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CLN2215v OurPractice Advisories ADVANCED z1 Introduction z2 Triggering…

- - - - - Exercise 1: Test Your Work https://d.pr/i/dSQ5PF ; https://d.pr/i/Gz0gbq ; https://d.pr/i/9MZ1hZ
        https://d.pr/i/WFK2C0
        https://d.pr/i/Y5c8g0
        To test this OPA, you'll order Levothyroxine for your patient, wait a little, and see the message in the endocrinology nurse's In Basket.
        
        You should be in your Innusha patient's encounter in your TRNCLN## Endocrinology department (the encounter you just created).
        
        Click ADD ORDER in the Visit Taskbar on the bottom of the patient workspace.
        
        Search for "Levothyroxine 100" and select the order for Levothyroxine (SYNTHROID, LEVOTHROID) 100 mcg tablet.
        
        Confirm that only your order for Levothyroxine appears in the orders cart and click SIGN ORDERS.
        
        In the Pharmacy Search window, search for and select External Outpatient Pharmacy.
        
        In the Select Pharmacies window, click Accept.
        
        CHECK: Your OPA should not appear. If it does appear, you forgot to hide it from users. That's okay for now. Make a note to fix it later but accept the OPA and move on to the next step.
        
        Search > OPA Review.
        
        Select Show Background Advisories (bottom left) then click Apply Filters.
        
        CHECK: You should see "TRNCLN## Levothyroxine ordered" and Actions Taken will include scheduling your asynchronous OPA.
        
        Troubleshooting tips if you don't see your OPA: * Are the criteria attached to the base in the correct order? With the correct logic? * Are all records released? * Refresh OPA Review. * If you still don't see your OPA, tell your instructor.
        
        Log out.
        
        Take a short break until you are confident that 3 minutes have passed since you signed the Levothyroxine order.
        
        Everyone will log in to Hyperspace as the same Foundation System endocrinology nurse:
        
        **User ID**: endorn
        
        **Password**: epic
        
        Do not change the default login department (it should be EMC Endocrinology).
        
        Go to In Basket (a startup activity) and open the OurPractice folder.
        
        Sort the messages by Subject and scroll to your assigned numbers.
        
        If you do not see the **OurPractice** folder and/or a message with your assigned numbers, **Refresh** In Basket.
        
        CHECK: You should see a message with the subject: "TRNCLN## Levothyroxine active > 6 weeks and no recent TSH labs - review required."
        
        There will be many other messages with other trainees' numbers. Ignore them.
        
        Select your message and look at the details. It should appear like so:
        
        https://d.pr/i/KQX9yh
        
        Which field in which of your records configured the message that appears above (the circled part)?The Unformatted Header Text field in your asynchronous OPA record. |
        | --- | --- |
        | | Write It Down: What would be different if you had immediately discontinued the Levothyroxine after ordering it? Would this message even be here? Why or why not? If you had discontinued the Levothyroxine (without replacing it with a new order for Levothyroxine), this In Basket message would NOT have been sent. Remember: Your asynchronous OPA is linked to TRNCLN## CL ACTIVE OP LEVOTHYROXINE ORDER criteria record. If that criteria was not met when the asynchronous OPA was scheduled to occur, the asynchronous OPA would not have triggered and no In Basket message would have been sent. |
        | --- | --- |
        Pretend that you scheduled a lab draw for the patient to have their TSH checked.
        
        Select the message for your "TRNCLN## Levothyroxine active > 6 weeks and no recent TSH labs - review required" OurPractice Advisory and click Done.
        
        The message disappears from In Basket. If it does not, refresh In Basket.
        
        Log out.
        
        Log back into Hyperspace as your builder (2230##/train). You've finished this exercise.
        
        - Use One OPA as Criteria for Another OPA https://d.pr/i/gWTFXW ; https://d.pr/i/QHsMK3 ; https://d.pr/i/YigpXP ; https://d.pr/i/YnJmun
        
        The OurPractice Advisory form allows you to create a criteria that asks "Has this particular OPA been triggered for this patient in the last X hours?" If the answer is yes, then the patient is included in that criteria.
        
        https://d.pr/i/cDXsbJ
        
        - Evaluation and Planning
        
        | Due to recent infectious disease outbreaks, your Clinical Decision Support committee is creating an OPA to escalate an existing alert for patients who need an evaluation for measles. |
        | --- |
        
        Currently, if a user documents certain reasons for visit or vital signs that could be indicative of measles, OPA #1 triggers in Storyboard:
        
        https://d.pr/i/LLRZpG
        
        The OPA appears passively to all clinicians but response rates have not been satisfactory. Later, if users have not acted on the OPA or taken appropriate action to rule out measles for the patient, OPA #2 should fire, essentially escalating the alert:
        
        https://d.pr/i/nZQiCT
        
        You need to design and create OPA #2.
        1. Plan criteria build:
        | Include patients... | For whom OPA #1 was triggered | | --- | --- | | Exclude patients... | Who have a measles diagnosis ; Who have an order for measles evaluation; For whom measles evaluation does not apply | | How can you configure a criteria record to include patients for whom a certain OPA has already triggered? | Use the OurPractice Advisory form - indicate the base or asynchronous record and a lookback period. |
        1. Plan base build:
        | What displays? | Critical alert that patient should be evaluated for measles | | --- | --- | | For which users? | All clinicians | | When and where? | When users open the patient chart | | Follow-up action? | Order the Measles Evaluation SmartSet | | Require acknowledgement? | Recommended |
        1. Plan record build:
        | How many criteria records? | include patients for whom OPA #1 was triggered ; include patients with measles diagnosis; include patients with order for measles evaluation; include patients with Measles dx does not apply SmartData Element | | --- | --- | | How many base records? | One | | How many other records? | None |
        :check: :check: The build for OPA #2 will look like this:
        https://d.pr/i/RLacDd
        
        - Exercise 3: Configure the Escalated Alert and Test Your Work https://d.pr/i/XsEo4I ; https://d.pr/i/mbk4gy ; https://d.pr/i/NuxH1O
        In this exercise, you'll finish configuring the base for OPA #2 and test your work.
        Finish Configuring the Base
        1. You should still be editing your new base record (TRNCLN## BASE AMB MEASLES RISK ESCALATION). 2. For Contact Comment, enter: "This OPA appears if TRNCLN## Base Amb Measles Risk triggered and the patient still has no measles diagnosis documented or labs ordered." * Replace ## with your 2-digit number. 3. On the Display form, for Importance level, select Critical. * Since this OPA is an escalation of another OPA, you're changing the importance level. 4. In Formatted Header Text, add "TRNCLN##" at the beginning of the sentence. * For example: "TRNCLN## This patient has fever and rash and no record of measles immunization, consider measles. Review CDC Measles Information and consider suggested orders." * Adding your assigned numbers will make it easier to confirm your OPA is triggering appropriately during testing. * Ignore the recommendation about length in the Formatted Header Text field. Your organization's Clinical Decision Support committee should develop a strategy for displaying OPAs and how best to ulitize the various fields in the Display form. 5. Leave the current text in Summary Text. Even though this escalated OPA will not trigger in the Storyboard, OPAs that are deferred by users will still appear in the Storyboard and this field will be referenced. 6. Go to the Criteria form and remove ALL linked criteria records. 7. Link these criteria to your base record in this order: * TRNCLN## CL TRNCLN## BASE AMB MEASLES RISK WAS TRIGGERED * CL MEASLES DX \[5725\] * CL MEASLES RNA PCR TEST ORDERED \[5729\] * TRNCLN CL MEASLES DX DOES NOT APPLY SDE \[98404291\] 8. Configure the Logic: 1 AND NOT 2 AND NOT 3 AND NOT 4. 9. On the Restrictions form: * Confirm that this OPA will trigger only for patients being seen in your TRNCLN## Endocrinology department. * You can leave the existing encounter type exclusions. 10. On the Triggers form ensure the OPA will trigger only when a user opens the patient encounter. * Hint: You need to remove the existing trigger and add a new one. 11. On the SmartSets, Order Sets, and Pathways form, confirm that MEASLES AMB ORDERS \[2728\] will be suggested. 12. Go to the Visit Diagnoses form and confirm that Measles will be suggested with a Frequency of Manually Unselected. 13. Go to the Acknowledge Reasons form and confirm the following. Make adjustments as needed: * Row 1: * Acknowledge Reason: Follow-up action(s) taken * Applies To: Current user, current encounter only * Button?: Yes * Button Caption: Action taken * Row 2: * Acknowledge Reasons: Does not meet criteria * Apply To: Current user, current encounter only * Button?: Yes * Button Caption: Not applicable * SmartData Element: Measles dx does not apply * Context: Encounter * Value: Yes * Default Lockout time after acknowledgement: 168 hours 14. For Acknowledge Reason Requirement, select Recommended. 15. Go to Summary and compare your record to the following screenshots and fix any errors:
        https://d.pr/i/VI7YHj
        https://d.pr/i/EMvWyw
        https://d.pr/i/uAM7AZ
        
        Go to the Edit form and release your base.
        
        Save and close any open records.
        
        - Reviewing the Chapter https://d.pr/i/dh34N2
        
        True or False: An asynchronous OPA can only generate automatic follow-up actions (such as sending an In Basket message or triggering a task template).
        
        True
        
        True or False: When setting up an asynchronous OPA to fire at a later time, you should select one of the manual frequencies in the base record.
        
        False
        
        Which of the following are ways that a chain can be broken for an asynchronous OPA that is firing itself on a recurring basis? Choose ALL that apply.
        A. The timeout configured in the base record is reached. B. The criteria linked to the asynchronous OPA are no longer met. C. The OPA has fired the number of times configured in the base record. D. A user can Complete Advisory in In Basket.
        A,B,D
        
        Test Your Work https://d.pr/i/29BLFj ; https://d.pr/i/eXA0Oo
        Now you'll create an encounter in your TRNCLN## Endocrinology department and test your work. OPA #1 (already configured) should trigger first. And then OPA #2, that you just created, should trigger second. 1. Confirm that you're logged in to **Hyperspace** as your builder (2230##/train). 2. Search > Encounter. 3. Search for and select your Mathilda patient. It is essential that you create the test encounter appropriately. 1. In the Encounter Selection window, click Create an Encounter and enter the following: * Type: Office Visit * Department: TRNCLN## Endocrinology (replacing ## with your 2-digit number) 2. Confirm that you changed the Department to your TRNCLN## Endocrinology department, then click Accept. 3. Rooming > Visit Information. * You may need to click the Visit Information section to enter new data. 4. In Reason for Visit, enter: * Fever * Rash 5. Click **Next**. * CHECK: OPA #1 triggers in Storyboard.
        https://d.pr/i/OBELbG
        1. Hover over the OPA to see more information. 2. Click the OPA in Storyboard - but do NOT acknowledge the OPA! 3. Click Cancel to close the OPA. 4. Close Mathilda's patient workspace. 5. Search > Encounter. * Hint: Use the equal = sign. 6. Search for and select your Mathilda patient. * Hint: Use the equal = sign. 7. Open the most recent office visit that you created in TRNCLN## Endocrinology. * CHECK: Your critical OPA triggers.
        https://d.pr/i/WpY1bp
        1. Click **Not applicable** and click **Accept**. * You just applied the SmartData Element Measles dx does not apply to this encounter for Mathilda. 2. CHECK: OPA #1, which originally appeared in Storyboard, should disappear since its criteria are no longer met. 3. Close Mathilda's patient workspace. If you reopen Mathilda's encounter, will OPA #2 trigger again? It should not. 1. Reopen Mathilda's encounter in TRNCLN## Endocrinology. * Search > Encounter. * Search for and select your Mathilda patient. 2. CHECK: OPA #2 does NOT trigger again when you reopen the encounter.
        * Why not? The logic statement is no longer met due to the SmartData Element now applied to this encounter.
        3. You've finished this exercise.
        
        - Create a Criteria That Uses the OurPractice Advisory Form https://d.pr/i/buq5FC
        You need to build a criteria record that includes patients if OPA #1 has triggered in their current encounter.
        1. Confirm you're logged in as your builder (2230##/train). 2. Search > OurPractice Advisory. 3. Create and release a new criteria record called "TRNCLN## CL trncln## base amb measles risk was triggered" (replacing ## with the assigned numbers from your pre-class email). 4. Click Add Criteria Type and add OurPractice Advisory. 5. For Previously triggered OurPractice Advisory, enter TRNCLN## BASE AMB MEASLES RISK (replacing ## with your 2-digit number). 6. Leave Lookback (hours) blank.
        | :check: | Two important points about the Lookback (hours) field on this form:The system will check to see if the linked OPA was triggered during the CURRENT encounter ONLY. For example, if you entered a lookback of 72 hours, the system would not check prior office visits and admissions to see if the OPA had been triggered.If you leave Lookback (hours) blank, the criteria will be met if the OPA has ever been triggered for the current encounter. |
        | --- | --- |
        Note that this form only allows you to _include_ patients. To exclude patients for whom the linked OPA was triggered, use NOT logic to link the criteria record to the base. 1. Go to Summary and compare your record to the following screenshot and fix any errors.
        https://d.pr/i/YAATpY
        
        - Including Patients With a Measles Diagnosis https://d.pr/i/xwFsQE
        You've identified a criteria record that includes patients with a measles diagnosis. This Foundation System criteria record is already used in OPA #1.
        Please do not edit this record - all trainees will use it.
        https://d.pr/i/pvrDds
        | | Why aren't you including patients with a visit diagnosis of measles?There's another OPA that triggers for patients with a visit diagnosis of measles but who do not yet have an order for measles evaluation. You'll explore that OPA in a later lesson. |
        - Including Patients With an Order for Measles Evaluation https://d.pr/i/jKaHYJ
        You've identified a criteria record that includes patients with a signed order for a lab test to confirm a measles diagnosis. This Foundation System criteria record is already used in OPA #1.
        Please do not edit this record - all trainees will use it.
        https://d.pr/i/QZx8k1
        
        Continue: - Including Patients with a SmartData Element https://d.pr/i/BacTsC
        What are SmartData Elements? SmartData Elements are records in the HLX master file. They are discrete data points used to collect information that is NOT directly tracked by Chronicles items.
        OPA base records can assign SmartData Elements as a follow-up action automatically and prompt users to assign them. You can configure an acknowledge reason to apply a SmartData Element to a patient. And you can build a criteria record to include patients with certain SmartData Elements. Foundation System contains hundreds of SmartData Elements. | :check: | When OPA #1 triggers, if a user selects the acknowledge reason **Not applicable**, the custom SmartData Element Measles dx does not apply is assigned at the encounter level to the patient. |
        https://d.pr/i/t2W0UI
        If OPA #1 does not apply to a patient, then OPA #2 should not trigger. If a user acknowledged OPA #1 by clicking Not applicable and automatically assigned that SmartData Element to the patient's current encounter, then you can use the SmartData Element identify that patient to exclude them from the target patient population for OPA #2. You've identified a criteria record that includes patients with the SmartData element Measles dx does not apply documented on the current encounter. Please do not edit this record - all trainees will use it.
        https://d.pr/i/LRH5qt
        | | For more information about SmartData Elements, refer to the following documents:
        
        CLN301 SmartForms Administration
        
        SmartForms Setup and Support Guide |
        
        - Create the Base Record for the Escalated Alert https://d.pr/i/qh3vpI
        
        This base will be configured similarly to OPA #1, TRNCLN## BASE AMB MEASLES RISK, the initial measles risk OPA that triggers in Storyboard. For efficiency, you'll copy TRNCLN## BASE AMB MEASLES RISK and make updates that apply to OPA #2.
        
        Open your TRNCLN## BASE AMB MEASLES RISK record.
        * TRNCLN## BASE AMB MEASLES RISK (replacing ## with your 2-digit number) already exists in the training environment. * If you closed the Decision Support Editors, Search > OurPractice Advisory.
        
        At the top of the Decision Support Editors, click Save As.
        
        For Name, enter "TRNCLN## base amb measles risk escalation.
        
        - Chaining Asynchronous OPAs https://d.pr/i/HWroL1 ; https://d.pr/i/ZA2kkG
        In the example you just completed, you created an OPA base that triggered when a user ordered Levothyroxine. It didn't appear to the user and it scheduled an asynchronous OPA to fire later. At that time, the asynchronous OPA checked to see if the patient still had an active order for Levothyroxine. Because the patient did, the OPA sent an In Basket message. The build looked like this:
        https://d.pr/i/QLZ7A4
        When you tested the asynchronous OPA, you logged in as a nurse and (after the designated time) saw the In Basket message. You scheduled a lab draw for the patient and marked the message as done. At this point, you (as the nurse) have done your job. The patient should come in for their lab draw, and based on the TSH results, the physician may adjust the dosage.
        But what if the patient doesn't come in for their lab draw? What if another week passes and the Levothyroxine is still active and there are still no TSH results? Your endocrinology staff might want to receive another In Basket message so they can proactively reach out to the patient again. You can do this by chaining your asynchronous OPA.
        Chaining means configuring an asynchronous OPA to schedule either:
        
        Itself to fire again at a later time, either once or on an ongoing basis. This is typically used to send recurring reminders to the same group of users.
        
        A different asynchronous OPA to fire again at a later time. This is often used to escalate an OPA that has not been addressed. For example, the second asynchronous OPA might be routed to a pager in addition to an In Basket pool.
        
        :check:You will add the following loop (in red) to your OPA build:
        https://d.pr/i/Yj0V4n
        
        - Configure an Asynchronous Chain https://d.pr/i/WtMNyM
        You can configure an asynchronous chain similarly to how you scheduled the initial asynchronous OPA from the base record.
        
        Confirm that you're logged into Hyperspace as your builder (2230##/train).
        
        Search > OurPractice Advisory.
        
        Open TRNCLN## ASYNCH LEVOTHYROXINE ACTIVE > 6 WEEKS AND NO RECENT TSH LAB RESULTS.
        
        Add the Asynchronous Advisories form.
        
        For Asynchronous Advisory, enter TRNCLN## ASYNCH LEVOTHYROXINE ACTIVE > 6 WEEKS AND NO RECENT TSH LAB RESULTS.
        
        When an asynchronous OPA has a follow-up asynchronous OPA, the Frequency field is required. The only two choices are Once Automatically and Always Automatically. You cannot select a manual frequency because an asynchronous OPA is always hidden from users.
        | | The In Basket message should be sent every 7 days if the patient is still on Levothyroxine and does not have recent TSH results. So the asynchronous OPA should reschedule itself every time it triggers. |
        | --- | --- |
        
        Configure the following fields:
        
        Frequency: Always Automatically
        
        Relative time: N+2 Minutes * Realistically you would likely set the Relative time to something like 7 days. For testing purposes you're setting it to just 2 minutes.
        
        https://d.pr/i/j7Y27F
        
        A reminder of the frequencies you have selected in the base and asynch:
        
        Frequency (in base): Once Automatically
        
        Frequency (in asynch): Always Automatically
        
        Leave the record open.
        
        - Breaking the Chain pdf https://d.pr/i/wBKckq ; https://d.pr/i/xJnKyQ
        A chain of asynchronous OPAs like the one you just configured will continue until one of three things happens:
        
        The Timeout in the OPA base record is reached.
        
        The criteria linked to the asynchronous OPA is not met at the time the asynchronous OPA is scheduled to trigger.
        
        A user clicks Complete Advisory from one of the In Basket messages and accepts the OPA that appears as a pop-up.
        
        To limit the overall duration of an asynchronous chain, enter a value in the Timeout (hours) field of the OPA base. This field is found on the Asynchronous Advisories form. After that number of hours, the asynchronous OPA will cease scheduling itself (or any other asynchronous OPAs).
        https://d.pr/i/fKU12W
        If you don't set a timeout in the base record, the asynchronous chain will continue indefinitely as long as the criteria are still met. :check:The only way users can manually break the chain is via the Complete Advisory button in the In Basket message.
        If you expect that users will want to break the OPA chain using the Complete Advisory button (as opposed to taking action on the patient so that the criteria are no longer met), consider changing the Unformatted Header Text of your asynchronous OPA to provide guidance. You can require users to provide an acknowledge reason, which helps to prevent users from accidentally breaking the chain.
        
        You should still be in TRNCLN## ASYNCH LEVOTHYROXINE ACTIVE > 6 WEEKS AND NO RECENT TSH LAB RESULTS. If not, open that record now.
        
        Go to the Acknowledge Reasons form and add two acknowledge reasons:
        
        https://d.pr/i/8YRArL
        
        Row 1:
        
        Acknowledge Reason: Previously completed
        
        Button: Yes
        
        Button Caption: Awaiting TSH results
        
        Row 2:
        
        Acknowledge Reason: See comments
        
        Button: Yes
        
        Button Caption: See comments
        
        Required Comment: Yes
        
        Acknowledge reason requirement: Always Required
        
        | :check: | There are no Lockout fields in the asynchronous record's Acknowledge Reasons form. When a user clicks Complete Advisory from the In Basket message (and accepts the pop-up), the asynchronous OPA will stop scheduling future instances no matter which acknowledge reason a user chooses, or even if they don't choose an acknowledge reason. |
        | --- | --- |
        Now that you've configured your asynchronous OPA to chain, you can test it.
        
        Save and close this record.
        
        - Exercise 2: Test Your Asynchronous OPA Chain https://d.pr/i/lun9kO
        
        Search > Encounter.
        
        In the Name/MRN field, search for and select your Lorelei patient.
        
        This is a new patient for testing because you already triggered your OPA on the last patient.
        
        Refer to your classroom information sheet for your patient's last name.
        
        It is essential that you create the test encounter appropriately so that you will be able to see your OPA.
        
        In the Encounter Selection window, click Create an Encounter and enter the following properties:
        
        Type: Office Visit
        
        Department: TRNCLN## Endocrinology
        
        Confirm that you changed the Department to your TRNCLN## Endocrinology department, then click Accept.
        
        To trigger your OPA you must first order a prescription for Levothyroxine.
        
        Click ADD ORDER in the Visit Taskbar.
        
        Search for "Levothyroxine 100" and select the order for Levothyroxine (SYNTHROID, LEVOTHROID) 100 mcg tablet.
        
        Confirm that only your order for Levothyroxine appears in the orders cart and click SIGN ORDERS.
        
        In the Pharmacy Search window, search for and select External Outpatient Pharmacy.
        
        In the Select Pharmacies window, click Accept.
        
        Log out.
        
        Take a short break until you are confident that 3 minutes have passed since you signed the Levothyroxine order.
        
        Everyone will log in as the same Foundation System endocrinology nurse:
        
        **User ID**: endorn
        
        **Password**: epic
        
        Do not change the default login department (it should be EMC Endocrinology).
        
        Go to In Basket and open the OurPractice folder.
        
        Sort the messages by Subject and scroll to your assigned numbers.
        
        CHECK: You should see a message with "TRNCLN## Levothyroxine active > 6 weeks and no recent TSH labs - review required."
        * If you don't see your new message or you see a warning about the message being retracted, you may need to click **Refresh** at the top left of In Basket.
        
        CHECK: Confirm that you are looking at the message for _your_ Lorelei patient.
        
        There will be many other messages with other trainees' numbers. Ignore them.
        *
        
        Pretend that you scheduled a lab draw for the patient to have their TSH checked. https://d.pr/i/5Jm7yl
        
        Select the message for "TRNCLN## Levothyroxine active > 6 weeks and no recent TSH labs - review required" OurPractice Advisory and click Done.
        
        The message disappears from In Basket. If it does not, **Refresh** In Basket.
        
        If you receive a message that says, "This message has been retracted and is no longer available," click **OK**. Then **Refresh** In Basket and click **Done** again. This can happen if you attempt to mark the message as Done at the moment the asynchronous chain is repeating its action.
        
        You just dismissed that message for your Lorelei patient but the patient still has an active order for Levothyroxine. The asynchronous chain is still going for that patient, and within the next 2 minutes you should see a new message appear. Remember, you planned to initially fire the asynchronous OPA 6 weeks after the initial order of Levothyroxine and then every 7 days after that. For testing purposes, you reduced the initial delay to 3 minutes and the subsequent delays to 2 minutes.
        
        Wait at least 2 minutes.
        
        After at least 2 minutes have passed, make sure you're still logged in as endorn/epic.
        
        Refresh In Basket.
        
        CHECK: You should see a new message for your Lorelei patient because the asynchronous OPA triggered again and the patient still has an active Levothyroxine order.
        
        Select the message for your Lorelei patient.
        
        Above the message, select the "..." menu and hover your cursor over Complete Advisory. Note what the tooltip says:
        
        https://d.pr/i/frpJGZ
        
        Click Complete Advisory.
        
        CHECK: You should see the acknowledge reason buttons and they should have a stop sign next to them.
        
        Click Awaiting TSH results.
        
        Click Accept.
        
        Refresh In Basket.
        * CHECK: The message for your Lorelei patient is gone. The asynchronous chain is BROKEN!
        
        Log out.
        
        Log back in as your builder (2230##/train).
        
        You've finished this exercise.
        
        - What if an Asynchronous Chain Runs Unchecked? https://d.pr/i/8lNri0
        Given that an asynchronous OPA chain can continue triggering and triggering, will it clog up In Basket with messages? No. When an asynchronous OPA fires and there is already an In Basket message for that patient and OPA, the system just adds details to the existing message. The message itself can get very long, but you won't see multiple messages for the same patient and the SAME OPA.
      - Create Criteria, Asynchronous, In Basket Message, and Base Records to Alert Endocrinology Staff https://d.pr/i/SOYPEW
        Create the Criteria
        https://d.pr/i/CmnvtL
        https://d.pr/i/SgEJ2j
        
        Both the base and asynchronous OPA records link to the same criteria record. The asynchronous OPA record also links to an additional criteria record that checks for recent lab results. You should create the criteria records first.
        
        **Log in to Hyperspace as your builder ﴾2230##/train﴿. Select the default department: TRN## Dept
        for Training.
        Search > OurPractice Advisory.
        Create and release a new criteria record named "TRNCLN## CL active op levothyroxine order"
        ﴾replacing ## with the assigned numbers from your pre‐class email﴿.
        It should include patients who have orders for the following generic medication:
        Levothyroxine Sodium [2810001010]
        The criteria should consider only outpatient orders. Configure the Medication
        ﴾Include﴿ Properties to match.
        Compare your criteria record summary to the following screenshot and fix any errors.
        
        https://d.pr/i/ZkLLcU
        
        **Next, you'll build another criteria record to ensure this OPA does not include patients who have had their
        TSH labs drawn recently.
        Create and release a new criteria record named "TRNCLN## CL has recent tsh lab results."
        Add and fill out the Lab Components form:
        Common Name: TSH
        Function: Exist
        Collection Time Lookback: 7
        Lookback Unit: calendar days
        
        https://d.pr/i/RLJK5E
        
        https://d.pr/i/2GApCO
        
        Compare your criteria record summary to the following screenshot and fix any errors:
        https://d.pr/i/h3GHVu
        
        Create the Asynchronous Record https://d.pr/i/FPGVAk
        The OPA base record will link to the asynchronous OPA record. So, you should create the asynchronous record before the base record. Asynchronous records are in the same LGL master file as base and criteria records. Use a naming convention to distinguish them. Instead of beginning with "CL" or "Base," they should start with "Asynch."
        
        **Create a new asynchronous OurPractice Advisory record named "TRNCLN## asynch levothyroxine
        active > 6 weeks and no recent tsh lab results."
        Be sure to give it a Record Type of Asynchronous.
        Release the record.
        - As with criteria records, it's okay to release an asynchronous record as soon as you create it.
        
        https://d.pr/i/GUfjlQ
        
        Why? Until you link it to another OPA record, it will never be triggered.
        :check: - On the Display form, notice that there is no Display to user? field. Asynchronous OPAs never display to users; they are always hidden.
        
        Enter the following Unformatted Header Text:** "TRNCLN## Patient has an active order for
        Levothyroxine sodium for 6 weeks or longer. Confirm recent TSH lab results or contact patient to
        schedule TSH lab draw."
        :check:This will appear in the In Basket message that the asynchronous OPA sends to endocrinology staff.
        
        Note that once you move to another field, the Unformatted Header Text field will include a
        recommendation to use a maximum of 100 characters. In a base record, you should keep
        the Header Text to a minimum and use the Body Text for additional detail. **Because
        asynchronous OPAs don't display to users and there's no Body Text field in the Display form
        for asynchronous OPA
        leave the Header Text as is. https://d.pr/i/S5obJx
        On the Criteria form, attach the following criteria records in this order:
        TRNCLN## CL ACTIVE OP LEVOTHYROXINE ORDER
        TRNCLN## CL HAS RECENT TSH LAB RESULTS
        If a patient has recent TSH lab results, the asynchronous OPA should not trigger.
        Update the logic to exclude those patients.
        For Logic, enter: 1 AND NOT 2.
        When the scheduled trigger time is reached, the asynchronous OPA will check to see if this
        criteria and logic combination is met. If it is not met, then the asynchronous OPA will NOT trigger.**
        
        Configure the In Basket Message pdf https://d.pr/i/1iitss ; https://d.pr/i/7zm06Q
        
        **You can configure an OPA to send (or suggest sending) an In Basket message using the In Basket Message form.
        
        Click Add Action Type and add In Basket Message.
        For Subject, enter: "TRNCLN## Levothyroxine active > 6 weeks and no recent TSH labs - review required."
        Once you enter a subject, additional fields become editable.
        
        - Click the magnifying glass for the Frequency field.
        There are only two choices: Always Automatically and Once Automatically. There are no "Manual" choices because they require the OPA to appear to users.
        - "Once Automatically" sends the message only the first time this asynchronous OPA triggers during an encounter.
        - "Always Automatically" sends the message each time the OPA triggers.
        Configure your OPA to automatically send the message each time the asynchronous OPA triggers:
        Message priority: Routine
        Message type: OurPractice
        Frequency: Always Automatically**
        Table :check:
        
        Subject The text you enter here will be the subject line of the In Basket message.
        
        Message Priority Choose between Low, Routine, High, or Urgent. This determines the priority of the In Basket message.
        
        Message Type Determines the message type that will be sent. Message types determine in which In Basket folder the message will appear. They also determine what Report (LRP) records display as part of the message, and what actions you can take from the message.By default, the message type will be "OurPractice" [550]. You can create custom message types and message type definitions.
        
        Message Subtype If you need more specific message routing configuration, select a subtype. If left blank, no message subtype mapping will be applied.
        
        Frequency Always Automatically will send an In Basket message every time the OPA is triggered. Once Automatically will send an In Basket message automatically the first time the OPA is triggered. Manual options are only available for OPAs that display to users.**
        
        The body of the In Basket message will be the Header Text of the asynchronous record.
        
        Once you've configured the message itself, you need to enter one or more recipients. The options are:
        
        Extension: Use an Extension (LPP) record to determine who should receive the message. For example, one extension will send the In Basket message to the patient's primary care provider (PCP). Another sends a message to the user who triggered the OPA.
        Individuals: The In Basket message will be sent to each User (EMP) record listed. Each user will receive their own copy of the message, which must be marked "Done" by that user.
        Classes: The In Basket message will be sent to each user record included in the class. Each user will receive their own copy of the message, which must be marked "Done" by that user.
        Pools: The In Basket message will be sent to each of the pools listed. Every user who belongs to a pool will see a message, but once a single user marks that message as "Done," it will be done for everyone in that pool. If you want an OPA to send a message to a group of users but only one user needs to follow up on the message, this is generally the best option.
        
        If you enter multiple recipients, all of the recipients listed will receive the messages. For example: If you entered "Earle, Jesse" in the Individuals field and "EMC IM NURSES" in the Pools field, then the message would be sent to both the EMC Internal Medicine nurses pool and Jesse Earle.
        
        Configure your OPA to send this In Basket message to the EMC END NURSES [20300] pool.
        Go to Summary and compare your asynchronous record summary to the following screenshot and fix any errors: https://d.pr/i/o3ioED
        
        Create the Base https://d.pr/i/RYVQdG
        https://d.pr/i/S9G2x1
        Summary
        https://d.pr/i/EXJaEQ
        https://d.pr/i/U8b0T8
        Now that you've created two criteria records and the asynchronous record, create the base record that ties it all together. This OPA won't appear to users; it will trigger behind the scenes when a user signs a prescription for Levothyroxine and will schedule the asynchronous OPA to fire at a later time.
        
        Create a new OPA base record named "TRNCLN## base levothyroxine ordered (schedule asynch)."
        
        Do not display this OPA to users.
        
        https://d.pr/i/7XxkKX
        
        Enter the following Unformatted Header Text: "TRNCLN## Levothyroxine ordered."
        
        This text will appear in the In Basket message end users see. Keep an eye out for it when we test our build in Exercise 1.
        
        https://d.pr/i/CkDeNC
        
        Go to the Criteria form and attach TRNCLN## CL ACTIVE OP LEVOTHYROXINE ORDER.
        
        This is the same criteria to which your asynchronous OPA is linked.
        
        On the Restrictions form, limit this OPA to appear for patient encounters in the TRNCLN## Endocrinology department.
        
        | | This OPA should trigger when users sign a prescription for Levothyroxine. |
        
        On the Triggers form, select the appropriate Trigger.
        
        https://d.pr/i/9rqJ9m
        
        Do NOT release or close your record. Go on to the next section.
        
        Scheduling the Asynchronous OPA https://d.pr/i/PG3uYk ;
        When your base OPA is triggered, it should schedule your asynchronous OPA to trigger 6 weeks later. You can configure this on the Asynchronous Advisories form of your base record.
        
        Click Add Action Type and add Asynchronous Advisories.
        
        https://d.pr/i/zQHQSM
        
        In the Asynchronous Advisories field, enter TRNCLN## ASYNCH LEVOTHYROXINE ACTIVE > 6 WEEKS AND NO RECENT TSH LAB RESULTS.
        
        Once you've attached your asynchronous OPA to your base, you need to determine how it will be scheduled. There are two ways you can schedule an asynchronous OPA: using a Relative time or an Absolute time. Use one field or the other; you cannot use both.**
        
        https://d.pr/i/yk7nf7
        
        If you use the Relative time field**, enter the number of minutes, hours, or days after which you want the asynchronous OPA to trigger. The system will reformat your answer into something like "N+48 hours," where N represents the moment that the base OPA is triggered.
        
        If you use the Absolute time field, enter a specific time of day (for example "0800"). The asynchronous OPA will trigger at that time
        
        Consider how delay it is: Relative time: = similar to timer ; Absolute time = specific time
        For example, a physician signs a prescription for Levothyroxine at 0905 on Sunday. If your base uses a Relative time of N+12 hours, then your asynchronous OPA will be scheduled for 2105 the same day. But if your base has an Absolute time of 0900, then your asynchronous OPA will be scheduled for 0900 on Monday.
        
        Configure your base record so that your asynchronous OPA is scheduled 6 weeks after the base record is triggered:
        Relative time: N+42 Days
        
        https://d.pr/i/X5C9Ja
        
        Prepare for Testing https://d.pr/i/IlZwvg
        
        To test this OPA, you'll need to change the Relative time in your base record so that you don't have to wait 6 weeks to see if the asynchronous OPA triggers. Then you'll order Levothyroxine for your patient, wait a little, and see the message in the endocrinology nurse's In Basket.
        
        **Return to the Asynchronous Advisories form and change the Relative time to "N+3 Minutes." https://d.pr/i/6G4cGP
        
        https://d.pr/i/H54Mzl
        
        Save and close all open records.
        Search > Encounter.
        In the Name/MRN field, search for and select your Innusha patient.
        Refer to your classroom information sheet for your patient's last name.
        It is essential that you create the test encounter appropriately so that you will be able to see your OPA.
        In the Encounter Selection window, click Create an Encounter and enter the following properties:
        Type: Office Visit
        Department: TRNCLN## Endocrinology
        https://d.pr/i/31OFnf
        https://d.pr/i/0P7rlv
        Confirm that you changed the Department to your TRNCLN## Endocrinology department (replacing ## with your assigned number), then click Accept.
        https://d.pr/i/8rnpHe
        
        Which Frequency should you use? pdf https://d.pr/i/9ozqKC ; https://d.pr/i/0vMVaW ; https://d.pr/i/ma0LwA
        https://d.pr/i/olsQHj
        https://d.pr/i/TWWhQ7
        
        If you select Manually Once, Manually Selected, or Manually Unselected, then the user can choose whether to schedule the asynchronous OPA. It will appear as a suggested follow-up action. Scheduling the asynch will appear as a suggested follow-up, similar to how suggested order or questionnaire series would appear. The Caption field controls how that suggested action appears. :check: The asynchronous OPA will ONLY be scheduled if the user selects Schedule and then accepts the OPA.
        
        For example, pretend that you set Display to user? to Yes in the base and then configured the Asynchronous Follow-up screen as shown below. When a user signs an order for Levothyroxine, they see the OPA appear as shown below. If the user keeps Schedule selected and accepts the OPA, the asynchronous OPA will occur 6 weeks later.
        https://d.pr/i/GiM09O
        :check:If you set Display to user? to No in the base record, you should NEVER use one of the "Manually..." frequencies. A manual frequency only suggests that the user who triggered the OPA schedule the asynchronous OPA to fire again later. If the base record is hidden from end users, they'll never have the opportunity to do that. If you leave the Frequency field blank, the default value is Manually Once. :check:
        
        If you select a Frequency of Once Automatically or Always Automatically, the asynchronous OPA will be scheduled automatically when the base is triggered - even if the base is hidden from the user who triggers it. This configuration is more common.
        
        The difference between Once Automatically and Always Automatically is whether the asynchronous OPA is scheduled ONLY the first time the OPA base is triggered during a patient encounter, or whether it's scheduled each time the base is triggered.
        
        If the Frequency is set to Once Automatically, your asynchronous OPA is scheduled to occur 6 weeks after the first prescription for Levothyroxine is signed. Subsequent orders during the SAME encounter do NOT schedule additional instances of the asynchronous OPA.
        
        If the Frequency is set to Always Automatically, your asynchronous OPA gets scheduled to occur 6 weeks after each Levothyroxine prescription is signed.
        
        You want to schedule your asynchronous OPA 6 weeks after the patient's first prescription for Levothyroxine is ordered - only after the first signed prescription.
        
        **Select a Frequency of Once Automatically.
        
        Confirm that your Asynchronous Follow-up form matches the following screenshot. If it doesn't, fix any errors: https://d.pr/i/9YBmI3
        
        Go to Summary and compare your base record summary to the following screenshot and fix any errors: https://d.pr/i/5nYyvM
        
        If everything looks correct, release and save your base.
        Leave the record open.
        
        place holder
        
        More images on IB messages config
        Inbox Message Summary
        https://d.pr/i/oJ37wI
        https://d.pr/i/6iLNoR
        https://d.pr/i/K6LzBK
        https://d.pr/i/ONowwD
        https://d.pr/i/jEsMRl
        https://d.pr/i/s6ot8K
        Header Text
        https://d.pr/i/JI4rUb
        Subject
        https://d.pr/i/KmwzPC
        Extension is like anyone can use that same extension; If use Classes: everyone will get same message and EVERYONE will need to click DONE . Pools: Shared message that only need one person to mark as DONE to retract it
        https://d.pr/i/0KnFkk
- - - - - Troubleshooting Strategies https://d.pr/i/1Tny09 ; https://d.pr/i/gzdHal
        Test Mode
        
        When you use Test mode (Patient: your Hansel patient, Contact: Hospital Encounter, User: your builder), it appears that the OPA should fire:
        https://d.pr/i/kvPQal
        
        Test mode evaluates what is currently true on the patient's chart - whether the logic statement is met for the attached criteria. It also evaluates patient encounter and user restrictions. It's helpful for testing passive OPAs or OPAs with a trigger of Open Patient Encounter. It is less helpful for testing OPAs with interruptive triggers, such as Sign Order.
        OPA Troubleshooting Mode
        
        OPA Troubleshooting mode is useful for testing interruptive OPAs that are triggered by actions that you can't test with the Test button in Decision Support Editors. Your instructor will demonstrate how to use this tool. Please do not follow along.
        
        In Hyperspace, Search to open the Session Information Report.
        
        In the Additional Support Reports section, click 'Toggle OurPractice Advisory Troubleshooting.'
        
        Click OK on the pop-up.
        
        Now every time you hit a trigger in Hyperspace logged in as that user, you'll get the option to see what OPAs could have fired. When you open a chart, enter an order, sign orders, file flowsheet data, etc., you'll see a message like this:
        https://d.pr/i/b4Y1w2
        If you click Debug, you'll see something like this:
        https://d.pr/i/cDBxEe
        This report shows you all the OPAs that might have triggered for this patient, user, and trigger. You can expand each OPA to see which criteria did or didn't pass. If an OPA doesn't appear in the Debug window, it means that it didn't pass the checks on the Restrictions form of the base record.
        
        After you've completed your troubleshooting, remember to return to the Session Information Report and click Toggle OurPractice Advisory Troubleshooting to turn off OPA Troubleshooting mode.
        
        OPA Troubleshooting Mode can also be turned on for an entire workstation, not just an individual user. This is done in Text, within the Workstation record.
        | | Disable OPA Troubleshooting mode as soon as you are done testing to avoid performance issues. |
        | | If you turn on OPA Troubleshooting mode in Text at the workstation level it is turned on for every user at a workstation. At many sites, including the certification environments, everyone might be using the same workstation.
        Please DO NOT turn it on in a PROD or certification environment! |
        
        Moving OPAs to Storyboard https://d.pr/i/6LKBui
        Triggering OPAs in Storyboard allows users to act on them when they're ready. You may be able to improve action taken rates for both passive and interruptive OPAs by moving them to Storyboard.
        | | The Clinical Decision Support committee is reviewing an OPA that encourages providers to place a SmartSet for a patient with a measles diagnosis. |
        | --- | --- |
        https://d.pr/i/hyLQse
        See The OPA in Action https://d.pr/i/5KmT2e ; https://d.pr/i/IVRCqJ
        
        You should still be logged in to Hyperspace as your builder (2230##/train).
        
        Search > Encounter.
        
        Search for and select your Innusha patient.
        
        Create a new encounter in your TRNCLN## Endocrinology department:
        
        Click Create an Encounter.
        
        Type: Office Visit
        
        Department: TRNCLN## Endocrinology (replacing ## with your 2-digit number)
        
        Confirm that you selected your assigned TRNCLN## Endocrinology department.
        
        Click Accept.
        
        Add a visit diagnosis of Measles.
        
        Measles complication type: without complication
        
        CHECK: A high priority OPA appears in the OurPractice Advisories section.
        
        Close the patient workspace.
        
        Reopen your Innusha patient's office visit in TRNCLN## Endocrinology.
        
        Search > Encounter.
        
        Search for and select your Innusha patient.
        
        Open the most recent office visit in TRNCLN## Endocrinology.
        
        CHECK: Upon opening the patient workspace, the measles OPA triggers again, interrupting your workflow.
        
        Note the option to Defer, which allows users to move the OPA to the Storyboard for later action. This can be useful if a clinician or other user wants to take action on the OPA later, but it does not prevent the OPA from displaying as an interruptive, pop-up OPA if a user were to close and then re-open the patient's chart again.
        
        In the OPA, click Dismiss.
        
        Close the patient workspace.
        
        | | Write It Down: What are some advantages of triggering an OPA when a user opens a patient workspace? (Trigger: Open Patient Encounter) = Immediately alerts the user; Helpful for critical OPAs that may impact the workflow |
        | --- | --- |
        | | Write It Down: What are some disadvantages of triggering an OPA when a user opens a patient workspace? (Trigger: Open Patient Encounter) = Alert fatigue ; User may not have reviewed the chart and may not want to act on the OPA yet ; Low acceptance rates |
        
        Reviewing the Chapter https://d.pr/i/sYigI8
        
        When should you consider expanding the criteria evaluation in a base record?
        
        If the trigger in a base record has an initial criteria prescreening check and none of the associated forms are configured in the attached criteria records, you may need to expand the criteria evaluation.
        
        True or False: You should turn on OPA Troubleshooting Mode in a Production environment.
        
        False
        
        Which of the following are potential advantages of displaying an OPA in the Storyboard instead of using an interruptive trigger? Answer ALL that apply.
        A. Minimizing alert fatigue
        B. It interrupts the workflow and requires immediate action
        C. Users can act on the OPA when they've reviewed the appropriate clinical information
        D. Storyboard OPAs allow for more a more complete explanation of the OPA in the Summary Text
        
        A, C
        
        - Configure an OPA to Appear in Storyboard https://d.pr/i/8apIOB
        **#####
        | Epic recommends reviewing all OPAs that currently display to users with Open Patient Encounter triggers or in navigators as possible candidates for Storyboard. |
        | --- |
        In order for an OPA to appear in Storyboard, the following must be true:
        
        The base record has a trigger of Storyboard Notifications (99).
        
        The base record has an importance level assigned.
        
        The Storyboard that appears to the user includes a column for displaying OPAs.
        
        | | Your Clinical Decision Support Committee has decided to revise the triggers assigned to the measles SmartSet OPA. Since this OPA has not been deemed critical, it can appear passively in Storyboard. The Storyboard affecting users in outpatient encounters already includes an OPA column. |
        | --- | --- |
        
        Open your TRNCLN## BASE AMB MEASLES DX SUGGEST MEASLES SMARTSET base record (replacing ## with your 2-digit number).
        
        Search > OurPractice Advisory.
        
        Go to the Triggers form.
        
        Remove the Open Patient Encounter trigger.
        
        Add the Storyboard Notifications trigger.
        
        Click Save.
        
        You may see a Build Inspector error suggesting that you add Summary Text.
        
        Either click Go to issue in the Build Inspector error or go to the Display form.
        
        Summary text displays in Storyboard. The field supports plain text and has a 40-character limit.
        
        In Summary Text, enter "TRNCLN## Measles Diagnosis Present."
        
        Click Save.
        
        Reopen your Innusha patient's office visit in TRNCLN## Endocrinology.
        
        Search > Encounter.
        
        Search for and select your Innusha patient.
        
        Open the most recent office visit in TRNCLN## Endocrinology.
        
        CHECK: Your measles SmartSet OPA does NOT appear upon opening the patient workspace.
        
        CHECK: Your OPA appears in Storyboard with the appropriate summary text.
        
        In Storyboard, hover over the OPA summary text.
        
        https://d.pr/i/A9dxK9
        
        In Storyboard, click the OPA summary text to act on the OPA.
        
        The OPA now appears as a pop-up window.
        
        In the OPA, click Cancel.
        
        Leave the patient workspace open.**
        
        - Storyboard OPA Considerations https://d.pr/i/ktsOlV
        Now users will see this high priority OPA regardless of which activity they're using in the patient workspace and can act on it as needed. However, the same OPA is triggering twice - in Storyboard and in the OurPractice Advisories navigator section (trigger: General Navigator Section).
        | | Write It DownWhat are some disadvantages to the same OPA triggering in Storyboard and a navigator?Alert fatiguePerformance considerations |
        | --- | --- |
        Epic recommends preventing duplicative advisories and potential performance issues by removing additional triggers. If you configure an OPA to appear in Storyboard, you should remove (or not include) the following triggers:
        
        General Navigator Section
        
        IP Admission Navigator Section
        
        IP Discharge Navigator Section
        
        IP Rounding Navigator Section
        
        IP Transfer Navigator Section
        
        Open Patient Encounter
        
        You'll improve the OPA by removing the navigator-based trigger.
        
        Return to your TRNCLN## BASE AMB MEASLES DX SUGGEST MEASLES SMARTSET record.
        
        Go to the Triggers form.
        
        Remove General Navigator Section from the triggers.
        
        There should now be only one trigger: Storyboard Notifications.
        
        Click Save.
        
        Return to your Innusha patient's office visit in TRNCLN## Endocrinology.
        
        Refresh the OurPractice Advisories section.
        
        The measles OPA should disappear from the navigator.
        
        The measles OPA now appears only in Storyboard.
        
        Close the patient workspace.
        
        - Expanding the Criteria Evaluation https://d.pr/i/UEW0qM
        When you made your OPA base, you selected a Trigger of File Doc Flowsheets. That's the best choice because LDAs are documented as a type of flowsheet. The patient's Education should be updated as soon as the nurse completes documentation that the patient has a central line.
        Many triggers have an initial criteria prescreening check, which means that the advisory first checks for a specific type of criteria associated with the trigger. For example, the File Doc Flowsheets trigger first checks flowsheet criteria. If the OPA base isn't linked to a criteria record that directly evaluates flowsheet data on a criteria form (e.g. Flowsheets form), then the advisory never fires when a user files information in Flowsheets, even if the patient meets criteria that are attached to the advisory.
        These prescreening checks are included with many triggers in order to prevent OPAs from over-firing. If the OPA is displayed to users, over-firing will increase alert fatigue and, regardless of whether the OPA is displayed to users or not, over-firing will make reporting on OPAs less accurate and effective.
        Your OPA did use a criteria that evaluated whether the patient had an LDA, but it did so with a CER rule. You didn't use the Flowsheets form in the criteria record, so the initial criteria prescreening check failed and your OPA didn't fire.
        https://d.pr/i/CRESfB
        
        - Expanding the Medication Criteria Evaluation https://d.pr/i/97QNcV
        If you set Criteria evaluation to Skip initial medication criteria prescreening check in an OPA base record, then that OPA could fire during a medication-related workflow even if it does not include any medication-related criteria. It could also fire when the medication-related workflow includes a medication that is not relevant to the OPA.
        You can Skip initial medication criteria prescreening check for the following triggers. For details on the prescreening check associated with these triggers, see the OPA Triggers section of the OurPractice Advisories Setup and Support Guide available on Galaxy.
        
        18-Enter Order
        
        21-Open Order Set
        
        23-Sign Orders
        
        24-Select item in SmartSet
        
        25-Sign SmartSet
        
        31-Medication Administration
        
        33-RX Verify New Order
        
        34-RX Verify Discontinued Order
        
        35-RX Verify Edited Order
        
        36-RX Reverify Order
        
        51-Release Signed Held Order
        
        53-Accept MAR Administration Form
        
        61-Add Order to Treatment Plan
        
        62-Sign Treatment Plan Order
        
        63-Release Treatment Plan Order
        
        73-RX After Verify
        
        If you have an OPA that should potentially fire when administering or verifying any medication, set Criteria evaluation to Skip initial medication criteria prescreening check on the Triggers form.
        https://d.pr/i/w6d0GR
        | :check: | Use caution when expanding the medication criteria evaluation, or you may annoy your users with OPAs that fire at nonsensical times. |
        
        The following triggers have an initial criteria prescreening check. For details on the prescreening check associated with these triggers, see the OPA Triggers section of the OurPractice Advisories Setup and Support Guide available on Galaxy.
        pdf: https://d.pr/i/fGPV8t ; https://d.pr/i/JbrRfF
        
        6-Enter Problem
        
        7-Enter Diagnosis
        
        10-Enter Result
        
        18-Enter Order
        
        19-Select Procedure in Order Set
        
        20-Select Medication in Order Set
        
        21-Open Order Set
        
        22-File Doc Flowsheets
        
        23-Sign Orders
        
        24-Select item in SmartSet
        
        25-Sign SmartSet
        
        31-Medication Administration
        
        33-RX Verify New Order
        
        34-RX Verify Discontinued Order
        
        35-RX Verify Edited Order
        
        36-RX Reverify Order
        
        49-File Discrete Data in NoteWriter
        
        50-Discontinue Order
        
        51-Release Signed Held Order
        
        52-Auto Discontinue Order
        
        53-Accept MAR Administration Form
        
        61-Add Order to Treatment Plan
        
        62-Sign Treatment Plan Order
        
        63-Release Treatment Plan Order
        
        64-Quality Measures
        
        73-RX After Verify
        
        74-Enter Community Order
        
        75-Sign Community Order
        
        80-Enter Patient Goal
        
        To make an OPA skip the initial criteria prescreening check, change the Criteria evaluation setting on the Triggers form.
        
        Edit TRNCLN## BASE ADD CENTRAL LINE TEACHING TITLE record to use the expanded trigger check.
        
        Search > OurPractice Advisory.
        
        Go to the Triggers form.
        
        For Criteria evaluation, select Skip all initial criteria prescreening checks.
        
        Save your base record.
        
        In your Hansel patient's chart, go to the Avatar activity.
        
        If your Hansel patient's chart is not open, go to Patient Lists and open it.
        
        Your Hansel patient should already have an LDA for the PICC line you added earlier.
        
        You don't need to remove and add the LDA again. It's already there! You just need to trigger the File Doc Flowsheets action. You could also file an LDA assessment in Flowsheets.
        
        Hover over the LDA and click Assess.
        
        Enter a Site Assessment.
        
        Go to the Education activity > Education tab.
        
        CHECK: You should see Central Venous Catheter. You may need to expand the title to see the teaching points.
        
        Close Hansel's chart.
        
        | :check: | Be careful about skipping initial criteria prescreening checks. In this particular example, it's the correct option because:
        
        You want the OPA to fire based on someone adding an LDA to the Flowsheets (making File Doc Flowsheets the appropriate trigger).
        
        The criteria aren't directly evaluating flowsheet data, so the trigger wouldn't otherwise fire.
        But imagine if the advisory wasn't hidden from users and you didn't exclude patients who already had the teaching title. The OPA would then appear any time a user filed flowsheet data for a patient who had a previously documented central line. It could become an annoying and distracting OPA.
    - - Evaluation and Planning
        1. Plan criteria build:
        | Include patients who... | Receive a central line for the first time (during this encounter) |
        | --- | --- |
        | Exclude patients who... | Already have the Central Venous Catheter Education title |
        | How can you configure a criteria record to identify patients with a central line? | Central lines are documented on a patient's chart using Lines, Drains, and Airways (LDA) functionality and duplicable flowsheet build. A criteria record cannot directly evaluate duplicable flowsheets. You need to extend criteria build with a CER rule. |
        | How can you configure a criteria record to identify patients with certain Education? | A criteria record cannot directly evaluate Education. You need to extend criteria build with a CER rule. |
        2. Plan base build:
        | What displays? | Nothing! OPA does not display to users. |
        | --- | --- |
        | For which users? | All clinicians |
        | When and where? | When user documents adding a central line (trigger: File Doc Flowsheet). |
        | Follow-up action? | Add Education title via a task template |
        | Require acknowledgement? | N/A |
        3. Plan record build:
        | How many criteria records? | include patients with a central lineinclude patients with the Central Venous Catheter Education title |
        | --- | --- |
        | How many base records? | One |
        | How many other records? | CER rule that returns true for patients with a central lineCER rule that returns true for patients with Central Venous Catheter Education titleTask template that adds Central Venous Catheter Education title |
        The build for this OPA will look like this:
        https://d.pr/i/at9JI2
        
        What are some advantages to creating multiple, simpler CER rules rather than fewer, more complex CER rules?
        
        Advantages:
        
        Reusability
        
        Easier to troubleshoot
        
        Easier to report on/analyze
        
        Disadvantages:
        
        More records to maintain
        
        System performance**
        
        - Identify the Central Line LDA Groups https://d.pr/i/fOE2JP
        **LDAs are a special type of flowsheet group, but not every LDA group represents a central line. To make this OPA work, you need to identify the flowsheet groups that represent central lines.
        
        Go to Patient Lists and open your Hansel patient's chart.
        
        Go to the Flowsheets activity.
        
        In the activity toolbar, click LDA Avatar.
        
        You're now in the Avatar activity.
        
        In the Add LDA search field, enter "central" and press Enter.
        
        Not all of the choices are central lines. In reality, you'd work with a clinician to identify which choices should count as central lines.
        
        Press ESC to close the search window. Do not add any LDAs to Hansel's chart.
        
        Identify the "Central Venous Catheter" Teaching Title https://d.pr/i/7Dsi5J
        
        You need to identify the teaching title for Central Venous Catheter for:
        
        a CER rule that tests whether the patient has that teaching title.
        
        a task template to add the teaching title to the patient's chart.
        
        You can find the names and IDs of teaching titles, topics, and points in the Education activity.
        | | Teaching titles, topics, and points represent different levels of detail and organization in a patient's Education record.
        
        Titles group topics and points together.
        
        Topics are optional. They're used to break up larger titles.
        
        Points are the specific items a provider needs to discuss with a patient or caregiver. Documentation occurs at this level. Points can be linked to topics and/or titles.
        For more information, see the Patient Education Setup and Support Guide. |
        
        Go to Search > Education.
        
        Go to the Education tab.
        
        Click Add Title.
        
        In the Add a new title search field, click the magnifying glass, find the CENTRAL VENOUS CATHETER title, and make note of its ID.
        
        | | Write It Down: Central Venous Catheter Education Title ID:304118 |
        | --- | --- |
        Do not add this teaching title to the patient's chart.
        
        Confirm that you have not added any education, and close Hansel's chart.
        
        Extend Criteria with CER Rules https://d.pr/i/qdTriN ; https://d.pr/i/zHbcn3
        
        You need two criteria records for this OPA:
        
        includes patients with an active central line
        
        includes patients who already have the Central Venous Catheter teaching title
        
        Both of these criteria must link to a CER rule.
        Including Patients with an Active Central Line
        
        You've identified a criteria record that links to a CER rule to include patients with a central line.
        Please do not edit these records - all trainees will use them.
        https://d.pr/i/z0bJfp
        https://d.pr/i/opp9qQ
        Excluding Patients Who Already Have the Teaching Title https://d.pr/i/IN3ZOV ; https://d.pr/i/QAgMCu
        
        You've identified a criteria record that links to a CER Rule to include patients with the Central Venous Line teaching title. You'll attach the criteria record to your base with NOT logic to exclude patients who already have the education title.
        Please do not edit these records - all trainees will use them.
        https://d.pr/i/HYU6jt
        https://d.pr/i/vSXOb4
- - - - - Reviewing the Chapter
        
        True or False: Every time an OPA triggers, a new ALT record is created.
        
        False. The first time an OPA triggers in a patient encounter, a new ALT record is created. If the OPA continues to trigger in that same encounter, the system will file the data for each triggering to additional contacts on the same ALT record.
        
        Which of the following are true about using SlicerDicer to investigage OPAs? Answer ALL that apply.
        
        A. You'll need to work with the reporting analysts at your organization before you use SlicerDicer
        B. You can add a report created in SlicerDicer to a dashboard
        C. There is an OPA data model that you can use for your investigation
        D. Details from your SlicerDicer session can be exported to Excel
        
        B, C, D
      - How to Set Up the OPA Data Model https://d.pr/i/B75FHD ; https://d.pr/i/orPHyW ; https://d.pr/i/XH49qE ; https://d.pr/i/thxIFB
        
        You can use SlicerDicer to do ad hoc reporting, investigate a hunch, export your results, and create Radar dashboard components.
        
        | | You want to monitor the number of OPAs firing by department. You'll explore two dashboards then create a Radar dashboard component in SlicerDicer and explore the reporting options available in the OPA data model. |
        | --- | --- |
        
        You should be logged in to Hyperspace as your builder (2230##/train). If not, log in now.
        
        Go to My Dashboards.
        
        Use the OurPractice Pulse Dashboard (IDM 70350) to monitor how often OPAs are triggered across your organization. Metrics are organized by inpatient versus outpatient and interruptive versus passive alerts.
        
        Open the OurPractice Pulse Dashboard and explore the metrics.
        * Click on the title of the dashboard that's currently displaying. * In the Search for reporting content field, search for "ourpractice pulse." * From the search results, open the the OurPractice Pulse Dashboard. You can also click the star to favorite it.
        | | For more information about configuring Pulse dashboards, refer to the Pulse Setup and Support Guide.For more information about Pulse metrics - quantitative measurements of Hyperspace activity stored in the Benchmark Definitions (IDN) master file - search for "pulse" in the Metric Repository. |
        | --- | --- |
        
        Open the Clinical Decision Support dashboard (IDM 70000) and explore the existing components.
        * Click OurPractice Pulse. * In the Search for reporting content field, search for "clinical decision." * From the search results, open the Clinical Decision Support Dashboard.
        Since you'll customize this dashboard, you should create a new view. Each view is a collection of a user's changes to a dashboard and users can create multiple views per dashboard, to account for multiple use cases.
        
        In the top right corner, click the views button and select New View.
        
        https://d.pr/i/HYs68z
        
        For Display Title, enter "TRNCLN## OPAs" and click Accept.
        
        Next, create a new SlicerDicer component.
        
        In the top right corner, click the options menu (three vertical dots) and select Create Component.
        
        https://d.pr/i/QEkwXS
        
        In the Select a Data Model window, click OurPractice Advisories.
        
        If this is the first time you're using SlicerDicer, you'll be prompted with a tutorial.
        
        You may click through the tutorial, or click outside of it to exit.
        
        Hover over Population, Slices, and Measures to learn about each.
        
        In the Measures card, click Number of OurPractice Advisories.
        * Distinct Count = number of ALT CSNs.
        
        Slice the population base (all OPAs that have fired) by department:
        * In the Slices card, click the plus sign (+). * Click Department. * Click Department. * Under Slice by Department, click Grab Top 10.
        
        Slice the data by trigger:
        * In the Slices card, click the plus sign (+). * Click OurPractice Advisory. * Click Trigger. * Under Slice by Trigger in the right column, search for and select Open Patient Encounter.
        
        Slice the data by action taken:
        * In the Slices card, click the plus sign (+). * Click OurPractice Advisory. * Click Any Action Taken?
        
        https://d.pr/i/B1QVbZ
        
        Exercise 2: Explore the OPA Data Model https://d.pr/i/nixD4E
        
        Now that we've worked through one possible scenario in SlicerDicer, take some time to explore on your own. What other questions are you interested in answering with SlicerDicer? You'll need to re-open SlicerDicer by searching or using the button in your Hyperspace toolbar and can then explore various population criteria, slices, and measures in the OPA data model. Keep in mind that the actual data is limited in our training environment.
        
        Beyond the Basics: Feedback and Tune-Up Utility
        
        The information in this section is beyond the basics for the OurPractice Advisories Advanced badge.
        
        Gather Feedback From Users About OPAs
        
        https://d.pr/i/Mha6PM
        
        Allow clinicians to submit their opinions on interruptive OPAs by enabling feedback and then use that feedback to improve those alerts. If users enter a free-text comment, the comment can be sent in an In Basket message, type 551-Feedback Message. There are multiple options for configuring message recipients: * If your organization uses GetSmart metadata to track OPA owners, the free-text feedback is sent to the OPA owner by default. For more information about GetSmart metadata, refer to: [Track Review Decisions in Metadata Records](https://galaxy.epic.com/Redirect.aspx?DocumentID=3493446).
        https://d.pr/i/NZk86C
        * Configure recipients in a base record on the User Feedback form if you would like the feedback to be sent to someone other than the OPA owner or if your organization is not using GetSmart metadata to track OPA owners.
        https://d.pr/i/dEHeuP
        * You can also specify recipients in a profile record.
        https://d.pr/i/azvgUK
        You can report on OPA feedback in the SlicerDicer OPA data model with the Discrete Feedback and Feedback Comment filters. You can turn off the OPA feedback feature in individual base records and in a profile record (I LPR 2026).
        Run the OPA Tune-Up Utility
        
        To identify interruptive OPAs that may be contributing to alert fatigue, use the OPA Tune-Up Utility at least twice a year. The utility analyzes ALT data and looks for patterns in your organization's interruptive OPAs. It considers a variety of factors, such as acceptance rates and departments. Your Epic representative will run the utility and send you the results in a spreadsheet. You should leverage the OPA data model in SlicerDicer to investigate further. The results include suggestions for improving interruptive OPAs, such as adding lockouts to reduce firings.
        
        For information about the results spreadsheets, refer to [Review the OPA Tune-Up Spreadsheet.](https://galaxy.epic.com/Redirect.aspx?DocumentID=100085704)
        
        Success Tracking
        
        Reporting on whether your OurPractice Advisories are successful or not will help you continually improve your decision support program. Success tracking reporting tools, like the OPA Pulse Dashboard, SlicerDicer, OPA Tune-Up, and more, will consider an OPA successful if an action was taken from it. For many OPAs, this is a good indicator of whether the OPA led to a desired outcome.
        
        In some cases, success for an OPA might be something other than whether an action was taken. In these situations, configure Success Tracking in a base record to determine how to track success for that particular OPA.
        
        https://d.pr/i/1LZ5x2
        
        For more information about the unique ways you can track success in individual OPAs, refer to the Track How Successful Your Advisories Are
        
        **####
        
        Remove the Any Action Taken and Trigger slices.
        * In the Slices card, hover over each and click X.
        
        Click Create Component (bottom right corner).
        
        Update the component Name and Date Range if you'd like.
        
        Under Save to Group, select Create New Group.
        
        There is an additional Dashboard Parameter that we won't need for this SlicerDicer component.
        
        Scroll down to the Dashboard Parameter.
        
        Hover your mouse over the Department Parameter, and click the X.
        
        Click Add to Dashboard.
        
        Search > SlicerDicer.
        
        Select the OPA data model.
        
        Click Load.
        
        In the New group, open the session you just created as a component.
        
        Click Share.
        
        You can share sessions with other users who have appropriate security.
        
        In the Share Session window, click Cancel.
        
        In the Visual Options card, click the detail table option.
        
        https://d.pr/i/fPm0Vd
        
        Explore the details within each row.
        * You can also export the detail table to Excel (right click).
        
        Click Save.
        
        Click Save Session.
        * Your changes will be reflected in the component based on this session.
        
        Close SlicerDicer.
        
        Back on the Clinical Decision Support dashboard, press ALT+\= to refresh the entire dashboard.
        * If you made any changes to your component, you should see them.
        | | Looking for something in SlicerDicer that you don't see? You probably want to create another filter. If the data exists in Caboodle, you may be able to quickly build a new filter. For more about creating custom SlicerDicer filters, see COG2020v SlicerDicer Custom Build. |
        | --- | --- |
        
        Not sure where to start or what kinds of reports in SlicerDicer to create? Check out these example reports, available on Report Repository:
        
        [Most Common Interruptive OPAs](https://datahandbook.epic.com/Reports/Details/3959997)
        
        [Most Ignored OPAs](https://datahandbook.epic.com/Reports/Details/3960003)
        
        [Any Action Taken on a Specific OPA by Department](https://datahandbook.epic.com/Reports/Details/3960000)
        | | For simpler reporting needs, the following Reporting Workbench templates are available:OurPractice Advisory Build Template (R HGR 17900)OurPractice Advisory Template (R HGR 17600)OurPractice Advisory Usage Template (R HGR 17700) |
        | --- | --- |**
    - - - ALT Contacts for Passive OPAs https://d.pr/i/yu9gBN
        
        Since passive OPAs could trigger each time that a navigator or Storyboard refreshes, there's the potential for the creation of a lot of ALT contacts. Here's how Epic determines whether an ALT record and/or contact will be created for OPAs:
        
        https://d.pr/i/uRcKtp