Wellness Reminders, Immunizations, and aCPGs

1. Wellness Reminders, Immunizations, and aCPGs Overview for Navy Training Conference Aug 9, 2007 David Parker, MD

2. AHLTA Wellness Reminders Overview

3. Enterprise Configuration • Determines what Wellness reminders are turned on for what patient population • Based on USPSTF guidelines applicable to general population • Configurable by Age and/or Gender • The schedule for these can be changed (or the reminder inactivated altogether) for a particular patient by clinic personnel.

4. Automated Clearing • Reminders are automatically cleared by the system by: • Lab or Radiology results • Based upon an enterprise-level mapping of results to reminders • Encounter Documentation • Based upon vitals or procedures • Note: Pneumococcal Vaccination is based upon the documentation of the Pneumococcal Vaccine PROCEDURE code, not the immunization itself

5. Reminders Tab in AP • The AP/Reminders tab shows the Reminders for the patient • There is a default action set for each • Send the order set for that reminder at the MTF (set in Reminder Mapping module*) • The order only turns the reminder “yellow”. The result, once received, will clear the reminder altogether • Document Complete • Just check the ones you want to address and hit submit *Note: Nothing else should be done at the MTF level than setting the default order. Anything else OVERRIDES the enterprise configuration and is likely less accurate.

6. Immunizations Overview

7. Enterprise Configuration & Interfaces • The Enterprise Configuration was recently completely reviewed and updated by MILVAX • All vaccines are in system with their schedules configured per guidance • AHLTA Immunizations improved interface with DEERS for AD is now operational. • Pulls from DEERS are triggered by appointments • Immunizations Bidirectional interface with NMO is waiting Navy-side development to be finished • Will seed historical immunizations • Includes dependent immunizations • Army interface is (semi-)operational • AF is re-starting this month

8. Immunizations Hints • Don’t forget “Groups” • Add the “Anthrax” or “Centcom AOR” group(s), for example, to automatically determine schedule, etc. for a patient for whom these are applicable. • Pediatric and Service-specific “groups” are automatically applied by the system • CTS • Don’t forget to set up your “Stock” in Immunizations Admin module so that you can “give” a vaccine to a patient.

9. Updates for Immunizations with 3.3 • Coding aspects of Immunizations better automated in 3.3 • Encounter association facilitated • Procedure codes for the immunizations given automatically applied to the encounter

10. aCPG Functionality Overview

11. aCPG Goals • General Tools applicable to a broad range of tracking needs • CPG implementation • Tracking (disease-based or situation-based, whether clinical or not) • Point-of-care focused • Easily actionable reminders • with automated clearing of lab, rad, and encounter documentation-oriented reminders • Automatically presented to user for a patient on a registry that is activated for the clinic of the encounter • Easy access to appropriate templates, order sets, questionnaires • Registry-specific autocites • CPG Reminders Integrated with Wellness Reminders • Don’t bother clinic personnel for whom a particular registry/CPG is not applicable • Configurable to be active or not by facility and down to the local clinic level

12. About Registries • Enterprise, MTF, Clinic, & Personal registries • Associated reminder protocols • automatically presented to user • Templates/Order Sets & Questionnaires that are pre-positioned for the AHLTA user • MTF and Clinic-based filtering • Registry Patient List • Custom filtering • Automated and Manual registration • Automated out of encounter information • Securable • Access can be restricted to specific people or clinics, PCM