Preventive care reminders

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Sample Reminders from the Clinical Decision Support Expert Panel Based on content from the Partners HealthCare

It is important to note that, although we make this content available in good faith (and use much of it ourselves), neither the expert panel, the CERT-HIT, Brigham and Women\’s Hospital, Partners HealthCare or the Agency for Healthcare Research and Quality guarantee this content – it is provided as is and must be reviewed for correctness and completeness by any potential user.

Needs Pneumovax (age > 65 and no Pneumovax ever) Rule\#: 142 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Age > 65 Recommendation Logic: No Pneumovax on file Recommendation Order pneumovax

Needs repeat pneumovax >65 Rule\#: 143 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Age > 65 AND one (and only one) pneumovax on file Recommendation Logic: latest pneumovax was performed 5 years ago and when patient was less than 65 years of age Recommendation Order pneumovax

Needs Pneumovax (high risk medical condition) Rule\#: 144 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Age 18-65 AND Patient has a high risk medical condition Recommendation Logic: No pneumovax on record Recommendation Order pneumovax

Repeat Pneumovax (high risk medical condition) Rule\#: 145 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Patient has high risk medical condition Recommendation Logic: One and Only One pneumovax given >5 years ago Recommendation Perform pneuomax

Influenza Vaccination Older Than 50 Rule\#: 146 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Age > 50 Recommendation Logic: Today is within flu season: Oct, Nov, Dec, Jan, Feb (Oct 1 to March 1), no previous vacc. Recommendation Perform influenza vaccination.

Needs Influenza Vaccination 18-50 (high risk)

Rule\#: 147 Rule category Health Maintenance Primary Clinical Area Vaccinations Risk Group Definition Age 18-50 AND Patient has a high risk medical condition AND Today is within flu season: Oct, Nov, Dec, Jan, Feb Recommendation Logic: NO Flu shot during the current flu season Recommendation Influenza Vaccine concept ID: 1516 Osteoporosis Management for At-Risk Populations Rule\#: 148 Rule category Health Maintenance Primary Clinical Area Osteoporosis Prevention Risk Group Definition ((Female at least 65 years) OR (Female 50-64 has risk factors for osteoporosis \[smoking, past smoking, prior fracture since age 45, use of oral glucocorticoids for >=3 months or family history of osteoporosis)) Recommendation Logic: No osteoporosis meds on med list and no bone density scan on file Recommendation Order bone densitometry


Overdue for mammography (High FHx Risk) Rule\#: 149 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND High FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND age>40 yrs, <75 yrs Recommendation Logic: No mammogram in the past 12 months. Recommendation Order mammogram

Overdue for mammography (High FHx Risk)

Rule\#: 150 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule B Female AND High FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is =< 40 years and > 25 years AND (Age of youngest affected (with Breast cancer) relative - patient\’s age) < = 10 years ) Recommendation Logic: No mammogram in the past 12 months Recommendation Order mammogram

Overdue for mammography (Mod FHx Risk)

Rule\#: 151 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND Mod FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient >40 years, <75 yrs Recommendation Logic: No mammogram in the past 12 months. Recommendation Order mammogram

Overdue for mammography (Mod FHx Risk)

Rule\#: 152 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule B Female AND Mod FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is =< 40 and > 25 years of age AND(Age of youngest affected (with Breast cancer) relative - patient\’s age) <= 10 years) Recommendation Logic: No mammogram in the past 12 months. Recommendation Order mammogram


Overdue for mammography (Average Risk)

Rule\#: 153 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND Avg FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is older than 40 years of age, <75 yrs Recommendation Logic: No mammogram in the past 12 months. Recommendation Order mammogram

Almost due for mammography (High FHx Risk)

Rule\#: 155 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND High FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is older than 40 years of age, <75 yrs Recommendation Logic: Last mammogram 10-12 (inclusive) months ago Recommendation Order mammogram

Almost due for mammography (High FHx Risk)

Rule\#: 156 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule B Female AND High FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is =< 40 and > 25 years of age AND Age of youngest affected (with Breast cancer) relative - patient\’s age) <= 10 years) Recommendation Logic: Last mammogram 10-12 (inclusive) months ago Recommendation Order mammogram

Almost due for mammography (Mod FHx Risk)

Rule\#: 157 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND Mod FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND older than 40 years of age, <75 yrs Recommendation Logic: Last mammogram 10-12 (inclusive) months ago Recommendation Order mammogram

Almost due for mammography (Mod FHx Risk)

Rule\#: 158 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule B Female AND Mod FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is =< 40 and > 25 years of age AND Age of youngest affected (with Breast cancer) relative - patient\’s age) <= 10 years Recommendation Logic: Last mammogram 10-12 (inclusive) months ago Recommendation Order mammogram Almost due for mammography (Average Risk)

Rule\#: 159 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Rule A Female AND Avg FHx Risk of Breast cancer AND Bilateral Mastectomy NOT on problem list AND Patient is older than 40 years of age, <75 yrs Recommendation Logic: Last mammogram 10-12 (inclusive) months ago Recommendation Order mammogram

Overdue for pap smear

Rule\#: 161 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Female AND age > 18 and < 65 AND hysterectomy and TAH-BSO not on problem list Recommendation Logic: Last pap > 3 years ago Recommendation Perform pap

Almost due for pap smear

Rule\#: 162 Rule category Health Maintenance Primary Clinical Area Cancer Screening Risk Group Definition Female AND age > 18 and < 65 AND hysterectomy and TAH-BSO not on problem list Recommendation Logic: Last pap 2.5 - 3 years ago Recommendation Perform pap smear

NO risk factors, almost due for Lipids Assessment (male)

Rule\#: 192 Rule category Health Maintenance Primary Clinical Area Lipid creening Risk Group Definition Age >35, <80 AND not diabetic AND no CHD and its equivalents AND FHx for CHD is AVERAGE AND problem list does not contain smoking and hypertension AND male RISK GROUP DEFINITION No total cholesterol in >54 months or no previous data AND No LDL in >54 months or no previous data Recommendation Order lipid panel

NO risk factors, almost due for Lipids Assessment (female)

Rule\#: 193 Rule category Health Maintenance Primary Clinical Area Lipid creening Risk Group Definition Age >45, <80 AND not diabetic AND no CHD and its equivalents AND FHx for CHD is AVERAGE AND problem list does not contain smoking and hypertension AND female AND No total cholesterol in >54 months or no previous data AND No LDL in >54 months or no previous data Recommendation Order lipid panel Literature/ref. 1. NCEP/ATP III. Executive Summary of the Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). JAMA, Vol 285 (19): 2486-2497. 2. USPSTF. Screening Adults for Lipid Disorders. Am J Prev Med. 2001; 20 (3S): 73-76.


LMR Reminder: NO risk factors, Overdue for Lipids Assessment (Male)

Rule\#: 190 Rule category Health Maintenance Primary Clinical Area Lipid creening Risk Group Definition Age >35, <80 AND not diabetic AND no CHD and its equivalents AND FHx for CHD is AVERAGE (change it to NOT(moderate or high) AND problem list does not contain smoking and hypertension AND male AND no total cholesterol in >5 years or no previous data AND No LDL in >5 years or no previous data Recommendation Order lipid panel

LMR Reminder: NO risk factors, Overdue for Lipids Assessment (female)

Rule\#: 191 Rule category Health Maintenance Primary Clinical Area Lipid creening Risk Group Definition Age >45, <80 AND not diabetic AND no CHD and its equivalents AND FHx for CHD is AVERAGE (change it to NOT(moderate or high) AND problem list does not contain smoking and hypertension AND female AND No total cholesterol in >5 years or no previous data AND No LDL in >5 years or no previous data Recommendation Order lipid panel Literature/ref. 1. NCEP/ATP III. Executive Summary of the Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). JAMA, Vol 285 (19): 2486-2497. 2. USPSTF. Screening Adults for Lipid Disorders. Am J Prev Med. 2001; 20 (3S): 73-76.

LMR Reminder: Risk Factor: Family History, Almost due for Lipids Assessment

Rule\#: 188 Rule category Health Maintenance Primary Clinical Area Lipid screening Risk Group Definition Age>20 and <80 AND not diabetic AND not CHD equivalent AND FHx risk for CHD is MODERATE AND no total cholesterol or no previous data AND No LDL or no previous data > 54 months Recommendation Order lipid panel LMR Reminder: Risk Factor: Family History, Almost due for Lipid Assessment

Rule\#: 189 Rule category Health Maintenance Primary Clinical Area Lipid screening Risk Group Definition Age>20 and <80 AND not diabetic AND not CHD equivalent AND problem list contains HTN OR smoking AND No total cholesterol in >54 months or no previous data AND No LDL in >54 months or no previous data Recommendation Order lipid panel Literature/ref. 1. NCEP/ATP III. Executive Summary of the Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). JAMA, Vol 285 (19): 2486-2497. 2. USPSTF. Screening Adults for Lipid Disorders. Am J Prev Med. 2001; 20 (3S): 73-76.