Patient Alerts
From TAPASWiki
Patient Alerts are envisioned as a key piece of improving the coordinated delivery of care amongst users in a shared care environment. Not only are they generalized alerts about a patient, as recommended by the e-MS, but they extend the e-MS by providing patient "events" that can be directed from a patient chart to a specific time, person, or group. They are different from user messages in that alerts are patient centric (they are tied to the patient record) compared to messages which are not (they are tied to a sender / receiver - although they may talk about a patient they are not part of the patient record).
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Patient Alert Characteristics
In TAPAS, patient alerts have several properties. Specifically, these include:
- Patient Specific
- User / Group Specific
- Timed
- User Generated
Patient Specific
All Patient alerts are tagged to a patient summary. They are connected to the patient chart and will show when that patient's summary chart is accessed.
Other elements that are not tied to patients (e.g. user tasks) will be considered in the future.
User / Group Specific
Alerts can be tagged to specific users so that they show up in their own personal "To Do" list.
This will be important in organizing patient tasks for an individual user. It will also be useful in a shared care environment where tasks can be passed from RN to MD, etc.
Being tagged to a specific user does not mean that alerts would not show up in the patient summary. Rather it indicates that they would ALSO show up in the users to do list as an alert at the appropriate time. Users will be able to filter their "My Alerts" list based on their personally assigned alerts, any group that they are a part of and a union of all the groups and personal assigned alerts (all my alerts).
In the patient chart, all Alerts should appear regardless of who is viewing that patient. The alerts, when created, should default to no user assigned. These will only show up in the list in the patient's chart and not on anyone's to do list.
Timed
Alerts can be timed, so they appear only when needed. Timing is specified by date only, not time. Start and End dates are optional for the alert. Default is no timing.
This is important for activities that need to be considered in the future. For example, follow up appointments with specialists (e.g. to repeat a Gastroscopy in a year) can be set to start in one year's time. The users do not have to remember what to do, it will simply remind them when it is time to act.
This reduces the users cognitive clutter and improves follow up as elements are not lost.
Manual Alerts
The alerts discussed in this category (and the ones stored in TAPAS) are manually generated by users of the system. Users, based on clinical judgement and administrative need, are able to set their own alerts in TAPAS for patients that are providing care for.
These manual alerts are distinct and different than the automated alerts described below.
Automated Alerts
In TAPAS automated alerts will be provided by EGADSS. Please see www.egadss.org for more information about EGADSS.
Currently EGADSS will be provided a limited set of preventive care reminders to users as they see patients (triggered by opening up the patient record).
It is expected that the automatic and manual alerts will be displayed in the same alerts side panel, but not in the editing alerts panel.
Users will be able to view more details on the alerts, as provided by EGADSS. See the EGADSS page for more description of how this will occur.
Tapear Screen Elements & Mock Ups
The following mock ups illustrate the views into the alerts sections of TAPAS. They are meant for the developers and interested parties to see how we are designing the system. Over time, these will be replaced with actual screen shots.
Patient Alerts Panel (Main Panel)
This is the main area to manage a patient's manual alerts (add / edit / delete etc.) It consists of the two standard sections: list and edit panels.
In the list section alerts are shown with their start date, title, part of the description, and who they are assigned (a single user or group).
The user can view only active alerts (default) or include inactive alerts (shown in grey) by ticking the "View Inactive" option at the top.
Details of an alert can be viewed / edited in the action panel by clicking on the list element.
New alerts for a patient are created by clicking "New Alert".
In the action panel the user can update the following:
- Title (mandatory, free text)
- Start Date (mandatory, date) defaults to today
- End Date (optional, date) defaults to no end in sight
- Assigned to - (optional, pick list of all active clinical users and groups) defaults to no assignment.
- Comments - (optional, free text)
Changes are saved with the "Save" button, cancelled with "cancel".
An alert is completed with "complete" - so it is no longer active but remains in the system for easy future reference or deleted with "delete" if it is in error. The user should confirm completing and be warned when deleting the alerts.
Patient Alerts Side Panel
The Patient Alerts Side Panel is shown in the patient screen and shows all active alerts in a single list. Both manual and automated alerts are shown for the patient.
Non-active alerts are not shown on this view. It is meant to only show the views of what is active and important at the time the patient's summary is opened.
My Alerts (My Workspace Panel)
The "My Alerts" panel is where users can review and edit any active alerts that have been assigned to them or a group that they belong to.
See the Doctor Workspace for details about this screen.
Patient Alerts on the PDA
My Patient Alerts will also be viewable on the PDA through their own screen.
Given the size of the PDA screen there will be no side bars, etc.
Automated alerts (from EGADSS) will not be shown at this time as this is an offline system meant for on call.
There will be a separate screen to view the details of the current alert. This will also allow for editing of the alerts (deactivating, changing details, etc). The user will be able to create alerts from this screen as well.
My Alerts on the PDA
Users will be able to view a list of alerts on the PDA. This will be a list of active alerts for patients that have been assigned to the user or groups that the user belongs to.
The user will be able to filter the list of active alerts on this screen by group (and include an "all" and "only me" option to show all alerts assigned to the user including groups and excluding groups, respectively).
From the list screen, users will be able to view the details of an alert by tapping on it.
Like the patient alert screen, the user will be able to edit existing alerts. However, the user will need to enter the summary to add a new alert to a patient's summary.
Exporting to an e-MS
At this time, when an e-MS is created, only active alerts that are not assigned to anyone at the time of document creation will be added. This eliminates several issues with our extension of the e-ms model for TAPAS. It also means that "task based alerts" - Phone Dr. XXXX to follow-up will not be shared outside the office and generic alerts "Code Status" will be.
