Difference between revisions of "Reminder Definitions"

Latest revision as of 00:49, 26 July 2012

Introduction

A "Reminder" is a clinical rule that is typically applied against a particular patient to determine if it is due. Examples:

• Does patient need mammogram now?
• Is colonoscopy due now?

Fileman Structure top

Below is the Fileman data dictionary of the file used to store the reminder definitions. More discussion below the file display

 File: REMINDER DEFINITION                                            Branch: 1
 REF  NODE;PIECE     FLD NUM  FIELD NAME
 ===============================================================================
   1  0;1                .01  NAME                                         [RF]
   2  0;3                1.2  PRINT NAME                                    [F]
   3  0;4                1.3  DO IN ADVANCE TIME FRAME                     [FX]
   4  0;5                1.4  RELATED REMINDER GUIDELINE      <-Pntr  [P811.9']
   5  0;6                1.6  INACTIVE FLAG                                [SX]
   6  0;7                1.7  INACTIVE CHANGE DATE                         [DX]
   7  0;8                1.8  IGNORE ON N/A                                [FX]
   8  0;9                1.9  SEX SPECIFIC                                  [S]
   9  0;10              1.91  PRIORITY                                      [S]
      1;0                  2  DESCRIPTION                         <-WP [811.92]
  10   -0;1              .01   -REMINDER DESCRIPTION                        [W]
      2;0                  3  TECHNICAL DESCRIPTION               <-WP [811.93]
  11   -0;1              .01   -TECHNICAL DESCRIPTION                       [W]
      7;0                  7  BASELINE AGE FINDINGS             <-Mult [811.97]
  12   -0;1              .01   -REMINDER FREQUENCY                        [MFX]
  13   -0;2                1   -MINIMUM AGE                             [NJ3,0]
  14   -0;3                2   -MAXIMUM AGE                             [NJ3,0]
       -1;0                3   -AGE MATCH TEXT               W:^ <-WP [811.973]
  15    --0;1            .01    --AGE MATCH TEXT                            [W]
       -2;0                4   -AGE NO MATCH TEXT            W:^ <-WP [811.974]
  16    --0;1            .01    --AGE NO MATCH TEXT                         [W]
  17   -3;1                5   -NO. OF AGE MATCH LINES                      [F]
  18   -3;2                6   -NO. OF AGE NO MATCH LINES                   [F]
      20;0                20  FINDINGS                        <-Mult [811.902V]
  19   -0;1              .01   -FINDING ITEM                   <-Pntr Var [MVX]
  20   -0;2                1   -MINIMUM AGE                             [NJ3,0]
  21   -0;3                2   -MAXIMUM AGE                             [NJ3,0]
  22   -0;4                3   -REMINDER FREQUENCY                         [FX]
       -1;0                4   -FOUND TEXT                  W:^ <-WP [811.9024]
  23    --0;1            .01    --FOUND TEXT                                [W]
       -2;0                5   -NOT FOUND TEXT              W:^ <-WP [811.9025]
  24    --0;1            .01    --NOT FOUND TEXT                            [W]
  25   -0;5                6   -RANK FREQUENCY                          [NJ3,0]
  26   -0;6                7   -USE IN RESOLUTION LOGIC                     [S]
  27   -0;7                8   -USE IN PATIENT COHORT LOGIC                 [S]
  28   -0;8                9   -BEGINNING DATE/TIME                        [FX]
  29   -0;9               10   -USE INACTIVE PROBLEMS                       [S]
  30   -0;10              11   -WITHIN CATEGORY RANK                    [NJ3,0]
  31   -0;11              12   -ENDING DATE/TIME                           [FX]
  32   -0;12              13   -MH SCALE                              [NJ15,0X]
  33   -3;1               14   -CONDITION                                  [FX]
  34   -3;2               15   -CONDITION CASE SENSITIVE                    [S]
  35   -0;13              16   -RXTYPE                                     [FX]
  36   -0;14              17   -OCCURRENCE COUNT                        [NJ2,0]
  37   -3;3               18   -USE STATUS/COND IN SEARCH                   [S]
       -5;0               21   -STATUS LIST              W:^ <-Mult [811.90221]
  38    --0;1            .01    --STATUS                                  [MFX]
  39   -10;1              22   -INTERNAL CONDITION                          [F]
  40   -11;1              23   -V SUBSCRIPT LIST                            [F]
  41   -6;1               24   -NO. OF FOUND TEXT LINES                     [F]
  42   -6;2               25   -NO. NOT FOUND TEXT LINES                    [F]
  43   -15;E1,245         26   -COMPUTED FINDING PARAMETER                  [F]
  44   -0;15              27   -USE START DATE                              [S]
  45   -0;16              28   -INCLUDE VISIT DATA                          [S]
      25;0                25  FUNCTION FINDINGS               <-Mult [811.925I]
  46   -0;1              .01   -FUNCTION FINDING NUMBER               [MNJ3,0X]
       -1;0                1   -FOUND TEXT                  W:^ <-WP [811.9251]
  47    --0;1            .01    --FOUND TEXT                                [W]
       -2;0                2   -NOT FOUND TEXT              W:^ <-WP [811.9252]
  48    --0;1            .01    --NOT FOUND TEXT                            [W]
  49   -3;1                3   -FUNCTION STRING                            [FX]
       -5;0                5   -FUNCTION LIST                 <-Mult [811.9255]
  50    --0;1            .01    --FUNCTION NUMBER                      [MNJ3,0]
  51    --0;2            .02    --FUNCTION                   <-Pntr  [P802.4'X]
        --20;0            20    --FUNCTION ARGUMENT LIST      <-Mult [811.9256]
  52     ---0;1          .01     ---FINDING NUMBER                    [MNJ3,0X]
  53   -10;1              10   -LOGIC                                       [F]
  54   -0;6               11   -USE IN RESOLUTION LOGIC                     [S]
  55   -0;7               12   -USE IN PATIENT COHORT LOGIC                 [S]
  56   -0;2               13   -MINIMUM AGE                             [NJ3,0]
  57   -0;3               14   -MAXIMUM AGE                             [NJ3,0]
  58   -0;4               15   -REMINDER FREQUENCY                         [FX]
  59   -0;5               16   -RANK FREQUENCY                          [NJ3,0]
  60   -40;1              40   -NAME                                        [F]
  61   -6;1               41   -NO. FOUND TEXT LINES                        [F]
  62   -6;2               42   -NO. NOT FOUND TEXT LINES                    [F]
  63  30;1                30  CUSTOMIZED COHORT LOGIC                      [FX]
  64  31;1                31  INTERNAL PATIENT COHORT LOGIC                [FX]
  65  32;1                32  PATIENT COHORT FINDINGS COUNT            [NJ2,0X]
  66  32;2                33  PATIENT COHORT FINDINGS LIST                 [FX]
  67  34;1                34  CUSTOMIZED RESOLUTION LOGIC                  [FX]
  68  35;1                35  INTERNAL RESOLUTION LOGIC                    [FX]
  69  36;1                36  RESOLUTION FINDINGS COUNT                [NJ2,0X]
  70  36;2                37  RESOLUTION FINDINGS LIST                     [FX]
  71  40;1                40  AGE FINDINGS COUNT                       [NJ2,0X]
  72  40;2                41  AGE FINDINGS LIST                            [FX]  
  73  42;1                42  INFORMATION FINDINGS COUNT               [NJ2,0X]
  74  42;2                43  INFORMATION FINDINGS LIST                    [FX]
  75  45;1                45  CUSTOM DATE DUE                              [FX]
  76  46;1                46  CUSTOM DATE DUE FUNCTION                      [F]
  77  46;2                47  NUMBER OF ARGUMENTS                       [NJ2,0]
      47;0                48  CUSTOM DATE DUE ARG LIST        <-Mult [811.948A]
  78   -0;1              .01   -FINDING                                 [NJ3,0]
  79   -0;2              .02   -FREQUENCY                                   [F]
      50;0                50  WEB SITES                       <-Mult [811.9002]
  80   -0;1              .01   -URL                                        [MF]
  81   -0;2              .02   -WEB SITE TITLE                              [F]
       -1;0                1   -WEB SITE DESCRIPTION           <-WP [811.90021]
  82    --0;1            .01    --WEB SITE DESCRIPTION                      [W]
  83  51;1                51  LINKED REMINDER DIALOG        <-Pntr  [*P801.41']
      60;0                60  GENERAL COHORT FOUND TEXT     W:^ <-WP [811.9003]
  84   -0;1              .01   -GENERAL COHORT FOUND TEXT                   [W]
      61;0                61  GENERAL COHORT NOT FOUND TEXT  W:^ <-WP [811.961]
  85   -0;1              .01   -GENERAL COHORT NOT FOUND TEXT               [W]
  86  62;1                62  # OF GEN. COHORT FOUND LINES                  [F]
  87  62;2                63  # GEN. COHORT NOT FOUND LINES                 [F]
      65;0                65  GENERAL RES. FOUND TEXT        W:^ <-WP [811.965]
  88   -0;1              .01   -GENERAL RES. FOUND TEXT                     [W]
      66;0                66  GENERAL RES. NOT FOUND TEXT    W:^ <-WP [811.966]
  89   -0;1              .01   -GENERAL RES. NOT FOUND TEXT                 [W]
  90  67;1                67  # GEN. RES. FOUND LINES                       [F]
  91  67;2                68  # GEN. RES. NOT FOUND LINES                   [F]
  92  0;11                69  RESCISSION DATE                               [D]
      70;0                70  SUMMARY COHORT FOUND TEXT     W:^ <-WP [811.9004]
  93   -0;1              .01   -SUMMARY COHORT FOUND TEXT                   [W]
      71;0                71  SUMMARY COHORT NOT FOUND TEXT  W:^ <-WP [811.971]
  94   -0;1              .01   -SUMMARY COHORT NOT FOUND TEXT               [W]
  95  72;1                72  # SUM. COHORT FOUND LINES                     [F]
  96  72;2                73  # SUM. COHORT NOT FOUND LINES                 [F]
      75;0                75  SUMMARY RES. FOUND TEXT        W:^ <-WP [811.975]
  97   -0;1              .01   -SUMMARY RESOLUTION FOUND TEXT               [W]
      76;0                76  SUMMARY RES. NOT FOUND TEXT    W:^ <-WP [811.976]
  98   -0;1              .01   -SUMMARY RES. NOT FOUND TEXT                 [W]
  99  77;1                77  # SUM. RES. FOUND LINES                       [F]
 100  77;2                78  # SUM. RES. NOT FOUND LINES                   [F]
 101  100;1              100  CLASS                                       [RSX]
 102  100;2              101  SPONSOR                         <-Pntr  [P811.6X]
 103  100;3              102  REVIEW DATE                                   [D]
 104  100;4              103  USAGE                                       [RFX]
      110;0              110  EDIT HISTORY                   <-Mult [811.9001D]
 105   -0;1              .01   -EDIT DATE                                   [D]
 106   -0;2                1   -EDIT BY                         <-Pntr  [P200']
       -1;0                2   -EDIT COMMENTS                  <-WP [811.90012]
 107    --0;1            .01    --EDIT COMMENTS                             [W]
  <> <> <>

Definition Parts top

Main parts of Reminder Definitions

• Findings (patient data)
• Cohort Logic (a logical combination of Findings) -- describes who the reminder applies to
• Resolution Logic. Another logical string that determines how the reminder can be resolved. (e.g. Mammogram 'Performed' would resolve Mammogram 'Due')

Key fields in REMINDER DEFINITION file top

Age & Frequency issues top

• Stored in the BASELINE AGE FINDINGS field (#7), which is a multiple.
• Baseline frequency: how often the reminder needs to be done. E.g. Q 12 months, or Q 2 years
  • Stored in REMINDER FREQUENCY sub-field (#.01)
• Age Range: What ages the reminder applies to. E.g. Ages 12-26 yrs
  • Stored in MINIMUM AGE sub-field (#1)
  • And MAXIMUM AGE sub-field (#2)
• Can have multiple Age/Freq's for each reminder. E.g. Q 1 yr for ages 20-50, then Q 2 yrs for ages 51 yrs and up.

Gender specific top

• Field SEX SPECIFIC (#1.9).
• If left blank, then applies to both genders.

FINDINGS field (#20), (A multiple) top

FINDING ITEM sub-field (#.01) top

• This is variable pointer to data items.
  • 50 -- DRUG
  • 9999999.09 -- EDUCATION TOPIC
  • 9999999.15 -- EXAM
  • 9999999.64 -- HEALTH FACTOR
  • 9999999.14 -- IMMUNIZATION
  • 60 -- LABORATORY TEST
  • 601.71 -- MH TESTS AND SURVEYS
  • 101.43 -- ORDERABLE ITEM
  • 71 -- RADIOLOGY PROCEDURE
  • 811.4 -- REMINDER COMPUTED FINDING
  • 811.2 -- REMINDER TAXONOMY
  • 811.5 -- REMINDER TERM
  • 9999999.28 -- SKIN TEST
  • 50.605 -- VA DRUG CLASS
  • 50.6 -- VA GENERIC
  • 120.51 -- VITAL MEASUREMENT
  • 810.9 -- REMINDER LOCATION LIST

Finding Modifiers -- Applying to all findings top

• Modify how a particular finding is used

REMINDER FREQUENCY field (#3).

• See Age Rage discussion 1 line below.
• Min & Max Age Range (fields #1, #2). If this finding is found to be true, then use this Age & Frequency instead of baseline age and frequency. Stored in:
  • MINIMUM AGE sub-field (#1)
  • MAXIMUM AGE sub-field (#2)
  • REMINDER FREQUENCY sub-field (#3)
  • E.g. Create a health factor for family history of colon cancer. If health factor is true, then perhaps change starting time from 50 yrs baseline, Q 10 yrs, down to new age and frequency of 40, Q 3 yrs.
  • No need to set a value for these fields unless one wants to override the baseline age & freq. to something different.

RANK FREQUENCE field (#6)

• Used if there will be multiple findings, and more than one specifies an override age & frequency value. This field will then determine which has precedence. Multiple sub-record that is true that has highest index number will be used for the override.

USE IN RESOLUTION LOGIC subfield (#11)

• Examples: OR (!), AND (&) or NOT (')
• This specifies how finding is to be combined with the overall resolution logic of the net reminder.
• If the finding is to be used to resolve the reminder (e.g. mammogram finding was found, so reminder is no longer due), put a value in this field
• So if finding was mammogram, and it was found, then this finding will evaluate to TRUE. This TRUE value will be combined with other resolution findings using the logic combination term ("and", "or", "not"), to get a final logic value that shows if the reminder is due.

USE IN PATIENT COHORT LOGIC subfield (#12)

• Examples: OR (!), AND (&) or NOT (')
• This specifies how finding is to be combined with the overall cohort logic of the net reminder.
• If the finding is to be used to define the cohort, put a value in this field
• If nothing is put into this field for any/all of the Findings sub-records, then the default logic for the entire reminder will be (AGE)&(SEX). AGE will evaluate to TRUE based on the MIN AGE, MAX AGE fields. And SEX will evaluate to TRUE if patient's gender matches the SEX SPECIFIC field, or if the SEX SPECIFIC field is blank.

BEGINNING DATE/TIME sub-field (#9)

• Beginning time frame to search for data for this finding
• If not provided, then search for patient data goes all the way to the beginning of the patient record.
• Can be a set date, e.g. "5/4/1972"
• Can be a relative date indicator, e.g. "T-1Y". "T" indicates the time when the evaluation is being run.

ENDING DATE/TIME sub-field (#12)

• Ending time frame to search for data for this finding
• If not provided, then search goes to TODAY
• See above about set vs relative dates.

OCCURRENCE COUNT sub-field (#17)

• The number of occurrences to search for in the specified date range.
• E.g. 3 --> find the 3 most recent occurrences of the finding
• E.g. -3 --> find the 3 oldest occurrences of the finding
• If only 2 are present, then 2 will be returned. But in this example, more than 3 would not be returned.

Finding Modifiers -- Applicable to only certain fields top

USE INACTIVE PROBLEMS sub-field (#10)

• Refers to Taxonomies findings e.g. problem list

WITHIN CATEGORY RANK sub-field (#11)

• Refers to Health Factors findings

MH SCALE sub-field (#13)

• Refers to mental health tests type of findings

RXTYPE sub-field (#16)

• Refers to Drug findings.
• Determines whether to search inpatient, outpatient, non-VA meds, or some combination thereof. If blank, all are searched.

USE START DATE sub-field (#27)

• Refers to Drug findings and Orderable Items
• Date of finding is the Start Date for the Rx (when it was released) instead of the default of the stop date of the Rx (the release date + supply duration).

INCLUDE VISIT DATA sub-field (#28)

• Refers to Patient Care Encounter (PCE) (V-file) findings
• If value=YES, then data from the PCE instance is available for use in a Condition.
  • Visit IEN
  • Date visit created
  • DFN
  • Location of Encounter
  • Station Number
  • Service Category
  • DSS ID
  • Outside Location
  • Status
  • Primary provider

CONDITION sub-field (#14) top

• This is a way to check the value of a data value. E.g. if finding is a potassium lab test, could have condition of "IF (V<2.5)!(V>5.5)"
• If the condition logic string evaluates to false, then the finding that contains it will evaluate to false.
• Sometimes more data is available than just a simple value "V". There can be a subscript for V, called CSUB (condition subscript). E.g. 'IF V("CSUB")<7' OR 'IF V("COLOR")="BLUE"'.
• In PCE description above, the data, such as "DFN" would be available as a condition subscript.

CONDITIONS CASE SENSITIVE sub-field (#15) top

• Same as CONDITION sub-field (#14) above, except it is case sensitive. Allows lower case CSUB's etc.

USAGE field (#103) top

• Determines how reminder will be used
• Can be a combination of codes:
  • C -- CPRS: Must have C to be shown in CPRS
  • L -- Reminder Patient List: Use this when the reminder will be used with patient lists
  • P -- Patient: This flag is used with MyHealtheVet. Shows reminders to patients.
  • R -- Reminder Reports: If one wanted to have 2 similar reminders, one that clinicians use, and a slightly different one for reports, then could mark the 2nd one with R to indicate to use it with the report.
  • X -- Reminder Extracts
  • * -- All of the above except L and P

RELATED REMINDER GUIDELINE field (#1.4) top

• Old field. Depreciated.

PRIORITY field field (#1.91) top

• LOW, MEDIUM, OR HIGH priority. Affects grouping of displayed alerts in CPRS

DO IN ADVANCE TIME FRAME field (#1.3) top

• Allows reminder to be shown as DUE SOON, when due period coming. E.g., if colonoscopy is due at age 50 yrs, and the value for this field is "6M", then 6 months before age 50 yrs, the reminder will be shown as DUE SOON.

CUSTOMIZED COHORT LOGIC field (#30) top

• Use this when more complex logic is needed than is provided by the simple FINDINGS:USE IN PATIENT COHORT LOGIC

CUSTOMIZED RESOLUTION LOGIC field (#34) top

• Use this when more complex logic is needed than is provided by the simple FINDINGS:USE IN RESOLUTION LOGIC

LINKED REMINDER DIALOG field (#51) top

• This is used when there is a reminder dialog that can be used to resolve the reminder.