather difficult time was dealing with EPRP requirements and the clinical reminders we created to address these requirements.  As a result we also added the clinical reminders that are DUE to the health summary by using the component called “Reminders Due”. The health summary set up looks like this and will continue on to the next slide.

##                                                                    NUTRITION/WEIGHT COUNSELING/ED

-                                                                    EXERCISE EDUCATION
-                                                                    TOBACCO USE SCREENING/BHH FY 0
-                                                                    COLORECTAL CANCER SCREENING
-                                                                    PROSTATE CANCER SCREENING
-                                                                    HEPATITIS C SCREENING/V13
-                                                                    MST SCREEN
-                                                                    DEPRESSION SCREEN FY07/BHH
-                                                                    PNEUMOVAX/V13
-                                                                    INFLUENZA VACCINE/V13
-                                                                    TETANUS DIPTHERIA IMMUNIZATION
-                                                                    DIABETIC EYE SCREENING/V13
-                                                                    PEDAL PULSE FOOT EXAM/V13
-                                                                    FOOT SENSORY EXAM/V13
-                                                                    FOOT VISUAL/V13
-                                                                    FALL RISK ASSESSMENT
-                                                                    TOBACCO CESSATION - MEDS/REFER
-                                                                    CHF WEIGHT EDUCATION
-                                                                    PTSD SCREEN POSITIVE - 3Q F/U
-                                                                    PTSD SCREENING
-                                                                    PROBLEM DRINKING SCREEN FY07/M
-                                                                    SCI RENAL ASSESSMENT-BH
-                                                                    VA-TBI SCREENING
- CVF   35      Fut Clinic Visits

**Notes:**
The CBOC’s have found this health summary very beneficial especially for immunizations and the reminders that are due. This information tells them what they need to cover during the visit. The Reminder’s Due section that I have listed here contains all the reminders we have set to display on the cover sheet in CPRS. The CBOC has printed material about what needs to be done for each reminder so they can cover what they need and then document in CPRS later when they can get to a computer. The health summaries can be batch printed for the clinic patients with appointments on that particular day so they do not have to be printed individually.

## ----------------------------- IM - Immunizations -----------------------------

- INFLUENZA               09/20/2006 BLACK HILLS
- PNEUMO-VAC           09/26/2006 MISSION CBOC
- TD-ADULT                  10/26/2005 MISSION CBOC
- ----------------------------- CR - Reminders Due -----------------------------
-  The following disease screening, immunization and patient education
-  recommendations are offered as guidelines to assist in your practice.
-  These are only recommendations, not practice standards.  The
-  appropriate utilization of these for your individual patient must be
-  based on clinical judgment and the patient's current status.
-                                                           --STATUS-- --DUE DATE--  --LAST DONE--
- Hyperlipidemia Screen/BHH-Male       DUE NOW     DUE NOW       unknown
- Allergy Assessment                             DUE NOW     DUE NOW       unknown
- Nutrition/Weight Counseling/ED          DUE NOW     DUE NOW       unknown
- Exercise Education                              DUE NOW     DUE NOW       unknown
- Hepatitis C Screening/V13                   DUE NOW     DUE NOW       unknown
- MST Screen                                         DUE NOW     DUE NOW       unknown
- Pneumovax/V13                                   DUE NOW     DUE NOW       unknown
- Influenza Vaccine/V13                          DUE NOW     DUE NOW       unknown
- Tetanus Diptheria (TD-Adult)/V13        DUE NOW     DUE NOW       unknown
- Fall Risk Assessment                           DUE NOW     DUE NOW       unknown
- Tobacco Cessation - Meds/Referrals   DUE NOW     DUE NOW       unknown
- PTSD SCREENING                              DUE NOW     DUE NOW       unknown
- Problem Drinking Screen                      DUE NOW     DUE NOW       unknown

**Notes:**
On this slide I am displaying a portion of the health summary report that includes the immunizations and reminders that are DUE – this is what shows up as DUE on the cover sheet in CPRS. This is the data the CBOC’s need to effectively take care of the patients and to make sure all preventive health measures have been addressed. This is list of reminders that were due at the time the health summary report was generated. Keep in mind that there are several reminders that trigger another reminder to be due when the screening is positive. Some examples includes a  positive depression screen, positive TBI screen, or one of the sections of the VA Iraq/Afghanistan reminder. Since the information may not be entered into CPRS immediately, the CBOC’s did have to develop a process to ensure the positive screens are addressed appropriately. 

## Chronic Disease Management Health Summary

- Reminder dialog template is completed for each of the chronic disease entities which creates a number of health factors
- Three chronic disease programs have been established at Black Hills Health Care System: CHF, COPD, and Diabetes
- Health Summary for each includes the health factors and one of them contains lab results
- Chronic Disease Initiative implemented throughout the VISN. VISN has ability to pull the health factors for reporting purposes

**Notes:**
At the Black Hills Health Care System, we have also implemented a Chronic Disease Management Program along with other facilities in VISN 23. As part of the program, staff complete a reminder dialog template for each of the three chronic disease entities we have implemented which are COPD, CHF, and Diabetes. These templates will generate a number of health factors that can be used for tracking and reporting purposes. We then created health summaries for each of the disease entities so the staff can easily view these health factors and to pull information about the patient and for running reports. In addition to the health factors in the health summary, we also included other pertinent information for the various disease entities. For example, the diabetic health summary also includes lab results for glucose and HGBA1C. Other health summaries contain vitals signs and other lab results.

## Title:  V23 CDM CHF HF Report

-                                    Max        Hos  ICD   Pro  CPT
- Abb   Ord    Component Name        Occ  Time  Loc  Text  Nar  Mod  Selection
- ------------------------------------------------------------------------------
- SHF   5       CDM CHF HFs               5Y
-                                                                    CDM INITIATIVE ACTIVE PT - CHF
-                                                                    CDM CASE MANAGED PT - CHF
-                                                                    CDM INITIATIVE DECLINED - CHF
-                                                                    CDM INITIATIVE DISCHARGED - CH
-                                                                    CDM INITIATIVE UNABLE TO CONTA
-                                                                    CDM CHF ABCD STAGE = A
-                                                                    CDM CHF ABCD STAGE = B
-                                                                    CDM CHF ABCD STAGE = C
-                                                                    CDM CHF ABCD STAGE = D
-                                                                    CDM CHF NYHA CLASS I
-                                                                    CDM CHF NYHA CLASS II
-                                                                    CDM CHF NYHA CLASS III
-                                                                    CDM CHF NYHA CLASS IV
-                                                                    CDM CHF EF </= 9%
-                                                                    CDM CHF EF = 10-19%
-                                                                    CDM CHF EF = 20-24%
-                                                                    CDM CHF EF = 25-29%
-                                                                    CDM CHF EF = 30-34%
-                                                                    CDM CHF EF = 35-40%
-                                                                    CDM CHF EF >/= 41%
-                                                                    CDM CHF BETA BLOCKER OPTIMIZED
-                                                                    CDM CHF BETA BLOCKER ADVERSE R
-                                                                    CDM CHF BETA BLOCKER REFUSED
-                                                                    CDM CHF ACE/AGB OPTIMIZED
-                                                                    CDM CHF ACE/AGB REFUSED

**Notes:**
This slide and the next slide will show you what health factors are included in the health summary for CHF so these are the possible health factors that can be generated from the CHF reminder dialog template. The health summary was created using the component called “Selected Health Factors”. These health factors were all created locally with a standardized naming convention that all start with CDM for Chronic Disease Management. What was nice about this VISN program was the reminders were developed by the Minneapolis VA. The reminders were then exported to the other VA’s in the VISN so the health factors were automatically generated when the reminder was imported. We did not have to create the individual health factors. We did have to create the health summary and add each health factor which is what I am displaying here.

## Title:  V23 CDM CHF HF Report

-                                    Max        Hos  ICD   Pro  CPT
- Abb   Ord    Component Name        Occ  Time  Loc  Text  Nar  Mod  Selection
- ------------------------------------------------------------------------------
- SHF   5       CDM CHF HFs               5Y
- 			           CDM CHF ACE/AGB HYPERKALEMIA
-                                                                    CDM CHF ACE/AGB WORSE RENAL FX
-                                                                    CDM CHF ACE/AGB ADVERSE RX
-                                                                    CDM CHF ALDOSTERONE ANTAG HYPE
-                                                                    CDM CHF ALDOSTERONE ANTAGONIST
-                                                                    CDM CHF ALDOSTERONE ANTAGONIST
-                                                                    CDM CHF ALDOSTERONE ANTAGONIST
-                                                                    CDM CHF ALDOSTERONE ANTAGONIST
-                                                                    CDM CHF DEFIB CANDIDATE-HAS DE
-                                                                    CDM CHF DEFIB CANDIDATE-NO
-                                                                    CDM CHF DEFIB CANDIDATE-YES
-                                                                    CDM CHF PACEMAKER CANDIDATE-HA
-                                                                    CDM CHF PACEMAKER CANDIDATE-NO
-                                                                    CDM CHF PACEMAKER CANDIDATE-YE
-                                                                    CDM CHF HF ED NOT COMPLETED
-                                                                    CDM CHF HF ED COMPLETED
-                                                                    CDM CHF HF ED REFUSED
-                                                                    CDM CHF ACTION PLAN ESTABLISHE
-                                                                    CDM CHF ACTION PLAN NOT ESTABL
-                                                                    CDM HTH CANDIDATE - YES
-                                                                    CDM HTH CANDIDATE-NO
-                                                                    CDM HTH PATIENT REFUSED
- SVS   10      Vital Signs Selected 5    1Y
-                                                                    WEIGHT
-                                                                    BLOOD PRESSURE
-                                                                    PULSE

**Notes:**
As you can see there are lots of health factors within just the CHF reminder dialog template. All of the possible health factors need to be included in the health summary set up so when the health summary is run, all pertinent health factor information can display in the report. We added selected vital signs to also be a part of the report – in this case we included weight, blood pressure and pulse for the past year.

## *************  CONFIDENTIAL V23 CDM CHF HF Report SUMMARY   pg. 1 **************

- XXX, XXXX    000-00-0001                                     DOB: 10/08/1920
- ----------------------- SHF - CDM CHF HFs (max 5 years) -----------------------
- Category
-   Health Factor                                                      Visit Date
- CDM INITIATIVE ACTIVE PATIENTS
-   CDM INITIATIVE ACTIVE PT - CHF                  01/02/2007
- CDM CASE MANAGED PATIENTS
-   CDM CASE MANAGED PT - CHF                     01/02/2007
- CDM CHF BETA BLOCKER
-   CDM CHF BETA BLOCKER OPTIMIZED          01/02/2007
-              Metoprolol 50 mg Q day
- CDM CHF ACE/AGB
-   CDM CHF ACE/AGB OPTIMIZED                      01/02/2007
-              Lisinopril 40 mg Q day
- CDM CHF HEART FAILURE ED
-   CDM CHF HF ED COMPLETED                         01/02/2007
- CDM CHF ACTION PLAN
-   CDM CHF ACTION PLAN ESTABLISHED         01/02/2007
-              Pt invited to attend Living Well Workshop, and is being sent
-              home with Home Telehealth Device
- ---------- SVS - Vital Signs Selected (max 5 occurrences or 1 year) ----------
- Measurement DT    WEIGHT                      BP             PULSE
-                                       LB(KG)[BMI]
- 02/20/2007 15:00  226(102.51)[31*]            131/75      95
- 01/22/2007 08:54  222.7(101.02)[30*]         117/78      94
- 01/17/2007 12:39  222(100.70)[30*]            108/69      98
- 10/23/2006 11:33                                         110/71
- 10/23/2006 10:59  213.3(96.75)[29*]            84/63       89

**Notes:**
Here is a health summary report for someone with a completed CHF reminder dialog template. The report will list the health factors that were generated from the template. As you can see the report is concise and displays the status of the patient in terms of the health factors and comments added by the staff. The report also displays selected vital signs which will help staff track how the patient is doing in terms of weight, pulse and blood pressure. Staff can run these health summaries by individual patients or batch print for a clinic if they want which is especially useful for the chronic disease management clinics.

## EPRP Health Summary with components forCRS Reminders Summary   and  CM  Reminder Maintenance 

- BASELINE MEDICAL EVALUATION/V2
- AMIODARONE FOLLOWUP
- ASCVD/LDL>120
- BREAST CANCER DETECTION/V13
- CERVICAL CANCER DETECTION/V13
- COLORECTAL CANCER SCREENING
- V-DEPRESSION SCREENING
- DEPRESSION SCREEN FY07/BHH
- POS DEPRESSION SCREEN FOLLOWUP
- DIABETIC EYE SCREENING/V13
- HEMOGLOBIN A1C/V13
- PEDAL PULSE FOOT EXAM/V13
- FOOT SENSORY EXAM/V13
- FOOT VISUAL/V13
- DM BP>160/100/V13
- DM MICROALBUMINURIA/V13
- HTN BP>160/100/V13
- HYPERLIPIDEMIA SCREEN/BHH-FEMALE
- HYPERLIPIDEMIA SCREEN/BHH-MALE
- HEPATITIS C SCREENING/V13

**Notes:**
We also have a health summary created to help the EPRP reviewer in doing their monthly chart reviews.

There are 2 components to the EPRP Health Summary – the CRS Reminders Summary and CM Reminder Maintenance. Both components have the same reminders in them and they are listed on this slide and the next. We created this health summary to assist the External Peer Review Process (EPRP) in finding data in the chart. We have clinical reminders set up for many of the things the EPRP reviewer is looking for. We encourage staff to complete the clinical reminders when they are due so consistent documentation is found on all charts when addressing each reminder. By using the clinical reminders, the EPRP reviewer can use this health summary to assist with chart reviews. If the reviewer does not find the data they need on the health summary, then a more in depth chart review is done to search for this data. The reviewers are very good at what they do but it can be difficult to find information if it is buried in a note somewhere or in an addendum. This health summary helps them find the information easily.

## CRS Reminders SummaryCM  Reminder Maintenance

-  INFLUENZA VACCINE/V13
-  PNEUMOVAX/V13
-  TETANUS DIPTHERIA IMMUNIZATION
-  ALLERGY ASSESSMENT
-  EXERCISE EDUCATION
-  NUTRITION/WEIGHT COUNSELING/ED
-  PROSTATE CANCER SCREENING
-  MST SCREEN
-  TOBACCO USE SCREENING/BHH FY 07
-  TOBACCO CESSATION - MEDS/REFERAL
-  MENTAL HEALTH SCREEN(PC)
-  PTSD SCREENING\MPLS
-  PTSD SCREEN POSITIVE - 3Q F/U
-  PROBLEM DRINKING SCREEN/BH
-  PROBLEM DRINKING SCREEN FY07/M
-  ANTIPSYCHOTIC MEDS/BHH

**Notes:**
Here is the remaining list of reminders that are part of the EPRP Health Summary. Most of the items are locally created reminders created to meet EPRP requirements.

## ---------------------------------------------- CRS - Reminders Summary --------------------------------------------

-                                                                        --STATUS-- --DUE DATE--  --LAST DONE—
- Baseline Medical Evaluation                          RESOLVED   07/10/2010    07/10/2007
- ASCVD/LDL>120                                          N/A
- Breast Cancer Detection/V13                        N/A
- Cervical Cancer Detection/V13                      N/A
- Colorectal Cancer Screening                        DUE SOON   08/10/2007    08/10/2006
- Depression Screening                                   RESOLVED   02/27/2008    02/27/2007
- Depr Scr Pos - Needs F/U Assessment        RESOLVED   06/18/2008    06/18/2007
- Diabetic Eye Screening/V13                          DUE SOON   10/10/2007    10/10/2006
- Hemoglobin A1C/V13                                    RESOLVED   04/24/2008    04/24/2007
- Pedal Pulse Foot Exam/V13                         DUE SOON   09/26/2007    09/26/2006
- FOOT SENSORY EXAM/V13                       DUE SOON   09/26/2007    09/26/2006
- FOOT VISUAL/V13                                       DUE SOON   09/26/2007    09/26/2006
- DM Microalbuminuria                                    RESOLVED   12/12/2008    12/12/2006
- Hyperlipidemia Screen/                                RESOLVED   05/21/2009    05/21/2007
- Hepatitis C Screening/V13                           DONE                                  04/27/2001
- Influenza Vaccine/V13                                 RESOLVED   12/12/2007    12/12/2006
- Pneumovax/V13                                          DONE                                  00/00/1998
- Tetanus Diptheria (TD-Adult)/V13               DUE SOON   01/01/2008    00/00/1998
- Allergy Assessment                                     RESOLVED   09/26/2007    09/26/2006
- Exercise Education                                      RESOLVED   04/24/2008    04/24/2007
- Nutrition/Weight Counseling/ED                   DUE SOON   09/26/2007    09/26/2006
- Prostate Ca Screen Education/BHHCS       N/A                                      04/27/2001
- MST Screen                                                DONE                                  03/29/2002
- Tobacco Use Screening                              N/A
- Tobacco Cessation - Meds/Referrals          N/A                                      02/27/2007
- Mental Health Screen(PC)                          **DUE NOW**    03/23/2007     03/23/2006
- PTSD SCREENING                                    RESOLVED  03/23/2011    03/23/2006
- Evaluation of Positive PTSD Screen           N/A                                       06/18/2007

**Notes:**
The EPRP Clinical Reminder health summary report looks like this.
When the reviewer uses this health summary, they can see exactly what date the reminder was last addressed and go right to the notes for that date. As you can see from this Clinical Reminder Summary report, the status of the reminders are displayed as well as when it was last resolved. The reviewer knows that the last done date relates to the reminder and the reviewer knows they have to look at more recent documentation if the reminder was  suppose to have been completed sooner. For example, they may need to look at more recent notes for documentation for the mental health screen because it states that it is DUE NOW in case some one documented an outside exam without using the reminder. We discourage this, but it can still happen.

This health summary helps the reviewer find things quickly and allows them to spend more time finding other more difficult things. 

## CM Reminder Maintenance

- DM Microalbuminuria                  RESOLVED   12/12/2008    12/12/2006
-      Frequency: Due every 2 years for all ages.
-      Cohort:
-       Hospitalization Diagnosis:
-           07/10/2007 250.00 DMII WO CMP NT ST UNCNTR data node: M ICD3
-      Resolution: Last done 12/12/2006
-          Reminder Term: MICROALBUMIN LAB TESTS/V13
-        Laboratory test: _MICROALBUMIN/CREAT RATIO; specimen: URINE
-            12/12/2006 value - 15.43
- Colorectal Cancer Screening          DUE SOON   08/10/2007    08/10/2006
-      Frequency: Due every 1 year for ages 50 to 80.
-      It is recommended that patients between the ages 50 and 80, be
-      screened for Colorectal Cancer.  This reminder is resolved by either
-      FOBT x 3 in last year, Colonoscopy in last 10 years, or
-      Flexisigmoidoscopy in last 5 years.
-      Resolution: Last done 08/10/2006
-       Laboratory test: OCCULT BLOOD; specimen: FECES
-        08/10/2006 value - NEG
-       Laboratory test: OCCULT BLOOD 2; specimen: FECES
-        08/10/2006 value - NEG
-       Laboratory test: OCCULT BLOOD 3; specimen: FECES
-        08/10/2006 value - NEG

**Notes:**
The Reminder Maintenance section of the health summary is the second part and this health summary component is very helpful because it includes actual lab results along with dates they were completed. This report helps the reviewer in finding results without having to dig through the lab package to find the fecal occult blood results for example, because the actual results displays right with the clinical reminder.

Again, all of this helps ensure a better and more accurate review.

## Slide 88

**Notes:**
The last example I am going to show you is just one way we have incorporated the use of health summary objects into our daily work flow. As you recall, the CAC is able to create health summary objects out of available health summary components without the help of a programmer.

Here is a template we created for documenting interdisciplinary discharge planning that includes a health summary object which you will see in one of the following slides.

## Slide 89

**Notes:**
We created the template as a reminder dialog so staff can place an order while they are creating a progress note. If we were not placing an order, a standard template could also have been used because a health summary object can be used in any place where standard objects can be used.

## Slide 90

**Notes:**
It is in this section of the discharge planning note that we added the health summary object. This whole template is associated with a particular note title so we were able to create an object using the health summary component for “selected progress notes” to find the last discharge planning note. In fact this object is set to look for the last 5 discharge planning notes within the last 30 days and displays them to the person entering the note. This object is a display only object which displays the last notes so the author can see what was identified previously as a discharge need. They could then decide if it is still needed for discharge or not. This saves staff the trouble of searching for past notes and makes their job a little easier, because we all know that once you start a template, you can not minimize the template to go looking for data to allow you to complete the template. Soon we should have the ability to minimize templates, but until the functionality exists, this solution has worked very well for us. 

## Slide 91

**Notes:**
Health Summary has been around for a long time and is very useful. When working on new project, we usually have to chip away at the process identifying all the pieces that contribute to the process.

## Slide 92

**Notes:**
Sometimes we even have to blast our way through it. Frequently, health summary, health summary components, and health summary objects can offer some very useful tools in helping us get the job done. 

## Slide 93

**Notes:**
When we get all the pieces pulled together and get our ducks in a row, the result can be some pretty amazing products some of which we have shown you today.

## Questions?