Flowsheets

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Definition

When selected, the system displays a selected flowsheet using data from the selected patient’s record. The available flowsheets are listed in the Group By box. Flowsheets are defined by the organization.

Building Flowsheets

Flowsheets can consist of Items from the OID and/or Medcin Findings. If building flowsheets from Medcin Findings data elements, then skip to step 10. For items built from the OID follow these steps:

Phase 1: Map out all items needed in the flowsheet

When building flowsheets using the OID, it’s important to map out all of the possible answers the client would like for each data element and how the client would like those answers (free-text/numeric/date/picklist). In order to obtain the possible answers for each item, a clinical person will most-likely need to be consulted. For this article, we will use an Anticoagulation Flowsheet as an example. The data elements we will use and their possible answer types are listed below:

Indication for Treatment: (Free Text)
Duration of Treatment: (Free Text)
PT: (Result from either interface or user manually enters)
INR: (Result from either interface or user manually enters)
Date of Last treatment: (date)
Current Dose: (Types of Warfarin/Coumadin doses; Possible Answers: 1MG, 2MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG, and 10 MG)
Dose Changed: (Possible Answers: Yes/No)
New Dose: (Types of Warfarin/Coumadin doses; Possible Answers: 1MG, 2MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 MG, and 10 MG)
Next Follow-up: (Date)
Comments: (Free Text)

Phase 2: Create Answers and Answer Picklists

For our example, the answers/picklist we will need to create that do NOT already exist in the Answer dictionary is the dosages. The Yes/No picklist already exists in the Answer dictionary and as a picklist.

Once you have mapped out the possible answers, you need to go to the Answer dictionary.
If the answers exists (yes/No, etc), then use those answers to create a picklist in the Answer dictionary for the data element in the flowsheet.
1. If the answer does not exist, decide if the answer can be entered into an existing node in the answer dictionary or if a new node needs to be created.
  1. If a node needs to be created, select the word "Answer" and click the Add button to the left.
  2. Type the name of the node (try to make this generic, i.e. if this is dosages of coumadin in mg, you may want to name the node "dosages" so it can house multiple dosages not just those related to Coumadin)
2. Select the node that will house the answers and click the Add button to the right.
3. Enter the Code, Name, and Mnemonic. The Name should be how you want the answer to display. (i.e. Code=OneMG, Name=1 MG, Mnemonic=OneMG)
4. Continue the last two steps until all answers for this node are entered.
After all answers are created in the right nodes, click the Picklist button.
- Existing picklists will display.
Create any new picklists by clicking "Add Picklist" and naming the picklist after the result item (i.e. Coumadin Dosages).
Once the picklist is created, assign answers to the picklist by selecting the picklist and clicking Add Entry. Add all items that apply to this specific picklist. You may have to create multiple picklists.
- Note, you should NOT create a new picklist for Yes/No as one already exists.

Phase 3: Verify and Create New RID Items

To build a new flowsheet for Renal Failure patients (example), follow these steps:

1. Login as TWAdmin

2. Go to PhysAdmin

3. Select “by category”

4. Select “flowsheets”

5. Select a specialty (Remember that only users assigned to this specialty will see the flowsheet)

6. Hit “new”

7. Enter a name for the flowsheet in the “name” field

8. Determine the following parameters:

Chrono Sort - descending or ascending
Blank rows - hide or show (recommend setting this to “hide”, which will only show rows that contain data. This makes the flowsheet easier to read)
View - date sequence or date/time (recommend date sequence as date/time tends to be confusing to look at)

9. Click “link” to link flowsheet to appropriate ICD9 (select Renal Failure and Renal Disease) then select “ok”

10. Click “add item” to add an item from the Orderable Item Dictionary. Remember the item must be “active” in order to select it.

11. Highlight “laboratory”, then search for BUN.

12. Highlight the appropriate BUN from the list then right arrow to move it to the “Selected Orderable Items” window on the right.

13. Search for Creatinine.

14. Highlight the appropriate Creatinine from the list then right arrow to move it to the “Selected Orderable Items” window on the right.

15. Click “Ok” to see the items that have been added to the flowsheet. They may appear as folders with multiple analytes (results) inside each folder. To see all of the analytes, click the + sign next to the folder to expand.

16. Click “add findings”, to add Medcin items to the flowsheet (if required). Adding Medicin is particularly useful when certain items are being documented within a V11 note that also need to be tracked via a flowsheet. For example, if a provider checks a renal patient for "pitting edema", then documents the result at numerous visits using the Medcin term “pitting edema”, adding this same Medcin item to the flowsheet will allow the answer to post to the flowsheet as well.

17. To add this item, highlight Physical Exam then select the radio button next to “Search”.

18. Type in the search box key words related to the desired finding (e.g. search “pitting edema”, select “ it then click “ok” to add to the flowsheet). The finding will now appear within the flowsheet.

19. Select the “preview” tab to see the flowsheet from the end user perspective.

20. Return to the “build” tab. If an item needs to be removed, this can be done by highlighting the item and hitting the “remove” button. Items can also be moved up by highlighting the item and hitting the up arrow next to the “remove” button.

21. Save the flowsheet by clicking the “save” button. It should now be visible to the users assigned to the specialty associated with the new flowsheet.

Troubleshooting

Eliminating equivalent RID rows in a flowsheet: How to avoid duplicated rows in your flowsheet that are created by using the "Considered equivalent only for flowsheet graph:" is by creating an additional orderable item for the purpose of flowsheet display.

For example let’s take CAD (coronary artery disease) flowsheet – on this flowsheet you would want to include total cholesterol when you build this in Phys Admin. The logical thing seems to be to go to Phys Admin search for Total Cholesterol and add that orderable item to your flowsheet. If you are working with multiple lab vendors chances are you will have several versions of cholesterol resultable mapped to that order – one for each of your lab vendors:
- Cholesterol for LabCorp
- Chol for Cerner
- Cholesterol, Total for Quest

If you have used the function in the RID “Considered equivalent only for flowsheet graph” and tied the three cholesterol resultables mentioned above what will happen is when ONE of those is resulted it will duplicate the results for each of those line items in the flowsheet. For example let’s say that patient A goes to LabCorp and has the Cholesterol checked and resulted. When you look at the flowsheet not only does a line item show for Cholesterol with the results, but you will see two additional lines on the flowsheet for Chol and Cholesterol, Total with the results for Cholesterol in them. Basically the same result will be seen in triplicate.

How to avoid this: Instead of going into Phys Admin and adding the different orderables to the flowsheet we create a new special order in the OID (and this is what we attach in Phys Admin to our flowsheet). We call it “CAD Panel” and we attach to that orderable only ONE resultable representing each order that we want on the flowsheet. So for instance in our CAD Panel Order we only attach the one result of “Cholesterol” (and leave out the additional two - Chol and Cholesterol, Total). We still use the “equivalent” function, but now regardless which result comes back – whether it’s for LabCorp, Cerner, or Quest we only have ONE line that shows on the flowsheet.

Common Flowsheets

Flowsheet Q and A