R AF T EHR 2014 for MU2 D Integrated Problem List
Objectives Explain MU required features Provide an overview of the IPL Explain essential steps to train providers (postdeployment survival). Discuss recommended implementation plan for the IPL. Provide hands on training using the IPL
Why change to the IPL? 2014 CEHRT MU required features: SNOMED CT for problem list Care Planning Treatment regimen elements for Clinical Quality Measures Supports transition to ICD 10 for encounters
Essentials for IPL The IPL has a wide range of functionality. Most of the functionality is optional for clinicians, however, enabling staged implementation. Required entry is not overwhelming, so we will begin with the 3 required steps essential in the early transition period.
MU Required Features SNOMED CT Problem List Care Planning/Treatment Regimen
Integrated Problem List: IHS Additions Longitudinal Data Collection and Aggregation Problem data are stored and visible in the problem information Allows users to view the evolution of the problem over time Care planning is associated with problems Some visit data is now associated with problems used as POVs Visit Instructions Patient Education (when entered about a problem) Treatment/Regimen Referrals (when problem selected as reason for referral) Consults (when problem selected as clinical indication) We encourage user requests for report views to aggregate problem data and care planning that will better suit needs in the field.
Integrated Problem List: IHS Additions Get SCT Reverse Mapping Tool
Integrated Problem List: IHS Additions POV Selection Tool with Options for Additional Care Planning and Patient Education Documentation
Integrated Problem List: IHS Additions Care Planning and Patient Education Documentation
Integrated Problem List: IHS Additions Pick List Examples
Why Does This Mean For Clinical Users? Redesigned problem list Use of SNOMED CT terms Changes the way problems are entered and managed Changes the way POVs are selected Impacts all users that document a POV Supports transition to ICD 10 for encounters
Preparing for Transition Clean up Problem Lists singe most important task to prepare for the IPL transition Remove/consolidate redundant problem entries. Remove entries that do not belong on the problem list. Inactivate resolved problems. Code the un coded problems Provide training to end users Modify provider schedules to allow time for the transition post deployment
Hands On Learning Pick a patient and visit Convert current ICD 9 to SNOMED CT term Add a POV from the existing problem list Search for an additional POV URI Document education and treatment regimen Document care planning
Easing the Stress of the First Days Scenario: It is the first day of clinic after EHRp13 was installed. Providers have fewer patients scheduled in anticipation of delays to adapt to the software changes. The first patient is here for a follow up and has a sore throat and cold symptoms.
Step 1: Update Problems Update ONLY those problems to be addressed with the patient today. Note that any problem with leading * in provider narrative needs update to SNOMED prior to use
Step 1: Update Problems 1. Highlight the problem and click Get SCT This opens the ICD 9 to SNOMED reverse mapping tool.
Step 1: Update Problems 2. Highlight the SNOMED Concept and click Select to update the entry
Step 1: Update Problems Reverse mapping tool will display a selection of SNOMED terms for most ICD coded problems Un coded problems (.9999) will NOT reverse map Use the Pick List or the SNOMED Search to update problems that are not coded Cleaning up the problem list is very important
Step 2: Add New Problems ONLY add problems to be addressed with the patient today. 3. Click Pick List
Step 2: Add New Problems 4. Select problem(s) and click Save
POV and Clinical Indications Updated problems and new problems are now available to: Be selected for the POV Be selected for Clinical Indications when placing orders Only problems that have been updated to SNOMED terms are available to be selected on the Clinical Indication dropdown menu.
Step 3: Select POV 5. Highlight the problems to be managed today. 6. Click the POV button.
Step 3: Select POV 7. Click Save to set as POVs
MU Required Features SNOMED CT Problem List Care Planning/Treatment Regimen
Update Problem Review 1. Highlight problem for update and click Get SCT Use the Pick List or SNOMED Search for un coded problems 2. Highlight the SNOMED Concept and click Select to update the problem Add New Problem 3. Click Pick List 4. Select problem(s) and click Save Select POV 5. Highlight the problems to be managed today 6. Click the POV button 7. Click Save
IPL Projected Progression of Usage
IPL Projected Progression of Usage ** Visit Instructions, Goals and Care Planning notes display on the Clinical Summary and Transition of Care Summary, and can drop into encounter documentation.
It Takes a Village to Migrate to IPL Recommend leveraging all clinicians to participate as they encounter opportunities to update in their workflow: Nursing Example: ordering standing order labs can update problems prior to selecting as Clinical Indication Pharmacy Example: update problems and select as POVs for medication refills. It is NOT appropriate to engage non clinician staff (clerks, coders, medical records) in the migration of the problem lists from ICD 9 to SNOMED terms.
Hands On Learning Demonstrate Steps 1 3 to a partner (as if demonstrating to user) Use the Pick List to add an administrative SNOMED term
Questions