Knowledge Activity: Clinical Reminder Data

Visualization V (Informatics)

Student instructions
1. If you have questions about this activity, please contact your instructor for assistance.
2. You will review the chart of Edgar Cash to complete this activity. Your instructor has
provided you with a link to the Clinical Reminder Data Visualization V (Informatics)
activity. Click on 2: Launch EHR to review the patient chart and begin this activity.
3. Refer to the patient chart and any suggested resources to complete this activity.
4. Document your answers directly on this activity document as you complete the activity.
When you are finished, you will save this activity document to your device and upload
this activity document with your answers to your Learning Management System (LMS).

Prerequisites
1. Use of Microsoft Excel® is required to complete this activity
2. This activity is the final activity in a sequential 5-activity series. Completion of the
activities below is required to successfully complete this activity:
 Orientation to Data Analytics I
 Applied Data Analytics II
 Applied Data Analytics III
 Orientation to Data Visualization IV

The activity
The Central Clinic has developed a notification process in the electronic health record system.
Its purpose is to inform providers when a patient may be due for certain preventive care
procedures and tests. These preventive care reminders are displayed in the patient's EHR on
the Alerts tab and on the patient info bar with a clock symbol. When a clinical reminder is due,
the clock turns red and is accompanied by a number which signifies the number of due
reminders.

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Central Clinic’s standard preventive care clinical reminder recommendations were developed
based on current research and national guidelines for the general population. Each standard
preventive care clinical reminder is for patients who are at average risk for a particular
condition. Patients who are at high risk will need a custom clinical reminder. For example,
Central Clinic’s recommendation for women at an average risk of breast cancer is to begin
yearly mammograms at age 40. Breast cancer survivors or women at a high risk for breast
cancer due to family history or other factors should work with their physician to create an
individualized screening plan.

At each patient visit, the healthcare team should review preventative care clinical reminders
and discuss any questions or concerns the patient may have. Preventive care clinical reminders
should be resolved if the patient received the care elsewhere. The healthcare team should also
document any procedures that have been completed at a non-Central Clinic facility, so the
record can stay up to date. Certain preventive care procedures, such as a mammogram or
colonoscopy, require a record of the procedure to update the Central Clinic EHR.

Launch the patient’s EHR included with this activity under 2: Launch EHR. Go to the Alerts tab
and review the clinical reminders. Answer the questions below.

Questions
1. What Clinical Reminders are listed in this patient’s EHR?

Three clinical reminders are listed, including colorectal cancer screening, lipid
measurement, and influenza vaccine are listed in this patient’s EHR.

2. Which Clinical Reminder(s) are Due for this patient?

The clinical reminder for influenza vaccine is due.

3. Which Clinical Reminder(s) are Overdue for this patient?

The clinical reminder for colorectal cancer screening is overdue.

4. Which Clinical Reminder(s) are Not Due for this patient?

The clinical reminder for lipid measurement is not due.

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 5. How is the Colorectal Cancer Screening Clinical Reminder resolved?

The clinical reminder is resolved annually, by screening for colorectal cancer using a
highly sensitive guaiac-based fecal occult blood test (gFOBT).

6. How is the Lipid Measurement Clinical Reminder resolved?

The clinical reminder is resolved by drawing a fasting lipoprotein profile each year.

7. What is the schedule, or frequency, of the Lipid Measurement Clinical Reminder?

Every year.

8. How long ago was the Lipid Measurement Clinical Reminder last done?

Given on the day of accessing the EHR (01/30/2024).

9. Is there documentation in the EHR that resolves the Lipid Measurement Clinical
Reminder? Describe. Hint: View the other tabs in the chart.

The documentation of a lipid panel in the “Labs” tab resolves the Lipid Measurement
Clinical Reminder. The EHR system allows the documentation of the required
information to resolve its clinical reminder, as a way to enhance effectiveness.

Clinical Reminders and Clinical Decision Support (CDS)

10. What is the description/rational for the Influenza vaccine Clinical Reminder?

The description /rationale states that everyone six months and older is recommended
for annual flu vaccination, with rare exceptions.

11. When was the last completed date?

Unknown.

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 12. The patient reports to the nurse that he had a flu shot a month ago at a work-sponsored
vaccination event. What do you think the nurse should document?

The nurse should update the last completed date followed by documentation of the
outside facility entered in the notes.

13. What happens when you press the “MedlinePlus” button under Alert Details|
Resources?

It triggers the opening of another browser tab, offering a MedlinePlus search for
influenza vaccine resources.

A report was generated to find out how many patients currently need Colorectal Cancer
Screening as indicated by a Clinical Reminder status of Due or Overdue. Close out of the chart
and download the report ‘Clinical Reminder Data’ (found under 1: Overview & Resources
along with this activity document). Using Microsoft Excel, generate pivot tables to answer the
following questions. Please refer to the pre-requisite activity Orientation to Data Analytics I for
a step-by-step refresher on how to create a pivot table.

 First, create a pivot table with ‘Colorectal Screen Status’ as the Row and ‘Colorectal
Screen Status as the ∑ Values (count).

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 14. How many patients are overdue for colorectal cancer screening?

1,716

15. How many patients are currently due or overdue?

2,593

16. How many patients are up-to-date with colorectal cancer screening?

1,394

There are three different tests that can be used at Central Clinic for colorectal cancer screening.
These tests each have a different frequency of screening, one-year, five-years, and ten-years.

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Providers and patients work together to select the best test for the patient based on risk
factors, personal preference, and insurance coverage.

The guaiac-based fecal occult blood test (gFOBT) detects occult (hidden) blood in the stool
through a chemical reaction and is screened every year in the office

The CT colonography (virtual colonoscopy) still requires full bowel prep, but is a less-invasive
alternative to the full colonoscopy. It is done every five years.

The full colonoscopy is an invasive visual exam that requires full bowel prep and an entire day
to complete. It is done every ten years.

For reporting purposes, these tests can be identified by the documented schedule in the
Reminder. Every one-year = gFOBT, every five-years = CT colonography, and every ten-years =
full colonoscopy.

 Generate another pivot table to answer the following questions. Hint: Use the
‘Screening Frequency’ field as the Row and the ∑ Values (count).

17. How many patients receive the gFOBT for colorectal cancer screening?

1,595

18. How many patients have chosen the CT colongraphy test for colorectal cancer
screening?

877

19. How many patients receive the full colonoscopy for colorectal cancer screening?

1,515

 Add some additional data to your pivot table to determine of the status of the three
types of tests. Hint: Add the ‘Colorectal Screen Status’ field to the Rows area and move
‘Screening Frequency’ to the Columns area.

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 20. Of the three screening tests, which has the highest rate of adherence (is not due)?
Explain.

The 01 year (gFOBT test) has the highest rate of adherence. This conclusion is derived
from the available information indicating that, of the three screening tests, it has the
highest number of patients that are not due.

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 21. Generate a PivotChart to demonstrate these results. Copy and paste it here. Why did
you select the type of chart that you did?

Column
Count of Screening Frequency Labels
10 Grand
Row Labels 01 year 05 year year Total
Due 352 191 334 877
Not Due 643 268 483 1394
Overdue 600 418 698 1716
(blank)
Grand Total 1595 877 1515 3987

Critical Thinking

22. According to the Journal of the National Cancer Institute, “the best test is the one that
gets done” (Gupta, 2014). Using this logic, which test for colorectal cancer screening do
you think the Central Clinic should promote and why?

Central clinic should promote the gFOBT screening. This screening has the highest
number and the highest percentage of current screenings, meaning it gets done.

23. The Central Clinic is interested in knowing if there is any evidence of racial disparity in
patients who are due or overdue with colorectal cancer screening. Do these data
demonstrate evidence? Hint: Create another pivot table that includes the Race/Ethnicity
data and the Colorectal Screen Status.

No one racial category stands out statistically from the others.

Read the resource, An Evaluation of Communication Strategies to Increase Preventative

Screening (found under 1: Overview & Resources along with this activity document) and answer
the following questions.

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 24. What interventions were implemented in the article to increase men’s preventative
health screening adherence?

In the article, Clinical reminder stickers on patient charts were implemented to increase
men’s preventative health screening adherence

25. What lessons learned in the study could be applied in the Central Clinic to increase the
percentage of patients who are up-to-date with colorectal cancer screening?

Central clinic should keep patients informed on their upcoming screening by sending
emails or letters

Submit your work

Document your answers directly on this activity document as you complete the activity. When
you are finished, save this activity document to your device and upload this activity document
with your answers to your Learning Management System (LMS). If you have any questions
about submitting your work to your LMS, please contact your instructor.

Learning objectives
1. Analyze strategies for the management of information (4)
2. Utilize classification systems, clinical vocabularies, and nomenclatures (3)
3. Analyze technologies for health information management (4)
4. Interpret statistics for health services (5)
5. Manage data within a database management system (5)

References
Gupta, e. (2014). Challenges and Possible Solutions to Colorectal Cancer Screening for the
Underserved. JNCI, 106(4).

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Holland, D. J., Bradley, D. W., & Khoury, J. M. (2005). Sending men the message about
preventive care: An evaluation of communication strategies. International Journal of
Men's Health, 4(2), 97-114. http://dx.doi.org/10.3149/jmh.0402.97

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