236H MH Reminders and Mental Health Assistant

1
236HMH Reminders and Mental Health Assistant

• Katy Lysell
• Anthony Puleo

2
Mental Health and Clinical Reminders Enhancements

• Mental Health - YS5.0185
• Restructures the files, adds multiple MH tests
  (PHQ-2, PC PTSD, Braden, etc)
• New GUI for the Mental Health Assistant
• Clinical Reminders - PXRM2.06
• Updates CR to use new MH file structure (old
  entries still recognized for historical reports)
• Updates National reminders
• Multiple fixes (reports, extracts, dialogs)
• Health Summary - GMTS2.777
• Provides HS component for MH tests

3
Mental Health Assistant

• Graphical User Interface (GUI) for the Mental
  Health testing package.
• Originally released 2002
• Mental Health testing package implemented 1987
• Provides secure computer environment for patient
  administered testing
• Only VistA application currently available that
  stores survey/self report information as data
• 2,800,000 assessments using MHA instruments
  completed in FY07

4
MHA3 New FeaturesPatch YS5.0185

• MHA files completely restructured in VistA
• Launch from CPRS Tools Menu
• Pass progress note to CPRS
• New Instruments for MH Screening, nursing, TBI
• With clinical reminders patch 6, all MHA
  instruments will work with reminders (instruments
  with free text response types will need CPRS v27
  and MH dll to work in reminder dialogs)
• Reminders will be able to use MH scales and
  individual responses in finding logic

5
MHA Components

• YS5.0185KIDS install
• MHA Executable
• MHA Secure Desktop
• MH dll
• YS_MHA.dll (reminders will use for presenting MHA
  instruments in CPRS v27)
• MHA3_DLL.Scoring (for use with some tests with
  complex scoring, distributed with patch)

6
What does file structure mean?

• Old structure, results only stored as response
  string TTFT, report recalculated on the fly every
  time test accessed
• Very difficult to research test results on long
  tests
• All tests had to be coded into system using M code

7
New File Structure

• Series of connected files that store entire test
  administration data
• Can evaluate scales, questions, raw or
  transformed scores rather than just response
  strings
• Greatly facilitates addition of new test
  contentcreate instrument using Delphi tool that
  translates it to VistA file structure
• HL7 messaging used to create national testing
  database

8
MHA Authoring Tool (not a released product)
9
New Instruments Added in MHA3

• BOMC (Blessed Orientation Memory Concentration)
  Test
• Braden Skin Risk Assessment
• Morse Falls Risk Scale
• PHQ-2
• PC-PTSD
• TBI 2nd Level Evaluation

10
Modified Instruments in MHA3

• AUD-C Invoke Skip Logic add option Never as
  response to Item 1 and 0 as response to Item 2
• PHQ-9 Add 10th question regarding impact of
  symptoms on overall functioning

11
Considerations in Implementation of MHA

• Restricted Access
• All clinical staff can have access to MHA package
  (controlled with YS Broker1 option)
• YSP Keygiven only to psychologists or clinicians
  with training in psychological testing (existing
  security key)
• YSP key controls access to tests that are
  restricted by the nature of the license granted
  for their usage
• If user has MHA access and no YSP key, will not
  be able to administer or view those tests that
  are restricted

12
Tests Restricted with YSP Key
13
Considerations in Implementation of MHA

• Chart Documentation
• MHA will now pass progress note to CPRS
• Mental Health Diagnostic Study Note
• New historical visit
• No note passed for restricted instruments
• MH Instruments in Reminder Dialog
• Pass test results to note that is used for
  processing reminders
• Can customize note documentation through dialog
  set up

14
Considerations in Implementation of MHA3

• Deleting data erroneously entered on patients
  chart
• MHS Manager Menu YSMANAGER
• Psych Test Utilities YSUTIL
• Delete Patient Data YSMKIL
• Option will remove test administration from
  patient record
• MHS Manager Menu YSMANAGER historically given
  to MH/Psychology Leadership at facility
• CAC may need access to the Delete Patient Data
  YSMKIL option to manage tests entered when
  reminders are processed on the wrong patients
  chart

15
Usability Features of MHA

• Speed Tab
• Set to On/Off
• With speed tab, automatically advance to next
  item
• One Question at a Time vs. All Questions at Once
• Control presentation of test itemsmay be useful
  with patient administration
• Modify font size
• May be useful with patient administration

16
Hands-on

• Icons
• Access/Verify Code
• Access Code VEHU
• Verify Code VEHU
• ( represents your student number)
• Patient usage
• number, PATIENT
• Please follow instructors
• If you need help, raise your hand

17
Clinical Reminders Enhancements
Anthony Puleo
18
YS_MHA.DLL and CPRS 27

• Using YS_MHA.DLL with CPRS 27 allows for
  increased functionality in Reminder Dialogs
• Tests appear cleaner in appearance
• Cleaner progress note text
• Faster to process
• Informational message based on the MH Test Score
• Multiple Result Group processing for each scale
  associated with a MH Test
• Can use all MH Tests up to 100 questions in a
  Reminder Dialog
• Enhanced MH Test Required functionality

19
MH Test Required

• New option for the this prompt in dialog set-up
  for a MH dialog element
• Choose from
• 0 Optional open and optional complete (partial
  complete possible)
• 1 Required open and required complete before
  finish
• 2 Optional open and required complete or
  cancel before finish

20
New YS Option

• YS Broker1
• This needs to be assigned as a secondary menu
  option to users who will do the following
• Process MH tests in the new MHA3 executable
• Have access to reminder dialogs in CPRS
• Consider the same as the OR CPRS GUI CHART option

21
Use of MH DLL Parameter

• OR USE MH DLL is a new parameter that is set to
  Y when CPRS 27 is installed.
• This is a system level parameter
• This parameter determines if CPRS should try to
  use the MH DLL when processing a MH Test from a
  Reminder Dialog.
• This parameter can be set to No to have CPRS
  default to processing the MH test the old way

22
Changes to Reminder Dialogs

• Result groups must point to a MH test and a valid
  scale for the MH test
• Multiple result groups can be used for a MH test
  (CPRS 27 and MH DLL)
• Informational pop-up message with result elements
  (CPRS 27 and MH DLL)
• MH test required functionality has been changed
  (CPRS 27)

23
Change to Reminder Evaluation Logic

• PXRM2.06
• Allows reminders to use individual responses,
  scales within MH instruments as findings in
  reminder logic

24
Changes to Health Summary for MHA3

• Adds MH instrument results as health summary
  components
• MHA Administration List
• MHA Score
• -------------------- MHAS - MHA Score (max 10
  occurrences) --------------------
• Date Instrument Raw
  Trans Scale
• 10/22/2007 0935 AUDC 2
  Total
• 09/06/2007 1005 AUDC 2
  Total