CPRS Tickler Text object completed.

[kdt...@gmail.com]

Hey all,

I posted earlier about making "tickler" file functionality in CPRS. I
have finished this, and use TIU Text Objects. This means it could be
used in any CPRS without any modifications needed.

How to use it:
==========
1. Drop a Tickler template into one's note in CPRS.
This will look something like this:

======= [TICKLER MESSGE] =======
#DUE#: <put-DUE DATE here> <----- to be edited.
================================
Message: ...


2. Sign the note.
3. When the due date/time arives, then an addendum will be added to
the note, and an alert is created to this addendum noting that a
signature is due. It is at this point that one can see whatever
message was put into the tickler, and do what ever follow up is
needed.
4. When done, sign the addendum.

The final note might look like this


*** ACUTE MEDICAL ISSUE VISIT Has ADDENDA ***

09/03/08 (423) 123-4567
======= [TICKLER MESSGE] =======
#DUE#: 9/3/08 @ 3:20 pm
================================
Message: ...



/es/ KEVIN S TOPPENBERG
Family Physician
Signed: 09/03/2008 15:15

09/03/2008 ADDENDUM STATUS: COMPLETED
* * Tickler message due date has arrived * *
==============================================
This note may be edited if needed until signed.

Please note original tickler message.

/es/ KEVIN S TOPPENBERG
Family Physician
Signed: 09/03/2008 15:22


If there is interest in this, I could distribute a patch.

Kevin

[Nancy Anthracite]

This sounds like it is a really great addition!

I assume that the alert is generated using the usual alert system and thus
there will be a record that an alert was delivered and a way to track/log if
it was accomplished and a way to access it was generated and responded to it
for reports. Also, is there a way to know what alerts in notes are pending?
Can the alert be delivered to more than one person or transferred from being
delivered to the author of the note to a third party?

I know this sounds over the top, but these are all CCHIT requirements for
alerts.

--
Nancy Anthracite

[kdt...@gmail.com]

Nancy, see below:

On Sep 3, 4:20 pm, Nancy Anthracite <nanthrac...@verizon.net> wrote:
> This sounds like it is a really great addition!
>
> I assume that the alert is generated using the usual alert system and thus
> there will be a record that an alert was delivered

Yes, I use the usual alert system. The TIU package has a call that is
used to create the alert that a note needs signing. When I make the
addendum to the note, I call this function.

and a way to track/log if
> it was accomplished and a way to access it was generated and responded to  it
> for reports.  

I have a custom fileman file (in my numberspace) called TMG TICKLER
MESSAGES. This keeps a record of the patient, the document that
contains the original tickler message, the date/time it is due, and
it's status: UNSIGNED, SIGNED, COMPLETED, or ORPHANED, and also the
recipient of the tickler message. This is a standard Fileman file, so
it would be available for reports. However, the text of tickler
message itself is stored in the body of the note (i.e. progress note),
not in my custom file.

Also, is there a way to know what alerts in notes are pending?  

It would not be a difficult matter to cycle through all the TICKLER
MESSAGES entries that are SIGNED, (but not yet COMPLETED), and then
grab the tickler message out of the pointed-to note. So yes, this
could be done.

> Can the alert be delivered to more than one person or transferred from being
> delivered to the author of the note to a third party?

Because it uses the standard alert system, these things can be done.
One can specify a surrogate for one's alerts, so they will then be
delivered on. This surrogate wouldn't be the expected signer of the
note, which means that they might not be able to process the alert
when they got it. (This is a problem with VistA as it is today, not
my doing).

>
> I know this sounds over the top, but these are all CCHIT requirements for
> alerts.
>

I didn't realize that CCHIT wanted alerts. Is this for the next
certification cycle? But it sounds like we are basically already
there. What do we need to do to wrap this up? I.e. what kind of
reports do we need etc?

Kevin

[Nancy Anthracite]

I would have to dig through the 68 pages of requirements to find all of the
references to alerts and reminders and how they have to be accounted for.
There are needs for lots of them and ways to process them so this one alert
is helpful in the big picture.

On Wednesday 03 September 2008, kdt...@gmail.com wrote:

--
Nancy Anthracite

[kdt...@gmail.com]

Yeah, I just love long long lists of required features... :-)

OK. I'll wait until this issue clarifies.

Thanks
Kevin

[Nancy Anthracite]

Don't wait! Let testing begin!

--
Nancy Anthracite

[kdt...@gmail.com]

OK. We are going to start using it in our office, so we can give it a
real-world testing.

Kevin

[Matt King]

Very clever solution, Kevin! Could the addendum signature go to
another person in the office who cold then complete it and sign off?
I'm pretty sure the answer is yes.

m

[kdt...@gmail.com]

Well, when an addendum is created, there is an expected signer. I
could assign who ever needs to be the signer. But once that is
assigned, then that is who is supposed to sign it. I don't think
currently that there is a way to have a surrogate signer. (I hope
someone can prove me wrong). I could have an additional signer
assigned. They two people need to sign the note. Is that what you
ment?

Kevin

[kdt...@gmail.com]

I think I have the tickler system ready for standard Fileman
reports. I added a computed field that gets the first line of the
tickler message as it's computed value. So one can run a tickler
report with:

STATUS; USER; PATIENT; DUE DATE; FIRST LINE OF MESSAGE; TIU
DOCUMENT
---------- -------- ----------- --------------
------------------------------- --------------------
PENDING KST ZZTEST 1/1/1980 GET MAMMOGRAM
ADDENDUM
....

Kevin

On Sep 3, 4:52 pm, "kdt...@gmail.com" <kdt...@gmail.com> wrote:
> Nancy, see below:
>

[Matt King]

Normally, when you make an addenum you can change the author, simply
by

[Matt King]

Opps, I think a made a bad post.

When you MANUALLY create an addenum on an existing note (or any note
for that matter), you always have the option to change authors by
hitting the "change" button on the upper right hand side. When you
close the note or addendum, you will no longer be able to see it.
Instead, it will alert the "author" and show up as an unsigned
document.

On Sep 4, 7:36 am, "kdt...@gmail.com" <kdt...@gmail.com> wrote:

[kdt...@gmail.com]

OK, so you are saying that my code could send the addendum to User-A,
but when User-A edited the note, then they could change the author of
the note to User-B and leave it unsigned. So then the addendum would
show up on User-B's list. That's a cool idea I hadn't thought of.
Thanks!

I have just written some code that will allow for pending tickler
messages to be assigned from one recipient user to another. That way,
if a nurse were to quit or be replaced, then I could reassign all the
messages that were headed her way to someone else. It is a text-mode
(roll-n-scroll) interface. But this would have to be done *before*
the addendum was created. But I like Matt's idea for *after* the
addendum was created.

Thanks,
Kevin

[Matt King]

Actually, there already is a way in CPRS to forward all messages to
another person. It can be done for a lunch hour, a vacation time or
forever. Look under TOOLS>OPtions>Notifications>surrogate settings.
There is a way to do it in the roll and scroll already also, but I
don't know it without research.

m