Check out the video HERE.
A flowsheet is a patient-specific tracking dashboard that displays important clinical data over time so providers can monitor progress and make informed treatment decisions.
Manage Flowsheets:
To view available Flowsheets you would need to navigate to Administration > System Management > Manage Flowsheets:
This area will list any available Flowsheets:
This area advises on the icd9 trigger code to populate the Flowsheet in the patient's eChart. In the picture above the Flowsheets are all set to Disable. Alternately, you can click Enable to activate a Flowsheet, or Disable to deactivate it.
Please note that any changes made under the Administration panel will affect all providers on the EMR.
Now that we know the icd9 codes to trigger the available Flowsheets, we can assign them to a patient to populate under Measurements.
Assigning A Flowsheet:
From within a patient's eChart you would need to click the + for Disease Registry:
From the new window we will want to search by a icd9 code, or a descriptive word and click Code Search:
Once the appropriate icd9 code has been entered, we would click Add to assign it to the patient:
After closing the Disease Registry window, the desired Flowsheet would then be populated under Measurements:
By clicking on the Flowsheet it will open in a new window to review any entries.
Measurements:
The Flowsheet can be accessed from the Measurements section to review any historical data, and review trends.
Let's become more familiar with this page:
Items will be listed in the centre for tracking. Any box can be clicked to open and update data:
Once saved, a box will appear beside that item with the new value and date entered:
The data entered will appear in different colours, each representing a different status for that item.
White: the value entered is within a Normal range
Yellow: the value entered is outside of Normal range, and considered a Warning colour
At the very top will be recommendations that you can click Show/Hide:
This will then list any items that have not been reviewed with the patient:
On the left hand side there are 3 options for manually entering in data:
These options will generate a new window with boxes to enter new data instead of clicking each individual item.
For instance, if we click Add Overdue, it will load a window with any item that has not been entered yet:
At the top of the window you can enter in a specific date if it differs from the current date.
The Save button will be located at the bottom of the window.
There will be quick access to patient information regarding medications, and diagnosis on the left side:
By clicking Show/Hide you can choose to display the additional information, or not.
There may also be suggestions located on the left regarding additional diagnosis to be assigned to the patient:
When you click on a suggestion you will receive a pop up message advising that the task has been completed:
Any entries entered with a Comment will be listed at the very bottom of the Flowsheet with a number to indicate which tab the Comment corresponds with:
Mapping Measurements:
Lab results can be mapped to populate directly within a Flowsheet.
This process involves identifying a LOINC code associated with a specific measurement, identifying the id associated with it as presented by a lab source (Lifelabs, Dynacare, Alpha, etc.), and finally pairing it (or mapping) to the associated measurement in OSCAR.
Once this is done, OSCAR will know what measurements to add automatically to the eChart when the lab is transmitted electronically and associated with a patient, or display it in the Grid Display.
We would need to navigate to Administration > System Management > Customize Measurements and select View Mapping:
This will load a new window displaying all the mapped measurements. Here is a breakdown of the columns displayed:
MEAS: indicates what Measurement this code is mapped to.
Loinc Code: The LOINC code for the associated measurement
Desc: the description/name of the associated measurement.
MDS/GDML/etc.: These are names of associated lab providers. Each lab may have its own ID of how it identifies the associated measurement.
Please note that if the link "map" is appearing, this means that this measurement is NOT mapped.
For example, the screenshot below shows that LOINC code 718-7 is associated with the following identifier codes. Each lab has its own identifier code for the measurements.
- MDS (lifelabs) - Hemoglobin: -HGB
- GDML (Dynacare): - Hemoglobin: 418
- Excelleris: - Hemoglobin: -HGB
This indicates the identifier codes from lab sources are mapped to the 718-7 LOINC code. However, since the "map" link is still showing, this means that the LOINC code 718-7 is not mapped to any measurement in OSCAR. As such while OSCAR can identify the measurement within the lab, it does not know which measurement to enter into the system for LOINC code 718-7:
Once 718-7 is mapped using the "map" button to the appropriate measurement, OSCAR will know to add it to the Measurements section of the eChart.
Here we will need to select the appropriate measurement from the list and click Update Measurement Mapping:
The measurement will now appear as mapped under View Mapping:
Now, if a GDML lab is transmitted with the Measurement Identifier (418 - Hemoglobin), OSCAR will automatically add this as a hemoglobin measurement into the patients eChart, as it now knows that 418 is associated with this specific Measurement.
Creating New Flowsheet:
In order to create a new custom Flowsheet you will need to navigate to Administration > System Management Create New Flowsheet:
Here we can enter in the information to begin creating a new Flowsheet:
Please note that the entry in the Trigger field must be typed out in the format "icd9:DX" to ensure that it is set up correctly and able to be linked through Disease Registry within the patient's eChart.
In our example, we're creating a Flowsheet with the diagnostic code 278.
After the information is entered, we would click Create to save.
Once saved we would need to select it to begin adding our items to that Flowsheet:
In the new page that loads, you will need to click Add to begin entering in values that you want recorded within this Flowsheet:
Here we would select items to be included in the Flowsheet.
For example, we will add Weight:
The information would need to be entered after selecting the Measurement and can click Save once done!
Create Rule allows you to enter in values to trigger the colours that were set at the start for Warning and Recommendation values.
Once more items have been added to the Flowsheet, Display Position can be used to set the order of the items.
After clicking Save it will load the main page displaying any items entered:
We would want to repeat this step until all items are entered.
From the eChart, we would register the patient with 278 under Disease Registry to populate the Obesity Flowsheet:
Please contact Support with an questions at help@oscarprodesk.ca