Panel Management Workbook Support

Panel Management Workbook Support GPSC – General Practice Services Committee

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Version: 1.0 Date of Revision: January 27th, 2020

TABLE OF CONTENTS

PHASE 1: EMPANELMENT .................................................................................................. 4

Step 1: Unassigned Patients .............................................................................................. 4

Office Provider Assignment Tool .................................................................................... 4

Step 2: Confirm MRP with Patients .................................................................................... 8

Step 3: Define Patient Statuses ....................................................................................... 10

Add New Patient Status................................................................................................ 11

Applying a Patient Status ............................................................................................. 11

Apply Status Per Patient............................................................................................... 11

Apply Status in Mass .................................................................................................... 11

Step 4: Update Patient Statuses ..................................................................................... 12

Action Patients ............................................................................................................. 13

Step 5: Regular Review of Active Patients ...................................................................... 14

Step 6: Calculate Panel Size .......................................................................................... 14

PHASE 2: PANEL CLEAN-UP ............................................................................................ 16

Step 1: Choose Conditions ............................................................................................. 16

Step 2: Code Consistently .............................................................................................. 16

History of Problems ...................................................................................................... 16

Diagnostic Code Favorites ........................................................................................... 18

Step 3: Create a Registry ................................................................................................ 18

Step 4: Update Patient Data ........................................................................................... 20

Step 5: Maintain Registries ............................................................................................. 20

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PHASE 3: PANEL OPTIMIZATION .................................................................................... 20

Step 1: Update Remaining Registries .............................................................................. 20

Step 2: Review Registry Needs ...................................................................................... 20

Step 3: Engage the Team ............................................................................................... 21

Recurring Tasks ........................................................................................................... 21

Hosting Monthly/Quarterly Quality Improvement Meetings ........................................... 23

Step 4: Recalls and Care Planning Activities .................................................................. 26

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PHASE 1: EMPANELMENT STEP 1: UNASSIGNED PATIENTS

Office Provider Assignment Tool Office Provider Assignment is a tool in Accuro that allows searching on a provider by applying one or more rules in order to then mass assign an Office Provider to all patients in the search results. The rules that can be applied are:

Rule 1: Selected provider is family physician and patient has no other office provider.

Rule 2: Selected provider is family physician and patient has different office provider.

Rule 3: Selected provider is most commonly seen and patient has no office provider.

Rule 4: Selected provider is most commonly seen and patient has different office provider.

Rule 5: Selected provider is last seen and patient has no office provider.

Rule 6: Selected provider is last seen and patient has different office provider.

a. Selected provider is family physician and patient has no office provider – if chosen, the provider name matching your selection and currently populating the Family Physician field on this patient record will automatically populate the Office Provider field only if the patient has no Office Provider currently assigned. If there is already a provider name in the Office Provider field, the rule will not be applied.

b. Selected provider is family physician and patient has different office provider – in this case, the provider name matching your selection and currently populating the Family Physician field on this patient record will be applied to the Office Provider field even if a different provider name is currently assigned.

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c. Selected provider is most commonly seen and patient has no office provider – if chosen, the provider name matching your selection will be applied to the Office Provider field on the patient record if they are the provider the patient sees most frequently and there is no other provider currently assigned.

d. Selected provider is most commonly seen and patient has different office provider – in this case, the provider name matching your selection will be applied to the Office Provider field on the patient record if they are the provider the patient sees most frequently even if a different provider name is currently assigned.

e. Selected provider is last seen and patient has no office provider – if chosen, the provider name matching your selection will be applied to the Office Provider field on the patient record if they are the provider last seen by this patient and there is no other provider currently assigned

f. Selected provider is last seen and patient has different office provider – in this case, the provider name matching your selection will be applied to the Office Provider field on the patient record if they are the provider last seen by this patient even if a different provide name is currently assigned.

Once you have searched, applying one or more of the rules, you can assign an Office Provider to the patients displayed. The Office Provider will be currently selected provider. You can also print out a list of these patients, if required, to work manually.

1. Tap the Alt key to open the Accuro Menu, then click Tools and select Office Provider Assignment from the list displayed. The Patient Office Provider Assignment window is displayed:

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1. Click the dropdown at the top of the window and select the provider from the list displayed.

2. Click to select the checkboxes next to the rules you wish to apply. 3. Click the Search button. A list of patients fitting your search criteria are displayed.

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To mass assign an Office Provider to Patient Records

1. Now that the list is displayed, it may be reviewed before applying the change. If there are patient records to which you do not wish the change to apply, you can deselect the record by unchecking the checkbox at the left side of the row.

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2. Click the Assign button at the bottom of the window to apply the changes to patient records. A confirmation message is displayed.

3. Click the Yes button to continue. The patients are assigned to the current office provider selected and a confirmation message is displayed.

4. Click OK to close the message. 5. Repeat as required for all providers.

STEP 2: CONFIRM MRP WITH PATIENTS As indicated in Step 1 above, the Office Provider field in the Patient Demographics is used to capture the MRP for each patient.

Each patient encounter is an opportunity to confirm patient information, including their MRP. When patient demographics are updated in the Patients section of Accuro the last updated field reflects the date of the update and the user who selected the Update Patient button.

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The act of updating a patient’s demographics is also logged in the Audit Logs. Accuro users who are System Administrators can access the Audit Logs by going to the Accuro Menu in the bottom left corner and searching “audit” and then selecting ‘Audit Logs’. In the Audit Log window, select the Activity Filter and sort by the Activity ‘Update Patient’ next select “List Results”. Other filters can be utilized to further narrow the results by date range, user or even patient. STEP 3: DEFINE PATIENT STATUSES Patient Status is a field in the Patient Demographics that allows a user to categorize patients for reporting. The Patient Status is also connected to color, providing a visual indicator when searching patients in the EMR.

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Add New Patient Status 1. To add a new Patient Status to be used for any patient, go to the Patients section along

the Navigation bar on the left of the Accuro window. 2. Search for any patient in the search area at the top of the screen 3. Open the tab ‘Status History’ 4. Click the edit button at the bottom of the tab, this opens the “Manage Patient Status”

window 5. Click the add button here to add a new status 6. Type the name of the status in the first column, such as “Last seen < 2 years” 7. Click into the color column to choose a color associated to this status. The default is

black, but choosing a different color can bring attention to a specific group of patients 8. Press OK after choosing the color 9. Ensure the box for ‘Available /w Pt Status’ is checked 10. You can move the status up or down in the list with the blue arrows on the right 11. Click ‘OK’ once done.

Applying a Patient Status Patient statuses can be applied on a per patient basis, or as a mass action. Apply Status Per Patient

1. Once a patient is loaded as the globally selected patient, move to the Patients Demographics in the Patients section on the Navigation bar on the left of Accuro

2. Near the top of the screen, the Patient Status dropdown is visible, open the dropdown to see the available statuses to choose from

3. Select the appropriate status for the selected patient, and click ‘Update Patient’

Apply Status in Mass For users familiar with the Query Builder, you can generate a query to isolate Patients that require their status to be updated. An example might be:

1. Open Query Builder from the Accuro icon menu either by searching for ‘Query…’ or at Reports | Query Builder (Alerts)

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2. Create a Definition of Patients with a status of Inactive, a specific Office Provider, and a rule of having an appointment in the last year.

a. Reference the User Guide for details on how to create a Query Builder Definition by navigating to the Accuro Start Menu> Help> Accuro User Guide> Search: Query Builder

3. To run this query, click the Run Report button at the bottom-right of the window. This query now creates a report of all inactive patients for the selected Office Provider with a visit in the last year.

4. For all Patients that should be active, highlight the rows by holding down the Control key to multi-select.

5. Either Right Click or use the Drop Down at the bottom to select the ‘Set Patient Status’ option.

6. Select the appropriate status, in this example ‘Active’ and click Ok 7. All previously selected Patients will have their statuses set to ‘Active’

STEP 4: UPDATE PATIENT STATUSES An Active Patients Dashboard was created in Accuro’s Advanced Reporting to assist in determining the number of Active Patients for a Provider and to drill down to the underlying list of patients. To access the report:

1. Launch Advanced Reporting either from a quick launch button or from the Accuro icon menu at Reporting | Advanced Reporting

2. Expand Public | Panel Management 3. Click Active Patients in the report list 4. Under the Options select:

a. Clinic b. Provider(s)

5. Click Apply at the bottom to generate the report

Graphs will show representing the proportion of Active Patients from when they were last seen (last 0-3 years, last 5 years, etc.) or their number of active Rxs (1-4, 5-9, etc.).

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To see the list of Patients in a group, left click the pie chart of the desired group. A list of Patients will be shown. The user can either click the ‘Back to Chart’ button for the full chart or work from the list to update any Patients.

Action Patients As in the previous section to mass apply Patient statuses, users can select to action Patients from the report containing the list of patients.

1. In the top right of a report containing a list of Patients select the Export menu and then select Accuro.

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2. Since the reporting is somewhat segmented from Accuro, you will be prompted to confirm that the Patients map correctly.

3. Click Confirm 4. The same report window from #3 in the Apply Status in Mass section will appear. 5. Follow steps 4-7

STEP 5: REGULAR REVIEW OF ACTIVE PATIENTS Tasks for specific Patients might be an approach to use in Accuro. Please reference the Recurring Tasks section. STEP 6: CALCULATE PANEL SIZE The Panel Balance report was created in Accuro’s Advanced Reporting to automate the calculations required in the workbook. To access the report:


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2. Expand Public | Panel Management 3. Click Panel Balance in the report list 4. Under the Options select:

a. Clinic b. Provider(s) c. # of Months of Data to assess from the current date back d. (Optional) Known/Preferred Provider Visits per Day


The report will display by Provider and have the measures listed with a legend for additional clarification.

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PHASE 2: PANEL CLEAN-UP STEP 1: CHOOSE CONDITIONS Use the chart in the Code Consistency section of the Panel Management Manual and Workbook to begin a list of 3-5 conditions. The appendix on that document also contains some suggestions, like Hypertension or Diabetes. STEP 2: CODE CONSISTENTLY The main area of Accuro that is used to track conditions is in the EMR, within the “History of Problems” Medical History Band. Although this is the space within Accuro that should be used to code conditions, the Dashboards may also use billing diagnostic codes as a backup to ensure that patients are not missed. History of Problems Medical History Bands in the EMR > Encounter Notes, are used to track patient’s diagnoses. Any user with permission to modify this information sees a green add button on the band, to add new problems.

After selecting the add button, you can search for a specific diagnosis by the numeric code, or description. The options button, at the right allows you to choose which code lists are searched. For example, you may want to include the ICD9 code list, but not ICD10 codes.

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After typing in the search criteria, press ‘Enter’ or the “Search” button to display the results.

From the search results, you can select an item to add to the patient’s problem list, or mark any of the results as Favorites. Select the Star to the right of the line item to mark it as a favourite. Any History of Problem can be modified by selecting the edit button (pencil) then choosing the

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history item that needs to be modified. Be sure to click ‘OK’ to save any changes. Diagnostic Code Favorites Favorites are a good way to consistently use the same diagnoses for all patients and users. Once favorites are added, they are visible as soon as you go to add a new problem for a patient, without needing to search. Favorites can also be imported from one user to another with the “Import” button. You can build a consistent list of conditions, and import it to all users to ensure consistency in coding:

1. Search for a test patient in the EMR and click the Add button to add a new History of Problem for this patient. You won’t be adding any medical history items, just populating the list to use for real patients in the future

2. Take your condition list, created in Step 1 and search each condition in the Diagnostic Search window

3. Click the Star for each condition 4. Continue to search for new conditions and select the Star until the list is complete 5. Now, when any user logs into Accuro that is responsible for adding Medical History

items they should go to the EMR and search for a test patient, clicking the Add button to add a new History of Problem

6. Instead of adding an item, or searching, click the “Import” button 7. A dropdown list of users with Favourite lists displays 8. Select the user to import the list from to preview their list 9. Once you’ve confirmed it is the list you want, select ‘Import All” 10. Confirm that you want to continue by pressing “OK” on the popup

STEP 3: CREATE A REGISTRY To access the reports:


2. Expand Public | Panel Management 3. To the right will be a listing of various dashboards

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4. Click on the desired Chronic Disease Management - …. in the report list 5. Under the Options select:

a. Clinic b. Provider(s) c. Include No Diagnosis/Concern (optional)


An example of a chart follows where there are a percentage of Patients with a current diagnosis, some with a potential diagnosis derived from their current Rxs, and some with a potential diagnosis derived from billing diagnosis activity.

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To drill down to the specific Patients in the category of diagnosis (i.e. current or potential), click on the section of the pie. The list of Patients will be displayed in a report and can be actioned as describe in the Action Patients section. STEP 4: UPDATE PATIENT DATA Accuro EMR does not have the ability to mass apply a new or updated condition into the History of Problems Medical History Band. The codes will need to be updated manually. See History of Problems for information on how to add new conditions to a patient’s chart. STEP 5: MAINTAIN REGISTRIES Continual monitoring of the registries can be accomplished by following the steps in the Step 3: Create a Registry section. The dashboards will be available and will always run against the current Accuro data.

PHASE 3: PANEL OPTIMIZATION STEP 1: UPDATE REMAINING REGISTRIES The workbook has this step looking at additional conditions. The same steps can be followed as in in the Step 3: Create a Registry section. All the conditions from the workbook will be available within the different dashboards. The dashboards have been labeled so that the conditions are included in the name. For example, the Chronic Disease Management - OA, Frailty, COPD dashboard displays patients with active or potential chronic diagnoses per Doctors of BC specifications for Osteoarthritis, Frailty, COPD. STEP 2: REVIEW REGISTRY NEEDS

Reviewing the registry for quality improvement is part of this phase. The workbook suggests an example of looking at patients in one of the registries and knowing if they have been in for a visit in the last year.

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The Patient detail report, as described in the Update Patient Statuses section, includes a last appointment date. This can be used when reviewing Patients in the registry and how long since they have been seen. One advanced approach could be to follow the steps in the Action Patients section. Instead of setting a status, you could choose to Create Patient Cohort or Assign Flag. You can then utilize Accuro’s query builder to use the Cohort or Flag as part of the criteria for a new definition, and further filter for Patients who have been seen in the last year (see steps 1-3 in the Apply Status in Mass section). STEP 3: ENGAGE THE TEAM

Recurring Tasks Engage your team by setting up recurring tasks that can act as reminders to rerun your reports, update patient statuses or even to host meetings. To set a reoccurring task, click on the New Task icon in the Home Section:

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Select the user or users on the left-hand side of the window that the task should be assigned to. You can highlight everyone who shares a common role by clicking on the role heading or you can hold the Ctrl key down on your keyboard and click on the individual usernames. Ensure that the task is not associated to a specific patient by leaving the checkbox next to the Patient field unchecked. Consider creating a custom task type titled BC Panel Management Review or an alternative naming convention that works for your clinic. To create a custom task reason, click into the Task Drop down and select manage. Use the Add Button to create a new task type. Select a priority for this task in the drop down. Note that depending on the user(s) the task is sent to that the priority or ‘Urgent” or “Very Urgent” will prompt a pop up when the task becomes due. You can then set an initial time for this task to be due. An example would be in 1 month or by a specific date. Any clarifying notes to the task can be added to the Note section.

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Lastly, to ensure this task recurs, click on the word “Recurring”. Here you can specify the time

intervals and end time for this task to recur. Hosting Monthly/Quarterly Quality Improvement Meetings If you decide to hold monthly or quarterly quality improvement meetings, there are two options to record these in Accuro. The first is by booking a non-patient appointment in Accuro to block off the time the meeting is to take place. The second is to record it in the Office Calendar. To create a non-patient appointment, schedule an appointment as usual (ie. Right click on the scheduler and select Create Appointment). In the Appointment Details window, select the appropriate Type and/or Reason if required and any clarifying notes in the Notes section. At the bottom of the window, ensure No Patient is selected. If you want this meeting to recur, select recurring and set your desired parameters. When you are finished click ok.

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If the meeting times you booked on the scheduler also need to be available for a provider to see patients, you can add another booking column by right clicking at the top of your Scheduler and selecting Bookings and Add Bookings.

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The second option for recording Meetings in Accuro is to utilize the Office Calendar. Every user in your Accuro with access to the Scheduler will have access to this communal calendar. At the bottom of the Scheduler, click on the Calendar Icon:

Right click on the day you wish to have the meeting and select Set Note:

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Give the item a title and add any additional notes if necessary. Each user can refer to this calendar to see upcoming meetings.

STEP 4: RECALLS AND CARE PLANNING ACTIVITIES Accuro uses Patient Tasks to track recalls and reminders. Patient Tasks are visible to all users in the Virtual Chart but are generally assigned to a single user or group of users to complete. Tasks can be created in many ways:

• An Action Button docked to the main Accuro screen

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• Through the F7 shortcut • By right clicking on any item in a patient chart and choosing ‘send task’ • In the Home section with the ‘New Task’ button.

For more information about creating and using tasks, please see the Accuro User Guide by navigating to the Accuro Start Menu> Help> Accuro User Guide> Search: Tasks

Documents

Panel Management Workbook Support