1. IHS - EHR Version 1.1 Indian Health Service - Electronic Health Record Chris Lamer, PharmD Stephanie Klepacki Chris Lamer, PharmD Stephanie Klepacki The Wellness Tab and CRS

4. Patient Education

6. Patient Education Codes Condition Topic Readiness to learn Level of understanding Provider Time Goal Comment DM-EX-DIST-P-CCL-5min- GS-Will walk 3x per week- Does not exercise

7. Patient Education Codes Local development Submitted and approved by PEP-C –Added to the Protocol manual & RPMS –Protocols Outcomes Standards –Lesson plans Local development Submitted and approved by PEP-C –Added to the Protocol manual & RPMS –Protocols Outcomes Standards –Lesson plans

17. Patient Education and CRS Used in the following GPRA measures –Tobacco Cessation (Counseling) Tobacco (TO-, -TO) Secondhand Smoke (-SHS) –Alcohol Screening (FAS Prevention) Alcohol and Other Drugs (AOD) –Intimate Partner/Domestic Violence Screening Domestic Violence (DV-, -DV) Used in the following GPRA measures –Tobacco Cessation (Counseling) Tobacco (TO-, -TO) Secondhand Smoke (-SHS) –Alcohol Screening (FAS Prevention) Alcohol and Other Drugs (AOD) –Intimate Partner/Domestic Violence Screening Domestic Violence (DV-, -DV)

18. Patient Education and CRS (cont’d) –Depression Screening Depression (DEP-) Behavioral and Social Health (BH-) Suicidal Behavior (SB-) Postpartum Depression (PDEP-) –Comprehensive CVD-Related Assessment Tobacco Screening (TO-, -TO, -SHS) Lifestyle Counseling –Nutrition/Medical Nutrition Therapy (-N, -MNT) –Exercise (-EX) –Lifestyle Adaptation (-LA) –Depression Screening Depression (DEP-) Behavioral and Social Health (BH-) Suicidal Behavior (SB-) Postpartum Depression (PDEP-) –Comprehensive CVD-Related Assessment Tobacco Screening (TO-, -TO, -SHS) Lifestyle Counseling –Nutrition/Medical Nutrition Therapy (-N, -MNT) –Exercise (-EX) –Lifestyle Adaptation (-LA)

19. Patient Education and CRS (cont’d) Used in the following non-GPRA measures –Tobacco Use and Exposure Assessment –Alcohol Screening and Brief Intervention (ASBI) in the ER (CRS 8.0) –Nutrition and Exercise Education for At Risk Patients –Appropriate Medication Therapy after a Heart Attack & in High Risk Patients (3 topics; breastfeeding education is used as a contraindication for statin therapy) Used in the following non-GPRA measures –Tobacco Use and Exposure Assessment –Alcohol Screening and Brief Intervention (ASBI) in the ER (CRS 8.0) –Nutrition and Exercise Education for At Risk Patients –Appropriate Medication Therapy after a Heart Attack & in High Risk Patients (3 topics; breastfeeding education is used as a contraindication for statin therapy)

20. Patient Education and CRS (cont’d) –Prenatal HIV Testing (HIV counseling measure; not HIV testing measure) –Pre-Diabetes/Metabolic Syndrome (Tobacco Screening, Lifestyle Adaptation) –Medications Education –Prenatal HIV Testing (HIV counseling measure; not HIV testing measure) –Pre-Diabetes/Metabolic Syndrome (Tobacco Screening, Lifestyle Adaptation) –Medications Education

21. Patient Education and CRS (cont’d) Patient Education Report –Available from the CRS Other National Reports Menu dedicated entirely to the following patient education measures Rate of User Population Patients Receiving Patient Education Rate of Time by Provider Discipline Rate for Top 25 Diagnoses/Disease State with Education Rate for Top 25 Education Topics Rate for Top 15 Provider Disciplines Who Educated Rate of Patient Understanding of Education Goal Setting (CRS 8.0) Patient Education Report –Available from the CRS Other National Reports Menu dedicated entirely to the following patient education measures Rate of User Population Patients Receiving Patient Education Rate of Time by Provider Discipline Rate for Top 25 Diagnoses/Disease State with Education Rate for Top 25 Education Topics Rate for Top 15 Provider Disciplines Who Educated Rate of Patient Understanding of Education Goal Setting (CRS 8.0)

22. Health Factors and Exam Codes

24. Health Factors and CRS Used in the following GPRA measures –Tobacco Cessation Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, or Cessation-Smokeless Quit Tobacco Use: Previous Smoker, Previous Smokeless –Comprehensive CVD-Related Assessment Tobacco Screening: Any Tobacco Health Factor –Alcohol Screening (FAS Prevention) Screening: Any Alcohol Health Factor (i.e. CAGE) Used in the following GPRA measures –Tobacco Cessation Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, or Cessation-Smokeless Quit Tobacco Use: Previous Smoker, Previous Smokeless –Comprehensive CVD-Related Assessment Tobacco Screening: Any Tobacco Health Factor –Alcohol Screening (FAS Prevention) Screening: Any Alcohol Health Factor (i.e. CAGE)

25. Health Factors and CRS (cont’d) Used in the following non-GPRA measures –Tobacco Use and Exposure Assessment Screening: Any Tobacco Health Factor Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, Cessation-Smokeless Smokeless Tobacco Users: Current Smokeless, Current Smoker and Smokeless, or Cessation- Smokeless Exposure to Tobacco Smoke: Smoker in Home or Exposure to Environmental Tobacco Smoke Used in the following non-GPRA measures –Tobacco Use and Exposure Assessment Screening: Any Tobacco Health Factor Tobacco Users: Current Smoker, Current Smokeless, Current Smoker and Smokeless, Cessation-Smoker, Cessation-Smokeless Smokeless Tobacco Users: Current Smokeless, Current Smoker and Smokeless, or Cessation- Smokeless Exposure to Tobacco Smoke: Smoker in Home or Exposure to Environmental Tobacco Smoke

26. Health Factors and CRS (cont’d) –Alcohol Screening & Brief Intervention in the ER (CRS 8.0) Screening: Any Alcohol Health Factor (i.e. CAGE) Positive Screen: CAGE 1/4, 2/4, 3/4 or 4/4 –Pre-Diabetes/Metabolic Syndrome Tobacco Screening: Any Tobacco Health Factor –Alcohol Screening & Brief Intervention in the ER (CRS 8.0) Screening: Any Alcohol Health Factor (i.e. CAGE) Positive Screen: CAGE 1/4, 2/4, 3/4 or 4/4 –Pre-Diabetes/Metabolic Syndrome Tobacco Screening: Any Tobacco Health Factor

30. CRS and Exam Codes Used in the following GPRA measures –Diabetic Retinopathy Diabetic Retinal Exam: Exam Code 03 –Access to Dental Service Annual Dental Visit: Exam Code 30 –Alcohol Screening (FAS Prevention) Alcohol Screening: Exam Code 35 –Intimate Partner/Domestic Violence Screening Domestic Violence Screening: Exam Code 34 –Depression Screening, Comprehensive CVD-Related Assessment Depression Screening: Exam Code 36 Used in the following GPRA measures –Diabetic Retinopathy Diabetic Retinal Exam: Exam Code 03 –Access to Dental Service Annual Dental Visit: Exam Code 30 –Alcohol Screening (FAS Prevention) Alcohol Screening: Exam Code 35 –Intimate Partner/Domestic Violence Screening Domestic Violence Screening: Exam Code 34 –Depression Screening, Comprehensive CVD-Related Assessment Depression Screening: Exam Code 36

31. CRS and Exam Codes (cont’d) Used in the following non-GPRA measures –Diabetes Comprehensive Care Diabetic Retinal Exam: Exam Code 03 Diabetic Foot Exam: Exam Code 28 –Diabetes: Access to Dental Service Annual Dental Visit: Exam Code 30 –Alcohol Screening & Brief Intervention in the ER (CRS 8.0) Alcohol Screening: Exam Code 35 Positive Screen: Exam Code 35 w/positive result –Pre-Diabetes/Metabolic Syndrome Depression Screen: Exam Code 36 –Fall Risk Assessment Fall Risk Screen: Exam Code 37 Used in the following non-GPRA measures –Diabetes Comprehensive Care Diabetic Retinal Exam: Exam Code 03 Diabetic Foot Exam: Exam Code 28 –Diabetes: Access to Dental Service Annual Dental Visit: Exam Code 30 –Alcohol Screening & Brief Intervention in the ER (CRS 8.0) Alcohol Screening: Exam Code 35 Positive Screen: Exam Code 35 w/positive result –Pre-Diabetes/Metabolic Syndrome Depression Screen: Exam Code 36 –Fall Risk Assessment Fall Risk Screen: Exam Code 37

33. Personal Health Component

36. CRS Asthma Measures Non-GPRA asthma topics included in the Selected Measures (Local) Reports –Asthma Active Clinical patients with two asthma-related visits (Dx of 493) during the Report Period or categorized in ARS as persistent (active patients as Severity 2, 3 or 4). Broken down by age groups 0-5, 5-64, 65+. Active Clinical patients from measure above who were hospitalized for asthma during the report period. Non-GPRA asthma topics included in the Selected Measures (Local) Reports –Asthma Active Clinical patients with two asthma-related visits (Dx of 493) during the Report Period or categorized in ARS as persistent (active patients as Severity 2, 3 or 4). Broken down by age groups 0-5, 5-64, 65+. Active Clinical patients from measure above who were hospitalized for asthma during the report period.

37. CRS Asthma Measures (cont’d) –Asthma Quality of Care (HEDIS measure) Active Clinical patients ages 5-56 with persistent asthma w/o emphysema or COPD who received one dispensed prescription for primary asthma therapy medication during the report period. Broken down by age groups: 5-9, 10-17, 18-56. –Persistent asthma defined by diagnosis and/or medication data or inclusion in ARS as active patient with severity level of 2, 3, or 4. –Primary asthma therapy includes: Inhaled Corticosteroids, Nedocromil, Cromolyn Sodium, Leukotriene Modifiers or Methylxanthines –Asthma Quality of Care (HEDIS measure) Active Clinical patients ages 5-56 with persistent asthma w/o emphysema or COPD who received one dispensed prescription for primary asthma therapy medication during the report period. Broken down by age groups: 5-9, 10-17, 18-56. –Persistent asthma defined by diagnosis and/or medication data or inclusion in ARS as active patient with severity level of 2, 3, or 4. –Primary asthma therapy includes: Inhaled Corticosteroids, Nedocromil, Cromolyn Sodium, Leukotriene Modifiers or Methylxanthines

38. CRS Asthma Measures (cont’d) –Asthma and Inhaled Steroid Use Active Clinical patients ages 1+ in ARS as persistent or who have had two asthma-related visits during the report period who were prescribed an inhaled corticosteroid during the report period. Broken down by age groups: 1-4, 5-19, 20-44, 45-64, 65+. –Excludes patients active in ARS with a severity of 1 during the report period. –Inhaled corticosteroid includes: Mometasone (Asmanex), Beclovent, Qvar, Vancenase, Vanceril, Vanceril DS, Bitolerol (Tornalate), Pulmicort, Pulmicort Respules, Pulmicort Turbohaler, Salmeterol/fluticasone (Advair), Triamcinolone (Azmacort), Fluticasone (Flovent). –Asthma and Inhaled Steroid Use Active Clinical patients ages 1+ in ARS as persistent or who have had two asthma-related visits during the report period who were prescribed an inhaled corticosteroid during the report period. Broken down by age groups: 1-4, 5-19, 20-44, 45-64, 65+. –Excludes patients active in ARS with a severity of 1 during the report period. –Inhaled corticosteroid includes: Mometasone (Asmanex), Beclovent, Qvar, Vancenase, Vanceril, Vanceril DS, Bitolerol (Tornalate), Pulmicort, Pulmicort Respules, Pulmicort Turbohaler, Salmeterol/fluticasone (Advair), Triamcinolone (Azmacort), Fluticasone (Flovent).

41. CRS and Refusals Refusals count for many measures. Some of the GPRA measures that count refusals include: –Diabetic Retinopathy (retinal exam) –Access to Dental Services (dental visit) –Adult Immunizations: Influenza –Pap Smear –Mammogram –Colorectal Cancer Screening –Depression Screening –Prenatal HIV Testing Refusals count for many measures. Some of the GPRA measures that count refusals include: –Diabetic Retinopathy (retinal exam) –Access to Dental Services (dental visit) –Adult Immunizations: Influenza –Pap Smear –Mammogram –Colorectal Cancer Screening –Depression Screening –Prenatal HIV Testing

45. Immunizations

50. CRS Immunization Measures CRS uses immunization data in the following topics –Childhood Immunizations (19-35 Months): DTaP, IPV/OPV, MMR, Hepatitis B, HiB, Varicella, Pneumococcal –Adolescent Immunizations (13 and 13-17 Years): MMR, Hepatitis B, Varicella, Td/Tdap, Meningococcal, HPV –Adult Immunizations (50 Years and Older): Influenza, Pneumococcal CRS also includes contraindications and parent/patient refusals CRS uses immunization data in the following topics –Childhood Immunizations (19-35 Months): DTaP, IPV/OPV, MMR, Hepatitis B, HiB, Varicella, Pneumococcal –Adolescent Immunizations (13 and 13-17 Years): MMR, Hepatitis B, Varicella, Td/Tdap, Meningococcal, HPV –Adult Immunizations (50 Years and Older): Influenza, Pneumococcal CRS also includes contraindications and parent/patient refusals

51. Skin Tests

52. PPD Process Create a visit Document administration of the PPD Create a visit Document administration of the PPD

54. Documenting a PPD 72 hours later - PPD reading: –Create a visit –Edit the PPD already entered Requires the visit to be unlocked 72 hours later - PPD reading: –Create a visit –Edit the PPD already entered Requires the visit to be unlocked

57. CRS Web Site www.ihs.gov/cio/crs