Tip Sheet for QHR-Accuro Users 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. Foundation for success: Commitment to standardization in the EMR It is strongly recommended to maximize use of standardized data fields and templates to record patient information in the EMR. It is helpful before process redesign to determine how to record your patient information in a standardized way to obtain the desired reports or queries and gain whole team commitment to meet the new expectations. For example, if a clinic has a standard problem list, it is easy to search for patients with single or multiple problems. Part I: Panel Identification: Patients are managed in the Patients area of the EMR. The Office Provider and Patient Status are two key fields. A clinic must have consistent practices with Patient Status as it is an important field in the Query Builder (Alerts) in running reports for screening. To set the Office Provider 1. Click the Patients button on the side bar. 2. Click the Providers tab. 3. Click the Ellipses button to the right of the Office Provider text box. 4. Providers that exist in your clinic are displayed in the search results by default. To select one, click the provider's name to select and click Select. 5. Click Update Patient.
To set Patient Status 1. Click the Patients button on the Side bar. 2. Click the and select the Patient Status from the list displayed. 3. Click the Update Patient button. Patient Status History Patient Status History allows you to add other statuses and colours. Patient Status History also allows you to see the historical status of a patient; this will come in very helpful when validating patient panels and during ongoing panel management. A. Creating additional statuses During panel identification and management a clinic may wish to create additional statuses. For example a clinic may create a status such as Active 2014 to mark all the patients that were validated that year. This would be done for each year. Steps to Add a Status 1. Go to Patient Status History Tab, or press F8. 2. Press the green plus button. 3. Click in the row that appears to change status (default is "Active"), date, or description. The most recent status will get copied in to the main patient status at the top of the screen. For administrators, you can stop this from happening by turning off the System Setting (Help > Manage Security > System Settings > "Update Patient Status When Adding Status History"). B. Viewing Patient Status History The F8 window brings up the Patient Status History window on the selected patient, and when you switch patients, the window reloads itself. An interesting thing about the F8 window is it always stays on top of Accuro. This is on purpose so you can position it somewhere unobtrusive and always see the statuses for patients. If you don t like the window on top, then simply close it each time. For panel identification and management, it is highly recommended that front staff keep the Patient Status History window open while checking in patients. 2
Deceased patients If a clinic is going to engage in outreach screening, managing the status of deceased patient is critical to ensure that a deceased patient s name does not appear on a list for outreach. Screening processes apply to active patients in the clinic. Clinics have the option to configure their system settings to add a default status when a patient is marked as deceased. It is sensible that deceased patients are all marked as inactive automatically when marked as deceased. Check your General Settings in System Settings. The default Status for Deceased Patients is None. This can be managed in General Settings. Ideally, set the status for deceased patients to Deceased or, some clinics may choose, Inactive. 1. Click Users in the Menu bar. 2. Click Manage Security. 3. Click the Systems Settings tab. 4. The General tab appears. 5. Choose your Status for Deceased Patients. 6. Save Settings. Recommended Accuro Help files: Patient Status History (Tech Tuesday # 14) Manage a Status Demographic data Manage demographic/registration information for each patient and validate it regularly. Clinics may choose to use the Patient Status History (F8) to monitor the last date the patient status and demographic information was updated. 3
Important Fields in the Demographics Tab Patient Status use to separate active from inactive patients Office Provider - primary care provider the patient is attached to Deceased mark when a patient is deceased Last Updated when patient demographics are changed the Last Updated band will show o Date/time last updated o Who made the change o Office Other options: Current Enrollment Status primary care clinics could use this field to mark active patients that are validated as members of the Office Provider s panel. Another option for validating a patient as a member of a physician panel is to create a Active 2014 status in Patient Status. This would need to be done each year. 4
Part II: Panel List To produce a list of active patients attached to each provider, use Reports or Alerts (Query Builder) to identify the patients with a Patient Status as Active for each Office Provider participating in ASaP. Accuro has some pre-built Reports and the ability to customize reports with the Alerts (Query Builder). The pre-built Scheduling Reports that will be useful for panel include: Office Provider Patients - Creates a list of all patients for a selected Provider. The option is available to be able to list by a Patient Status. More than one Provider and Status can be selected at a time by holding down the Ctrl key whilst making selections. Patient Status Summary - Creates a list of patients seen with selected Status(es) by selected Provider(s) between two selected dates. The report can be configured to include the current status of a patient or to include status history details. Patient Visit Summary - Generates a list of all patients seen by Provider(s) between two selected dates. There is an option to show All Patients, Exclude No Show patients or to display Only No Show Patients, as required. To create a Report: Click Reports on the Menu bar. (Or enter Ctl + R) Select Reporting from the list displayed Click to select the appropriate provider. To select more than one, hold the Ctl button and click select. Select the required (Scheduling) Report on the left hand side. Complete the steps on the right hand side. Click the Generate Report button to display the report. o The report can be printed or exported. It is recommended to export the report to Excel or Open Office Calculator as a csv file so that it can be used for screening planning or improvement. Click the Generate Export button In the Save window displayed browse to where the file is being saved, type in the appropriate filename and click OK. The file is saved at your chosen location. Custom Reports: New to the Alert/Query Builder? The following are recommended Accuro help files: Alert Definitions Create an Alert Definition Add Rules to an Alert Definition Run a Report on an Alert Definition Query Builder Example: Total Count of Patients Export Alert Matches Save Appointment List to csv File to be Used for a Mail Merge To produce a list of active patients attached to each provider, use the Alerts (Query Builder) to identify the patients with a Patient Status as Active for each Office Provider participating in ASaP. 5
Overview: The workflow for creating an Alert (query/ report) is as follows: 1. A Definition is created (this is the name of the query/report) 2. Add the Rules (criteria/filter/constraint). 3. Run the report on the query (all the rules in the definition fun concurrently). 4. The results of the query are displayed as Alert Matches Optional next steps 1. Actions may be selected for the patient listed such as: Create task Set Patient Status Assign Flag Create Forms (these can be outreach letters) 2. The list/report may be Exported note save the list as a csv file to open in Open Office Calculator or a Microsoft Excel spreadsheet. Note: An exported list would be required for: Panel list Chart review process Creating a list for patient outreach i) Create the Alert Definition 1. Click Reports on the Menu bar. 2. Select Alerts (Query Builder) from the list displayed. The Alert Definitions window is now displayed. 3. Click the Add button (green plus) in the top-left corner under Definitions. 4. Type in the name of the definition (title of your report) and click OK. The next set of steps involves selecting the criteria or Rules for your Alert Definition (report). ii) Adding the Rules to the Alert Definition 5. Select a Category of to add into the New Rule by clicking on the downward pointing triangle. 6. Select the appropriate item from the list. 7. Complete the fields in the Manage Rule area a. Click the New button to add more criteria 8. Click Add Rule to add the criteria to the Alert Definition. iii) Run Report iv) View the displayed Alert Matches v) Export as csv file 6
Part III: Offers of Screening in the Patient Chart Before beginning the chart review discuss where the screening maneuvers are documented. During the ASaP chart review, the following locations are recommended places to look for screening offers. In Accuro, the Virtual Chart tab of the EMR will show a summary of the record for that patient. Tip: In the Virtual Chart, enter a search term in the Search Patient Chart field to search for screening offers. For example, enter mammo to find a mammogram or smok to find documentation of smoking. Expand areas in the left hand column to find Labs or Documents 7
Screening Maneuver Interval Potential Location in EMR (noting that clinicians may have unique patterns of use) Blood Pressure (18 +) Annual Clinical Notes or Physical History Height (18 +) Annual Clinical Notes or Physical History Weight (18 +) Annual Clinical Notes or Physical History Tobacco Use Assessment (18 +) Annual Encounter Notes > Lifestyle or Risk Factors Exercise Assessment (18+) Annual Encounter Notes > Lifestyle or Risk Factors Alcohol Use Assessment (18 +) Annual Encounter Notes > Lifestyle or Risk Factors Flu Vaccination Screen (18+) PAP Test (women 21-69) Mammography (women 50-74) Annual 3 years 2 years Immunization Summary Encounter Notes > Labs Encounter Notes > Letters (Consult Report) or Documents CV Risk Calculation (women 50-74, men 40 74) 3 years CVD Risk (Framingham 10 Year CVD Risk) Calculator Fasting Lipid Profile (women 50 74, men 40 74) 3 years Encounter Notes > Labs One of: One of: [all patients 40 +_) [all patients 50 74) Fasting Glucose or 3 years Encounter Notes > Labs Hgb A1c or 3 years Encounter Notes > Labs Diabetes Risk Calculator 3 years FOBT or FIT 2 years Encounter Notes > Labs Sigmoidoscopy or 5 years Encounter Notes > Letters or Documents Colonoscopy 10 years Encounter Notes > Letters or Documents 8
The Clinical Notes area of the EMR provides an overview of the notes for a patient and should be reviewed for screening offers. If the Encounter Summary tab is not displayed in the clinic, it can be enabled. This is a tab that settles in between the Virtual Chart and the Medications tab. It is designed to take all of the clinical notes/letters, expand them, and stack them on top of each other in one big scrollable view. The notes are in reverse chronological so the most recent one is at the top. This is useful view to get an idea of the content of previous visits easily. It is also in the F3 (Quick Patient Summary) window. Steps to turn on Encounter Summary 1) Click on File, User Preferences 2) Click on the Display category 3) Click on the EMR Workflow tab 4) Enable the third checkbox called "Show Encounter Summary Tab" 5) Press Apply, then OK. Note: There is a link at the bottom of each note in the Encounter Summary tab that opens the full note in edit mode. This is also useful for seeing what medical history items were added on the day of the note, like blood pressure, height and weight. 9
Quick Summary opens the Quick Patient Summary for the currently selected patient. To access the Quick Patient Summary choose F3.This gives you access to three tabs: Virtual Chart, Patient Summary and Encounter Summary. The Encounter Summary tab displays all clinical notes for the patient fully expanded ordered reverse chronologically. Underneath each note; a link labelled "Click to Open Clinical Note...". Click this to open the clinical note for editing. There is also an option to show the Encounter Summary tab as part of the EMR section. 10
Framingham Risk Calculator: CVD Risk: The 2012 Canadian Cardiovascular Society standard Framingham Risk Calculator has been adopted as the new default in Accuro. This calculator is called "CVD Risk". This is an "Estimation of 10 year Cardiovascular Disease Risk". Reference: Anderson et al. CCS Dyslipidemia Guidelines Update 2012 To access the CVD Risk Calculator: - Click Tools on the Menu bar and select Framingham Risk Calculator. - Enter the patient information - Click OK and Close. The results are saved to the patient s Encounter Notes section. 11
Tracking Tracking is a relatively new feature of Accuro EMR (EMR, Encounter notes) that displays the count of outstanding tasks, un-reviewed labs and outstanding orders. With Tracking, a physician or preventative care outreach coordinator can be aware of any preventative investigations, such as a fasting glucose or a fecal immunochemical test (FIT), that have not been reconciled to the order. Each user has to turn tracking on. To enable Tracking: 1. Go to the EMR > Encounter notes 2. In the lower left corner, click the gear icon next to the word Tracking 3. Turn on the Enable Tracking checkbox. 4. Click the green plus to add the items you want to show in tracking. Choices are: o Tasks show outstanding tasks o Unreviewed Labs shows any labs sitting in a physician inbox not reviewed yet o Outstanding Orders show any requisitions done without results linked back (requires the use of requisition forms set up for lab orders). o CMD shows conditions the patient has CDM form on (requires CDM to be turned on and worksheets used) o Preventative Care (Ontario only) 5. Click OK. Recommended Accuro Help files: Tracking in Encounter Notes Enable Tracking in Encounter Notes CDM Worksheets This feature of Accuro was created for specific provincial programs across Canada. Alberta users if they do not have access, can request access to the worksheets and edit them for screening and prevention. Call QHR Client Services to have the module enabled. Recommended Accuro Help Files: CDM Worksheets in Accuro User Guide CDM Worksheets Assistance The Alberta Medical Association offers EMR Advisory Services to physician member clinics. The EMR helpline for information or advice is 1.855.454.8400. More information is available at the AMA website. EMR vendors have additional resources beyond calling the help desk; users should be familiar with the help files and video tutorials that may be accessed through their EMR help link. Clinic training may also be arranged. Ask your vendor about user meetings or webinars. 12