RPMS EHR CAC Review
Content Developed by: Philip Taylor, BA, RN Clinical Consultant Medsphere Systems Corporation 2
Learning Objectives Create to facilitate communication, promote quality patient care and patient safety, and meet professional and legal standards. Increase efficiency in documentation through implementation of well designed with "point and click" elements. Ensure completeness, accuracy and standardization of EHR documentation by providing structured. Demonstrate the process of importing RPMS data elements via TIU Templates into progress notes to reduce "double entry" of data by endusers. Demonstrate use of TIU Template components (data objects and template fields) to add clinically pertinent information to electronic orders and consult requests to improve quality of documentation. Demonstrate the process for sharing between facilities and how to obtain prior-built note templates from IHS FTP site. 3
provide a mechanism for structured input of text into RPMS-EHR. While the most common use for TIU Templates is to output text into Progress Notes, there are other uses available within RPMS-EHR. 4
Who can Create and Edit Shared Templates? Only users in the user class of Clinical Coordinator can create Shared Templates. 5
Template Creation Access to Personal Templates is controlled by a Parameter: TIU PERSONAL TEMPLATE ACCESS Select PARAMETER DEFINITION NAME: TIU PERSONAL TEMPLATE ACCESS Personal Template Access TIU PERSONAL TEMPLATE ACCESS may be set for the following: 1 User USR [choose from NEW PERSON] 2 Location LOC [choose from HOSPITAL LOCATION] 3 Service SRV [choose from SERVICE/SECTION] 4 Division DIV [MEDSPHERE DEMO HOSPITAL] 5 System SYS [DEMO.MEDSPHERE.COM] Enter selection: 5 System DEMO.MEDSPHERE.COM ---- Setting TIU PERSONAL TEMPLATE ACCESS for System: DEMO.MEDSPHERE.COM ---- PERSONAL TEMPLATE ACCESS:? READ ONLY allows use, but not creation of, personal templates. Select one of the following: 0 FULL ACCESS 1 READ ONLY 2 NO ACCESS 6
Template Fields Who can create or modify template fields? This is controlled by the parameter: TIU FIELD EDITOR CLASSES. TIU is pre-configured to allow the user class of Clinical Coordinator to create new template fields. Locally you may decide to add additional users without giving them Clinical Coordinator and access to Shared Templates. 7
Template Field Availability Regardless of who is allowed to create TIU Template fields, once created, the template fields are available to all users who are allowed to create templates. 8
Template Field Types Edit box fields Combo box fields (Drop Down box fields) Button fields Check box fields Radio button fields Date fields Number fields Word processing fields Hyperlink fields Text fields 9
Template Field Types Specific Examples of each of these field types are available in an accompanying resource PowerPoint presentation. 10
Common Properties of Templates Display Only Only Show First Line Indent Dialog Items One Item Only Hide Dialog Items Required 11
Template Properties Display Only: Generally used for a text field that give the template user directions or help. Can also be used for templates and dialogs. 12
Template Properties Template Formatting: Indenting, One Item Only, Only Show First Line, and Hide Dialog Items are tools that can improve the appearance and usability of the input template. 13
Template Properties Required: It is tempting to make fields required to force users to enter necessary information, but use this sparingly because it can be very frustrating and may cause providers to abandon use of templates altogether! 14
Standardization Use a standard approach when creating any new template fields. Use beginning text in fields so that related items group together in the list, making it easier to find them later when building the template. 15
Standardization (cont.) Example: Site Abbreviation: CIH Specific Template: ANTICOAG CIH ANTICOAG DX CIH ANTICOAG INR HI RANGE CIH ANTICOAG INR LO RANGE CIH ANTICOAG TIME This will group like elements together and aid in template building and future maintenance. 16
Appearance of It is possible to create that look good for text entry. It is possible to create that output good looking text. But it is not always possible to create a TIU Template that does both at the same time. 17
Using Template Notes In the Template Editor To annotate a template to record why or when a change was made. This can be particularly useful if more than one CAC edits templates. This can also be where EHR Committee approval of the template is recorded. 18
Using Template Notes 19
Using the Copy Button Templates can be created in the My Templates folder and then copied to the Shared Templates folder when completed. But beware, this action is not truly copy, but more akin to creating a shortcut link. After copying, if either of these templates are edited both will be changed! 20
Using the Copy Button 1. Click the destination folder (e.g., Shared Templates). 2. Click the template to copy. 3. Click Copy. 21
Importing IHS Templates IHS uploads and stores TIU templates at its national FTP site. These templates are publicly accessible at: ftp://ftp.ihs.gov/pubs/ehr/templates/tiu%20note%20templates/ When returning to the IHS FTP site remember to click View > Refresh to update the browser s cache. 22
Importing IHS Templates 23
Importing and Exporting If an exported.txml file is double clicked, the browser will attempt to open it because it is an XML type file. Only TIU within EHR can properly process a.txml file. Those who have created HTML will see similarities in raw exported TIU files. 24
Raw TIU Template File <CPRS_TEMPLATE> <TEMPLATE NAME="PHN Consult"> <TYPE>G</TYPE> <STATUS>A</STATUS> <DIALOG>1</DIALOG> <BOILERPLATE_TEXT> <p>this PATIENT IS BEING REFERRED TO PHN SERVICES FOR:</p> <p></p> <p>{fld:phn CONSULT}</p> <p></p> <p>{fld:va*w-p8lines}</p> </BOILERPLATE_TEXT> </TEMPLATE> <TEMPLATE_FIELDS> <FIELD NAME="PHN CONSULT"> <TYPE>X</TYPE> <INACTIVE>0</INACTIVE> <LENGTH>0</LENGTH> <DEFAULT_INDEX>0</DEFAULT_INDEX> <REQUIRED>0</REQUIRED> <SEPARATE_LINES>0</SEPARATE_LINES > <MAX_LENGTH>0</MAX_LENGTH> <INDENT>0</INDENT> <PAD>0</PAD> <MIN_VALUE>0</MIN_VALUE> <MAX_VALUE>0</MAX_VALUE> <INCREMENT>0</INCREMENT> <ITEMS> <p>abnormal Pap</p> <p>communicable Disease</p> <p>gestational Diabetes</p> <p>newborn</p> <p>positive HCG</p> <p>postpartal</p> <p>other</p> </ITEMS> 25
Exported When exported, are very small text files that can be sent as e-mail attachments. 26
Other Uses for Templates Where can template fields be used in addition to progress notes? Discharge summaries Quick orders that have free text fields (e.g., comments) Generic orders that have word processing fields Consult reasons for request (using template editor) Reminder dialogs 27
Questions and Discussion 28