Using Wolf EMR for Panel Identification and Screening Part I Begin Panel Identification Before you begin panel processes, it is useful to have some data to inform your starting point. Note: Useful Help Files in Wolf include: Practice Search Practice Search Rules Practice Search Exam Findings (Video Tutorial) How to Use Bulk Add in Practice Search (Video Tutorial) Useful Searches: 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. Does this list really reflect his active patient population? When the list of patients is produced from this search, it shows the last visit E2
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. 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. 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 consent to change all these patients to inactive by changing their status to Left Practice or Lapsed (depending on clinic preference). He may choose to keep certain patients on the list active. 2
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. Some common INACTIVE 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 o Vaccination clinic patient 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. Left Practice: When a patient informs the clinic that he/she is moving away. For more information see the Guide to Panel Identification available through the Toward Optimized Practice Website. 4
* New patient status creation requires administrator privileges. To create new custom patient status*: 1) From the Home screen, choose Configuration > View > Patient Data Codes > Patient Status 2) In the Patient Status Maintenance screen, complete the Description, Status Code (an in-clinic code you give to the status), a location (typically, these are Hospital, Outpatient and Clinic) and the sort order, which organizes the order they appear in the drop down menu. 3) Click the Inactive box if the status is to NOT be included for the physician s active patient panel. 4) Choose if the patient type is billable. Almost all patient types are billable with the exception of: a. Test Patient - for training purposes, this patient is both inactive and non-billable; 5
b. Deceased patient - is both inactive and non-billable (this status has already been created by Wolf and not the clinic) If the clinic bills for long term care through the clinic EMR, then the status must be billable. 5) Save (by clicking the floppy disk icon). 6) If creating another status click on the New icon (piece of paper icon), and begin again. 7) Click Exit when done. 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 6
Panel identification involves searching for patients that are not considered active members of a physician s panel. See the Panel Identification Guide, available on the TOP website. To change the list of patients to Lapsed or Left Practice 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. 2) Choose Selection > Update Patient Status 7
3) When the Change Patient Status screen appears, using the drop down menu, change the Status to Lapsed (or Left Practice ) 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. 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. 8
Notes on 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. 4) Select Save Status when done. Note on searching to include Inactive patients: 9
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. 10
Conducting a Practice Search and excluding a patient status from the search: Example: A clinic has a specific patient population that is given a unique status. In the ABC Clinic the physician treats patients from the Calgary Flames and wants these patients to be Active but does not wants to include these patients in the General Population Rules that are created in the clinic (they are going to create unique Rules for these patients). Just the patients with this status can be excluded by using the status field in Practice Search. Also, using Status as a parameter of Practice Search, the clinic could create unique Rules for this patient population. In this case the status of Flames is Active and Billable when it is created. 11
Example general population search where the clinic wishes to Exclude the Flames population from the general population search: Identify active patients 18 to 79 with no weight on their record in the last year and exclude the Flames status. This search for the general active population excludes the patients with the Flames status. 12
Example: In the ABC clinic, a Rule is desired for ONLY the Flames population. 1) Conduct the Practice Search: Identify patients with the Status Flames that have NOT had their weight recorded in the last 4 months. 2) Save the search and create a Rule to provide notification that Flames get their weight checked every 4 months. 13
Part II: 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. To save this as a Rule, click on the Save Current Search icon, then, the following screen appears: 14
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, though, do not set up Rules for each physician in the clinic. Set up clinic-wide Rules. 15
2) Weight Identify active patients age 18 to 79 with no weight observed in the last year. Rule: Weight screening due 16
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) 17
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. 18
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) 19
6) Exercise Assessment _ DRAFT - 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) 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. 20
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) 21
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) 22
8) Fasting 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: Fasting lipids due 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) 23
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 lipids due 24
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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. 26
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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. 28
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) 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. 29
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. This clinic is excluding women from the screen with a documented bilateral complete mastectomy in the surgical history. Rule: Mammogram due (> 2 yrs since) A mammogram search could also be created looking for a document keyword of Mammogram (see Colonoscopy) provided that mammograms have consistently had that keyword attached to the documents as they are attached linked to a patient. If the clinic is free typing the document keyword and is inconsistent with the naming, the search must be created to look for all the possible keywords associated with a mammogram. If the keywords have not been consistent, it is a good time to start using consistent keywords when linking documents to a patient. Create a set list to choose from with no free typing. 30