Transcript RPMS Optimization slides

RPMS Optimization
Elvira Mosely, MSHS, RN
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Learning Objectives
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Explain the importance of precise information technology
setup, configuration and maintenance.
Review the clinical components of an electronic health
record and how proper configuration and optimization
impact end-user functionality.
Discuss the importance of identifying RPMS Package
Owners who will accept responsibility for on-going
maintenance of individual components of an electronic
health record.
Work collaboratively across disciplines to define, discuss
and plan a process for updating and maintaining
components of an electronic health record and the
importance of communicating changes and updates to
end-users.
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Are My Site’s Patches Current?
• How do I determine current patch level?
• Use the menu option Display Patches for a
Package in Kernel Installation and Distribution
Package (KIDS).
• Menu option may only be available to Site
Manager.
• For the latest software versions and patches of
RPMS Packages:
http://www.ihs.gov/Cio/RPMS/index.cfm?modul
e=home&option=software
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RPMS Packages Important to EHR
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Adverse Reaction Tracking:
(GMRA)
Contract Health: (ACHS)
Diabetes Management
System: (BDM)
Health Summary (IHS):
(BHS)
Immunization: (BI)
Laboratory: (LR)
Patient Information
Management: (PIMS)
Patient Registration (AG)
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Pharmacy: (Multiple
packages)
Radiology: (RA)
Referred Care Information
System: (BMC)
Third Party Billing: (ABM)
Text Integration Utilities:
(TIU)
VA Health Summary:
(GMTS)
Women's Health: (BW )
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Some RPMS Packages Important to
EHR
• The list on the previous slide is not
exhaustive, any infrastructure RPMS package
may impact EHR.
• Other important packages related to EHR:
Fileman: (DI)
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PCC: (BJPC)
iCare: (BQI)
Emergency Room System: (AMER)
RPMS Kernel: (XU)
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Some RPMS Packages Important to
EHR
• Generally speaking, all RPMS packages need to
have the latest patches installed to maintain
proper operation of EHR and to maintain correct
functions for GPRA, CRS, and Meaningful Use.
• If a particular package is not maintained, at a
future date you may discover a different package
requires the package in question being patched
up to current level. In this instance, you would
have to install all missing patches before being
able to proceed.
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Adverse Reaction Tracking
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Data Entry Staff:
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Assign GMRA-USER key and use the ALG mnemonic to document allergies in
PCC.
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Do not place allergies on the Problem List!
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Run this option periodically: PLAL Reports Listing Allergies recorded on
PROBLEM LIST
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Enter allergies into the Adverse Reaction Tracking Package and remove any
allergies from the Problem list.
•Pharmacy:
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Assign a pharmacist trained to use the Adverse Reaction Tracking package to
review and verify all new allergies entered using EHR.
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Sites with no pharmacist may choose to utilize Auto-Verify of Allergies.
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Contract Health and HIM
• CHS and medical records staff should
collaborate to identify a process to include
notice that outside referral and diagnostic
reports have been returned to the facility and
are available for provider review.
• This process may be included in notifications
so that both the provider and the CHS staff
will be informed of the completed contract
health service item.
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Diabetes Management System
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Diabetes registry must be configured and updated with
new diabetic patients.
Lab taxonomies must be maintained consulting with
laboratory informaticist for names of lab tests at your
facility.
Medication taxonomies must be maintained consulting
with pharmacy for medications used at your facility.
Build smart Health Summary with Diabetes Supplement.
Periodically conduct Automated Diabetes Audit and
compare to Hand Audit using the same patient cohort.
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Health Summary (IHS)
• Sites need to build and maintain Health
Summaries needed by providers.
• Build and maintain smart Health Summaries
with supplements for asthma, anticoagulation, diabetes, pre-diabetes, and
women's health.
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Immunization
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Assign BIZMENU key and BIZ EDIT PATIENTS key to all users who enter
immunizations.
Periodically review all vaccines using the option:
VAC
Vaccine Table Edit
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Activate vaccines in use.
• Inactivate vaccines not used.
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Periodically review all vaccine lot numbers using the option:
LOT
Lot Number Add/Edit
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Activate lot numbers in use.
• Inactivate lot numbers no longer in use.
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Review Vaccine Information Sheet (VIS) dates within Vaccine Table.
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Immunization (continued)
• Review the site parameters using the option:
ESP Site Parameters Edit ensuring that lot
numbers are required.
• Determine who will enter new lot numbers
into the Immunization Package when they
arrive (i.e., immunization nurse or pharmacy
tech), if it will be a pharmacy tech, assign the
menu option: LOT Lot Number Add/Edit
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Immunization (continued)
• Entry of Immunizations is now encouraged
using a Super-Bill.
• For entry via Super-Bill, an Immunization pick
list must be created.
• For each Immunization add associations:
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Immunization
CPT for the syringe
Education code for literature
Education code for follow-up.
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Laboratory
• The following functions should be done by the
laboratory informaticist:
• Review laboratory exam CPT codes: (Lab menu >
BLR menu > CPT)
• Review accession test groups (menu of tests) and
create new accession test groups to be used by
clinics and wards.
• Ensure that setup for both point-of-care and
reference lab tests results display in the Lab
Package.
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Laboratory (continued)
• Review all tests in the Laboratory Test file
(File 60) and inactivate tests no longer in use:
Set the type to Neither.
• Review holders of the LRLAB Key.
• Assign LOINC codes to lab tests in the
Laboratory Test File (contact OIT for
assistance).
• Review setup of label printers for clinics, ER,
and inpatient to be used for EHR orders.
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Laboratory
(Prep for Point of Care Lab component)
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Identify what point-of-care (POC) labs you plan to use at your facility:
Give list to Lab Package Administrator.
Review EHR v1.1p5 notes and implementation guide.
Lab Package Administrator should make sure the labs are set up correctly
in the lab package according to the POC documentation provided with
EHR v1.1p5 and the Lab Package.
Determine process for POC labs: What locations (clinics) will use POC
labs?
Who (what personnel) will perform tests and enter results?
Ensure policies and procedures are in place to support POC lab use.
Add POC Lab component to the EHR GUI like any other component using
Design mode.
Use FileMan to complete configuration in the file called BLR BEHO POC
CONTROL.
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POC Lab component
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BLR BEHO POC CONTROL FILE
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Laboratory (continued)
• Non-laboratory CACs are strongly discouraged
from modifying laboratory files.
• The exception being those small sites without
a Lab who have attended the EHR-Lab for
Non-Laboratorians class.
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Pharmacy
• The following functions should be done by the
Pharmacy Informaticist:
• Clean & maintain drug file in Pharmacy 5/7:
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Major file cleanup efforts
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Pharmacy 7
EHR for Inpatient
ePrescribing
BCMA
• Maintain Pharmacy Data Management:
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Control access
Reports
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Pharmacy
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Assist with integration of RPMS and other systems:
• Automated dispensing systems
• EHR
• BCMA
Understand how changes in RPMS impact pharmacy systems.
Facilitate utilization of the Paperless Refill option.
Facilitate utilization of the EHR Coding Queue for managing
Paperless Refills.
Facilitate development and tracking of staff training:
• Baseline and updates
• Not just pharmacists
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Pharmacy
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Oversee pharmacy related patches working with site
manager.
NDF Patches:
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EHR Patches:
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Ensure installation.
Perform post-install maintenance.
Review install guides.
Configure any pharmacy related parameters, etc.
Other Patches that may impact pharmacy:
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Allergy
Immunizations
Point of sale
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Pharmacy
• The drug file impacts many areas and small
changes can have big consequences
elsewhere.
• Non-Pharmacy CACs are strongly discouraged
from modifying pharmacy files.
• The exception being those small sites without
an onsite pharmacist.
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Radiology
• Review Radiology Order menu ensuring it meets
provider needs.
• Inactivate procedures if no longer in use.
• Review radiology exams periodically:
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Radiology package >
Supervisor’s menu >
Utility File Maintenance menu >
Procedure Edit menu.
• Review CPT Codes periodically.
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Radiology (continued)
• Review process for radiology orders that need
to be overridden to completion if Radiology
Report is not entered into Radiology Package.
• Ensure process for getting Radiology Reports
into Radiology Package is functioning.
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Referred Care Information System
(RCIS)
• Delineate the steps of the referral process
(e.g., how are referrals entered into the system).
• Ensure the Link between RCIS and PCC is
working.
• Review template(s) within the RCIS application
to be utilized by your facility to populate data on
the purchase order (local category prompts).
• Ensure RCIS Site Parameters are configured
according to local practices and data and report
needs.
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Scheduling
(PIMS)
• Ensure clinic setup for locations within your facility are
correct for:
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Visit Type:
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Phone call
Chart review
Coordination of care or case management
Pharmacy
Lab
Radiology
Service category
• Ensure clinics create visit at check-in.
• Delineate your process to consistently check in
patients.
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Third Party Billing/Medical Records
Review the PCC Master Control file and ensure
that all of the packages are set to pass data to
PCC using the menu option:
UPMC
Update PCC Master Control File
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Suggested Packages to Include in the
Master Control File
Contract Health Mgmt System:
(ACHS)
Diabetic Tracking System:
(BDM)
ER Visit System: (AMER)
IHS Behavioral Health: (AMH)
IHS Dental: (ADE)
IHS RPMS CHR System: (BCH)
Health Summary: (BHS)
Lab Service: (LR)
IHS Laboratory: (BLR)
Outpatient Pharmacy: (PSO)
Pharmacy: (PS)
PIMS: (PIMS)
Radiology/Nuclear Medicine:
(RA)
Registration: (DG)
Referred Care Info System:
(BMC)
Women's Health: (BW)
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Third Party Billing/Medical Records
• Review the Third Party Billing package site
parameters for correct configuration
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Medical Records
• Review EHR Coding Queue (PCC Data Entry
Patch 8).
• Review Coding Paperless Refills process.
• Periodically review all fields of Health.
Summaries and update as necessary.
• Review process for tracking providers utilizing
EHR.
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Women’s Health
• Ensure site parameters are configured and
updated as required.
• Ensure link to Pass Procedures to PCC.
• Review case managers setup and update as
required.
• Review letters setup and update as required.
• Review PAP smears process. - Lab package
and/or the Women’s Health package.
• Review the system for entering PAP results in
Women’s Health package.
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Women’s Health (continued)
• Review system for entering mammography
exam, breast exams, and biopsies into
Women’s Health.
• Review system for printing letters and
tracking delinquent reports.
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Summary
• Remember that the primary CAC is not
directly responsible for all of these packages.
• It is important that a package owner be
identified and be made responsible to
configure, review, and maintain each
package.
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Summary
• The status of RPMS packages should be
reviewed periodically by the EHR Working
Committee to ensure correct configuration is
maintained, patches are installed, and
updates are made as needed.
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Questions and Discussion
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