[vvcemr] Re: Diagnoses, Problems and Procedures

  • From: Yeast Munn Jennifer Lee <jl.munn@xxxxxxxxxxxx>
  • To: "vvcemr@xxxxxxxxxxxxx" <vvcemr@xxxxxxxxxxxxx>
  • Date: Wed, 8 Oct 2014 12:00:36 +0000

Simon,

We get around this in UVIS using questions related to a surgery report and were 
planning on continuing in VetView by harnessing some of the better ways that 
questions can be handled in digital documents.  The way it works now is that in 
the event that we have a more generic procedure that creates the request, we 
have questions that allow you to define what specifically was done.  This does 
essentially create a kind of procedure list at the level of the request.  In 
UVIS the visualization is a bit hidden, but in VetView, we’re thinking it won’t 
be so hidden (theoretical at this point though).  So we agree with you that 
this is important for services that may have less specific billable items.

The question for clinical people is probably more where would this information 
be better visualized?  Does the way the problem list work translate well for a 
list of procedures as well or does it make more sense to be associated to a 
request or even some other way?  From a technical point of view, there is 
probably even a way to get to where you want to be using the infrastructure 
that is already in place for Digital Documents (VetView, if you’re in on the 
conversation, correct me if I am wrong).  Is that enough or does it need to be 
something definitively apart like the master problem list?

Jennifer

On Oct 8, 2014, at 7:44, Simon Roe 
<Simon_Roe@xxxxxxxx<mailto:Simon_Roe@xxxxxxxx>> wrote:

The problem with using a billable event for procedure is that there will be 
many instances where it will not be specific enough. The procedure request does 
not always fully reflect what was done during the procedure, because we don't 
always know beforehand. Information has to be entered after the event has 
occurred. It will work for some. I would strongly support the development of a 
Procedures List for all to use

Simon Roe

On Mon, Oct 6, 2014 at 10:10 AM, Shirley T. Arck 
<sarck@xxxxxxxxxxxxxxx<mailto:sarck@xxxxxxxxxxxxxxx>> wrote:
I forwarded the post to Kathy Ellis from VMDB.  Here is her response:

As a response to this person's post, it is possible to have Procedure list 
similar to a diagnosis list using SNOMED.  Currently the coders code the 
surgical procedures as well as certain other procedures, such as Chemo.  VMDB 
has thrown around the idea of creating a procedure listing.  What would be best 
is for the EHR to use charge capture, automatically coding charges that are 
specific enough to be coded without manually being done (example:  spays, 
castrations, tie-back surgery, etc.).  VetStar currently does this.  What we 
need is a VMDB master procedure list that institutions could then tie into 
their charges, surgery reports, etc.


From: vvcemr-bounce@xxxxxxxxxxxxx<mailto:vvcemr-bounce@xxxxxxxxxxxxx> 
[mailto:vvcemr-bounce@xxxxxxxxxxxxx<mailto:vvcemr-bounce@xxxxxxxxxxxxx>] On 
Behalf Of Shirley T. Arck
Sent: Sunday, October 05, 2014 3:34 PM
To: vvcemr@xxxxxxxxxxxxx<mailto:vvcemr@xxxxxxxxxxxxx>
Subject: [vvcemr] Re: Diagnoses, Problems and Procedures

I see a need for the separate MPL as well.  It’s an important part of our 
current paper medical record.  I really like your idea about structuring it 
similarly to the dx process.  Would be nice if there could also be some way to 
automate addition of some select problems to the MPL based on a particular 
procedure that was done.

Shirley


Shirley Arck, PharmD, FSVHP
Administrator
Veterinary Health Center
at Kansas State University
1800 Denison Ave.
Manhattan, KS   66506
Tel: 785-532-5708<tel:785-532-5708>
Fax: 785-532-4309<tel:785-532-4309>



From: vvcemr-bounce@xxxxxxxxxxxxx<mailto:vvcemr-bounce@xxxxxxxxxxxxx> 
[mailto:vvcemr-bounce@xxxxxxxxxxxxx] On Behalf Of Simon Roe
Sent: Thursday, October 02, 2014 8:00 AM
To: vvcemr@xxxxxxxxxxxxx<mailto:vvcemr@xxxxxxxxxxxxx>
Subject: [vvcemr] Diagnoses, Problems and Procedures

It appears that, as in UVIS, it will be difficult to find the meaningful 
Procedures for a patient in VetView. It will be very easy to list everything 
that is categorized as a procedure and has a procedure code, but these are of 
limited help when a clinician is trying to understand the previous management 
of a case. An example would be Exploratory Laparotomy. This will be a 
procedure, but doesn't tell the clinician what was done. It might lead to a 
diagnosis of Liver Carcinoma, but was it removed/biopsied/?? There is a need 
for greater clarity, just as we have in the Problem/Diagnosis process. We need 
a Major Procedures list. Currently, on paper, I enter the major procedures in 
the Master Problem List. So, after a problem of hip dysplasia, I will add 
"Total Hip Replacement, BFX, Left". If the dog is later lame on the right hind 
limb, it could still be hip dysplasia. If he is lame on the left hind limb, the 
differential diagnosis list is quite different.

While it is possible to continue this approach in an EMR, it muddies the MPL 
and makes an entry that doesn't fit the SOAP process. It would be better to 
have a separate list. My thoughts are that it would be very like the Diagnosis 
process where there would be a major term, the ability to add qualifiers, and a 
free text comment if needed.

I would love to hear thoughts from others about this concept, and other 
suggestions for how this could be done

Simon Roe

--
Dr. Simon Roe, BVSc, PhD, Diplomate ACVS
Professor, Small Animal Orthopaedic Surgery
Randall B Terry Companion Animal Veterinary Medical Center
1052 William Moore Drive,
Raleigh, NC 27607

Ph: 919-513-6334<tel:919-513-6334> office  919-513-6588<tel:919-513-6588> clinic

"Live fully. Love wastefully. Be all that you can be." adapted from Bishop Spong

'All electronic mail messages in connection with State business which are sent 
to or received by this account are subject to the NC Public Records Law and may 
be disclosed to third parties.'



--
Dr. Simon Roe, BVSc, PhD, Diplomate ACVS
Professor, Small Animal Orthopaedic Surgery
Randall B Terry Companion Animal Veterinary Medical Center
1052 William Moore Drive,
Raleigh, NC 27607

Ph: 919-513-6334 office  919-513-6588 clinic

"Live fully. Love wastefully. Be all that you can be." adapted from Bishop Spong

'All electronic mail messages in connection with State business which are sent 
to or received by this account are subject to the NC Public Records Law and may 
be disclosed to third parties.'


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