Veterans Health Gateway Tutorial 2.0 Triage and Health Information Solution

Veterans Health Gateway

Tutorial 2.0

Triage and Health Information Solution

When the user clicks on the VHG button in the TeleCare Record Manger (TRM) software, VHG opens and the Start screen appears. Most of the required

information is automatically transferred from Telecare Record Manager (TRM).

When the user clicks on the VHG button in the TeleCare Record Manger (TRM) software, VHG opens and the Start screen appears. Most of the required

information is automatically transferred from Telecare Record Manager (TRM).

Start ScreenStart Screen

If the user is not connected to TRM, then he or she must enter the required information.

If the user is not connected to TRM, then he or she must enter the required information.


In either case, the user must choose a Call Reason from the list.

In either case, the user must choose a Call Reason from the list.


Then the user clicks on Start.Then the user clicks on Start.

Note: the format of the Encounter: Start screen may vary, depending on which version of VHG is used.

Note: the format of the Encounter: Start screen may vary, depending on which version of VHG is used.


Locate Chief Complaint ScreenLocate Chief Complaint Screen

VHG advances to the Locate Chief Complaint screen. VHG filters algorithms according to age and gender. In this case, all

algorithms are appropriate for a 55 year old male.

VHG advances to the Locate Chief Complaint screen. VHG filters algorithms according to age and gender. In this case, all

algorithms are appropriate for a 55 year old male.

If the user has not already done so, he or she must briefly interview the caller, in order to identify the caller’s current symptoms. The user must then choose the Chief Complaint, which is the most serious, specific

symptom.

If the user has not already done so, he or she must briefly interview the caller, in order to identify the caller’s current symptoms. The user must then choose the Chief Complaint, which is the most serious, specific

symptom.

Locate Chief Complaint ScreenLocate Chief Complaint Screen

1

If the caller has symptoms, the user may perform a Symptom Search for

the Chief Complaint, …

If the caller has symptoms, the user may perform a Symptom Search for

the Chief Complaint, …

3

… or choose a Chief Complaint in the General or Skin lists.

… or choose a Chief Complaint in the General or Skin lists.2

… use the golden model to find the Chief Complaint, …… use the golden model to find the Chief Complaint, …

Enter text into the search field to perform a search for a symptom

algorithm, post-op condition algorithm or case-management algorithm, and then click on Go.

Enter text into the search field to perform a search for a symptom

algorithm, post-op condition algorithm or case-management algorithm, and then click on Go.

1. Chief Complaint Search: Text Search1. Chief Complaint Search: Text Search

This is the MOST powerful way to find the most

appropriate Chief Complaint.



The resulting search provides all of the algorithms that contain the word “chest”. In the

resulting list, click on the algorithm that best represents the patient’s chief complaint, in

order to start the triage process.

The resulting search provides all of the algorithms that contain the word “chest”. In the

resulting list, click on the algorithm that best represents the patient’s chief complaint, in

order to start the triage process.

1. Chief Complaint Search: Text Search1. Chief Complaint Search: Text Search





Click on the golden model to access the most commonly used symptoms that correspond to the

chosen body region.

Click on the golden model to access the most commonly used symptoms that correspond to the

chosen body region.

2. Chief Complaint Search: Golden Model2. Chief Complaint Search: Golden Model

In the resulting list, click on the algorithm that best represents the patient’s chief complaint, in order to start the triage

process. Remember: this is not the entire list of algorithms that apply to the chest.

In the resulting list, click on the algorithm that best represents the patient’s chief complaint, in order to start the triage

process. Remember: this is not the entire list of algorithms that apply to the chest.


Click on this image, in order to access posterior body

regions on the golden model.

Click on this image, in order to access posterior body

regions on the golden model.


Click on the golden model to access the most common symptoms that correspond to the

back. Remember: this is not the entire list of algorithms that apply to the back.

Click on the golden model to access the most common symptoms that correspond to the

back. Remember: this is not the entire list of algorithms that apply to the back.


3. Chief Complaint: General and Skin3. Chief Complaint: General and Skin

Click on the algorithm that best represents the

patient’s chief complaint, in order to

start the triage process.

Click on the algorithm that best represents the

patient’s chief complaint, in order to

start the triage process.

These lists contain the most common general algorithms

and skin algorithms.

These lists contain the most common general algorithms

and skin algorithms.

Duration of Complaint and Pain ScoreDuration of Complaint and Pain Score

After the user chooses an algorithm, he or she advances to the Duration of Complaint screen.After the user chooses an algorithm, he or she advances to the Duration of Complaint screen.

The user may access past triage encounter records on this patient by clicking on the double arrows, in

order to expand the list of Past Encounters.

The user may access past triage encounter records on this patient by clicking on the double arrows, in

order to expand the list of Past Encounters.

Current Patient information is displayed.Current Patient information is displayed.

Duration of Complaint and Pain ScoreDuration of Complaint and Pain Score

The user must enter a duration for the chief complaint. If the caller chief complaint is pain, the

user must choose a corresponding pain score.

The user must enter a duration for the chief complaint. If the caller chief complaint is pain, the

user must choose a corresponding pain score.

Duration of ComplaintDuration of Complaint

Choose a value for the duration of the Chief Complaint.

Choose a value for the duration of the Chief Complaint.

Duration of ComplaintDuration of Complaint

Choose a unit for the Duration of the Chief Complaint.

Choose a unit for the Duration of the Chief Complaint.

Pain ScorePain Score

Choose a value for the pain score. In this case, Rash (Localized) does

not require this action.

Choose a value for the pain score. In this case, Rash (Localized) does

not require this action.

Click on Continue in order to advance to the

first triage question.

Click on Continue in order to advance to the

first triage question.

Question ScreenQuestion Screen

A rationale is provided for each question. A rationale is provided for each question.

After the user completes the documentation in the Duration of Complaint screen, VHG advances to the Question screens.

After the user completes the documentation in the Duration of Complaint screen, VHG advances to the Question screens.

Question Screen: Answering QuestionsQuestion Screen: Answering Questions

The user may click on the Previous button to go back to the previous question.

This action resets the triage decision–making and allows

the user to change the answer to the previous

question.

The user may click on the Previous button to go back to the previous question.

This action resets the triage decision–making and allows

the user to change the answer to the previous

question.


The user must answer Yes or No to the question in order to proceed.

The user should use his or her best judgment if the caller does not know

the answer to the question.

The user must answer Yes or No to the question in order to proceed.

The user should use his or her best judgment if the caller does not know

the answer to the question.

Question Screen: Glossary WordsQuestion Screen: Glossary Words

The user may click on an underlined word, in

order to view a glossary definition.

The user may click on an underlined word, in

order to view a glossary definition.

Question Screen: Glossary WordsQuestion Screen: Glossary Words


If the user answers Yes to a question . . .If the user answers

Yes to a question . . .


If the user answers Yes to “You have taken your

temperature” . . .

If the user answers Yes to “You have taken your

temperature” . . .

. . . the positive responses are displayed on the left

side of the screen.

. . . the positive responses are displayed on the left

side of the screen.


. . . he or she chooses the highest temperature in degrees F., and . . .. . . he or she chooses the highest temperature in degrees F., and . . .

. . . records the temperature to the nearest tenth of a degree.. . . records the temperature to the nearest tenth of a degree.



After the temperature has been entered, the user clicks

on the Continue button.

After the temperature has been entered, the user clicks

on the Continue button.


When the Positive responses satisfy a triage endpoint, or urgency recommendation, VHG

immediately advances to the Disposition screen . . .

When the Positive responses satisfy a triage endpoint, or urgency recommendation, VHG

immediately advances to the Disposition screen . . .

VHG utilizes pregnancy, blood pressure and weight loss calculators, which are similar to the

temperature documentation function.

VHG utilizes pregnancy, blood pressure and weight loss calculators, which are similar to the

temperature documentation function.

On the Disposition Screen, VHG provides a System Recommendation.

This is the follow-up interval, within which the patient should receive care

from a health care provider.

On the Disposition Screen, VHG provides a System Recommendation.

This is the follow-up interval, within which the patient should receive care

from a health care provider.

Disposition Screen: VHG RecommendationDisposition Screen: VHG Recommendation

VHG provides a “System Concern”, which is a condition or a list of conditions. This list represents conditions that cause the

most concern, given the caller’s presentation. The System Concern does NOT represent an exact diagnosis for the

caller.

VHG provides a “System Concern”, which is a condition or a list of conditions. This list represents conditions that cause the

most concern, given the caller’s presentation. The System Concern does NOT represent an exact diagnosis for the

caller.

Disposition Screen: System ConcernDisposition Screen: System Concern

If the user disagrees with the VHG Recommendation, he or she may choose an alternate

follow-up interval for the Nurse Recommendation.

If the user disagrees with the VHG Recommendation, he or she may choose an alternate

follow-up interval for the Nurse Recommendation.

Disposition Screen: Nurse RecommendationDisposition Screen: Nurse Recommendation

The user must document the follow-up Location by choosing

an option from the list.

The user must document the follow-up Location by choosing


Disposition Screen: LocationDisposition Screen: Location

The user must document Patient Agreement, which reflects whether or not the patient agrees with the given

follow-up recommendation.

The user must document Patient Agreement, which reflects whether or not the patient agrees with the given


Disposition Screen: AgreementDisposition Screen: Agreement

Disposition Screen: RedirectionDisposition Screen: Redirection

The user must perform a Redirection Survey, by choosing


The user must perform a Redirection Survey, by choosing


Disposition Screen: ModifierDisposition Screen: Modifier

The user may choose a Modifier, which represents a reason for

shortening the follow-up interval. For example, the user may have decided

to change the follow up interval from 2-8 hours, to Urgent (now), because the caller has multiple chronic illnesses.

The user may choose a Modifier, which represents a reason for

shortening the follow-up interval. For example, the user may have decided

to change the follow up interval from 2-8 hours, to Urgent (now), because the caller has multiple chronic illnesses.

Disposition Screen: Nurse NotesDisposition Screen: Nurse Notes

The user may enter notes in the Nurse Notes field.The user may enter notes in the Nurse Notes field.

Disposition Screen: Patient EducationDisposition Screen: Patient Education

Copied health information is automatically placed in the Patient Education field. Please see the future section in

this presentation, “Accessing Health Information at the End of Triage”, for more information about this feature.

Copied health information is automatically placed in the Patient Education field. Please see the future section in

this presentation, “Accessing Health Information at the End of Triage”, for more information about this feature.

Disposition Screen: Adding Negative ResponsesDisposition Screen: Adding Negative Responses

The user may choose to add Negative responses to the Triage Encounter Note. The user clicks on the double arrows, in order to

expand the Add Pertinent Negatives list.

The user may choose to add Negative responses to the Triage Encounter Note. The user clicks on the double arrows, in order to

expand the Add Pertinent Negatives list.

IMPORTANT: users should not use the “Add Pertinent Negatives”

function if Telecare administrative policy prohibits adding Negative

responses to the Encounter Report. Please check with your

administrator.




administrator.

The user may click in the checkboxes, in order to add Negative responses to the

Triage Encounter Report, . . .

The user may click in the checkboxes, in order to add Negative responses to the

Triage Encounter Report, . . .





administrator.




administrator.

When the user is finished, he or she clicks on “Save and Preview Report,” in order to advance to the Preview Report screen.

When the user is finished, he or she clicks on “Save and Preview Report,” in order to advance to the Preview Report screen.

. . . or the user may click in the “Select all negatives”

checkbox, in order to add all Negative responses to the Triage Encounter Report.

. . . or the user may click in the “Select all negatives”

checkbox, in order to add all Negative responses to the Triage Encounter Report.





administrator.




administrator.

Preview Report ScreenPreview Report Screen

The nurse may edit the text in the report.

The nurse may edit the text in the report.

The format of the report may vary, depending on which version of VHG is used.

The format of the report may vary, depending on which version of VHG is used.

Preview Report ScreenPreview Report Screen

The user may return to the Disposition screen by clicking

on the Dispo Button. This action allows the user to

change information on the Disposition screen, and then

view the report again.

The user may return to the Disposition screen by clicking

on the Dispo Button. This action allows the user to

change information on the Disposition screen, and then

view the report again.

The user clicks on “Finalize Report” when he or she is finished editing the

report. VHG proceeds to the Final Report screen.

The user clicks on “Finalize Report” when he or she is finished editing the

report. VHG proceeds to the Final Report screen.

This is the final version of the report: the user may

not edit this text.

This is the final version of the report: the user may

not edit this text.

Final Report ScreenFinal Report Screen


Click on “Return to TRM” in order to send the report to TRM. The VHG browser will close

and workflow continues in TRM.

Click on “Return to TRM” in order to send the report to TRM. The VHG browser will close

and workflow continues in TRM.


In the rare event that TRM or CPRS is not available, the user can continue to use VHG. When the user

reaches the Final Encounter Report screen, the user must 1) copy the Triage Encounter note and paste it

into another application, such as Notepad. And then, when TRM and CPRS are available, 2) the

note must be copied from Notepad and pasted into TRM or CPRS. The user may also print the report

by clicking on Print.

In the rare event that TRM or CPRS is not available, the user can continue to use VHG. When the user

reaches the Final Encounter Report screen, the user must 1) copy the Triage Encounter note and paste it

into another application, such as Notepad. And then, when TRM and CPRS are available, 2) the

note must be copied from Notepad and pasted into TRM or CPRS. The user may also print the report

by clicking on Print.

Accessing Health Information at the End of Triage

Related health information and care instructions

Accessing Patient Education InformationAccessing Patient Education Information

On the Disposition screen, the user may access Patient Education information from the libraries by entering text into

the Library Search field and clicking on Go . . .

On the Disposition screen, the user may access Patient Education information from the libraries by entering text into

the Library Search field and clicking on Go . . .

. . . or by clicking on the Care Advice links below. These links provide access to information that corresponds with the

System Concern.

. . . or by clicking on the Care Advice links below. These links provide access to information that corresponds with the

System Concern.


The user may click on a link to advance to specific

information.

The user may click on a link to advance to specific

information.

The user may click on a link to advance to related information.The user may click on a link to advance to related information.


For example, if the user clicks on a link to advance to the corresponding topic in

the health information library. . .

For example, if the user clicks on a link to advance to the corresponding topic in

the health information library. . .


. . . VHG advances to the corresponding topic: Home Treatment of Fever.

. . . VHG advances to the corresponding topic: Home Treatment of Fever.

Click on the grey banner, in order to access the corresponding section of text.



The corresponding text is displayed under

the grey banner.

The corresponding text is displayed under

the grey banner.



Clicking on underlined text provides a

glossary definition.



Clicking on blue highlighted text advances VHG to the corresponding topic in the

Health Information Libraries.



Accessing Patient Education Information to the RecordAccessing Patient Education Information to the Record

The user accesses another section by clicking on a grey banner.

The user accesses another section by clicking on a grey banner.

The corresponding text is displayed under the grey banner, and the

previous text disappears.

The corresponding text is displayed under the grey banner, and the

previous text disappears.

Accessing Patient Education Information to the RecordAccessing Patient Education Information to the Record

Adding Patient Education Information to the RecordAdding Patient Education Information to the Record

If the user reads information to the caller, he or she may select the text, in

order to add it to the encounter record . . .

If the user reads information to the caller, he or she may select the text, in

order to add it to the encounter record . . .


. . . by placing the mouse pointer at the end of the desired text, holding

down the left mouse button…




. . . and moving the pointer to the beginning of the desired text.



When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the triage encounter record. The user clicks on OK, in order to confirm the action.

When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the triage encounter record. The user clicks on OK, in order to confirm the action.

Hi-lighted instructions are included on the left side of the

screen.


screen.


Click on Dispo to return to the Disposition screen.

Click on Dispo to return to the Disposition screen.

Disposition ScreenDisposition Screen

When the user returns to the Disposition screen, copied health information has been automatically placed in the Patient Education

field.

When the user returns to the Disposition screen, copied health information has been automatically placed in the Patient Education

field.

Providing Health Information to Callers

When a caller does not require triage

Completing an Education CallCompleting an Education Call

. . . or 2) click on one of the health information library tabs.

. . . or 2) click on one of the health information library tabs.

2

1

If the patient calls for health information and does not have

symptoms, the nurse may access reference health information in two

ways: 1) perform a search by entering text into the search field

and click Go . . .

If the patient calls for health information and does not have

symptoms, the nurse may access reference health information in two

ways: 1) perform a search by entering text into the search field

and click Go . . .


For example, the user may enter the text string, “b-a-c-k”,

and then click on Go.

For example, the user may enter the text string, “b-a-c-k”,

and then click on Go.


Click on Back Pain: Overview, in order to access the topic from the Disease Library.

Click on Back Pain: Overview, in order to access the topic from the Disease Library.

VHG provides search results for b-a-c-k.

VHG provides search results for b-a-c-k.


. . . VHG advances to the corresponding topic: Back Pain.

. . . VHG advances to the corresponding topic: Back Pain.




The corresponding

text is displayed under the grey

banner.

The corresponding

text is displayed under the grey

banner.











If the user reads information to the caller, he or she may select the text, in order to add to the encounter record . . .If the user reads information to the caller, he or she may

select the text, in order to add to the encounter record . . .










When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the encounter

record. The user clicks on OK, in order to confirm the action.

When the user releases the left button on the mouse, VHG asks if he or she wishes to add the text to the encounter

record. The user clicks on OK, in order to confirm the action.


screen.


screen.


Additional resources are available on the right side of the screen: 1)

Related Images, 2) Related News, 3) Spanish and 4) Web Search.

Additional resources are available on the right side of the screen: 1)

Related Images, 2) Related News, 3) Spanish and 4) Web Search.


Click on the double arrows to expand or close the menu lists.Click on the double arrows to

expand or close the menu lists.


Click on the page number to advance through the list of items in the menu.

Click on the page number to advance through the list of items in the menu.


Click on an item in the menu to open it.Click on an item in

the menu to open it.


Click on Dispo to proceed to the Disposition screen.Click on Dispo to proceed to the Disposition screen.

When the user returns to the Disposition screen, copied health information is automatically placed in the Patient Education field.When the user returns to the Disposition screen, copied health

information is automatically placed in the Patient Education field.



If the user wants to arrange follow-up, he or

she may choose a follow-up interval under Nurse

Recommendation.

If the user wants to arrange follow-up, he or

she may choose a follow-up interval under Nurse

Recommendation.


And then, the user may choose a Follow-up Location.

And then, the user may choose a Follow-up Location.


The user may document Patient Agreement by choosing an option from the list. This response reflects whether or not the patient agrees with the given


The user may document Patient Agreement by choosing an option from the list. This response reflects whether or not the patient agrees with the given



The user may enter additional notes in the Notes field.The user may enter additional notes in the Notes field.


Click on “Save and Preview Report,” in order to advance to the Preview Report

screen and finish the record.

Click on “Save and Preview Report,” in order to advance to the Preview Report

screen and finish the record.

Navigation Buttons

Veterans Health Gateway

Always use the VHG navigation buttons.Always use the VHG navigation buttons.

Never use the browser navigation buttons.Never use the browser navigation buttons.

Navigation Button: Locate Chief Complaint ScreenNavigation Button: Locate Chief Complaint Screen

The Dispo button allows the user to advance to the Disposition screen. The user may take

this action if there is no need for a triage algorithm. For example, when the caller states that the patient is actively seizing.

The Dispo button allows the user to advance to the Disposition screen. The user may take

this action if there is no need for a triage algorithm. For example, when the caller states that the patient is actively seizing.

Navigation Buttons: Duration of Complaint and Pain Score Screen

Navigation Buttons: Duration of Complaint and Pain Score Screen

The Start Over button returns the user to the Chief

Complaint screen. This action allows the user to

choose another Chief Complaint and resets the triage decision-making to

correspond to the new chief complaint.




correspond to the new chief complaint.

The Dispo button allows the user to advance to the

Disposition screen.


Disposition screen.

The Previous button allows the user to go back one

screen.


screen.




correspond to the new chief complaint; however, all

currently collected responses are saved and

recorded in the Triage Encounter Record.








Disposition screen.


Disposition screen.

Navigation Buttons: Question ScreenNavigation Buttons: Question Screen

Navigation Buttons: Disposition Screen Navigation Buttons: Disposition Screen


screen.


screen.













Navigation Buttons: Information LibrariesNavigation Buttons: Information Libraries


screen.


screen.


Disposition screen.


Disposition screen.

Accessing Images

Valuable assistance for the user

Triage Questions: Viewing ImagesTriage Questions: Viewing Images

The user may click on an image, in order to see an

enlarged view.

The user may click on an image, in order to see an

enlarged view.

Triage Questions: Viewing ImagesTriage Questions: Viewing Images

The user must use the close buttons in order to close the image window.


Health Information Libraries: Viewing ImagesHealth Information Libraries: Viewing Images

. . . or 2) clicking on the camera icons in the text.. . . or 2) clicking on the camera icons in the text.

21

The user may view images in the health information libraries by 1) clicking on a title in the Related Images section on the

right side of the screen, . . .

The user may view images in the health information libraries by 1) clicking on a title in the Related Images section on the

right side of the screen, . . .

1. Viewing Related Images1. Viewing Related Images

Related Images are displayed in the same window. The user must use the Previous or Dispo buttons in order to proceed.

Related Images are displayed in the same window. The user must use the Previous or Dispo buttons in order to proceed.

2. Viewing Images Using the Camera Icons2. Viewing Images Using the Camera Icons

Clicking on the camera icon displays the image in

a pop-up window.

Clicking on the camera icon displays the image in

a pop-up window.

2. Viewing Images Using the Camera Icons2. Viewing Images Using the Camera Icons



Aborting the Clinical Encounter

Providing an alternative for infrequent mistakes

Aborting a Clinical EncounterAborting a Clinical Encounter

Rarely, a user may wish to Abort a clinical encounter, e.g., when the user starts an encounter on the wrong patient. This action aborts the decision-making process and completely erases all of the data collected during the triage session. In order to Abort, click on the Dispo button from any screen in

VHG . . .

Rarely, a user may wish to Abort a clinical encounter, e.g., when the user starts an encounter on the wrong patient. This action aborts the decision-making process and completely erases all of the data collected during the triage session. In order to Abort, click on the Dispo button from any screen in

VHG . . .

Aborting a Clinical EncounterAborting a Clinical Encounter

. . . and then click on the Abort button on the Disposition screen.

. . . and then click on the Abort button on the Disposition screen.


This takes the user to a blank Final Report screen. The only option is to return to TRM by clicking on the

Return to TRM button, which closes the VHG application. After returning to TRM, the user must

complete the assessment in TRM or launch another triage encounter by clicking on the VHG button in the

TRM application.

This takes the user to a blank Final Report screen. The only option is to return to TRM by clicking on the

Return to TRM button, which closes the VHG application. After returning to TRM, the user must

complete the assessment in TRM or launch another triage encounter by clicking on the VHG button in the

TRM application.

Thank You

DSHI Systems

Documents

Veterans Health Gateway Tutorial 2.0 Triage and Health Information Solution