Tip Sheet for Wolf Users

Transcription

1 Tip Sheet for Wolf Users January, 2014 The Alberta Screening and Prevention Initiative is focused on supporting primary care providers and team members to offer a screening and prevention bundle to all their patients through enhanced opportunistic and planned outreach methods, targeting patients who do not present for screening care. Part I: Panel Identification Opportunistic and outreach screening processes should be applied to the active, paneled patients for each provider. In Patient Maintenance, assign each active patient to a primary care provider in the practice. When patient data (such as address, phone number or primary care provider) has been verified, click the Patient Data Verification box. This stamps the chart with the date of the last recording. The clinic should set a default time to re-verify demographics at check-in (E.g., a minimum of once every 6 or 12 months). All staff in the front office should use the same process. 1

2 Patient Data Verification Box: Assigning patients to a Primary Service Provider Example: In Taber, they assign patients that are not part of the panel to Z Doctor, Non Taber. Some clinics create a Dr. Walk-in. This ensures that non-panel patients are not included in Practice Searches that will be used for screening processes. 2

3 To manage Patient Status, click on the Patient Status tab. Choose New Status Choose the appropriate status for the patient. For screening it is very important that a clinic manage the status of Deceased and Inactive patients using this field. This clinic also uses the Patient Status field to assign the long term care status to patients. Long term care patients are not included in searches or Rules for in-clinic processes such as routine preventative screening. All Test patients in your EMR must have an Inactive Status. Be sure to Save Status once the change has been made. 3

4 Clinic team members should use standardized conventions for patient statuses in the clinic organization. The clinic EMR administrator works with the front office staff team on this process. When marking a patient status as Deceased the chart will be marked with the date. Save Status change. The business as usual practice of updating demographics as well as managing physician attachment and patient status ensures that when the clinic receives a critical result the patient can be contacted in a timely manner. This process also ensures that the clinic team knows which physician is the primary provider responsible for that patient. Visit the Wolf EMR Online Help (by clicking on the Help icon from the Wolf Main Page) Useful files: Patient Maintenance Video Tutorial: Wolf EMR Patient Maintenance (found at the bottom of the page in the section More Video Tutorials ) 4

5 Part II: Practice Search From the Main Page, choose Practice Search You will see a screen that looks like this: 5

6 Click the box beside Search All Patients in the upper right. Choose Primary MD under Demographics. For the ASaP Chart Review, you will be searching for active patients from the ages of 18 and 79 assigned to each physician participating in the initiative. To find patients 18 to 79 indicate: Age is Between 18 and 79 Not Deceased and Active Patients Only is checked off by default. 6

7 It is possible to customize the views in the Practice Search. See the Patient List Column Configuration help file mentioned below. Once a new status has been created you may wish to assign it on bulk to a list of patients. For example, if the prenatal or long term care patients are not distinguished in the EMR, using Practice Search you can identify a list of patients, and then you may update the patient status for the selected patients. See the help file indicated below called How to Update the Patient Status for the Selected Patients. For Additional Assistance: Visit the TOP ASaP Web site to access the Wolf How-To Videos: Visit the Wolf EMR Online Help (by clicking on the Help icon from the Wolf Main Page) Useful files: Practice Search Practice Search > How to Use Practice Search Parameters Practice Search > Save Current Practice Search Practice Search > Practice Search Results Patient Lists Practice Search > Practice Search Results Patient Lists > Patient List Column Configuration 7

8 Practice Search > Practice Search Results Patient Lists > Actions for Practice Search Patient Lists Results > How to Update the Patient Status for the Selected Patients Wolf Video Tutorials: Practice Search Exam Findings Practice Search Separate observed dates for Labs and documents How to Use Bulk Add in Practice Search Note: To access Video Tutorials, the link to Available Video Tutorials will appear when a video tutorial matches a search term. The link to Video tutorials is always available in the help files; scroll down to the bottom right hand corner of the file to the link to Video tutorials. 8

9 Part III: Using the TOP Exam Template to Record Screening Offers A TOP Exam template is available for Wolf users. Instructions on how to download the template and build the flowsheet, see the How to Customize Exam Template and Flowsheet from the TOP ASaP EMR Knowledge Resources web site under the Wolf tab. Flu must be entered as a vaccination o Note: Your CDM Codes for vaccinations need to be maintained for your vaccines in Wolf as the descriptions of the flu vaccine changes annually. o Recommended Help Files in your Wolf EMR: CDM Vaccination Code Maintenance Vaccination Type Maintenance The person in the clinic with administrator privileges in your Wolf EMR is able to make these changes. PAP & Mammogram Must be entered through Preventive Care 9

10 Lab Results will populate Flowsheet automatically from incoming electronic results o Note: The Fecal Immunochemical Test (FIT) is a new investigation result that is received in your EMR. An EMR administrator in the clinic needs to be certain that the Merge Codes in the Lab Code Maintenance screen have been maintained so that the lab investigations are displayed in flowsheets or so that Rules work as planned. o Recommended Help Files in your Wolf EMR: Merge Codes Lab Code Maintenance All other TOP ASaP maneuvers are on the TOP exam template. This can be accessed from the physician s SOAP encounter or by using F6 for Front Office staff After entering F6, front office staff can choose the TOP exam template from the Structured Examinations drop down menu. 10

11 How to Access the TOP ASaP Exam template: In the EXAM section of the SOAP note, click on the drop-down menu beside EXAM to find the TOP template. 11

12 Fill in the patient information and use the drop down arrows to enter data for each screening field screening visit. Useful Tip: In Wolf EMR, more than one exam template may be used during a patient visit. 12

13 TOP ASaP Flowsheet: A flowsheet is a disease-specific clinical template collecting patient data and used to track patient data over a period of time. The data is pulled from information that is already entered in the Wolf EMR patient chart; therefore no manual entry is required. The flowsheet will work with the TOP Exam template to show records of offers over time. This is valuable for monitoring screening offers to the patient. To Access the TOP Flowsheet: Right Mouse click from the patient record Select View Flowsheet Select TOP Flowsheet from the drop down menu. The Flowsheet will pull data from the template, labs, preventative care (for pap smears and mammography) and from vaccinations to show the maneuvers over time. To have the TOP Flowsheet be a default for the selected patient, instead of having to choose it each time to view it, it can be added as a monitored flowsheet: 13

14 Select the flowsheet from the drop-down menu > click Add (a patient can have many monitored flowsheets) Useful features of flowsheets include: o Monitoring targets o Creating targets for individual patients o Modifying or overriding targets for individual patients o Filtering To learn more about Flowsheets in Wolf EMR, from your Wolf Help menu look up: CMD Flowsheets o How to Monitor Flowsheets / How to Remove Monitoring on Flowsheets o How to Create Targets for an Individual Patient o How to Modify/Override Targets for a Patient o How to Filter Flowsheets Chronic Disease Management Flowsheet Configuration Video Tutorial Changes to CMD Flowsheets. 14

15 Part IV: Rules Wolf EMR has powerful functionality called Practice Search Rules (or simply, Rules). These are searches which automatically trigger reminders and notifications for physicians and front office staff if a patient matches any rule criteria. For example a clinic may set a Rule to remind a team member that a patient is due for a screening maneuver. None of the Wolf pre-defined Preventative Rules are an exact match for ASaP so a clinic will need to create Rules. Tip: For clinics that have never used Rules, start small and increase incrementally. Visit the Wolf EMR Online Help (by clicking on the Help icon from the Wolf Main Page) to learn more about Rules. Useful files: Practice Search Rules Practice Search Rules > How to Create a Rule Practice Search Rule Exemption Video Tutorial: Exam Findings (how to query on patient exam findings, for example how to find all patients with a BMI over 30) Video Tutorial: Changes to Rules/In-Basket Video Tutorial: Separate observed dates for Labs or documents (this tutorial shows how to search for patients due for colorectal cancer screening) 15

16 Part V: Document Keyword Tips Mammography, colonoscopy and sigmoidoscopy results enter the EMR as consult reports or scanned documents and will be attached to patient record. Naming the document is a manual exercise and if the clinic has not had a practice of using standardized keywords, it may pose a problem for easily finding the result report. It is recommended to understand the keyword practice at the clinic if Practice Search, Practice Search Rules or a flowsheet are going to be used to search or monitor results. For example, if a mammogram result has the keywords Breast Centre or mamogram and the Rule is searching for the text mammo in Documents, then the Rule will not work. Similarly, if a colonoscopy consult report has the keywords consult report, Forzani Centre, pathology, cancer screen as keywords but the Rule is searching for colon, then the Rule will not work. It is recommended that the clinic review document keyword and process of attaching them to documents. There should be a printed list of keywords beside every workstation where keywords are entered that are agreed upon by the clinic team. Free typing of keywords, instead of selecting words from a drop down menu, can put a Rule at risk because of a misspelling. It is simple to do; this error could occur due to typing mamo instead of mammo or mammogram, similarly it could occur due to typing colen instead of colon or colonoscopy. Visit the Wolf EMR Online Help (by clicking on the Help icon from the Wolf Main Page) to learn more about Document Keyword Maintenance. Useful files: Documents > Link Document to a Patient Documents > Configure Linked Documents Configuration > Document Code Maintenance > Document Keyword Maintenance 16

17 Part VI: Cardiac Risk Worksheet The Cardiac Risk Worksheet displays the patient's current cardiac risk based on information from their patient record. You can determine the patient's potential cardiac risk by changing controllable risk factors to see how they affect the patient's cardiac risk. Before using the Cardiac Risk Worksheet go to the Wolf EMR Online Help (by clicking on the Help icon from the Wolf Main Page) Read the Cardiac Risk Worksheet help file. To Open the Cardiac Risk Worksheet there are two options; open from a SOAP Note for using the SMART menu. A) From a SOAP note: 1. Open the Workdesk 2. Open a patient s chart 3. Open a SOAP Note for that patient 4. Click on Cardiac Risk hyperlink located on the SOAP tab to the right of the Subjective section 17

18 B) From the SMART Menu 1. Open the WorkDesk 2. Open a patient s chart 3. Open the SMART Menu by right-clicking the patient s chart 4. Select the Cardiac Risk Worksheet menu item The following screen is displayed: 5. Enter the patients risk score in the TOP Exam template. 18