Reminder Dialogs

Introduction

• Reminder Dialogs allow a user to resolve the reminder by entering data into the progress note and PCC

• Saves a step and user does not need to do any typing

• Dialogs can be turned into templates to be used on the notes tab

Introduction

• Dialogs are usually a resolution to a reminder – i.e. documentation of a diabetic foot exam

• However, they may be used to enter PCC data even if there isn’t a reminder, as in patient education

What is a dialog?

• Way to record data in PCC and in progress note

• Looks like TIU template

What is a dialog?

• One click can open up other choices

• Can use check boxes or radio buttons

• As the user opens up a box, data goes into the progress note and/or PCC

What is a dialog?

• Prompts for comments can be added

• Health factor of PREVIOUS SMOKER was added to PCC

• Progress note is being created

What is a dialog?

• Education topics can be addressed

• Prompt for level of understanding

What is a dialog?

• When finished is clicked, the data is inserted into the progress note

• The data that went to PCC is visible at the bottom

PCC Data

Data went to PCC and is on the wellness tab

3 ways to get a dialog

• Import one through Reminder Exchange• Auto-generate one after a reminder is created• Create one from scratch making each piece

Dialog Menus

• Start out on the main Reminder Manager Menu

• Menu is DM Reminder Dialog Management

• Only 2 options• Dialog Parameters • Reminder Dialogs

DI- Reminder Dialogs

• Opens up to the reminders View

• Use CV to see the other items

Dialog Pieces

Choose from: P prompt E dialog element R reminder dialog F forced value G dialog group S result group T result element

• These are the building blocks of the dialog

• Prompts are the smallest piece

• Prompts go on elements• Elements go into dialogs or

they can go into groups• Groups go in dialogs

D for dialogs

Always check for where you are

Check Status

Is it linked?

AD for adding

Look at the dialog

Look at the Progress Note Text

Clean it up –

• Delete items not needed• Edit what it says in the progress note• Add new elements if desired• Auto-generate does NOT make any groups. It

does make the elements • You can choose to re-make the dialog and put

the elements into groups if desired

Display text and progress note text

• These two can be different• The display text is what the person entering the note

sees• Example: DIALOG/PROGRESS NOTE TEXT: Alcohol Screening - Enter results of the CAGE test ALTERNATE PROGRESS NOTE TEXT: CAGE test scores

Reminder Exchange Dialogs

• Dialogs entered through reminder exchange are inactive

• If the reminder has been added to the EHR, this message will appear

Activate the dialog

• In RPMS, go to the list of dialogs

• Choose the one you wish to edit

• Review the dialog• Choose ED to edit the

dialog

Edit the Dialog• NAME: IHS-TOBACCO SCREEN//• DISABLE: DISABLED IN EXCHANGE Replace @• SURE YOU WANT TO DELETE? Y (Yes)• CLASS: LOCAL//• SPONSOR:• REVIEW DATE:• SOURCE REMINDER: TOBACCO TEST//• Select SEQUENCE: 20//

Edit a Dialog Element

• You can edit a dialog element by choosing the number from the dialog screen

• Choices are – E Edit dialog– C Copy and replace– D Delete element

Make a dialog from Scratch

• What do you need?• Write it on paper first• Work from the bottom up, prompts, elements,

groups, dialog

Dialog to Make

• Dialog closed

Groups Open Up

• Group contains Elements

Fully Expanded

• Dialog after creation• Groups• Elements– Education Topics– Order

• Prompts

Prompts – the smallest level

• Those that start with PXRM come with reminders.

• All others are build from those

• A prompt must be attached to an element AND the comments prompt must also be included

Prompts• Select DIALOG to add: SIDE EFFECTS• Are you adding 'SIDE EFFECTS' as a new REMINDER DIALOG (the 79TH)?

No// Y• Prompt NAME: SIDE EFFECTS//• DISABLE Prompt:• CLASS: L LOCAL• SPONSOR:• REVIEW DATE:• PROMPT CAPTION: Side Effects• EXCLUDE FROM PROGRESS NOTE:• DEFAULT VALUE: • Select CHECKBOX SEQUENCE:

Elements – Where the work happens

• Naming Conventions– ED Education topics– HF Health Factors– EX Exams– IM Immunizations– OI Orderables– HD or TX for text only or headers

Elements – without PCC Data• Select DIALOG to add: HD HTN TAKING MEDS Are you adding 'HD HTN TAKING MEDS' as a new REMINDER DIALOG (the 80TH)? No//• DISABLE:• CLASS: L LOCAL• SPONSOR:• REVIEW DATE:• RESOLUTION TYPE: Not doing PCC Data• ORDERABLE ITEM:• FINDING ITEM: Not doing PCC Data

Elements – No PCC

• DIALOG/PROGRESS NOTE TEXT:– Is patient taking medications as directed?

• ALTERNATE PROGRESS NOTE TEXT:– Patient’s medication compliance

• EXCLUDE FROM PROGRESS NOTE:• SUPPRESS CHECKBOX:• Select ADDITIONAL FINDINGS:• RESULT GROUP/ELEMENT:• Select SEQUENCE:

Elements – Add Prompts

• Select SEQUENCE: 1 ADDITIONAL PROMPT/FORCED VALUE: SIDE EFFECTS prompt

LOCAL ...OK? Yes// (Yes)• OVERRIDE PROMPT CAPTION:• START NEW LINE: 1 YES• EXCLUDE FROM PN TEXT:• REQUIRED:• Select SEQUENCE: 10

ADDITIONAL PROMPT/FORCES VALUE: PXRM COMMENTSOK? Yes// Need this one for local prompts to appear

Element – Education Topic

• Select DIALOG to add: ED HTN MEDICATIONS• Are you adding ‘ED HTN MEDICATIONS' as a new

REMINDER DIALOG (the 83TH)? No// YNAME: ED HTN MEDICATIONS//

• DISABLE:• CLASS: L• SPONSOR:• REVIEW DATE:• RESOLUTION TYPE: DONE AT ENCOUNTER

Element – Education Topic• ORDERABLE ITEM:• FINDING ITEM: ED.HTN-MHTN-MEDICATIONS HTN-MEDICATIONS HTN-M ...OK? Yes//• DIALOG/PROGRESS NOTE TEXT:• The patient is able to verbally summarize their medication regimen• and the importance of compliance with therapy.• • Edit? NO//• ALTERNATE PROGRESS NOTE TEXT:• No existing text• Edit? NO//• EXCLUDE FROM PROGRESS NOTE:• SUPPRESS CHECKBOX:

Element – Education Topic• Select ADDITIONAL FINDINGS:• RESULT GROUP/ELEMENT:• Select SEQUENCE: 1 ADDITIONAL PROMPT/FORCED VALUE: PXRM LEVEL 1 PXRM LEVEL OF SEVERITY prompt NATIONAL 2 PXRM LEVEL OF UNDERSTANDING prompt NATIONAL CHOOSE 1-2: 2 PXRM LEVEL OF UNDERSTANDING prompt NATIONAL

OVERRIDE PROMPT CAPTION: START NEW LINE: 1 YES EXCLUDE FROM PN TEXT: REQUIRED: 1 YES

• Select SEQUENCE: 10 ADDITIONAL PROMPT/FORCED VALUE: PXRM COMMENT// OVERRIDE PROMPT CAPTION: PXRM COMMENT// START NEW LINE: Y YES EXCLUDE FROM PN TEXT: REQUIRED:

Element - Order• Select DIALOG to add: OI HYPERTENSIVE MEDS Are you adding 'OI HYPERTENSIVE MEDS' as a new REMINDER DIALOG (the 84TH)? No//• DISABLE:• CLASS: LOCAL//• SPONSOR:• REVIEW DATE:• RESOLUTION TYPE: ORDERED ...OK? Yes// Y (Yes) • ORDERABLE ITEM:• FINDING ITEM: Q.PSOZM HYPER PSOZM HYPERTENSION MEDS• ...OK? Yes//

Element - Order• DIALOG/PROGRESS NOTE TEXT:• Check to order or change medications Edit? NO//• ALTERNATE PROGRESS NOTE TEXT:• Medication change ordered Edit? NO//• EXCLUDE FROM PROGRESS NOTE:• SUPPRESS CHECKBOX:• Select ADDITIONAL FINDINGS:• RESULT GROUP/ELEMENT:• Select SEQUENCE: Input your edit comments. Edit? NO//

Group – Makes it prettier

• A group allows you to put several elements together. Groups can be hidden until clicked so they act like templates

• Users may select 1 or more items in the group

Group• Select Item: Quit// AD Add• Select DIALOG to add: GRP HTN LIFESTYLE CHANGES• Are you adding 'GRP HTN LIFESTYLE CHANGES' as• a new REMINDER DIALOG (the 97TH)? No// Y• NAME: GRP HTN LIFESTYLE CHANGES Replace• DISABLE:• CLASS: L

Groups

• SPONSOR:• REVIEW DATE:• RESOLUTION TYPE: Would apply• ORDERABLE ITEM: to entire group• FINDING ITEM: • GROUP CAPTION:• PUT A BOX AROUND THE GROUP: y

Group

• SHARE COMMON PROMPTS: 0• 1 yes• 0 no

• MULTIPLE SELECTION: 2 • 0 NO SELECTION REQUIRED• 1 ONE SELECTION ONLY• 2 ONE OR MORE SELECTIONS• 3 NONE OR ONE SELECTION

• HIDE/SHOW GROUP: H

Groups• GROUP HEADER DIALOG TEXT:

Check to document lifestyle changes discussed with patient Edit? NO//• GROUP HEADER ALTERNATE P/N TEXT: The following lifestyle changes were discussed with the

patient/family: Edit? NO//• EXCLUDE FROM PROGRESS NOTE:• SUPPRESS CHECKBOX: If you want it mandatory or for headers• NUMBER OF INDENTS: 2

Groups• INDENT PROGRESS NOTE TEXT:y• Select ADDITIONAL FINDINGS:• Select SEQUENCE: 1• DIALOG ELEMENT: ED HTN-WEIGHT CONTROL

dialog element LOCAL ...OK? Yes// EXCLUDE FROM PN TEXT:• Select SEQUENCE: 2 ……Continue to add elements to the group

Group view

Group – progress note text

Dialog – The upper level

• The dialog is now ready to be created• Dialog can be made up of elements and/or

groups

Dialog• Select Item: Quit// AD Add Reminder Dialog• GENERATE DIALOG AUTOMATICALLY: Y// NO• Select DIALOG to add: HTN INTERVENTION Are you adding 'HTN INTERVENTION' as a new

REMINDER DIALOG (the 98TH)? No// y• NAME: HTN INTERVENTION• DISABLE:• CLASS: l LOCAL• SPONSOR:

Dialog

• REVIEW DATE:• SOURCE REMINDER: HTN INTERVENTION

LOCAL• Select SEQUENCE: – Can enter the sequence number for what you

want on the dialog OR

Dialog

• Select the dialog• Select Sequence: Quit//

5• ARE YOU ADDING 5 AS

A NEW SEQUENCE NUMBER: N// y YES

• Select new DIALOG ELEMENT: GRP HTN LIFE

Dialog

• Puts it in • Often leave spaces

between items for later editions

• Easiest way to edit a dialog

• Can edit, delete, copy items

Finished dialog

Attaching to a Reminder

• A dialog made this way does not need to be attached to a reminder

• It can be a dialog template to be used in notes• If it has a source reminder, you must go back

to the reminder and attach it.• Select CV to change view and go to R for

reminders

Attaching

• Choose LR to link reminder

• LINKED REMINDER DIALOG: HTN INTERVENTION reminder dialog LOCAL

...OK? Yes//

Attaching

• How do you view this reminder?

• Add it to the list for the EHR and then test

• All changes must be made in RPMS

• No editing in the GUI

Test the Dialog

• Add this reminder to list• Start a note• View the reminder

Test the dialog

• Make changes until it looks the way you desire

• Then make it available for all needed clinicians

Test the dialog

• If you added any orders, are they working correctly?

Making a Dialog TIU Template

• A dialog can be used as a note template• Education dialogs are good examples since

you don’t always know when you are going to do the education

• They are still made in RPMS but not attached to a reminder

• When finished, they must be available to TIU

Attach to Parameter• TIU TEMPLATE REMINDER DIALOGS may be set for the

following:

1 User USR [choose from NEW PERSON] 3 Service SRV [choose from SERVICE/SECTION] 4 Division DIV [DEMO HOSPITAL] 5 System SYS [DEMO.CIAINFORMATICS.COM]

TIU TEMPLATE REMINDER DIALOG• Enter selection: 5 System DEMO.CIAINFORMATICS.COM • - Setting TIU TEMPLATE REMINDER DIALOGS for System:

DEMO.CIAINFORMATICS.COM -• Select Display Sequence: 1 • Display Sequence: 1// 1• Clinical Reminder Dialog: TEST// TEST reminder dialog LOCAL ...OK? Yes// (Yes) • Select Display Sequence: 2• Are you adding 2 as a new Display Sequence? Yes// YES • Display Sequence: 2// 2• Clinical Reminder Dialog: HTN INTERVENTION reminder dialog LOCAL ...OK? Yes// (Yes)

EHR Template Editor

TIU Reminder Dialog

New Type – Reminder Dialog

Make a new template

Reminder Templates

Attach it to the reminder dialog

Reminder Templates

Its now available in the template drawer

Reminder Templates

• These templates CANNOT be part of any other TIU template

• If you add it as a “sub template”, TIU will skip over it

• Questions