Home Forums Discussions General Discussion Health Maintenance

The HM section of V.5 is the last part we have not really implemented. I have been trying to puzzle it out, but it seems terribly cumbersome. For example, even if I put in a date for a colonoscopy, it keeps coming up with an alert because the criteria are "every 1-10 years", and I don't see a simple button that says "noted" or "done" or anything.

So, I guess my global question is this: Is the consensus among experienced users that the HM section is really ready for prime time and we should put in what looks like significant time to learn it; or is it liable to be re-vamped to a more user-friendly form soon, and best to wait a bit?

As a GI, I don't use the HM section at all. I do like the HM's apparent focus on colonoscopy. I think that a yearly colonoscopy for everyone is appropriate.

Do I need to put a :-) there, or is that assumed?

As soon as my heartrate drops below about 160, I can say it was assumed.

The HM about colorectal screening is unique in that it is really generic for screening based on fecal occult blood testing, sigmoidoscopy or colonoscopy and it is 1-10 years based on the type of testing. If you go into administrative options and Health Maintenance. I think you should either change that one or make your own new rules - you could set it for FOBT yearly, Sigmoidoscopy every 5, colonoscopy every 10 or whatever you want, but I would think you would want to make a standard for your office and what you do.

The neat thing is you can set your own rules - I set one called medication reconciliation - this reminds me at least once each year to go in and reconcile meds with pt. list/meds, I try to do this each visit, but pt. are poor about bringing in meds or list. I think the HM is useful and you should bite the bullet and start using them. Figure out if there are rules you want - make your own, adapt the ones there and jump in.

But, in reality, there is no standard. That is the main problem I have with any Health Maintenance Module. Different patients have different needs. Although one can certainly use these kinds of reminders to assist with the practice of medicine, the skill of the practitioner still remains vital. Just like an auto mechanic may use "the computer" to diagnose a problem, the best ones are those that can listen to the motor and know when it is right.

While there is no standard, there are a bunch of recommendations out there. Kudo's to Jon for separating them in the level of certainty and the ability to modify or add criteria. Some areas may have different needs based on the local population or disease prevalence.

Is it ready for prime time? It meets the needs/requirements. Will it be changed in the short run? Probably not, the focus is on adding PM, unless a brilliant reworking suddenly becomes obvious and simple to code (yeah, right. It works, it's useful and it can be tuned to your needs. It does take a bit of tuning to meet your needs, but it can be a good reminder generator.

The way I see to get a reminder for an annual colonoscopy in a patient with a villous adenoma and dysplasia, for example, is create a rule for colonoscopy for high risk polyps, add a risk factor for high risk polyps, and then remember to select the risk factor when I see the patient since there is no diagnosis code trigger. That seems to be a lot of extra electronic paperpushing for an unknown degree of benefit. Someplace in here, it seems to be turning me into a "healthcare administrator" instead of a doctor. So, if we ignore "meaningful use" and hopes of being repaid, which may or may not ever happen, is the consensus out there that this is really useful for patient care? Are real, live doctors in this community finding that they are forgetting fewer things? Are patients getting better care?

To the best of my knowledge, there have been no studies concluding that even having a basic EMR improves the quality of care given to patients. Having a Health Maintenance Module does not guarantee that a less-competent physician will suddenly become more competent. In all likelihood, they will ignore or skip over the mundane things in the HMM just as they do now.

Can you actually add your own risk factors into the HM section?

Yes

OK, so I was a smart-alec and thought I knew how to do this. I went assuming you could add your own risk factors, and now I can't figure out how to do it, and tech support was not sure either. Where DO you add your own risk factors Not HM items, but risk factors)?

Since I am only 1 mo in using AC, I have tried putting HM items on the summary page where you can graph cholesterol values. I want to be able to see what is due on one page w/ exact dates. I also put mammogram on this section. I haven't figured out how to use the actual HM section as an effective reminder system. Is there a way?

If you start exploring the HM section (and it has taken me 4 months to get to where other priorities let me do that) you will find that you can make your own selection of health maintenance rules... say, pneumovax in all patients over 60... and the HM will trip a reminder when a patient turns 60 if they have not been vaccinated. The problem that I am having is that as I can see that you can write a rule to trigger a HM item that excludes the item if a diagnosis is listed (like, Zostavax in a patient age 60 but who is HIV positive), but I don't see how to add a rule that triggers it.

For your examples, like tracking cholesterol, see Bert's post on "Sample Flow Sheet in Excel" he recently posted. You can, of course, graph anything in Excel as well.

I am not far ahead of you in the learning process. I have an MD partner, a PA who is tech savvy, and a couple of office folks who explore AC as well. Your screen name implies, you are pretty much on your own. It's perfectly ok to do whatever works for you at the moment, and get fancy as you go. My partner uses a hockey analogy; you can read about hockey till the cows come home, but sooner or later you just have to go out on the ice and start playing, and accept that you are going to play badly for some time.