Clinical (EHR) Reminders - Testing

1. Clinical (EHR) Reminders- Testing

2. Testing reminders - General • You must test each reminder at your local site before deploying to users • Test reminders: • Is the reminder applicable when it should be • Patient in cohort properly • Is the reminder not applicable when it should be • Patient is not in cohort properly • The reminder is due when it should be • The reminder is not due (resolved) when it should be

3. Testing reminders - General • For each reminder you test, select a patients who should be • In the cohort (applicable) and not due • In the cohort (applicable) and due • Not in the cohort (not applicable) • Remember you can check the status of a reminder on a real patient. You can only test resolution through data entry on EHR tabs or Dialogs on TEST patients! Your users will tell you when a reminder is due when it shouldn’t be (it is a nuisance). They may not notice when a reminder is not due when it should be! Test for this scenario very carefully!!!

4. Example • To test Colon Cancer Screening • Applicable (in cohort) • Pick patient over 50 • No history of colon cancer or polyps • Not Applicable (not in cohort) • Patient under 50 • Also test patient over 50 with history of colon cancer or polyps • Due • A patient who has not had FOBT, Sig, Barium Enema, Colonoscopy within the prescribed period of time • Not Due • Check patients with each type of resolution

5. Testing Reminders in RPMS • ALL reminders should be tested for content • Can be done by CAC and then by quality management • “Technical” test is done in RPMS • “Functional” test in EHR

6. Test the “technical” functioning of reminder If you request assistance from OIT or Medsphere, you will be asked to provide a screen capture of this test PXRM Managers Menu RT Reminder Test Reminder Test BEHORM Main Menu TST Reminder Test

7. Reminder Test • First you need to know what your Reminder Logic and your Findings are Your reminder definition will provide you the findings and the logic • Finding Item: IHS-ALCOHOL SCREEN (FI(1)=RT(43)) Finding Type: REMINDER TERM Use in Resolution Logic: OR • Finding Item: ALCOHOL SCREENING (FI(4)=EX(34)) Finding Type: EXAM Use in Resolution Logic: OR • Finding Item: IHS-ALCOHOL SCREEN 2007 (FI(5)=TX(83)) Finding Type: REMINDER TAXONOMY Use in Resolution Logic: OR • Finding Item: IHS-ALCOHOL 2008 EDUCATION (FI(6)=RT(37)) Finding Type: REMINDER TERM Use in Resolution Logic: OR Default PATIENT COHORT LOGIC to see if the Reminder applies to a patient: (SEX)&(AGE) Default RESOLUTION LOGIC defines findings that resolve the Reminder: FI(1)!FI(4)!FI(5)!FI(6)

8. Reminder Test • Select Patient • Select Reminder to Test Select Reminder Managers Menu Option: rt Reminder Test Select Patient: DEMO,FORTIES MALONE <A> M 01-20-1959 XXX-XX-2665 YAK 768 Select Reminder: IHS-ALCOHOL SCREEN 2008 You will now see the technical display of the reminder test and what the reminder finds.

9. The first section is the FIEV array, which corresponds to the findings in the reminder definition. If we look back at our definition inquiry, we see there are two findings in this reminder. The elements of the FIEV array are: FIEV(1)=0←not found, returns 0 FIEV(4)=1←found, returns 1, the next several lines extract specifics on the finding FIEV(4,"DATE")=3070625.0818←Date in FileMan format FIEV(4,"FINDING")=34;AUTTEXAM(←Exam file entry FIEV(4,"RESULT")=N←result negative FIEV(4,"SOURCE")=182228;AUPNVXAM(←Data came from V Exam file entry #182228 FIEV(4,"VALUE")=N FIEV(4,"VIEN")=2203900←Visit file entry is 2203900 FIEV(5)=0←not found, returns 0 FIEV(6)=0←not found, returns 0 FIEV("AGE",1)=1←found, returns 1, the next lines extract specifics on the finding FIEV("DFN")=19039←Patient’s DFN is 19039 FIEV("PATIENT AGE")=50←Patient’s age is 50 FIEV(1) = FI(1) = IHS-Alcohol Screen (Reminder Term) FIEV(4) = FI(4) = Alcohol Screening (Exam) FIEV(5) = FI(5) = IHS-Alcohol Screen 2007 (Taxonomy) FIEV(6) = FI(6) = IHS-Alcohol 2008 Education (Reminder Term)

10. The next section gives us additional information in the^TMP(PXRMID,$J) array: The elements of the ^TMP(PXRMID,$J) array are: ^TMP(PXRMID,$J,123,"AGE11A")=1 ^TMP(PXRMID,$J,123,"EXAM ALCOHOL SCREENING")=06/25/2007 Exam: ALCOHOL SCREENING; result - NORMAL/NEGATIVE ←date of exam in standard format and result ^TMP(PXRMID,$J,123,"FINDING 1 NOT_FOUNDB")= ^TMP(PXRMID,$J,123,"PATIENT COHORT LOGIC")=1^(SEX)&(AGE)^(1)&(1) ←cohort logic is evaluated to true ^TMP(PXRMID,$J,123,"PCL_FOUNDB")=REMINDER DUE if patient is over 13 AND no alcohol screening or ^TMP(PXRMID,$J,123,"PCL_FOUNDC")=alcohol related diagnosis in the past year ^TMP(PXRMID,$J,123,"PCL_FOUNDD")= ^TMP(PXRMID,$J,123,"PCL_FOUNDE")=REMINDER ON if due within 3 months ^TMP(PXRMID,$J,123,"REMINDER NAME")=Alcohol Screen ^TMP(PXRMID,$J,123,"RESOLUTION LOGIC")=1^(0)!FI(1)!FI(4)!FI(5)!FI(6)^(0)!0!1!0!0←resolution logic ^TMP(PXRMID,$J,123,"zFREQARNG")=Due every 1 year for ages 13Y to 110Y

11. The final section shows the Clinical Maintenance information that is returned to the calling application, for example Health Summary or the EHR: The elements of the ^TMP("PXRHM",$J) array are: ^TMP("PXRHM",$J,123,"Alcohol Screen")=DUE NOW^3080625.0818^3070625.0818 ←status with date due and last done - remaining lines are in display format ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",1)= ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",2)=Applicable: Due every 1 year for ages 13Y to 110Y within cohort. ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",3)=REMINDER DUE if patient is over 13 AND no alcohol screening or ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",4)=alcohol related diagnosis in the past year ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",5)= ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",6)=REMINDER ON if due within 3 months ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",7)= ^TMP("PXRHM",$J,123,"06/25/2007 Exam: ALCOHOL SCREENING; result - NORMAL/NEGATIVE Alcohol Screen","TXT",8)=Resolution: Last done 06/25/2007 ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",9)= ^TMP("PXRHM",$J,123,"Alcohol Screen","TXT",10)=

12. Clinical Maintenance Display

13. Functional Testing • For each reminder select: • A patient who should be in the cohort for whom the reminder should be due • A patient who should be in the cohort for whom the reminder should be not due • A patient who should not be in the cohort

14. First evaluate reminderThis will make ensure any data entered since accessing the patient is updated.

15. Determine status is correct Patient in cohort, and reminder is due: Patient is in cohort, and reminder is not due: Patient is not in cohort: Highlight→ right click→ clinical maintenance to see what the reminder used to cohort and resolve reminder

16. Clinical Maintenance for DUE reminder

17. Clinical Maintenance for NOT DUE reminder

18. Clinical Maintenance for NOT APPLICABLE reminder

19. Troubleshooting unexpected findings • If your status is not what you expect, look at your Reminder Inquiry to review your Reminder Definition

20. Troubleshooting unexpected findings • Reminder should be applicable: • Check your cohort logic • Check clinical maintenance – does the reminder find any data? • Usually is a taxonomy missing codes OR a patient has not had the dx or problem list entry in the effective period • Reminder is applicable but shouldn’t be • Check your cohort logic • Check clinical maintenance – what does the system find to cohort the patient • Often a past coding error, could be a taxonomy error – and incorrect code in the taxonomy

21. Troubleshooting unexpected findings • Reminder should be resolved: • Check your resolution logic • Check clinical maintenance – does the reminder find any data? • Usually is a problem with a term – sites forget to populate the terms with local names like labs, meds • Reminder is resolved but shouldn’t be • Check your resolution logic • Check clinical maintenance – what does the system find to resolve the reminder • Check the terms – may be a problem with the condition or the effective period/date

22. Troubleshooting tips • After entering data into RPMS, you must “evaluate reminder” for the reminder to update the status • Do your testing in the “All Evaluated” folder so you can “see” the status change on your reminders • Ordering a lab will not resolve a reminder. The lab RESULT will resolve the reminder • An active filled prescription resolves a reminder. If the effective period is 30 days, then the reminder is due on the 31st day and not resolved until it is active and filled again. • A V POV will not turn off the reminder for 24 hours. The info is cached to avoid slowing down the system. • A problem list entry will resolve the reminder immediately