1. 2015 User Conference Best Practices for Genetic Family History April 24th, 2015 Presented by: Jen Novakovich PM/EHR Trainer EHR Session BJ Bloom, RN, IBCLC Training Specialist

2. 2015 Office Practicum User Conference Objectives ❏ Identify what your practice needs to do to prepare for using the new family history. ❏ See how current family history in Office Practicum will be converted to the new format ❏ Learn how to document history in OP14 ❏ Understand the SNOMED-CT coding concepts associated with family history

3. 2015 Office Practicum User Conference Advantages of OP 14 Family History ❏ Reflects true genetic family ❏ Each entry associated with correct sibs ❏ Unique entry for each family member/problem ❏ Expanded family history questions ❏ SNOMED coding supports for clinical decision making ❏ Sort/Group/Filter for viewing data ❏ Meets 2014 Meaningful Use requirements

4. 2015 Office Practicum User Conference How to look at Family History ❏ Current information about diseases/conditions which tend to “run in families” ❏ Some specific genetic information about patterns of inheritance for diseases/conditions ❏ Generally take information about what is known today and from the past ❏ Use frequency to predict likelihood of relevance in medical decision making today

5. 2015 Office Practicum User Conference How is a Family defined in OP? Financial Family: People who are financially responsible for you Insurance Guarantor

6. 2015 Office Practicum User Conference How is a Family defined in OP? Social Family: People whom you live with/interact with Register Contacts

7. 2015 Office Practicum User Conference How is a Family defined in OP? Genetic Family: People with which you share genes Register Contacts Role Family History

8. 2015 Office Practicum User Conference Documenting Genetic Parents for New Patients ❏ If you permit, front desk may be making this initial decision, but be sure they understand the implications ❏ You can always fix it when you pull up the family history ❏ Exception: This question is not asked when adoption is already documented on perinatal history

9. 2015 Office Practicum User Conference Let’s See It!

10. 2015 Office Practicum User Conference Merging Contacts Does your office have duplicate contacts in your system?

11. 2015 Office Practicum User Conference Merging Contacts

12. 2015 Office Practicum User Conference Let’s See It!

13. 2015 Office Practicum User Conference Pre-update History Checklist: Patient Register: ❏ Review contacts to ensure correct relationships ❏ Confirm Resides With is correct for all Contacts ❏ Select Guarantors for each sibling on Insurance Tab ❏ Merge duplicate Contacts Haven’t updated to OP 14 yet? Here are some things you can do in preparation:

14. 2015 Office Practicum User Conference

15. Mapping Family Member Abbreviations Mapping OP 11 Family Member Abbreviations in OP 14 ❏ This list can be supplemented as you convert, so over the first few weeks your first-pass conversions should get cleaner ❏ Order is crucial when some abbreviations contain other abbreviations - sort most complicated at top of list

16. 2015 Office Practicum User Conference Post Update History Checklist Map ICD-9 codes to SNOMED In Chart--> History Tab: ❏ Confirm correct biological parents listed ❏ Review acronyms for family members and be consistent with naming ❏ Convert Hx ❏ Review for correct copying to sibs complete hx entries with any updates

17. 2015 Office Practicum User Conference Converting Family Histories After updating to OP 14 you will notice: ❏ Re-arrangement of history tabs ❏ All neonatal history sections are grouped under a tab named “Perinatal” ❏ Two family history tabs (this is temporary) Converting Old Family Histories from OP 11 to OP 14

18. 2015 Office Practicum User Conference OP 14 Family History

19. 2015 Office Practicum User Conference OP 14 Family History OP 14 Family History: Family Member AND Condition ❏ Family members are from a list of HL7 standards ❏ Medical problem defined by ❏ Problem description ❏ SNOMED (optional) ❏ Onset/Dx age range (optional) ❏ Notes/details (optional)

20. 2015 Office Practicum User Conference OP 14 Family History Maternal/Paternal Inheritance

21. 2015 Office Practicum User Conference OP 14 Family History Family History: Orienting to Maternal/Paternal Inheritance ❏ Choose patient’s GENETIC mother ❏ Natural mother ❏ Birth mother (adoption) ❏ Birth mother (other) ❏ Egg Donor ❏ Pulldown includes anyone with “Mother” as role/reason on contact table in Patient Register (defaults to lowest sort number) ❏ Siblings with the same mother in this field imply they share maternal genes ❏ Do the same for paternal genetic lineage

22. 2015 Office Practicum User Conference ❏ If genetic mother and father are defined above grid AND correct siblings are associated with each side of the family: ❏ When new data is added, most family members have an inherent “side” (paternal grandmother, maternal aunt, etc.) ❏ OP intelligently defaults appropriate sibs to copy to, but you can override as needed ❏ Each row of data displays the list of siblings it has been copied to ❏ You can edit to include/exclude siblings later on OP 14 Family History Sibling Mapping

23. 2015 Office Practicum User Conference OP 14 Family History Sibling Mapping for Sibling Family Member History ❏ If sibling list is identical for genetic mother and father, OP assumes same genetics (intact natural family) ❏ All siblings are pre-checked to copy-to ❏ Uncheck if inappropriate - “sib with asthma” except the sib who has asthma ❏ If sibling list is different for genetic mother and father, OP assumes genetics uncertain ❏ All siblings in common are pre-checked to copy-to ❏ You can manually specify additional appropriate siblings

24. 2015 Office Practicum User Conference OP 14 Family History Sibling Mapping - Manual

25. 2015 Office Practicum User Conference Let’s See It!

26. 2015 Office Practicum User Conference OP 14 Family History OP 14 History Organization

27. 2015 Office Practicum User Conference OP 14 Family History OP 11 Family History to be Converted ❏ Several items refer to multiple family members; multiple conversions will be performed for those ❏ Name and location of family members in Comment is crucial - must be recognized, and must be either first word of Note, or first word on new line or after a comma ❏ [Map] button lets you tell OP about your preferred family member abbreviations

28. 2015 Office Practicum User Conference OP 14 Family History Initial Conversion to OP 14 Family History Format ❏ OP 11 records which referred to multiple family members might need to be cloned, depending on Note syntax ❏ May want to use SNOMED chooser in Problem field to provide a more precise definition of the condition

29. 2015 Office Practicum User Conference OP 14 Family History Converting Family History (continued) ❏ When you have cleaned up all your entries... ❏ Archive OP 11 history ❏ OP 11 family history tab will disappear ❏ Will only use OP 14 Family History moving forward

30. 2015 Office Practicum User Conference OP 14 Family History History Sections Before and After Archiving

31. 2015 Office Practicum User Conference OP 14 Family History Selecting Siblings to Convert Family History

32. 2015 Office Practicum User Conference OP 14 Family History Copying Family History to a New Family Member

33. 2015 Office Practicum User Conference OP 14 Family History Family History Grouped by Family Member

34. 2015 Office Practicum User Conference OP 14 Family History Family History Grouped by Problem

35. 2015 Office Practicum User Conference Let’s See It!

36. 2015 Office Practicum User Conference Questions ?

37. 2015 Office Practicum User Conference We want your feedback!