Habitat for Health Summary Class 231

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Habitat for Health SummaryClass 231

• Judy Hollander DNS, RN CAC, Bronx NY
• Tamara Diltz-Andary, IRM Clinical Software Spc,
  Cincinnati, OH
• John Reiffenberger, CAC, Black Hills Health Care
  Sys.

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Habitat for Health Summary

• Health Summary originated as an Indian Health
  Service software package in the early 1990s. The
  first widespread use of health summary within the
  VA was with the release of version 2.5 in 1993.
• Current version 2.7 released in 1994

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Habitat for Health Summary

• Health Summary is a package that was designed to
  create customized reports from data stored in
  various different software programs. To pull the
  data from the different software packages Health
  Summary Components were made that can be
  controlled using
• Time Limits
• Number of Occurrences
• Selection of items within component

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Habitat for Health Summary

• Health Summary
• Software package data pulled in national
  components
• Automated Med Info Exchange (AMIE) CP
• Allergy Tracking
• Clinical Reminders
• Consults
• Dietetics
• Laboratory
• Medicine/Clinical Procedures
• Mental Health
• Nursing (Vital Signs) Order Entry/Results
  Reporting (OE/RR)

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Habitat for Health Summary

• Health Summary
• Software packages (cont)
• Patient Care Encounter (PCE)/Visit Files
• Pharmacy - Inpatient/Outpatient/IV
• Problem List
• Radiology/Vista Imaging
• Registration
• Scheduling Appointments
• Social Work
• Surgery
• TIU Discharge Summary Progress Notes

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Habitat for Health Summary

• Health Summary
• Local health summaries can be created using the
  various national components. Some sites may also
  have local components created with class III
  software. Health summaries can be created using
  the Health Summary Coordinator menu or the Health
  Summary Enhanced menu.

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Habitat for Health Summary

• Health Summary
• Originally were printed in paper format and could
  be batch by locations such as by clinic or ward.
  When encounter forms software was introduced
  health summaries could be added as a form to
  print in batches with other forms.

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Habitat for Health Summary

• Health Summary
• Using List Manager OE/RR version 2.5 health
  summaries were added as a type of report that
  could be viewed or printed from the Reports tab.
  When OE/RR 3.0 known as the Computerized Patient
  Record System (CPRS) released a GUI version
  health summaries were now a click away.

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Habitat for Health Summary

• Health Summary
• Clinical Reminders was originally installed as
  part of the Patient Care Encounter (PCE)
  software. There were health summary components
  created to bring in reminder data such as Due,
  History and Summary. The only way to show someone
  that a reminder was due was to add that component
  to the health summary back in the List Manager
  days.

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Habitat for Health Summary

• Health Summary Objects
• In January 2003 Health Summary Released patch
  GMTS2.758 to prepare for the use of health
  summary and components to create health summary
  objects.
• In May 2003 Text Integrated Utilities (TIU)
  released patch TIU1.0135 that provided a
  simplified way to create these health summary
  objects.

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Habitat for Health Summary

• Health Summary
• The CPRS we have today in a way has its roots in
  the way that health summary brought data together
  in a customized format so that users could more
  easily review.

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HEALTH SUMMARY TIU OBJECTS
Judy Hollander DNS, RN Clinical Applications
Coordinator JJ Peters VA Bronx, New York
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CREATION OF HEALTH SUMMARY TIU OBJECTS
Access menu option Create TIU/Health Summary
Objects
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Enter the name of the health summary. In this
case it is BRADEN SCALE BRX1
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Enter the name of the health summary. In this
case it is BRADEN SCALE BRX1
Suppress Print of Components without Data
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• Select the Health Summary Component
• CRS-- Reminders Summary

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• Delete Header Name for cosmetic reasons

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• Add the Selection Item. Here it is the specific
  clinical reminder you are interested in.
• I selected BRADEN SCALE ACUTE SETTINGS

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Yeah !!!!
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• To Test the Object
• Go to Notes Tab.
• Click on Options.
• Click on Edit Templates

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Click on New Template button
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Name your new template with a name that has at
least 3 characters
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I add some text to the template to make it more
understandable for the nurse/user
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What it looks like in the note template
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Other Uses of HS Objects

• VANOD PRESSURE ULCER History
• Demographics in Intake Note
• TBI symptoms in Consult Completion Note

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VANOD PRESSURE ULCER HISTORY HEALTH SUMMARY OBJECT
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Enter the name of the object. In this case it is
PRESSURE ULCER
Enter the name of the object. In this case it is
PRESSURE ULCER
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Continue to respond to prompts You will be
prompted to create a new Health Summary Type
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Select Component SHF PCE HEALTH FACTORS SELECTED
OCCURRENCE LIMIT 2 TIME LIMIT 1M
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• SELECTION ITEMS
• PRESSURE ULCER STAGE
• PRESSURE ULCER REASSESSMENT

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Done
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Demographics in Intake Note
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Health Summary Inquiry
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Progress Note View of Demographics
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TBI Symptoms in Consult Completion Note
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TBI Health Summary Inquiry
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Summary
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Summary

• Detailed description of how to create a health
  summary object that pulled into a progress note
  the status of the clinical reminder Do Braden
  Scale.

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Summary

• Detailed description of how to create a health
  summary object that pulled into a progress note
  the status of the clinical reminder Do Braden
  Scale.
• Gave three other examples using other health
  summary components
• Health factors that pulled in Pressure Ulcer
  history

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Summary

• Detailed description of how to create a health
  summary object that pulled into a progress note
  the status of the clinical reminder Do Braden
  Scale.
• Gave three other examples using other health
  summary components
• Health factors that pulled in Pressure Ulcer
  history
• Demographics

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Summary

• Detailed description of how to create a health
  summary object that pulled into a progress note
  the status of the clinical reminder Do Braden
  Scale.
• Gave three other examples using other health
  summary components
• Health factors that pulled in Pressure Ulcer
  history
• Demographics
• Health factors that pulled in TBI situation

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Reports Tab--Health Summaries REMOTE V03 CONSULTS
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Health Summary Inquiry
Component developed in VISN 2
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PLACING THE HEALTH SUMMARY ON THE REPORTS TAB
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Select System Level
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View from the Reports Tab
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Remote V03 Consults
Contains total history of the consult as well as
reason for request and associated progress note
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Patient Safety B-K Look Back Program

• Tamara Diltz-Andary
• Cincinnati VAMC
• Information Technology Specialist

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Patient Safety Alert

• In April 2006 VHA identified a patient safety
  alert regarding prostate biopsies procedures done
  by 21 VAMCs nationwide, using a particular
  vendors equipment and cleaning technique. There
  were over 27,000 veterans nation wide that were
  identified as having potential exposure. The
  Cincinnati VAMC was one of the sites affected.

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Identify Patients involved in Patient Safety Look
Back

• Listing of patients with procedure (FileMan
  search) of Surgery file with Diagnosis/CPT
• Identification of all patients within the
  electronic medical record who should have look
  back done using same search criteria (Clinical
  Reminder)
• Results of search for patients
• 1450 patients with the procedure
• 261 deceased at time of look back
• 1189 patients living patients to be notified

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Using Reminder Dialogs with Health Summary
Objects (cont)

• One reminder dialog was linked to the reminder
  and three additional reminder dialogs were used
  in the final review process. These reminder
  dialogs each had health summary objects so that
  date of surgery could be compared with labs order
  prior to the surgery, labs done after surgery and
  labs done as part of patient safety look back.

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Health Summary (cont)

• A total of 11 health summaries were created. We
  used the (TIU) in the title so that we could
  separate those converted to health summary
  objects. The "B-K Look Back Program" was built as
  a VISN health summary to look for all the lab
  needed to be reviewed at all sites in the VISN.
  Our site is a large facility referral site so
  many of these patients had data at the other
  facilities in our VISN.

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Health Summary

• Health summary obstacles Some of the Hepatitis
  and HIV lab tests were marked as Output only. Any
  lab marked as Output only can not be used by the
  lab package so those type of labs could not be
  pulled in to the health summary. Fortunately for
  our site those tests were not needed for the
  providers review.
• Due to the various differences in the Lab package
  at each site the VISN health summary had to be
  customized for each sites specific labs.

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B-K Reminder Dialog Education
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Reminder Dialog HS Components
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Reminder Dialog Recommendations
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Reminder Dialog Health Factors
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Progress Note Text with Object Data
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Progress Notes Text (cont)
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HEALTH SUMMARY TYPE
INQUIRY Title CBOC pre-visit Max
Hos ICD Pro CPT Abb Ord Component
Name Occ Time Loc Text Nar Mod
Selection ----------------------------------------
-------------------------------------- DEM 5
Demographics
BADR 10 Brief Adv React/All
OD 15 Outpatient Diagnosis
4 RXOP 20
Outpatient Pharmacy 6M
IM 25 Immunizations
CR 30 Reminders Due


BASELINE MEDICAL EVALUATION/V2

AMIODARONE FOLLOWUP

ASCVD/LDLgt100
BREAST CANCER
DETECTION/V13
CERVICAL CANCER
DETECTION/V13
POS DEPRESSION
SCREEN FOLLOWUP
DM
BPgt160/100/V13
DM
MICROALBUMINURIA/V13
HEMOGLOBIN
A1C/V13
HTN BPgt160/100/V13

HYPERLIPIDEMIA SCREEN/BHH-FEMA

HYPERLIPIDEMIA SCREEN/BHH-MALE

ALLERGY ASSESSMENT
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NUTRITION/WEIGHT COUNSELING/ED

EXERCISE EDUCATION

TOBACCO USE SCREENING/BHH FY 0

COLORECTAL CANCER SCREENING

PROSTATE CANCER SCREENING

HEPATITIS C SCREENING/V13
MST
SCREEN
DEPRESSION SCREEN
FY07/BHH
PNEUMOVAX/V13

INFLUENZA VACCINE/V13

TETANUS DIPTHERIA IMMUNIZATION

DIABETIC EYE SCREENING/V13
PEDAL
PULSE FOOT EXAM/V13
FOOT SENSORY
EXAM/V13
FOOT VISUAL/V13

FALL RISK ASSESSMENT

TOBACCO CESSATION - MEDS/REFER

CHF WEIGHT EDUCATION
PTSD SCREEN
POSITIVE - 3Q F/U
PTSD
SCREENING
PROBLEM DRINKING
SCREEN FY07/M
SCI RENAL
ASSESSMENT-BH
VA-TBI
SCREENING CVF 35 Fut Clinic Visits
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----------------------------- IM - Immunizations
----------------------------- INFLUENZA
09/20/2006 BLACK HILLS
PNEUMO-VAC 09/26/2006
MISSION CBOC TD-ADULT 10/26/2005
MISSION CBOC ----------------------------- CR -
Reminders Due ----------------------------- The
following disease screening, immunization and
patient education recommendations are offered as
guidelines to assist in your practice. These are
only recommendations, not practice standards.
The appropriate utilization of these for your
individual patient must be based on clinical
judgment and the patient's current status.

--STATUS-- --DUE DATE-- --LAST
DONE-- Hyperlipidemia Screen/BHH-Male DUE
NOW DUE NOW unknown Allergy
Assessment DUE NOW
DUE NOW unknown Nutrition/Weight
Counseling/ED DUE NOW DUE NOW
unknown Exercise Education
DUE NOW DUE NOW unknown
Hepatitis C Screening/V13 DUE
NOW DUE NOW unknown MST Screen
DUE NOW DUE
NOW unknown Pneumovax/V13
DUE NOW DUE NOW
unknown Influenza Vaccine/V13
DUE NOW DUE NOW unknown
Tetanus Diptheria (TD-Adult)/V13 DUE NOW
DUE NOW unknown Fall Risk Assessment
DUE NOW DUE NOW
unknown Tobacco Cessation - Meds/Referrals
DUE NOW DUE NOW unknown PTSD
SCREENING DUE NOW
DUE NOW unknown Problem Drinking Screen
DUE NOW DUE NOW
unknown
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Chronic Disease Management Health Summary

• Reminder dialog template is completed for each of
  the chronic disease entities which creates a
  number of health factors
• Three chronic disease programs have been
  established at Black Hills Health Care System
  CHF, COPD, and Diabetes
• Health Summary for each includes the health
  factors and one of them contains lab results
• Chronic Disease Initiative implemented throughout
  the VISN. VISN has ability to pull the health
  factors for reporting purposes

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Title V23 CDM CHF HF Report
Max Hos ICD Pro CPT Abb
Ord Component Name Occ Time Loc
Text Nar Mod Selection ------------------------
--------------------------------------------------
---- SHF 5 CDM CHF HFs 5Y

CDM INITIATIVE
ACTIVE PT - CHF
CDM CASE MANAGED
PT - CHF
CDM INITIATIVE DECLINED
- CHF
CDM INITIATIVE DISCHARGED
- CH
CDM INITIATIVE UNABLE TO
CONTA
CDM CHF ABCD STAGE A

CDM CHF ABCD STAGE B

CDM CHF ABCD STAGE C
CDM
CHF ABCD STAGE D
CDM CHF NYHA
CLASS I
CDM CHF NYHA CLASS II

CDM CHF NYHA CLASS III

CDM CHF NYHA CLASS IV
CDM
CHF EF lt/ 9
CDM CHF EF
10-19
CDM CHF EF 20-24

CDM CHF EF 25-29

CDM CHF EF 30-34
CDM CHF EF
35-40
CDM CHF EF gt/ 41

CDM CHF BETA BLOCKER OPTIMIZED

CDM CHF BETA BLOCKER ADVERSE R

CDM CHF BETA BLOCKER REFUSED

CDM CHF ACE/AGB OPTIMIZED
CDM
CHF ACE/AGB REFUSED
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Title V23 CDM CHF HF Report
Max Hos ICD Pro CPT Abb
Ord Component Name Occ Time Loc
Text Nar Mod Selection ------------------------
--------------------------------------------------
---- SHF 5 CDM CHF HFs 5Y
CDM CHF ACE/AGB HYPERKALEMIA

CDM CHF ACE/AGB WORSE RENAL FX

CDM CHF ACE/AGB ADVERSE RX

CDM CHF ALDOSTERONE ANTAG HYPE

CDM CHF ALDOSTERONE ANTAGONIST

CDM CHF ALDOSTERONE ANTAGONIST

CDM CHF ALDOSTERONE ANTAGONIST

CDM CHF ALDOSTERONE ANTAGONIST

CDM CHF DEFIB CANDIDATE-HAS DE

CDM CHF DEFIB CANDIDATE-NO
CDM
CHF DEFIB CANDIDATE-YES
CDM CHF
PACEMAKER CANDIDATE-HA
CDM CHF
PACEMAKER CANDIDATE-NO
CDM CHF
PACEMAKER CANDIDATE-YE
CDM CHF
HF ED NOT COMPLETED
CDM CHF HF
ED COMPLETED
CDM CHF HF ED
REFUSED
CDM CHF ACTION PLAN
ESTABLISHE
CDM CHF ACTION PLAN
NOT ESTABL
CDM HTH CANDIDATE -
YES
CDM HTH CANDIDATE-NO

CDM HTH PATIENT REFUSED SVS 10
Vital Signs Selected 5 1Y

WEIGHT
BLOOD
PRESSURE
PULSE
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CONFIDENTIAL V23 CDM CHF HF Report
SUMMARY pg. 1 XXX, XXXX
000-00-0001
DOB 10/08/1920 ----------------------- SHF - CDM
CHF HFs (max 5 years) -----------------------
Category Health
Factor
Visit Date CDM INITIATIVE ACTIVE
PATIENTS CDM INITIATIVE ACTIVE PT - CHF
01/02/2007 CDM CASE MANAGED PATIENTS
CDM CASE MANAGED PT - CHF
01/02/2007 CDM CHF BETA BLOCKER CDM CHF BETA
BLOCKER OPTIMIZED 01/02/2007
Metoprolol 50 mg Q day CDM CHF ACE/AGB CDM
CHF ACE/AGB OPTIMIZED
01/02/2007 Lisinopril 40 mg Q day
CDM CHF HEART FAILURE ED CDM CHF HF ED
COMPLETED 01/02/2007 CDM
CHF ACTION PLAN CDM CHF ACTION PLAN ESTABLISHED
01/02/2007 Pt invited to
attend Living Well Workshop, and is being sent
home with Home Telehealth
Device ---------- SVS - Vital Signs Selected (max
5 occurrences or 1 year) ----------
Measurement DT WEIGHT
BP PULSE
LB(KG)BMI 02/20/2007
1500 226(102.51)31 131/75
95 01/22/2007 0854 222.7(101.02)30
117/78 94 01/17/2007 1239 222(100.70)30
108/69 98 10/23/2006 1133

110/71 10/23/2006 1059 213.3(96.75)29
84/63 89
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EPRP Health Summary with components forCRS
Reminders Summary and CM Reminder Maintenance

• BASELINE MEDICAL EVALUATION/V2
• AMIODARONE FOLLOWUP
• ASCVD/LDLgt120
• BREAST CANCER DETECTION/V13
• CERVICAL CANCER DETECTION/V13
• COLORECTAL CANCER SCREENING
• V-DEPRESSION SCREENING
• DEPRESSION SCREEN FY07/BHH
• POS DEPRESSION SCREEN FOLLOWUP
• DIABETIC EYE SCREENING/V13
• HEMOGLOBIN A1C/V13
• PEDAL PULSE FOOT EXAM/V13
• FOOT SENSORY EXAM/V13
• FOOT VISUAL/V13
• DM BPgt160/100/V13
• DM MICROALBUMINURIA/V13
• HTN BPgt160/100/V13
• HYPERLIPIDEMIA SCREEN/BHH-FEMALE
• HYPERLIPIDEMIA SCREEN/BHH-MALE

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CRS Reminders SummaryCM Reminder Maintenance

• INFLUENZA VACCINE/V13
• PNEUMOVAX/V13
• TETANUS DIPTHERIA IMMUNIZATION
• ALLERGY ASSESSMENT
• EXERCISE EDUCATION
• NUTRITION/WEIGHT COUNSELING/ED
• PROSTATE CANCER SCREENING
• MST SCREEN
• TOBACCO USE SCREENING/BHH FY 07
• TOBACCO CESSATION - MEDS/REFERAL
• MENTAL HEALTH SCREEN(PC)
• PTSD SCREENING\MPLS
• PTSD SCREEN POSITIVE - 3Q F/U
• PROBLEM DRINKING SCREEN/BH
• PROBLEM DRINKING SCREEN FY07/M
• ANTIPSYCHOTIC MEDS/BHH

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----------------------------------------------
CRS - Reminders Summary --------------------------
------------------

--STATUS-- --DUE DATE-- --LAST DONE Baseline
Medical Evaluation
RESOLVED 07/10/2010 07/10/2007
ASCVD/LDLgt120
N/A
Breast Cancer Detection/V13
N/A
Cervical Cancer Detection/V13
N/A Colorectal
Cancer Screening DUE SOON
08/10/2007 08/10/2006 Depression Screening
RESOLVED
02/27/2008 02/27/2007 Depr Scr Pos - Needs
F/U Assessment RESOLVED 06/18/2008
06/18/2007 Diabetic Eye Screening/V13
DUE SOON 10/10/2007 10/10/2006
Hemoglobin A1C/V13
RESOLVED 04/24/2008 04/24/2007 Pedal
Pulse Foot Exam/V13 DUE
SOON 09/26/2007 09/26/2006 FOOT SENSORY
EXAM/V13 DUE SOON
09/26/2007 09/26/2006 FOOT VISUAL/V13
DUE SOON
09/26/2007 09/26/2006 DM Microalbuminuria
RESOLVED
12/12/2008 12/12/2006 Hyperlipidemia Screen/
RESOLVED
05/21/2009 05/21/2007 Hepatitis C
Screening/V13 DONE
04/27/2001 Influenza
Vaccine/V13
RESOLVED 12/12/2007 12/12/2006
Pneumovax/V13
DONE
00/00/1998 Tetanus Diptheria (TD-Adult)/V13
DUE SOON 01/01/2008 00/00/1998
Allergy Assessment
RESOLVED 09/26/2007 09/26/2006
Exercise Education
RESOLVED 04/24/2008 04/24/2007
Nutrition/Weight Counseling/ED
DUE SOON 09/26/2007 09/26/2006 Prostate Ca
Screen Education/BHHCS N/A
04/27/2001 MST Screen
DONE
03/29/2002 Tobacco
Use Screening N/A
Tobacco Cessation -
Meds/Referrals N/A
02/27/2007 Mental Health
Screen(PC) DUE NOW
03/23/2007 03/23/2006 PTSD SCREENING
RESOLVED 03/23/2011
03/23/2006 Evaluation of Positive PTSD Screen
N/A
06/18/2007
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CM Reminder Maintenance
DM Microalbuminuria RESOLVED
12/12/2008 12/12/2006 Frequency Due
every 2 years for all ages. Cohort
Hospitalization Diagnosis
07/10/2007 250.00 DMII WO CMP NT ST UNCNTR data
node M ICD3 Resolution Last done
12/12/2006 Reminder Term MICROALBUMIN
LAB TESTS/V13 Laboratory test
_MICROALBUMIN/CREAT RATIO specimen URINE
12/12/2006 value - 15.43 Colorectal Cancer
Screening DUE SOON 08/10/2007
08/10/2006 Frequency Due every 1 year for
ages 50 to 80. It is recommended that
patients between the ages 50 and 80, be
screened for Colorectal Cancer. This reminder is
resolved by either FOBT x 3 in last year,
Colonoscopy in last 10 years, or
Flexisigmoidoscopy in last 5 years.
Resolution Last done 08/10/2006 Laboratory
test OCCULT BLOOD specimen FECES
08/10/2006 value - NEG Laboratory
test OCCULT BLOOD 2 specimen FECES
08/10/2006 value - NEG Laboratory
test OCCULT BLOOD 3 specimen FECES
08/10/2006 value - NEG
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Questions?