Using TELUS Wolf EMR for Panel Identification & Preventative Care

Using TELUS Wolf EMR for Panel Identification & Preventative Care PART I: PANEL OVERVIEW... 2 PANEL REPORT... 3 PART II: PANEL IDENTIFICATION... 4 ATTACHING A PATIENT TO A PHYSICIAN... 4 PATIENT DATA VERIFICATION BOX... 5 ASSIGNING PATIENTS TO A PRIMARY SERVICE PROVIDER... 6 MANAGING PATIENT STATUS... 7 CREATING A CUSTOM PATIENT STATUS... 10 PRACTICE SEARCH FOR PANEL IDENTIFICATION... 19 USEFUL SEARCHES TO INFORM PANEL... 20 DOCUMENT KEYWORD TIPS... 25 PART III: RECORDING SCREENING OFFERS... 28 INFORMATION WITH A PLACE IN WOLF FOR DOCUMENTING SCREENING... 28 LAB INVESTIGATION OFFERS... 37 TOP ASAP EXAM TEMPLATE... 38 PART IV: PRACTICE SEARCH AND RULES... 42 PRACTICE SEARCH & RULES FOR ASAP... 43 January 2015 1 This resource was developed by Toward Optimized Practice (TOP)

Part I: Panel Overview Preventative patient care is applied to the active, paneled patients for each provider. It is important in the EMR to: Assign each active patient to a primary care provider Manage patient status o o o Active patients need to be distinguished from inactive patients; this includes those patients who have left practice, are transient/temporary, lapsed or are deceased. Some clinics create a unique status for populations of patients such as long term care or specialty service patients that are not part of the physician s panel, such as vasectomy or flu clinic patients. Patients who are not members of the family physician s panel can be managed by their status or potentially by assigning to a fictional physician such as Dr. Walk-in or Clinic Patient. Manage demographic/registration information for each patient and validate regularly. o Wolf has a patient data verified field to mark when patient information has been validated; this includes validating which physician is responsible for the patient s care. The chart is date stamped when verified. 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 may 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. Panel identification is not a project but a daily activity in the clinic. 2

Panel Report Use of Practice Search in the EMR enables the clinic team to produce a list of active, paneled patients by provider. Searches that will be useful when defining panels will be to: Identify a list of patients that have had no appointments within a given period (e.g., 3 years) and have no future appointments booked. Once this list is validated, it may be useful to reassign the status or physician attachment of these patients. Some clinics change the status of these patients to lapsed. Identify patients that still may be attached to a provider that is no longer at the practice. These patients will need to be reassigned. Long-term care patients are searchable by their address. Some providers prefer to assign a unique status or chart type to these patients. Managing the records of deceased patients is essential. Identifying deceased patients and marking the record as deceased is crucial if the practice is contemplating any type of patient outreach. Rural practices often have patient records for patients seen in Emergency and billed through the clinic EMR. These patients need to be identified and distinguished from clinic patients. Patient Data Verified is a search parameter in Wolf; this can be used to run a report based on verification dates. Once a list of patients is produced by a search and the clinic wishes to make a bulk change to the list of patients consider that the change does not necessarily need to be made patient by patient. Wolf EMR is capable of a bulk change. Identify the fields that front staff is expected to use in a consistent manner. Front staff should understand common expectations for the following field in Patient Maintenance: Primary Service Provider Alternate Service Provider Care Team Status 3

Part II: Panel Identification Attaching a Patient to a Physician In Patient Maintenance, assign each active patient to a primary care provider in the practice. 4

Patient Data Verification Box At patient check-in, when patient data (such as address, phone number and 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 an expectation for front office staff to re-verify demographics and attachment 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. 5

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 or the primary provider may be named after the clinic. This ensures that non-panel patients are not included in Practice Searches that will be used for screening processes. Understanding how you assign patients to providers and use statues will inform how you set up Practice Searches and Rules. 6

Managing Patient Status In Patient Maintenance, to manage patient status, click on the Patient Status tab. Click 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. Longterm care patients are usually not included in searches or Rules for in-clinic processes such as routine preventative screening. A clinic can create a status such as St. Stephen s Long Term Care to attach just those patients who reside there and are not part of the in-clinic panel. 7

Note: choosing the Wolf created Long Term Care Patient will mean those patients show up in billing daily. All Test patients in your EMR must have an Inactive Status. Be sure to Save Status once the change has been made. 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. Please refer to the Guide to Panel Identification on the TOP web site. When marking a patient status as Deceased the chart will be marked with the date. Save Status change (see screenshot below). 8

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 ) 9

Creating a Custom Patient Status It is beneficial to create unique patient statuses for the purpose of panel management. The status field is a parameter in Wolf Practice Search as patients can be sorted in Practice Search for panel management. A clinic can choose which status are active and inactive. Common statuses that are created include Long Term Care: Name of long term care centre patients whose records appear in the clinic EMR, e.g., St. Martha s Long Term Care, or Elk Lodge Long Term Care, etc. This makes searches for these patients, simple. Some clinics will create a unique status for each long term care site as it is useful for panel management or billing purposes. Specialty Clinic Services: Specialty clinic patients in primary care should be identified with a unique status that excludes the patient from an active office patient on the panel list. Examples: o Patients seeing a provider only for a vasectomy, in this case a clinic would need to make inactive status: Vasectomy patient o A clinic that opens their doors during flu vaccination season would need to make a Vaccination clinic patient or Flu Clinic o Some family physicians accept a patient for pre-natal care and expect the patient to return to the family practitioner who referred after the baby is delivered. This clinic may make a status called maternity care Temporary: Even though a primary care practice may be closed, many clinics will open their doors on a single occasion to a relative of a patient. For these occasions, the status of Temporary or Transient is beneficial. Hospital: Providers who keep a record of their hospital patients in the EMR, who are not part of the clinic practice, need a unique status. This is common in rural areas. New Patient: When a patient requests a meet and greet appointment but has not yet been accepted nor assigned to a physician. Lapsed: When a patient has not been in the clinic for an extended period of time (defined by the physician). Orphaned: When a physician retires or leaves practice, any patients that are not assigned to another provider. This assists the process of reassigning the patients or tracking to inform them about the change in the provider retiring or leaving the practice. Left Practice: When a patient informs the clinic that he/she is moving away. 10

To create new custom patient status* * New patient status creation requires administrator privileges. From the Home screen, choose Configuration > View > Patient Data Codes > Patient Status 11

1) In the Patient Status Maintenance screen, complete the Description, Status Code (an in-clinic code you give to the status) and the sort order, which organizes the order they appear in the drop down menu. The Location code is optional and can be left blank. 2) Click the Inactive box if the status is to NOT be included for the physician s active patient panel. 3) Save (by clicking the floppy disk icon). 4) If creating another status click on the New icon (piece of paper icon), and begin again. 5) Click Exit when done. 12

To Delete a Status 1) Click on the Status Code 2) From the top menu in Patient Status Maintenance choose File > Delete. 3) You will be asked to confirm Panel identification involves searching for patients that are not considered active members of a physician s panel. See the Panel Identification Guide click here. Visit the TOP website for other panel related resources www.topalbertadoctors.org. 13

To change the status of a list of patients as a Bulk Group Example: to change a list of patients to Lapsed as a bulk group 1) Choose Selection > Select All This selects (checks off) all the patients on the list. Individuals can be deselected by checking the box beside the name. 14

2) Choose Selection > Update Patient Status 15

3) When the Change Patient Status screen appears, using the drop down menu, change the Status to Lapsed and put a Start date in the Admission Date field. You may wish to write a note, (e.g, had no visit in 4 years.) 4) Click OK when done. The list of patients that had not visited the practice in the past 4 years and did not have a future appointment booked has been changed to Lapsed and they are no longer Active in the physician s panel. 16

At any time the clinic chooses to reactivate a patient, the patient status may be changed back to Office Patient or the default active patient for the clinic. Changing patient status of an individual back to active Open Patient Maintenance for the patient (F9 or click on Patient Maintenance). 1) Choose the Patient Status tab 2) Click New Status 3) Using the drop down menu, select a new status for the patient such as Office Patient. Today s date will appear in the *Start Date field. Click on the Start Date, if you wish to change the date the patient is active again. 17

4) Select Save Status when done. Note on searching to include Inactive patients: If it s new to have inactive patients in your clinic EMR, when Front Staff are using the Scheduler and using the Patient Search, the Include Inactive box needs to be checked. 18

Practice Search for Panel Identification From the Main Page, choose Practice Search On this screen: 1. Click the box beside Search All Patients in the upper right. 2. Choose Primary MD under Demographics. 19

Useful Searches to Inform Panel 1) Identify the list of active patients attached to a physician. Click the Search All Patients box. Note the total number of patients identified in the search. This search will identify all the patients currently attached to Dr. Adams in the EMR. Click to Show Search Results as a Patient List Review the number of active patients that Dr. Adams currently has. Consider: Does this list really reflect his active patient population? When the list of patients is produced from this search, it shows the last visit date in the report. Scan the list of dates. How far back in time are the dates of last visit? This will inform panel decision making, as the physician could have last visit dates that were many years ago. 20

2) To start to define active patients, identify all active patients that have NOT had a visit to the clinic in a period of time nor a future scheduled appointment. Ask the physician how far back to go in time to define an active patient. If the answer is 4 years, use the following search to identify all the patients of Dr. Adams that have NOT had a visit of any type in the last 4 years and do NOT have a visit scheduled in the next 6 months (or a specific time forward; it is not common for a clinic to book more than 6 months forward). This may be a clinic-wide decision to look back between 3 and 5 years to define an active patient. Once the patient list is produced and reviewed by Dr. Adams (and perhaps the team, too), obtain Dr. Adam s consent to change the status of all these patients to Inactive or Lapsed (depending on clinic preference). He may choose to keep certain patients on the list active. 21

Useful Tip: 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 in 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 Wolf help file called How to Update the Patient Status for the Selected Patients. 22

For Additional Assistance on Practice Search: Visit the TOP ASaP Web site to access the Wolf How-To Videos: http://www.topalbertadoctors.org/asap/resourcestools/emrkt/ 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 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. 23

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. 24

Document Keyword Tips Keywords are used in Wolf EMR when linking documents in the Document Properties window. Adding keywords not only makes the document easier to find and identify in the future, it can also be used when conducting a Practice Search, setting Rules and using Flowsheets. Using Rules or Flowsheets can change care processes from reactive to proactive. To make the most of the use of your Wolf EMR, careful use of Keywords can make a big difference. Logically, there should be one keyword that for each kind of document that distinguishes it from other kinds. There should be no free-typing and everyone who attaches keywords in the clinic uses the same list of keywords. For breast and colon cancer screening processes, it is vital that a keyword attached to every mammogram or colonoscopy be mammogram or colonoscopy because the results are returned to the primary care clinic and the report is named at the receiving clinic (E.g., NOT breast mammo, bilateral mammo, breast imaging, Breast Centre, Forzani Centre, etc. but simply mammogram ). It is recommended that the clinic review document keywords 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. Common mistakes: Staff may perceive that being more specific with document keywords is being helpful. Staff that do the work need to understand that by using a consistent list of keywords they enable proactive patient care with Rules or Flowsheets. Using the following words for colonoscopy: GI scope, referral for colonoscopy, Forzani Centre, Dr. GI Specialist, etc. 25

Clinic EMR administrators can manage the keywords for the clinic in the Configuration menu. For assistance see the Wolf Help file called Document Keyword Maintenance. Example Keyword List from a Real Alberta Clinic: Admit Air Contrast ALT Anti-HIV Anti-Nuclear (ANA) Appointment Notice Attending physical statement Audiology Report Beta HCG Biopsy Blood Culture Blood Type Blue Cross Authorization Body Fluid Culture Bone Density Bonnyville Cancer Centre Bubble Pack Authorization C-reactive Protein Cat Scan CEA Cervical Culture Chart Notes Chart Request Acknowledgement Chemistry Child Welfare Medical Chlamydia Claims Management Program Colonoscopy Colposcopy Report Consult Creatinine Critical Care Line Cross Cancer Cytology Report Diabetic Consult Discharge Instructions Discharge Summary Double Contrast Driver s Medical ECG Echocardiogram EA screen Endoscopy Ferritin Free testosterone Gastroscopy GC Probe Gynecological Cytology Report HBA1C Hematology Hepatitis Home Care Imaging Influenza INR Iron and TIBC Lipid Testing Mammogram Medical release and report Medications Mental Health Microbiology Millard Health WCB MRI MRSA Newborn Metabolic Screen NIHB Drug Exception No Show Occult Blood Oncology Imaging OPD Operative Report Ova & Parasite Pathologist Comment Patient Photo Perinatal Phenytoin Physician Admit Advice Pre-op medical Prenatal PSA Psychogeriatric Consult RAAPID North Patient Summary RAH Rapid Plasma Reagin Test Release of information Rx adaptation Rx request Serum Protein Elect. Slick Sputum Culture Stool Culture Superficial Culture Surgical Pathology Report Syphilis TB Update Throat culture Tom Baker Cancer Centre Troponin TSH UAH Ultra Sound Urethral Culture Urine Microalbumin Vaginosis Screen Vital Aire VRE WCB Wound Culture X-ray 26

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 January 2015 1 This resource was developed by Toward Optimized Practice (TOP)

Part III: Recording Screening Offers Information with a place in Wolf for Documenting Screening 1. 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 New Vaccination administrator privileges in Vaccination Type Maintenance your Wolf EMR is able to Enter new Vaccination Type make changes to the CDM Vaccination Code Maintenance and Vaccination Type Maintenance Flu Vaccination Entry for ASaP. In the Physician s Workdesk, user the Right-Click Pop Up Menu feature and select New Vaccination Or Or Open the patient s Medical Summary and double click on the <<Add Vaccination>> on the Current History tab. From the Front Office Workdesk, click the Vaccinations button. From the Patient Search screen, search for and double-click a patient. 28

Scenario 1 - Flu vaccination declined or offered at another site: The first box that is chosen is Administration Location. Choose Public Health in the drop down menu. This will immediately change the mandatory fields in the vaccination screen. 29

If the vaccination is refused check the Refused box And/or Date Refused enter a date when the patient declines to be vaccinated. This function is optional; you can use it concurrently with the Refused Check Box. The date captured is displayed in multiple places in WorkDesk. Refusal Reason entering a reason is optional NOTE: Selecting the Refused check box or entering a date makes the patient searchable within Practice Search by using the search parameter for Refused Vaccinations Closing the door saves the record and closes the screen. If refused, the vaccine refusal will appear in the Vaccinations area of the Current History for that patient. If delivered at a Public Health Site, enter Administered by Public Health and the mandatory fields such as the vaccination date and the vaccine. Scenario 2: Vaccination is offered and administered at the clinic. 1) Date: Enter the date by entering it in the text box or by clicking the calendar button and double-clicking to select date. When recording previous vaccinations it is possible that the exact date is not known. It is important to note that entering a date into this field creates a Vaccination Date. You can enter the approximate date as: o Month only, and it is recorded as the current year o Year only, and it is recorded as January of the selected year o Month and year 2) Administration Location: Enter by manually typing in the text box. 3) Administered By: Select the individual who administered the vaccine by selecting either Physicians or Nurse Practitioner, Clinic Staff, or Public Health 4) Vaccine: Click the drop down to select the flu vaccination. Select Series # and Lot # 5) Vaccination Injection Site, Reaction and Notes can be added. 30

Refused and delivered vaccinations appear in vaccinations area of Current Hx and are searchable. Flu vaccinations recorded in this manner will feed information to a patient s Flowsheet monitoring the flu vaccine. Recommending the Flu vaccine out of flu season: Clinics using the TOP male and female exam forms can record recommendations for the flu vaccine in the drop-down field titled Recommend Flu Vaccine. 31

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2. PAP & Mammogram There are two ways to enter a Pap: 1. Female GU exam OR 2. Preventive Care Procedure 33

3. Smoking The SMART banner smoking status for a patient will change when it is modified in the Personal Risks Screen. Personal Risks Screen can be opened three ways: Through the SMART Menu A Patient s Medical Summary The Quick Entry Form 4. Alcohol Alcohol is entered in the Harmful Substance History of the Personal Risks Screen or through the Personal Hx tab of the Medical Summary. Personal Risks Screen can be opened three ways: Through the SMART Menu A Patient s Medical Summary The Quick Entry Form When alcohol consumption is reviewed it can be entered in the TOP template as reviewed. 5. Vitals: Blood Pressure, Height and Weight These should be entered in a vital entry field (not in notes as they cannot be graphed, do not impact the Smart Banner, nor can they work with Rules or Flowsheets) 34

6. 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 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: 35

Print to save a copy to the patient record. The worksheet will be saved in Documents and titled Cardio Risk Profile. It is not necessary to print a paper copy for it to be saved. 5. Enter the patients risk score in the TOP Exam template. IMPORTANT: Printing the Cardiac Risk Worksheet (by clicking the print icon; not necessarily printing a paper copy for the patient) will create a document called Cardiac Risk Profile in the Document area for the patient. A Rule can be created around this document; similarly, a flowsheet can pull the date of the CV risk assessment. 36

Lab Investigation Offers Plasma Lipid Profile, Diabetes Screening, FIT test, Sigmoidoscopy and Colonoscopy are documented with the requisition or referral. Deferrals or declinations can be documented in the TOP ASaP Exam template. 1. Lab Results will populate Flowsheet automatically from incoming electronic results 2. 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. 3. 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. 37

TOP ASaP Exam Template Once Installed: How to Access and Use 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. 38

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. 39

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. Once built 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 download the TOP custom exam template and create a custom flowsheet see the TOP EMR Tip Sheet called Wolf Custom Exam Template and Flowsheet on the TOP website. 40

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: 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. 41

Part IV: Practice Search and 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 the rule criteria. For example, a clinic may set a Rule to remind a team member that a patient is due for a screening maneuver such as diabetes screening. None of the Wolf pre-defined Preventative Rules are an exact match for ASaP so a clinic will need to create Rules. Tips: 1) For clinics that have never used Rules, start small and increase incrementally. 2) How you have set up your panel will inform you if you need to exclude a status from your rules. To get started, 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) 42

Practice Search & Rules for ASaP Examples Using Practice Search in Wolf EMR for Preventative Screening in the General Adult Population. 1) Height - Identify active (not deceased patients) age 18 to 79 years with no height in their record. Rule: No Height on record Save Current Search Show Search Results as a Patient List Show the Search Results as a Patient List to validate. This list can be printed or saved as a csv file to open in Excel or Open Office Calc. 43

To save this as a Rule, click on the Save Current Search icon, then, the following screen appears: To Save the Search as a Rule: 1) Write some informative text to display when patients match the rule 2) Assign a priority (default is 5) 3) Click Active 4) Save as New Repeat the above steps with the following searches to turn them into Rules. These are set up as clinic-wide for all active patients. If beginning screening processes with one physician, a Rule can be set up for the active patients of just one physician. In general, after testing and trials, do not set up Rules for each physician in the clinic, it becomes a great deal to manage over time. 44

2) Weight Identify active patients age 18 to 79 with no weight observed in the last year. Rule: Weight screening due (> 1 year since) 45

3) Blood Pressure Identify active patients, age 18 to 79 with no blood pressure recorded in the last year. Rule: BP screening due (> 1 year since) 46

4) Tobacco Assessment Verified - Identify active adult patients, age 18-79 that have not had their tobacco status (smoking status) verified in the last 1 year (looking for Smoking Verified in the Personal Risks area of the Personal Hx tab). Rule: Tobacco screening due (> 1 year since) This search is looking for Smoking verified in the Personal Risks area of the Personal Hx tab. This search is looking for Smoking verified in the Personal Risks area of the Personal Hx tab. 47

5) Alcohol Assessment - Identify active adult patients; age 18 79, that have not had their alcohol assessment verified in the past year. Alcohol is verified in the Personal Risks area of the Personal Hx tab. (see previous page) Rule: Alcohol Assessment due (> 1 year since) 48

6) Exercise Assessment - Identify adult patients, age 18 79, that have not had their activity level recorded (exercise assessment) verified in the past year. NOTE: This maneuver can be challenging to measure depending on how the user is recording activity level/exercise. Rule: Exercise Assessment due (> 1 year since) Scenario 1 Exercise is recorded in the TOP ASaP Exam template: 49

Scenario 2: Exercise is recorded in Activity Level in Lifestyle How is exercise recorded in your clinic? This search identifies exercise recorded in the Activity Level drop down menu. The Search must be designed to measure based on where it is recorded. See the Wolf Help File on Practice Search Parameters. 50

7) Cardiovascular Risk Assessment - Identify adult males, age 40 74, that have not had cardiac risk worksheet recorded in the past 3 years nor a Framingham Score in the last 3 years. The CV Risk worksheet, when printed, is stored in the patient s Documents with the keyword Cardio Risk Profile. Look for absence of document. Rule: CV Worksheet Due (> 3 yrs since) 51

Identify adult females, age 50 74, that have not had cardiac risk worksheet recorded in the past 3 years nor or a Framingham Score in the last 3 years. The CV Risk worksheet, when printed, is stored in the patient s Documents with the keyword Cardio Risk Profile. Look for absence of document. Rule: CV Worksheet Due (> 3 yrs since) 52

8) Plasma Lipids - Identify adult males, age 40 74, that have not had fasting lipids completed in the past 3 years (look for patients with no LDL in received lab results) Rule: Plasma lipids due (> 3 years since) Identify adult females, age 50 74, that have not had fasting lipids completed in the past 3 years (look for patients with no LDL in received lab results) A Note on Lab Codes: Depending on if the lab codes have been merged in the background or if a clinic receives labs from multiple zones, you want to make sure you are capturing all of the possible ways that a clinic has received a lab result when creating a Rule or Practice Search. Using Lab Results (Received) you can select multiple ways a lab has been received in your EMR. For example, when putting the words LDL in the box to the left of Any Words you can see if there are multiple ways that LDL has been coded. If there are multiple ways, include them all in the search to be sure it captures them all. 53

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9) Diabetes Screening Identify active adults, age 40 79, that have not had diabetes screening (either a fasting glucose OR a hemoglobin A1C) completed in the past 3 years. Rule: Fasting glucose or HbA1c due (> 3 years since) 55

10) Vaccinations Influenza - Identify active adults, age 19 79, that have not had influenza injection completed or flu vaccine refused in the past 1 year. Rule: Vaccination screening due (> 1 yr since) Note: when conducting this search, clinics may identify that they need to do some vaccination code maintenance if they have many versions of influenza vaccine For this above search to work flu vaccinations and refusals (shown below) must be recorded in the Vaccinations field. 56

11) Colorectal Cancer Screening - Identify active, adults, age 50 74, that have not had colorectal cancer screening of either: a) Fecal Occult Blood or Fecal Immunochemical Test in the past 2 years*, OR b) Colonoscopy in the past 10 years * some clinics set this to 1 year This practice does not send patients for Sigmoidoscopy. If they did they would exclude any patient with a sigmoidoscopy report. Rule: Colorectal cancer screening due If the clinic is not using the keyword Colonoscopy when adding keywords to a colonoscopy report document, this search will NOT work. The recommended keyword is colonoscopy for colonoscopy reports however many clinics use ineffective keywords such as referral, Forzani Centre, etc. 57

12) Pap Test - Identify active, adult females, age 21 69, that have not had pap screening in the past 3 years. This search is looking for pap results that are located in the Preventative Care Procedure. This screen excludes women with a documented total hysterectomy in the surgical history. Rule: Pap test due (> 3 yrs since) 58

The Pap search needs to find the pap information as it is entered and/or received at your clinic. Base this search on how Paps are documented and/or how the results are received at your clinic. Questions to ask: Are Paps documented in Preventative Care? Are Paps documented in the Female GU exam? Does the clinic have a reliable source of incoming lab results in Investigations such as labs called Gynecological Cytopathology? 59

13) Mammogram - Identify active, adult females, age 50 74, that have not had a mammogram screening in the past 2 years. This search is looking for a mammogram entered as a Preventative Care Procedure and/or with a document with the consistently entered Keyword Mammogram. This clinic is excluding women from the screen with a documented Bilateral Complete Mastectomy in the surgical history. Rule: Mammogram due (> 2 yrs since) 60