Patient Prompt user guide v2.1.0

PATIENT PROMPT USER GUIDE

11 Jan 2018 Version 1.5.9

BPAC Clinical Solutions LP PO Box 6032 Level 9, 10 George St, Dunedin FAX +64 3 479 2569

BPAC Support Line 0800 633 236

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Table of Contents 1

Introduction ................................................................................................................................................................ 3

2

Accessing the Patient Prompt.............................................................................................................................. 3

3

Patient Prompt Key Features............................................................................................................................... 6

4

Health Planning Tool............................................................................................................................................... 7

5

CKD ................................................................................................................................................................................. 7

6

Smoking Status .......................................................................................................................................................... 8

7

Smoking Brief Advice ........................................................................................................................................... 10

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Alcohol Status.......................................................................................................................................................... 11

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Falls Assessment .................................................................................................................................................... 13

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CVD Risk Assessment ........................................................................................................................................... 17

11

Diabetes Assessment............................................................................................................................................ 18

12

Potential Screening Prompts: ........................................................................................................................... 19

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Flu Vaccinations ..................................................................................................................................................... 20

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Childhood Immunisations .................................................................................................................................. 20

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Mammograms ......................................................................................................................................................... 20

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Cervical Smears ...................................................................................................................................................... 21

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Blood pressure........................................................................................................................................................ 22

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Weight ........................................................................................................................................................................ 22

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Height ......................................................................................................................................................................... 23

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Diet conditions/advice ........................................................................................................................................ 23

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Conditions Management ..................................................................................................................................... 24

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Clinical Health Information Portal (CHIP) – BOP DHB only ................................................................ 24

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Classifications ......................................................................................................................................................... 25

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Patient Screening ................................................................................................................................................... 25

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Resizing and Positioning Patient Prompt .................................................................................................... 26

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Opening the Patient Prompt ............................................................................................................................. 27

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Setting up Auto-opening for each Staff Member: ..................................................................................... 27

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FAQ’s/Troubleshooting the Patient Prompt .............................................................................................. 28

BPAC Support Line 0800 633 236

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Introduction

1 Introduction Scope and Purpose The Patient Prompt was developed to provide integrated reminders for practitioners to regularly update and review areas such as CVD risk, smoking status, cessation and education, cervical smears, mammograms, flu vaccinations and other aspects of a patent’s health records as needed.

Process Overview

The Patient Prompt:    

Is a dynamic form which changes presentation according to clinical information recorded in the Patient Management System (PMS) and, as information is entered, updates to reflect completed consulations.

Utilises current information from the patient record.

Writes back updated measurements and statuses to the Patient record.

Acts as a reminder for clinicians to follow up important recalls and milestones.

BPAC has tailored the Patient Prompt to the specific requirements and advice guidelines requested by various PHOs. Therefore not allof the features decribed in this User Guide below will be available in all areas. Please contact your PHO if you would like to discuss the availablility of new features in your area.

2 Accessing the Patient Prompt Click on the Patient Prompt icon: The Patient Prompt is also available under the ‘Forms’ section of the bestpractice Main Menu:

Alternatively the Patient Prompt can be set to automatically open when you first select each patient. To do this, a User with Adminstration rights will need to tick this Access in the Users’ Setup. Go to: 1. Setup 2. Staff 3. Choose the User’s Name 4. On the Access tab 5. Tick ‘Patient Dashboard’ to Auto Open when first Select Patient 6. Tick ‘Remember Screen Positions’ BPAC CS Patient Prompt User Guide

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Accessing the Patient Prompt

The Patient Prompt may also be turned on or off as necessary by selecting the on/off switch at the top.

The Patient Prompt is active when the on/off button is GREEN The Patient Prompt is inactive when the on/off button is RED When the Prompt is turned off the data extract will not run and no information except the patient name will be displayed.

BPAC CS Patient Prompt User Guide

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Accessing the Patient Prompt

The Patient Prompt will only trigger for registered patients. If the patient is not registered then the Prompt will display the following: The Patient Prompt looks within the Patient Register (F3 in Medtech) under the ‘Registered’ field to establish if a patient is registered. The current Registered codes are either (R) or (O).

BPAC CS Patient Prompt User Guide

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Patient Prompt Key Features

3 Patient Prompt Key Features KEY: 1. The on/off switch is located at the top to turn the Patient Prompt on or off.

2. Update PMS writes back any changes and refreshes the current view of the Prompt with any new information from the PMS. 3. Smoking Status is reflected from the PMS. If the status is not recorded, the Prompt will turn red to prompt Users to do so.

4. CVD Risk Assessment or Diabetic Annual Review (for patients with diabetes) show red when a CVRA or DAR is overdue. The blue link takes you to the common form to complete this.

5. Shows during the flu season if an eligible patient is due for a flu vaccination.

6. Shows whether an eligible patient is due for a cervical smear.

7. Shows whether an eligible patient is due for a mammogram.

8/9/10. This will appear if blood pressure, heath or weight shoud be updated (see below).

11. Classifications allows for certain conditions such as heart failure or asthma to be viewed or entered.

12. Patient Screening allows for clinical information to be entered and also pulls through information from labs.

13. Update PMS as in 2 above - conveniently located at this location at the bottom also.

NB: Each of these points will be covered in more detail below.

If you encounter issues not addressed by this user guide, please contact your account manager for additional support.

BPAC CS Patient Prompt User Guide

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Health Planning Tool

4 Health Planning Tool If your PHO uses the Health Planning Tool, a link directly to the Health Plan for this patient will appear at the top of the Prompt. The colour of the band gives the following information about the plan for this patient:

BLUE : Assessments not started (even if Plan has been started).

RED : Assessment started and there is an overdue recall and the Plan has been printed.

Assessment started and there is no recall and the Plan has been printed, but it was printed more than a year ago.

AMBER : Assessments started and Plan never printed and either there is no recall or there is an up-to-date recall

GREEN : Assessments started and Plan has been printed and either: there is an up-to-date recall or there is no recall and the plan was printed in the last year

MedTech32 users with the Health Planning Tool also have message logging alerts on the Prompt. This alert will notify the User of the most recent eReferral activity for this patient and gives a direct link to the Message Logging screen which is accessed via BPAC Main Menu Dashboard / Settings / Message Logging.

5 CKD The criteria to Prompt with regard to CKD assessment is:  Patient is over 18 years of age  No previous record of Renal Replacement/Transplant or Dialysis as the CKD guidelines do not apply to these patients. In this case, seek the advice of a nephrologist  NB: In the case of pregnancy seek the advice of a nephrologist.

Stage of protein loss is measured in Urine albumin:creatinine ratio (ACR) or random Urine protein:creatinine ratio (PCR). The ACR is used unless the latest PCR is more recent than ACR in which case the PCR is used. If both ACR and PCR occur at the same time, the ACR takes precedence. There needs to be at least one observation for the CKD module to trigger advice.

If appropriate to run the CKD module, a link to the CKD module will show in the headline. The colours will be: Red: •acute kidney injury and stage > 2 •progressive decline and stage > 2 BPAC CS Patient Prompt User Guide

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Smoking Status

Orange: •progressive decline and stage <= 2 •progressive decline and normal kidney function •stable CKD (any stage) •not enough eGFR data available to determine trend

Green: •stable normal kidney function

Blue: •no eGFR data available

6 Smoking Status If the patient has no recorded smoking status then the following prompt is displayed in red:

The Patient Prompt trigger criteria are: 1. No smoking status recorded and the patient turns 15 years before the end of the current quarter.

2. Smoker and the last recorded status was over 365 days prior to the end of the current quarter.

3. If the patient has had a status of Recently quit for more than 365 days (at the end of the current quarter).

NB: The Patient Prompt uses the words ‘Trying to Quit’ to reflect a Classification of ‘Recently Quit 137G.00’:

4. If the patient was coded as Recently Quit (137G.00) >12 months ago, the Prompt will display red as a reminder to confirm the smoking status. If the patient has now stopped smoking for 12 months or more, their smoking status should be updated to Past: Read Code ‘Ex smoker (137S.00)’.

BPAC CS Patient Prompt User Guide

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Smoking Status

5. If the patient’s age is 15-25 years, Users will be prompted yearly to confirm the smoking status, no matter what the smoking status is.

If the patient’s smoking status is up to date, then the prompt will display green.

The following Smoking Status read codes are picked up by the prompt: Smoker: Current Smoker (137R.00), Trivial Smoker - < 1 cig/day (1372), Light Smoker - 1-9 cigs/day (1373), Moderate Smoker - 10-19 cigs/day (1374), Heavy Smoker 20-39 cigs/day (1375), Very Heavy Smoker - 40+ cigs/day (1376), Pipe Smoker (137H.), Cigar Smoker (137J.), Cigarette Smoker (137P.), Smoking Started (137Q.), Rolls own cigarettes (137M.), Tobacco dependence – unspecified (E2510), Tobacco dependence – continuous (E2511), Tobacco dependence – episodic (E2512).

Recently Quit: Ex Smoker < 12 months (ZPSA32), Recently quit/trying to give up smoking (137G.00), Keeps trying to quit (137C).

Past: Tobacco depend. In remission (E2513), Ex Smoker (137S.), Stopped Smoking (137K.), Ex pipe smoker (137N.), Ex cigar smoker (137O.), Current non-smoker (137L.), Ex Trivial Smoker(<1/day) (1377.00), Ex light smoker (1-9/day) (1378), Ex-moderate smoker (10-19/day) (1379), Ex-heavy smoker (20-39/day) (137A.), Ex-very heavy smoker (40+/day) (137B.), Ex-smoker - amount unknown (137F.), Ex Smoker NFD (ZPSA30), Ex Smoker >12 months (ZPSA31).

Non-smoker: Never smoked tobacco (1371.), Non Smoker (1371.11).

BPAC CS Patient Prompt User Guide

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Smoking Brief Advice

7 Smoking Brief Advice If the patient requires Brief Advice and Cessaton Support then the prompt will display the smoking status along with ‘Offer Advice’and options to offer cessation support as shown in 2, 3, 4 and 5 below.

The Patient Prompt trigger criteria are: 1. Current smoker & no brief advice offered in the last 12 months (measured at the beginning of the current quarter i.e. 15 months from the end of the current quarter) displays red.

2. Current Smoker and last advice and/or cessation support earlier this year displays orange. This is to support primary care to give advice and offer cessation support at the most recent opportunity patient was seen – in case the patient isn’t seen again in clinic within 12 months of the last advice.

3. Recently quit and no brief advice offered in the last 12 months (at the start of the current quarter i.e. 15 months from the end of the quarter) displays red.

The following read codes will be written back depending on the selection above.

1.

2.

3.

4.

5.

Brief smoking cess adv given (@ZPSB.10).

Smoking cessation behaviour support (@ZPSC.30).

Prescribed smoking cess medication (@ZPSC.20).

Referral to smoking cess support (@ZPSC.10).

Refused smoking cess support (@ZPSC.90).

BPAC CS Patient Prompt User Guide

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Alcohol Status

If Cessation support is offered or declined as in 2,3, 4 and 5 above then Brief Advice (@ZPSB.10) will automatically be ticked and written back to the PMS as shown in 1.

Declined cessation services (@ZPSC.90) cannot be selected if one of the following are already selected:  Provided cessation behavioural support (@ZPSC.30),  Prescribed cessation medication (@ZPSC.20),  Referral to cessation support (@ZPSC.10) and vice versa.

The following Smoking brief advice read code is also detected by the Patient Prompt: Brief advice to quit smoking provided (6791.00) Reminder : Brief smoking cess adv given (@ZPSB.10) is always written back when any option from 2-5 is entered

8 Alcohol Status In TAHN, Alliance Health + and other PHOs a Prompt for alcohol status is activated and will display.

If the patient is aged 16 to 99 and alcohol status has not been recorded, the Prompt will show red as below:

The three read codes written back into Classifications by the Patient Prompt are: • 136L – Within sensible limits • 136K – Above sensible limits • 136M – Current non-drinker The Alcohol Status will also display red if: Alcohol consumption is recorded (136L or 136M) and last recorded status >365 days If the most recent classification is 136K the status will always be coloured red.

If ‘Within sensible limits’ or ‘Above sensible limits’ are selected, then two additional tick boxes are made available, which are then also written back into classifications in Medtech: 6792 - Health ed. - alcohol 8H78 – Referral to counsellor

These will show green if the support is up to date or will show red if: • 136K – Above sensible limits and no support provided or last recorded support > 6 months ago • 136L – Within sensible limits and last recorded advice > 365 days ago

BPAC CS Patient Prompt User Guide

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Alcohol Status

NB: The Patient Prompt Alcohol Status has been designed to work with classifications, and is not programmed to deal with screening entries. Therefore a number like ‘10’ cannot be interpreted meaningfully as either within or above sensible limits and won’t be recognised up by the Prompt.

BPAC CS Patient Prompt User Guide

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Falls Assessment

9 Falls Assessment If your PHO has requested the BPAC FALLS Prompt and the current patient is:  

aged 65 to 75 years and are coded as Maori, Asian or Pacific Island ethnicities, or aged > 75 years

the Falls Risk Threshold Prompt will appear.

If a Falls Assessment has not been previously completed, or if the most recent falls screening term status was recorded more than 12 months ago, this will appear red and ask if the patient is in aged residential care:

This panel will show with the radio buttons both empty.

If the user selects yes, the patient is not eligible for the Falls assessment and "Further prompts for the Falls Risk Assessment for this patient will be disabled." If the user then clicks ‘Update Status’ on the Prompt, a FALLS status of "Not Eligible” is written back.

If the second panel (with four questions) was showing at this time, it will also be hidden. Clicking change will close up the falls risk panels – clicking again will open them.

It is assumed that once in aged residential care, chances are low of the patient subsequently moving out and becoming eligible for this assessment again. If a patient does move out, the FALLS screening term entry for this patient will need to be changed in MedTech32:  

either by changing the status to one of "Falls Risk" or "No Falls Risk" or by inactivating the screening entry containing the "Not Eligible" status.

BPAC CS Patient Prompt User Guide

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Falls Assessment

NB: MedTech32 functionality will mean data needs to be entered in the fields shown below in green before saving this altered screening entry.

If the user selects no to the question about Aged Residential Care, a second panel appears with four questions.

If any of these questions are answered Yes, the User will be Prompted to complete a Falls Assessment advanced form. If all the answers are No, a check box to record Brief Advice will be offered.

BPAC CS Patient Prompt User Guide

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Falls Assessment

If the most recent FALLS screening term status was recorded within the last 12 months and it is "No Falls Risk" and:  

the most recent advice date was more than12 months ago, or advice has never been recorded

the Falls Prompt will appear Orange with the following options:

Panels and advice will appear and disappear as described above, except the brief advice checkbox will not disappear unless at least one of the questions is answered with a yes. If the brief advice checkbox disappears the title will change from "Falls Risk Threshold: Brief advice due" to "Falls Risk Threshold".

Clicking change will close up the falls risk panels – clicking again will open them.

When the user clicks update PMS the 12 months until the prompt goes red starts from the current date.

The Falls Prompt will appear Green if:  

The FALLS screening term was updated within the last 12 months and it is "Falls Risk", or The FALLS screening term was updated within the last 12 months and it is "No Falls Risk" and Brief advice date has been recorded within the last 12 months.

BPAC CS Patient Prompt User Guide

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Falls Assessment

Clicking change will open the first panel of the Falls prompt. At that point it will behave as described above, except the colour will be green.

When the user clicks update PMS, the 12 months until the prompt goes red starts from the current date.

Update PMS: If the user has answered the first panel question no, and has answered all four of the second panel questions then:   

a calculated FALLS status is written back, the answers to the four questions are written back, the state of the brief advice checkbox and, if the brief advice checkbox is checked, also today's date is written back as Advice Date.

Calculated Falls status: If all 4 Falls Risk questions are completed and one of the answers is 'YES', the status is "Falls Risk". If all 4 Falls Risk questions are answered 'No', the status is "No Falls Risk" but if any questions is left unanswered, nothing is written back. If there is sufficient data to trigger one of these status write backs, the 12 months until the prompt goes red starts from the current date, regardless of the current colour of the prompt.

BPAC CS Patient Prompt User Guide

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CVD Risk Assessment

10 CVD Risk Assessment If a CVD Risk Assessment is due the prompt will display the following in red:

Population subgroup

Men

Women

Individuals without known risk factors

Age 45 years to <75

Age 55 years to <75

Māori, Pacific peoples or South-Asian* peoples

Age 30 years to <75

Age 40 years to <75

People with other known cardiovascular risk factors or at high risk of developing diabetes.

Age 35 years <75

Age 45 years <75

People with diabetes (type 1 or 2)

From the time of diagnosis to <75

From the time of diagnosis to<75

People with severe mental illness

From age 25 years to <75

From age 25 years to <75

Family history risk factors: • diabetes in first-degree relative (parent, brother or sister) • hospitalisation for or death from heart attack or stroke in a first-degree relative before the age of 50 years (father or brother, mother or sister) • Familial hypercholesterolaemia • Personal history risk factors: • people who smoke • gestational diabetes or polycystic ovaries syndrome • HbA1c 41–49 mmol/mol • BMI ≥ 30 or truncal obesity (waist circumference ≥ 102 cm in men or ≥ 88 cm in women) • eGFR<60 but >45 ml/min/1.73 m2 † • atrial fibrillation

If previous CVD risk assessment > 5 years ago - displays red If CVD recall overdue - displays red.

NB: If the patient is coded diabetic , there will be no CVD Risk Assessment prompt (see Diabetes Assessment below).

The patient prompt uses prioritised ethnicity.

The prompt will not trigger for patients >=75 years of age.

BPAC CS Patient Prompt User Guide

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CVD Risk Assessment

Early risk assessment You may be asked: • A question about severe mental illness as this now contributes to earlier CVD risk assessment, this will be due to a read code i.e. Eu322 (Major Depressive disorder) or a medication indicative of a severe mental condition i.e. Rispiradone.

• About your family history of diabetes in first-degree relative (parent, brother or sister) if you have coded 1252.00 as it now triggers earlier CVD risk assessment

• About early hospitalisation for or death from heart attack or stroke in a first-degree relative before the age of 50 years (father or brother, mother or sister) if a relevant read code has been coded in the patient’s classifications.

BPAC CS Patient Prompt User Guide

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Diabetes Assessment

Statin and Aspirin

If CVD risk is >=15% and Statin or Aspirin not prescribed in last 120 days:  User is prompted "CVD Risk >=15% not on Statin."  If risk is >=15% and not on aspirin user is prompted "CVD Risk >=15% not on Aspirin  If both conditions apply; user is prompted "CVD Risk >=15% not on Aspirin or Statin."

NB: If the patient has declined or is contra-indicated a statin or aspirin, advice will still state that patient is ‘not on Statin or Aspirin’ so appropriate clinical advice can be considered.

Link to the common form Clicking on the link below will link to the Common Form (unless you are in WBOP, where it will link to Halycon) which can then be completed within the current window.

If you have accessed the Common Form from within the Patient Prompt, you will be returned to the prompt upon exiting the common form.

Recalls If there is a CVD screening term or an overdue CVD screen but no recall for that patient then the prompt will recommend generating a CVD recall.

Clicking the generate recall will put a recall against the patient record. This will be calculated from the day of the last CVD screen. The recall will be dependent on the CVD risk; 1. Risk: >=15% then recall is in 12 months time 2. Risk: 10 – 14.99 % then recall is in 2 years time 3. Risk < 10 then recall is in 5 years time.

4. Overdue assessment: recall is generated in a week’s time.

If the patient is diabetic then there will be no separate CVD recall recommended (see Diabetes Assessment below).

11 Diabetes Assessment If a Diabetes Assessment is due the prompt will display the following:

The Patient Prompt trigger criteria is: 1. Diabetic & no Diabetes review - displays red 2. Diabetic & previous diabetes review > 335 days - displays red 3. Diabetes recall overdue - displays red BPAC CS Patient Prompt User Guide

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Potential Screening Prompts:

If there is an upcoming Diabetes Assessment due then the prompt will alert the number of days and display the following:

The Patient Prompt trigger criteria is: 1. Diabetic & previous diabetes review between 275 & 334 days - displays orange Link to the common form Clicking on the link below will link to the Common Form which can then be completed within the current window.

If you have accessed the Common Form from within the Patient Prompt, you will be returned to the prompt upon exiting the common form.

Recalls If there is a Diabetes screening term or overdue diabetes screen due but no recall for that patient then the prompt will recommend generating a Diabetes recall.

Clicking generate recall will enter a recall to the patient record. This will be calculated as due one year from the day of the last Diabetes Annual Review record. If the assessment is already overdue then the recall is entered for one weekâ&#x20AC;&#x2122;s time.

The following Diabetes read codes are picked up by the Patient Prompt: Diabetes Mellitus with no mention of complication (C100.00), Diabetes Mellitus with ketoacidosis (C101.00), Diabetes Mellitus with hyperosmolar coma (C102.00), Diabetes Mellitus with ketoacidotic coma (C103.00), Diabetes Mellitus with renal manifestation (C104.00), Diabetes Mellitus with ophthalmic manifestation (C105.00), Diabetes Mellitus with neurological manifestation (C106.00), Diabetes Mellitus with peripheral circulatory disorder (C107.00), Insulin dependent diabetes mellitus (C108.00), Non-insulin dependent diabetes mellitus (C109.00), Diabetes Mellitus with other specified manifestation (C10y.00), Diabetes Mellitus with unspecified complication (C10z.00)

12 Potential Screening Prompts: 1. Screening for Type 2 Diabetes If the patient has had gestational diabetes, indicated by readcode â&#x20AC;&#x2DC;Pregnancy + diabetes mellitus (L180.00) then you will be prompted to Consider screening for Type 2 Diabetes:

2. Screening for Type Coeliac Disease: The prompt to test for coeliac disease displays when the following criteria are met: BPAC CS Patient Prompt User Guide

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Flu Vaccinations

  

Patient does not have readcode J690.* Patient has at least one of the following readcodes : C1541.*, C046.00,C052.00,C020.*, M140.00, J521.00, PJ0.*, C1541.*, C046.00, C052.00, C020.*, M140.00, J521.00, PJ0.* Patient does not have any of the labs with the tblData_Item of "LB_Coel_Screening"

Clicking on the ‘read more’ link will offer the guidance for ‘Could this patient have coeliac disease?’

13 Flu Vaccinations A reminder for the Flu vaccine appears on the prompt during the period 01/03/YYYY to 31/07/YYYY each year.

The criteria and triggers are: 1. Age 65+ & no recorded flu vaccination 2. Diabetes (C10.00, C109.00,C108.00) & no recorded flu vaccination 3. Ischaemic Heart Disease (G3.00) & no recorded flu vaccination 4. Chronic Rheumatic Heart Disease (G1.00) & no recorded flu vaccination 5. Cerebrovascular Disease (G6.00) & no recorded flu vaccination 6. Heart Failure (G58.00) & no recorded flu vaccination 7. Congenital Heart Disease (P5.00 - P7z.00) & no recorded flu vaccination – exclude P75-P75z 8. Chronic Renal Disease (K05.00) & no recorded flu vaccination

14 Childhood Immunisations If an immunisation has been missed then the prompt will display the missing immunization(s) and when it was due:

15 Mammograms If a Mammogram is overdue then the prompt will display the following

The Patient Prompt trigger criteria is: 1. Female, age:45-69 & no recorded mammogram screening.

2. Female, age:45-69 & previous recorded mammogram screening > 720 days 3. Female, age:45-69 & no Mammography recall 4. If Mammography recall overdue

BPAC CS Patient Prompt User Guide

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Cervical Smears

Selecting the ‘Bilateral Mastectomy’ tick box above will write the following readcode to the PMS and this patient will not be prompted for a Mammogram again:  Bilateral mastectomy (71308.00)

16 Cervical Smears If the patient is overdue for a smear then the prompt will display the following:

The Patient Prompt trigger criteria is: 1. Female, 20-69 & Cervical Smear recall overdue or previous screening >= 3 years or no previous screening.

2. The prompt will also display red if the most recent outcome code is: a.

NSR (No Smear response), NR (Non Responder), GNA (Gone No Address), DNR (Did not respond), NON (non responder), GONE (Gone), NKA (No known address), NRR (No Response Recall), NRK2 b.

Unless recall due within 90 days 3. The prompt will look in recalls except where criteria 4 , 5 or 6 below is met 4. The prompt will be hidden permanently if the following outcome codes or read codes are used: XH (Exempt Hysterectomy), X (Exempt Smear), H (Hysterectomy), HYST (Hysterectomy benign), NN (Not Needed), CNR (Clinically not required), SH (Serious health) HYSN (Hysterectomy normal), Ca cervix screen – not needed (6855.00), No smear – benign hysterectomy (685H.00), No Smear - hysterectomy (685H.11), No smear – amputation of cervix (685I.00), No smear – no cervix (685K.00), Ca cervix screen – not needed (6855.00) 5. The prompt will be hidden for two years if the following outcome codes or read codes are used: Exempt Smeared Else (XE), Exempt Cannot Contact (XC), Cannot contact (CC), Done somewhere else (SE), Not sexually active (NSA), Refused (REFU), Declined (D), Gone/Done Elsewhere (E) , HYS (Hysterectomy abnormal) , HYSA (Hysterectomy abnormal); Ca cervix screen – not wanted (6853.00), Ca cervix screen – up to date (6856.00), Ca cervix screen – screen done (6859.00), Ca cervix screen – no result yet (685A.00), Ca cervix screen normal (685B.00), Ca cervix screen abnormal (658C.00), Ca cervix screen + fee claim (685D.00), Cervical smear status unknown (685E.00), Cervical smear due (685F.00), Ca cervix screen NOS (685Z.00).

6. The prompt will be hidden for three years if the read code No smear – not sexually active (685G.00) is written.

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Blood pressure

Selecting a tick box above will write the following back to the PMS: 1. If ‘Benign Hysterectomy’ is selected then: No Smear – Benign Total hysterectomy (685H.00).is written back to the PMS - this hides the prompt permanently.

2. If ‘Never Been Sexually Active’ is selected then: No Smear – not sexually active(685G.00) is written back to the PMS this hides the prompt for 3 years; 3. If ‘Smear Not Wanted’ is selected then: Ca cervix screen – not wanted (6853.00) is written back to the PMS this hides the prompt for two years; for those who have declined/refused.

NB: If an exempt code is subsequently followed by an outcome code (screening term), then the patient will be prompted for further smears according to the rules for the latest outcome.

If prompts are being received after two years for conditions that should be permanent (e.g. The outcome code of HYS has been used to mean ‘benign hysterectomy’, but the prompt hides alerts for two years when this code is used) they can be permanently hidden by entering the Read code ‘Ca cervix screen – not needed (6855.00)’.

If a smear recall is due within the next 90 days then the prompt will alert to the number of days until it is due:

17 Blood pressure If the patient requires an updated blood pressure the following prompt will be displayed

The Patient Prompt trigger criteria is: 1. Age: > 35 & no recorded blood pressure or previous recorded blood pressure > 335 days 2. If patient has heart failure, is on Hypertension medication(ACE/ARB, Beta Blocker, Thiazide Diuretic & Calcium Channel Blocker, Alpha Blocker, Diuretic K Sparing, Diuretic loop) and last recorded blood pressure > 9 months

18 Weight If the patient requires an updated weight measurement the following prompt will be displayed

The Patient Prompt trigger criteria is: 1. No recorded weight 2. If age < 3 years & last recorded weight > 3 months 3. Last recorded weight > 365 day

BPAC CS Patient Prompt User Guide

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Height

19 Height If the patient requires an updated height measurement the following prompt will be displayed

The Patient Prompt trigger criteria is: 1. No recorded height & age 18+ 2. If age < 3 years & last recorded height > 3 months 3. If age 4-18 & last recorded height > 365 days 4. Age 65-75 and last recorded height > 5 years 5. Age 75+ and last recorded height > 365 days

20 Diet conditions/advice An opportunity to record Diet/Exercise advice will be triggered if a patient’s BMI is >= 25 and no advice has been offered or advice is greater than a year old.

Selecting a tick box above will write the following back to the PMS:  If ‘Diet Education’ is selected, the following read code will be written back: Health Ed - Diet (6799.00)  If ‘Exercise Education’ is selected, the following read code will be written back: Health Ed - Exercise (6798.00) If the patient also has Diabetes recognized by Read Codes of: Diabetes Mellitus (C10.00), Type 2 Diabetes (C108.00), or Type 1 Diabetes (C109.00) then the option to record Diabetic Diet advice is also offered. If ticked, this will writeback Read Code: Pt advised re diabetic diet (8C4A1.00)

If the patient also has Hypertension recognized by a Read Codes of: Hypertensive Disease (G2.00) then the option to record Low Salt Diet advice is also offered. If ticked, this will writeback Read Code: Read Code: Pt advised re low salt diet (8CA48.00) BPAC CS Patient Prompt User Guide

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Conditions Management

21 Conditions Management The following are displayed if any of the conditions below are met: Medications must be long term and must have been prescribed within the last 120 days for them to be identified by the prompt.

The Patient Prompt trigger criteria is: 1. Elevated HbA1c (>64), not on insulin 2. Diabetic: Elevated ACR (Men > 2.5 , Female > 3.5), not on ACE/ARB 3. Non Diabetic: ACR > 30, not on ACE/ARB NB: If the patient has declined or is contra-indicated a statin, insulin or ACE/ARB advice will still state that patient is ‘not on Statin, insulin or ACE/ARB’ so appropriate clinical advice can be considered.

22 Clinical Health Information Portal (CHIP) – BOP DHB only In the Bay of Plenty DHB region, the Patient Prompt has a direct link available to CHIP – the clinical workstation developed by the BOP DHB. When the CHIP link on the Patient Prompt is clicked you will be taken straight to the electronic record of the patient you currently have open in your PMS.

Access to CHIP directly from the Patient Prompt requires the User to have a BOP DHB Information Access Agreement in place for the practice he/she is accessing the information from. If this has not been signed for the current clinic the User has accessed BPAC from, a link is provided to the agreement which can be signed and forwarded to the BOP DHB for them to turn on access for that User.

NB: Please contact BOP DHB for this access to be set up as BPAC does not manage the Access Agreements between Users and the BOP DHB directly.

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Classifications

23 Classifications Classifications can be viewed here and also written back to Medtech by using the tick box against that classification. These will be written back as long term.

24 Patient Screening The most recent patient screening and lab results can be viewed here. Screening results can be entered here and written back to the PMS for Blood Pressure, Height (cms), Weight (kgs), BMI, Waist Circumference, Heart Rate, Temperature, Peak Flow, Alcohol Consumption (units/day on heaviest regular drinking day).

When the cursor is clicked in a box to enter a new value, the date will display â&#x20AC;&#x2DC;todayâ&#x20AC;&#x2122; and an undo arrow will appear in case this was a mistake.

Click Update PMS at the top or bottom of the Patient Prompt to write this information back to the PMS.

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Resizing and Positioning Patient Prompt

25 Resizing and Positioning Patient Prompt When the Patient Prompt opens for the first time after a User logs into the PMS, it will appear in the top-left of your window and quite large. We recommend re-sizing and positioning this to the right. If you do not close the Patient Prompt between patients, it will remain in the position on the screen where you last placed it.

Using your cursor on the edge of the Patient Prompt window (cursor will appear) allows you to change the size and shape of the window and then reposition.

Before:

After:

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Opening the Patient Prompt

26 Opening the Patient Prompt The Patient Prompt can be launched in a new window from the MedTech toolbar using the icon However this will need to be the only Advanced Form window open at the time.

Alternatively, the Patient Prompt can be set to automatically open with each new patient. To allow this, the Patient Prompt must firstly be chosen as the Dashboard Form for the practice: Within Medtech:  Select Setup > Reference nos. The References page is displayed  Select the Documents (1) Tab  In the patient dashboard section, from the dashboard form dropdown, select the dashboard you wish to automatically open. For the patient prompt, select Bestpractice Patient Prompt (2).  Click OK

27 Setting up Auto-opening for each Staff Member: Once the Patient Prompt is set as the Dashboard Form for the practice, each staff member needs to have it set to ‘Auto open when they first select the patient’:

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FAQ’s/Troubleshooting the Patient Prompt

Within Medtech:  Select Setup > Staff > Members The list of staff members at the practice is displayed.  Double-Click on the staff member required.  Select the Access tab.  In the ‘Auto Open when select first patient’ section, click the checkbox beside Patient Dashboard.  Click OK  You will need to exit Medtech and log back in for this to take effect.

28 FAQ’s/Troubleshooting the Patient Prompt 

“This patient has had a CVD assessment/Mammogram/Smoking status/Smear, but it is still prompting for one?”

The most likely scenario is that the screening term that was written back into Medtech hasn’t been mapped within the appropriate concept map. Please contact BPAC Support Desk 0800 633 236 for assistance. 

“I am getting an ‘Error updating PMS: Error’ message when trying to write back to Medtech” Whenever this appears, it is most likely a screening term or missing concept map causing the error to appear, please contact 0800 633 236 for assistance in identifying which is causing the error.



“The Patient Prompt is not picking up medications”

A medication must have been marked as ‘long term’ and been prescribed within the last 120 days to be recognized by the Patient Prompt. If it has been and is still not getting picked up, it may be that the script isn’t being recognised within the database. Please use the ‘check meds’ functionality within best practice Dashboard to send the details to BPAC by using the following:

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FAQ’s/Troubleshooting the Patient Prompt

Within Best practice’s Main Menu:  Select Settings > Check meds  This will bring up a dialog box that will allow you to describe the situation that is causing the issue. When you click Send the medication details will be sent to BPAC.  Please do NOT send identifiable patient information  This will notify BPAC so we can identify why the medication isn’t being picked up and push any necessary changes to the table to resolve the issue.

 “The Patient Prompt hasn’t pulled through the patient’s /lab results/immunisations/Read Codes” Please use the ‘check labs/Immunisations/readcodes’ functionality within best practice Dashboard to send the details to BPAC by using the following: Within Best practice’s Main Menu:  Select Settings > Check labs/immunisations/readcodes  This will bring up a dialog box that will allow you to describe the situation that is causing the issue. When you click Send the lab/immunization/readcode details will be sent to BPAC.  Please do NOT send identifiable patient information  This will notify BPAC so we can identify why the item isn’t being picked up and push any necessary changes to the table to resolve the issue.  NB: if a lab result is on a scanned document, this is not in a format that is able to be picked up, therefore these would have to be manually entered.

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