1 / 32

Using the Clinical Registries Health Maintenance Report (CRHMR ) June 2019

Defense Health Agency. Using the Clinical Registries Health Maintenance Report (CRHMR ) June 2019. Overview. Overview of CRHMR Description, features and summary of element details Using the CRHMR Prepare for the encounter Access the CRHMR Copy information into TSWF form

brygid
Download Presentation

Using the Clinical Registries Health Maintenance Report (CRHMR ) June 2019

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Defense Health Agency Using the Clinical Registries Health Maintenance Report (CRHMR)June 2019 “Medically Ready Force…Ready Medical Force”

  2. Overview • Overview of CRHMR • Description, features and summary of element details • Using the CRHMR • Prepare for the encounter • Access the CRHMR • Copy information into TSWF form • Additional Background • Contact for questions

  3. CRHMR Description • Compiles an individual patient’s most current Preventive Services data into a consolidated summary report; only age >18 years at this time • See back-up slides for time lag of clinical data • Facilitates documentation of Preventive Services field in TSWF form • Copy-paste appropriate elements into TSWF form • Avoids need to search multiple sources for patient’s information • Patient’s age and sex determine the report content; based on USPSTF • Preventive services are flagged as DUE/OVERDUE when appropriate • Focuses on general population screenings, not disease specific needs • Available within CarePoint’s familiar Clinical Registries (locations may change) • Accessible by anyone with a PHI-enabled CarePoint account • A column in PCMH Huddle and Appointments registries, also patient details summary tab (right-click patient row in any registry or Patient Lookup)

  4. CRHMR features • Computerized collation of most current patient-specific data • Age/sex specific elements • Includes, among others • Date of report • 10-yr CVD risk estimate • Parameters used for CVD risk • Due/overdue logic mirrors MHSPHP • Standard screening elements as in the TSWF template Report copied from MHSPHP Clinical Registries - 06/11/2019 Lipids- 03/01/2016: LDL=142 HDL=40 TOTAL=285 10-yr CVD Risk Other Race/Ethnicity (ACC/AHA)- 3% 10-yr CVD Risk African American (ACC/AHA)- 4% 10-yr CVD Risk Components- Age: 55, Gender: F, Race: UNK, Chol: 285, HDL C: 40, Syst BP: 114, Htn Rx: No, Smoke: No, Diabetes: No 10-yr CVD Risk Current as of- 2018-12-31 Diabetes Screening- HgbA1c: 09/26/2018: 5.0 HIV Screening- 07/02/2012 HCV Screening- 06/28/2012 Colorectal Cancer Screening- Colonoscopy: 03/22/2018 Td/Tdap/Dtap vax- OVERDUE 10/16/2008 Influenza vax- 10/23/2018 Zostavax ZVL- None Recorded Shringrix RZV- 03/04/2019, DUE Mammogram- 02/28/2019 Chlamydia Screening- NOTE: Screening still recommended if at risk, but not routinely GC Screening- NOTE: Screening still recommended if at risk, but not routinely Consider for Aspirin Prophylaxis if 10 year CVD Risk is > 10% 1 2 3 • Advantages: • Avoids need to search other modules for most recent values • Improved accuracy over manually typed data • Improved completeness • Easily readable output 4 • Sample CRHMR (not a real patient)

  5. TSWF CORE form Preventive Services field and CRHMR • CRHMR: computerized aggregate of patient-specific data including 10-yr CVD risk estimate; copy-paste selections into TSWF form (screenshot example) • Current: pre-populated empty template, manually updated by support staff using various AHLTA modules Report copied from MHSPHP Clinical Registries - 06/11/2019 Lipids- 01/07/2019: LDL=0 HDL=31 TOTAL=210 10-yr CVD Risk Other Race/Ethnicity (ACC/AHA)- Unable to calculate … 10-yr CVD Risk African American (ACC/AHA)- Unable to calculate CVD … 10-yr CVD Risk Components- Age: 54, Gender: M, Race: WH, Chol: 229, HDL C: 35, Syst BP: Missing, Htn Rx: Yes, Smoke: No, Diabetes: No 10-yr CVD Risk Current as of- 2018-12-31 Diabetes Screening- None Recorded HIV Screening- 01/22/2016 HCV Screening- DUE because birth year between 1945-1965 Colorectal Cancer Screening-OVER DUE Td/Tdap/Dtap vax- 07/19/2010 Influenza vax- 11/06/2018 Zostavax ZVL- None Recorded Shringrix RZV- DUE, DUE Consider for Aspirin Prophylaxis if 10 year CVD Risk is > 10% • (not a real patient)

  6. Comparison (May 19 form version) (not a real patient)

  7. Additional Information about CRHMR CRHMR… • includes this statement at the top: “Report copied from MHSPHP Clinical Registries [date]” • includes a calculated 10-year CVD risk estimate • with lab parameters used, their date, and risk calculation date. • uses published ACC/AHA Pooled Risk estimation equations. • emits both “African American” and “Other race/ethnicity” estimates because existing demographic data can’t reliably determine race/ethnicity; providers will choose which is applicable for a patient • Is currently calculated on a monthly schedule with some lag; lab values used for the calculation may be different from the most recent lipid values shown • emits “not available” or other similar text if needed data are not available within MHS data systems • accommodates standard cancer screening options but cannot account for special cases or circumstances

  8. Additional Information about CRHMR cont’d • Information copied into the TSWF form is simple text and can be edited like any other text field within AHLTA; remember the 2,000 character limit for an AHLTA text field • The text count from a patient’s CRHMR varies, but even the largest reports have no more than 950 characters. • Users must thoughtfully determine if data already entered into the TSWF Preventive Services field should be retained rather than be replaced with CRHMR data.

  9. Element details:CVD and Diabetes • Lipids screening date and results for most recently available, otherwise: • Males: “Due at age 35” if < 35 yrs or “Due” if >35 yrs • Females: “Due at age 45” if < 45 yrs or “Due” if >45 yrs • 10-year CVD risk estimate calculation and parameters • Uses AHA/ACC calculator when parameters are available • Emits “Unable to calculate” if parameters are missing • May be a 3 month lag due to issues related to collating equation parameters • Result for both race groups displayed because of unreliable EHR race data; provider decides which to retain/utilize • Diabetes screening date and result • If BMI >25, emits result or “Diabetes screening: None recorded” • If BMI <25, emits “Diabetes screening: Not applicable” • If diagnosed diabetic, emits “Diabetes testing: [Date], [result]” (or “none recorded”)

  10. Element details:Cancer screening • Breast cancer screening • Women <39 years of age: nothing emits • Women 39-40 years of age: “Consider/discuss at age 40” • Women >40 years of age: utilizes MHS Pop Health Portal algorithms including date of last test or “DUE”/“OVERDUE” • Cervical (Pap or Pap/HPV): utilizes MHS Pop Health Portal algorithms • Emits date and type of last test or “DUE” or “OVERDUE” • Women <21 years of age: emits “Not applicable due to age” • Colorectal: utilizes MHS Pop Health Portal algorithms, accounting for colonoscopy, flex sig, fecal occult blood, FIT DNA, and Colon CT and their appropriate standard intervals • Emits date and type of last test or “DUE” or “OVERDUE”

  11. Element details:Infectious diseases • HCV screening: only for those born 1945-1965 • Date of test, “DUE because birth year between 1945-1965”, or “None recorded” • Chlamydia screening: (same as GC) • Females >17 and <25 years of age: date of test or “None recorded” • Females >24 years of age: “NOTE: Screening still recommended if at risk, but not routinely” • GC screening: (same as chlamydia) • Females >17 and <25 years of age: date of test or “None recorded” • Females >24 years of age: “NOTE: Screening still recommended if at risk, but not routinely” • HIV screening: • Date only, or “None recorded” if no result is on file

  12. Element details:Immunizations • Influenza: last vaccination or “None recorded” • Due/Overdue not included because it’s due for everyone annually • Td/Tdap/Dtap: date of last vaccination, “OVERDUE”, or “None recorded” • Shingles: 2 separate lines, one for Shingrix and one for Zostavax • “Zostavax ZVL”: starting at age >60 yrs: date or “none recorded” • “Shingrix RZV”: starting at age >50 yrs: date or “Due”, i.e. “Date/Date”, “Date/Due”, or “Due/Due” (see comments on slide 19) • Pneumococcal: uses MHS Pop Health Portal algorithms to emit dates, “Due”, or “None recorded” • HPV: 3 placeholders for date or “Due” for ages 15 through 26. ie. “Date/Date/Date” or “Date/Date/Due” or “Date/Due/Due” or “Due/Due/Due”

  13. Element details:Others • Folic acid: • Age 15 through 45 emits “Recommended for Folic Acid” • Aspirin prophylaxis: • If age 50 through 59: “Consider for Aspirin prophylaxis if 10-year CVD risk is >10%” • AAA screening: • Age 65 through 75 and male emits “Consider for AAA screening if ever smoked tobacco” • (Can’t be more definitive due to uncertain history of tobacco use in EHR.) • Lung Cancer screening: no report because unable to calculate pack-year history or quit duration • Osteoporosis screen: currently researching a patient-specific methodology

  14. Shingrix: additional details • ACIP recommends a 2-dose series 2-6 months apart • Fine print allows 2nd dose if not less than 28 days from 1st dose • Additional fine print allows +/- 4 days around a stated interval for actual immunization delivery • Including various existing data sources, some patients have >2 Shingrix CPT dates, most of which are within a few (1-7) days, indicating differences in administrative factors such as billing • Administrative factors are not expected to “echo” dates beyond 7 days • Therefore, the Shingrix algorithm was designed as follows: • Find a patient’s first recorded date and assign that date as the 1st dose • Find the next date that is > 24 days after that first date and assign that date as the 2nd dose. • If no Shingrix CPT codes for a patient, emit “Due, Due” • If one date or >1 date but all within 24 days of a first date, emit “DATE, Due” • If a 2nd date is > 24 days from the first date, emit “DATE, DATE”

  15. Using the CRHMR

  16. Using the CRHMR Overview of steps: • Prepare the TSWF form for the encounter • Access the CRHMR in MHS Pop Health Portal • Copy-paste information as needed

  17. 1. Prepare the TSWF form for the encounter • These instructions focus on preventive services documentation, not other steps in the encounter prep process; fit or adjust these steps as best suits your workflow. • Typically during “open not checked in” or “copy forward” process, may be any time • Team should coordinate on procedures for updating preventive services content • Open the patient’s encounter, S/O module, TSWF form (CORE family of forms). • Briefly orient as to the status of the existing Preventive Services field contents: • Do any expected elements require updated information or dates?

  18. 2. Access CRHMR in MHS Pop Health Portal • Open CarePoint’sMHSPHP. (Assumes familiarity with Clinical Registries; see back-up slides for more information) • If needed, set parameters for the date and provider encounters you are preparing. • Open PCMH Huddle or Appointments registry to find the HM column (or right click in any registry row, select Patient View; HM is in Patient Summary tab) • NOTE: First ensure “Health Maintenance” is selected using column picker. This step is only needed once: use “column picker” to select columns to view & rearrange their position order as desired; settings stay until changed by the user. See backup slides for additional detail. • Ensure the open AHLTA record and the HM entry are for the same patient. • In the patient’s MHSPHP Registry entry, scroll to Health Maintenance column.

  19. 3. Copy-paste into TSWF form • Copy an individual element. (e.g. lipid results and date, 10-year CVD risk, etc.) • Paste into the AHLTA TSWF Preventive Services field. (manually typing dates or values is not recommended due to the risk of errors.) • Repeat as needed; clean up any undesired text from TSWF Preventive Services field as needed. • ----Now you’re ready to move to the next patient----

  20. BACKUPS Additional details about the CRHMR and MHSPHP (as of June 2019)

  21. Establish access to MHSPHP Clinical Registries • Open the MHSPHP home page • If you don’t already have access, click “PHI Access” and follow instructions shown on the page.

  22. Open Clinical Registries, “Appointments” or PCMH Huddle

  23. Change to view tomorrow’s appointments • Default view is just today. • Click on Options on the far right of page. • Click the dropdown to select tomorrow or other options shown. • Enter start and end date for other days.

  24. Selected registry icons Mouse over any icon in MHSPHP for description Document generator DMIS filter Scroll to Grid Column picker • Document generator: shows a list of “canned” reports the user can generate, useful for team huddles • DMIS filter: for selecting which DMIS to view, if you have access to more than one DMIS • Column picker: used to select which data columns are shown and the order they are shown, left to right • Scroll to Grid: snaps to the viewable screen so the scroll bars on the right and bottom are easily found

  25. Manipulating Columns Column picker • Uncheck columns to hide (they move to bottom of list) • Rearrange the position of a column by dragging to new position in list of column names or by changing the “Position from left” number • Click Apply

  26. My Layouts in Column Picker • Can create multiple views • Can update a previous saved views • Can create a new view by editing a public view • (Only administrators can make public views) • But you can Share

  27. Changing Parent/Child DMIS • Click Hospital icon to open “Page Filter”. • If your facility is the only DMIS listed, you can ignore this step. • Selections made in Page Filter apply to all registries. • If you have access to more than one DMIS, the best way to see them all is to leave them all unchecked. This will display all DMISs. • If you check select all, only those listed will be checked. • If new providers or provider groups change names, they will not be included.

  28. Sorting Registries • Click on Column header to sort ascending (A-Z, low to high, old to new) • Click on Column header again to reverse order to descending • Click on small arrow in the column header to choose sort on that column • Can sort on multiple columns • In order of how you select the columns

  29. MHSPHP Data Sources • Each metric’s and registry’s data sources are described in the methodology documents (top of navigation menu) • Data is captured from: • DEERS: who is enrolled for metric and list criteria • CHCS Enrollment file: for recent enrollment changes • CHCS encounter data • CHCS Lab data • Direct care inpatient coded records • Direct care encounter data (CAPER) • Purchased care claims for inpt and outpt care • All meds dispensed in direct care or purchased care • Limited AHLTA data: vitals, TSWF MHSPHP AIM data, MH Scores

  30. Understanding Data Timeliness • CRHMR is updated nightly but uses some sources that update at different intervals • Some underlying data takes ~6 wks to receive and process • CVD risk estimates are updated monthly • Other lab tests should be included within 3 days of completion • Enrollment data/contact data: patients are redistributed on all lists according to nightly CHCS enrollment data • Data entered using the TSWF MHSPHP AIM form updates about one to three weeks after entry • Appointment registry updated every 5-15 minutes

  31. General MHSPHP Registry Timeliness

  32. QUESTIONS? • For MHSPHP or Clinical Registries access or functionality questions contact: • Judy Rosen: judith.i.rosen.ctr@mail.mil OR • Kevin Palk: kevin.d.palk.ctr@mail.mil OR • Michael Weisenburger: michael.a.weisenburger.ctr@mail.mil • For Health Maintenance Report content questions contact TSWF Team at • www.tswf-mhs.com/support/(scroll to bottom of the page and click on “Contact Us”)

More Related