Vitals Configuration

Overview

• (oderable vs non-orderable Orderable Items give an example of each?)

(Are all vitals orderable? if not please give example of each. for example is a comment orderable?)

• All Vitals are Orderable Items
• All Orderable Items must be mapped to a Resultable Item
• A Complex Orderable Item is an Orderable Item that can contain other Orderable Items
• A Complex Orderable Item does not needed to be mapped to a Resultable Item because its children are already mapped to Resultable Items.
• Both the parent and child Orderable Items are contained in the same dictionary, the OID (Classification: Clinical Findings > SubClassification: Vitals)
• A Complex Orderable Item containing vitals is called a Panel on the back end and a View on the front end.

High Level Process

1. Organizations should begin by reviewing the Allscripts delivered vitals orderable items and vital signs panels/views
2. Define what needs to be created and/or modified
3. Outline how the Vitals-specific system preference are to be set
4. Create Resultable Items for any new vital signs
5. Create Orderable items for any new vital signs and map to the corresponding resultable items
6. Create any new Complex Orderable Items (panels) and Add Orderable Items to create views

Create Resultable Items

All Orderable Items must have a Resultable Item

1. TWAdmin > Dictionaries > Dictionary: Resultable Item
2. Click 'Search' at the bottom of the screen to show/hide the search bar
3. Search for the needed item before creating a new item. (use 'Contains')
4. If the needed item already exists in the RID no further action is needed in the RID.
5. To create a new item click 'Add'
6. Enter 'Code', 'Name', 'Mnemonic' and 'Display Name'
   • The Code is the database key and must be unique
   • Always make 'Code' and 'Mnemonic' the same.
   • The code and mnemonic are limited to 10 characters and no spaces between characters
   • Always use the organization mnemonic as the prefix. This will make it easy to tell which items were created for the organization. For example a new vital sign of waist circumference added by New World Health could be given the code and mnemonic 'NWH_WstCir'
   • Make 'Name' and 'Display Name' the same
7. Configure details
8. Click 'Save'

Create Orderable Items (Vitals)

1. TWAdmin > Dictionaries > Dictionary: Orderable Item
2. Under Non-Medication and Immunizations, expand Clinical Findings Find and highlight Vitals
3. Click 'Search' at the bottom of the screen to show/hide the search bar
4. Search for the needed item before creating a new item. (use 'Name' 'Contains')
5. Click Add. A new row will appear within the grid
6. Enter 'Code', 'Name', 'Mnemonic' and 'Display Name'
   • The Code is the database key and must be unique within the OID
   • If the item is orderable, make the 'Code', 'Name', 'Mnemonic' and 'Display Name' the same as the Resultable item in the RID
   • Always make 'Code' and 'Mnemonic' the same
   • The code and mnemonic are limited to 10 characters and no spaces between characters
   • Always use the organization mnemonic as the prefix. This will make it easy to tell which items were created for the organization. For example a new vital sign of waist circumference added by New World Health could be given the code and mnemonic 'NWH_WstCir'
   • Make 'Name' and 'Display Name' the same
7. Indicate if the vital signs Orderable Item is orderable by placing a checkmark in the box (Are all vitals orderable? if not please give example of each)
   • Do not check the “Complex” Order Indicator
8. Select appropriate setting from the Orderable Via drop down list:
   • User Only – orderable in TouchWorks only (more explaination here?)
   • Interface Only – orderable through Order Interface only (more explaination here?)
   • User or Interface - orderable in TouchWorks and/or through Orders Interface
9. Select appropriate orderable item mode (OID Mode):
   • Draft
   • Active
   • No longer used
10. The 'Order Type' will automatically default to Clinical Findings
11. Click Save.
12. IF the new item is orderable, continue with the following steps. (Are all vitals orderable?)
13. Click on the Results collapsible detail pane
14. Click blue RID Selector link
15. Search for the Resultable item to link to the orderable item (use 'Entry Name' 'Contains') If the matching Resultable Item does not exist, you may need to go to the Resultable Item Dictionary, create a new Resultable Item, and then return here to link it)
16. Click the binoculars to search. The results will display within the grid.
17. Select the desired orderable item
18. Click the down arrow
19. Click 'OK'

Create Vital Sign Panels (Views)

1. TWAdmin > Dictionaries > Dictionary: Orderable Item
2. Under Non-Medication and Immunizations, expand Clinical Findings Find and highlight Vitals
3. Click 'Search' at the bottom of the screen to show/hide the search bar
4. Search for the needed Panel before creating a new Panel. (use 'Name' 'Contains')
   • The OID will already contain the Panels: Adult Female, Adult Male, Child <10, Child <3 (Allscripts RedHot series says delivered content contains Vitals Panels listed above and 'Vital Signs picklist which contains the orderable item Vital Signs' so shouldn't we see a Vitals Panel called 'Vital Signs' as well?)
   • The OID will already contain the Panel: 'AHS Vital Signs' Delivered as an enforced entry and disabled. This panel was intended to be used to display vital signs entered in versions of TouchWorks before v11.(so why is it still there?)
5. Click Add. A new row will appear within the grid
6. Enter 'Code', 'Name', 'Mnemonic' and 'Display Name'
   • The Code is the database key and must be unique within the OID
   • Always make 'Code' and 'Mnemonic' the same
   • The code and mnemonic are limited to 10 characters and no spaces between characters
   • Always use the organization mnemonic as the prefix. This will make it easy to tell which Panels were created for the organization. For example if New World Health wants to create a Panel for Adult Male but still retain the Allscripts Adult Male Panel the code and mnemonic 'NWH_AdultM' could be used.
   • Make 'Name' and 'Display Name' the same if possible and include the phrase 'Vital Signs' in the name
7. Indicate if the vital signs Orderable Item is orderable by placing a checkmark in the box (Are all vitals orderable? if not please give example of each)
8. Check the “Complex” Order Indicator
9. Select appropriate setting from the Orderable Via drop down list (see above)
10. Select appropriate OID Mode (see above)
11. The 'Order Type' will automatically default to Clinical Findings
12. Click Save.
13. Once saved, a new detail pane will appear titled 'Child Orders' (you may need to scroll down)

    

14. Click OID Selector link. The Link Child Orders Item(s)… dialog box will display.

    

15. Enter search terms for the first item to be included in the Panel (use 'Entry Name' 'Contains')
16. Click the binoculars to search. The results will display within the grid.
17. Select the desired orderable item
18. Click the down arrow
19. Repeat steps add additional orderable items
20. Once complete, click OK

    

Vital Signs Picklist Overview

• A Picklist is a subset of items in the OID. It can contain Complex Orderable Items (Panels/Views) or Indivdual Orderable Items (Vital Signs)
• A Vitals Picklist typically includes standard Vitals Panels(Views) and/or custom Vitals Panels(Views) that are needed for a given specialty or practice
• The vitals picklist determines which vital views the user can access
• Vitals Picklists can be assigned to users
• Organizations can associate a Vitals Picklist by setting a Results preference at the Enterprise, Organization, or User Level. (what does this mean?)
• Preference settings determine which vitals picklist the user can access.
• Personalize allows the user to alternate picklists, which would allow access to additional vital views.

In addition, they can set default vital sign views based on the age and gender of a patient.

• (is the 'TW Vitals' Picklist' an exception to these rules? does it drive the global selection options' located next to heart on Clinical Toolbar ?)

Edit / Create Vital Signs Picklists

1. TWAdmin > Dictionaries > Dictionary: Orderable Item
2. Click Picklist to view the existing Picklists
   • To add panels to the 'global selection options' (located next to heart on Clinical Toolbar), select the 'TW Vitals' Picklist
   • (V11.0 has a picklist named 'Vitals Panels' with only one entry, a Panel named 'Vital Signs'. What is the purpose of this Picklist?)
   • (Allscripts RedHot series says delivered content contains 4 Vitals Panels for M,F, <10 and < 3 and Vital Signs picklist which contains the orderable item Vital Signs. What is the purpose of this Picklist?)
   • To create a new picklist click Add Picklist, Enter a Picklist Name, Click OK then select the New Picklist in the left pane

   

3. Click Add Entry. The Add Entries dialog box will display.
4. Search for the desired vital signs panels via name, code, or mnemonic
   • (The iterative search returns some values but the binoculars are needed to return all values?)
   • If all the Vitals Panels contain a shared value such as 'VS' in the code or 'Vital Signs' in the name this will make seaching easier.

   

5. Select and add the desired panels one at a time
   • (Do not select 'AHS Vital Signs'? Allscripts RedHot seriessays "This panel was intended to be used to display vital signs entered in versions of TouchWorks before v11.")
6. Once complete, click OK.

   File:Add Panels.jpg

Setting System Preferences

TWAdmin > Preferences > Preferences > Preference: Results

• Vitals Preferences can be set at the Enterprise, Organization, or User Level
  • Preference settings determine which vitals picklist the user can access.
  • The vitals picklist determines which vital views the user can access.
  • Personalize allows the user to alternate picklists, which would allow access to additional vital views.

The Preference 'Vitals Picklist' determines which picklist the user will access when they enter vitals (via Clinical Tool Bar, Note, or Clinical Desktop/Flowsheet.

1. Set 'Ent/Org/User Settings:' to 'Enterprise'
2. Scroll down to the preference 'Vitals Picklist'
3. Select a picklist from the 'Value' field dropdown

In addition, There are 4 preferences that can be used to determine the default vital signs Panel(View) based on age and gender.

• 'Defualt Vitals - <10 years old'
• 'Defualt Vitals - 3 years old and younger'
• 'Defualt Vitals - Female 10 years old or older'
• 'Defualt Vitals - Male 10 years old or older'

Enter the 'Name' (not the display name) of the appropriate vitals complex Orderable Item Panel(View) into the 'Value' field, using the EXACT TEXT.

Create Vitals Flowsheets

1. Phys Admin Workplace > Expand By Category > Flowsheets
2. Specialty: defaults to 'Unassigned'
3. Create a new vital signs Flowsheet by clicking 'New'
4. Name the Flowsheet
5. Click 'Add Item' to add Orderable Items to the flowsheet
6. Select Classification: Clinical Findings > SubClassification: Vitals
7. Choose items and click OK

Need help with this section Are flowsheets created for vitals or configured via Clinical desktop views? How many vitals flowsheets would a typical practice have? Are the flowsheets mapped to panels or built from individual vital signs? Are vitals flowsheets assigned to specialties like regular flowsheets or is there a different arrangement?

For more information on building flowsheets see Build Flowsheets

Making the Date and Time editable

With certain workflows you may find it necessary to quickly jot down the vitals and return later to TouchWorks to enter that information. In order to change the date and or time to match when the vitals were taken, make the following changes to the desired vitals panel.

1. Log into the TWAdmin workspace
2. On the vertical toolbar, click Dictionaries
3. Select Orderable Item from the Dictionary drop down list
4. Under Non-Medication and Immunizations, expand Clinical Findings
5. Find and highlight Vitals
6. Select the desired Vitals panel to edit and on the details screen scroll down to Performing

By setting the Overdue Interval (I set mine to "10" following the example of a vitals panel provided by Allscripts) this allows the user to enter the correct date/time for when the vitals were taken.