Galen eCalcs - Module: Anticoag Module

Description

The Anticoag Module is designed to help clinicians begin anticoagulant therapy for patients by estimating the necessary dosage. The tool can also be used to track a patient's therapy over an extended period of time. Due to its robust design, the Anticoag Module has a separate tab in the HTB within TouchWorks. The module is broken into 3 sections; a collapsible flowsheet, an input form and an output table.

Flowsheet

The flow sheet within the module is a way for clinicians to view the patient's history without having to click back and forth between the module and clinical desktop. The flow sheet is collapsible for convenience. The filter option allows users to filter by 1 month, 3 months, 6 months or all visits.

Input Form

The input form is where users can enter data regarding the patient's current INR visit.

Data Fields Explained

The following table explains each data field and it's functionality.

    Fields that are carried forward will contain the same value from the last visit.
    Fields that are required will be bright yellow with a red asterisk next to them indicating that they must be filled out to commit the information.

Name of Field	Functionality	Carry Forward?	Required Field?
Systolic Blood Pressure	The patient's most recent Systolic Blood Pressure value	No	No
Diastolic Blood Pressure	The patient's most recent Diastolic Blood Pressure value	No	No
Heart Rate	The patient's most recent Heart Rate value	No	No
INR	A free text field to document INR value	Yes	Yes
INR Result Date	Date value associated with the INR value	Yes	Yes
Goal INR	INR Value ranges that are considered healthy for the patient	Yes	Yes
INR Relative to Range	Indicates where the patient's INR falls in comparison to their Goal INR	No	Yes
Indication For Therapy	Why the patient is receiving therapy	Yes	Yes
Indication Comments	Free text field for comments regarding therapy. Limit - 250 characters	Yes	No
INR Complications	Any complications the patient experienced	No	No
Treatment Duration	Indicates the length of therapy	Yes	Yes
Start of Therapy	Date field indicating the Start Date of INR therapy	No	No
Supervising Physician	The patient's current dosage	Yes	No
Current Total Weekly Dose	A text input for the patient's current dosage	Yes	Yes
Anticoagulant Name	The name/type of anticoagulant	Yes	No
Tablet Strength	Multiple dosage strengths can be selected	Yes	No
Hold Notes	Free text field for comments regarding discontinuation. Limit - 250 characters	No	No
Change Dose	A Yes/No field indicating if change in dosage is necessary	No	Yes
Next INR	The patient's recommended next visit date	No	Yes
Next Appointment	Date field for indicating patient's next INR therapy visit	No	No
INR Overdue	Date field for indicating when the patient's INR value is overdue	No	No
New Recommended Total Weekly Dose	Auto-calculates the patient's new weekly dosage	No	No
Non-Compliance Risk	Patient's level of disobedience	No	No
Bridging Indication and Comments	Check box and comments field. Limit - 250 characters	Yes	No
Internal Comments	Free text field for any additional comments; will be pulled into the provider summary print out summary	No	No
Patient Instructions	Additional instructions for the patients, will be pulled into patient print out summary	No	No
Medication Interactions	A text field listing potential (mapped) INR therapy drugs the patient is currently on	No	No

Weekly Dosage Table

The weekly dosage table will initially display the patient's previous dosage per day. When "Change Dose" is changed to "Yes" in the input form, the weekly dosage table will allow users to manually update/enter the appropriate dosage amounts the patient should be taking daily.

Configuration Options

Name	Description	Settings
Publishing	Controls whether or not the calculator is made available for use and will show for end users in eCalcs.	True (default) - when checked enables the calculator for use on the front end. False - when unchecked disables the calculator for use on the front end.
Acceptable Early INR Test Days	TEXT	TEXT TEXT
Algorithm Number	Indicates which algorithm the module will utilize.	1 (default) - uses the classic default algorithm model. 2 - this setting will utilize the new algorithm model option.
Associate Provider Summary Verification Task With Summary	TEXT	TEXT TEXT
Auto Collapse Flowsheet	Provides the option to show the AntiCoag module flowsheet expanded or collapsed when loading the module.	False (default) - all enabled module flowsheet fields will show in an expanded flowsheet format in the module. True - the module flowsheet is collapsed by default and the user can manually expand it if needed.
Create A Provider Summary	This option controls logic to trigger a summary document for the selected for the supervising/ordering provider.	True (default) - a Provider Summary RTF document is submitted to the chart for AntiCoag encounters. False - a Provider Summary RTF document is not submitted to the chart for AntiCoag encounters.
Create Patient Info Document	TEXT	TEXT TEXT
Create Task For Provider Summary	TEXT	TEXT TEXT
File Panel On INR Performed Date	TEXT	TEXT TEXT
Hid Recommended Weekly Dose On Chart	TEXT	TEXT TEXT
INR Entry Code	TEXT	TEXT TEXT
Late INR Task Priority Name	TEXT	TEXT TEXT
Late INR Task Type Mnemonic	TEXT	TEXT TEXT
Orderable Item Code	TEXT	TEXT TEXT
Print Out Document Type Entry Code	TEXT	TEXT TEXT
Provider Summary Document Type Entry Code	TEXT	TEXT TEXT
Provider Summary Verification Task Priority Name	TEXT	TEXT TEXT
Provider Summary Verification Task Type Mnemonic	TEXT	TEXT TEXT
Pull Next Appointment From Schedule	TEXT	TEXT TEXT
Require INR Overdue	Allows the option for the INR Overdue module field to be required or not.	False (default) - the INR Overdue field is not required in the module. True - the INR Overdue field is required for an AntiCoag encounter.
Require INR Relative To Range	TEXT	TEXT TEXT
Require Next INR	TEXT	TEXT TEXT
Require Supervising Physician	TEXT	TEXT TEXT
Set Task Owner To Encounter Provider	TEXT	TEXT TEXT
Show Anticoagulant Name In Flowsheet	Provides the option to show or hide the Anticoagulant Name field in the AntiCoag module flowsheet.	True (default) - the Anticoagulant Name field is shown on the module flowsheet. False - the Anticoagulant Name field is not shown on the module flowsheet.
Show Blank Blood Pressure On Patient Instructions	Provides the option to show or hide NULL Blood Pressure values in the Patient Instructions document.	True (default) - NULL Blood Pressure values will display and indicate so in the Patient Instructions document. False - NULL Blood Pressure values will not be shown or indicated in the Patient Instructions document.
Show Blank Blood Pressure On Provider Summary	Provides the option to show or hide NULL Blood Pressure values in the Provider Summary document.	True (default) - NULL Blood Pressure values will display and indicate so in the Provider Summary document. False - NULL Blood Pressure values will not be shown or indicated in the Provider Summary document.
Show Blank Heart Rate On Patient Instructions	TEXT	TEXT TEXT
Show Blank Heart Rate On Provider Summary	Provides the option to show or hide NULL Heart Rate values in the Provider Summary document.	True (default) - NULL Heart Rate values will display and indicate so in the Provider Summary document. False - NULL Heart Rate values will not be shown or indicated in the Provider Summary document.
Show Blood Pressure On Patient Instructions	Provides the option to show or hide the Blood Pressure values in the Patient Instructions document.	True (default) - Blood Pressure values will display in the Patient Instructions document. False - Blood Pressure values will not be shown in the Patient Instructions document.
Show Blood Pressure On Provider Summary	TEXT	TEXT TEXT
Show Bridging Comments In Flowsheet	Provides the option to show or hide the Bridging Comments field in the AntiCoag module flowsheet.	True (default) - the Bridging Comments are shown in the module flowsheet. False - the Bridging Comments are not shown on the module flowsheet.
Show Bridging In Flowsheet	Provides the option to show or hide the Bridging flag value in the AntiCoag module flowsheet.	True (default) - the Bridging flag value is shown on the module flowsheet. False - the Bridging flag value is not shown on the module flowsheet.
Show Change Dose In Flowsheet	Provides the option to show or hide the Change Dose field on the AntiCoag module flowsheet.	True (default) - the Change Dose field is shown on the module flowsheet. False - the Change Dose field is not shown on the module flowsheet.
Show Comments In Flowsheet	TEXT	TEXT TEXT
Show Current Dose Friday In Flowsheet	Provides the option to show or hide the Current Dose Friday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Friday field is shown on the module flowsheet. False - the Current Dose Friday field is not shown on the module flowsheet.
Show Current Dose Monday In Flowsheet	Provides the option to show or hide the Current Dose Monday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Monday field is shown on the module flowsheet. False - the Current Dose Monday field is not shown on the module flowsheet.
Show Current Dose Saturday In Flowsheet	Provides the option to show or hide the Current Dose Saturday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Saturday field is shown on the module flowsheet. False - the Current Dose Saturday field is not shown on the module flowsheet.
Show Current Dose Sunday In Flowsheet	Provides the option to show or hide the Current Dose Sunday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Sunday field is shown on the module flowsheet. False - the Current Dose Sunday field is not shown on the module flowsheet.
Show Current Dose Thursday In Flowsheet	Provides the option to show or hide the Current Dose Thursday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Thursday field is shown on the module flowsheet. False - the Current Dose Thursday field is not shown on the module flowsheet.
Show Current Dose Wednesday In Flowsheet	Provides the option to show or hide the Current Dose Wednesday field on the AntiCoag module flowsheet.	True (default) - the Current Dose Wednesday field is shown on the module flowsheet. False - the Current Dose Wednesday field is not shown on the module flowsheet.
Show Current Weekly Dose In Flowsheet	Provides the option to show or hide the Current Weekly Dose field on the AntiCoag module flowsheet.	True (default) - the Current Weekly Dose field is shown on the module flowsheet. False - the Current Weekly Dose field is not shown on the module flowsheet.
Show Diastolic Blood Pressure In Flowsheet	Provides the option to show or hide the Diastolic Blood Pressure field on the AntiCoag module flowsheet.	True (default) - the Diastolic Blood Pressure field is shown on the module flowsheet. False - the Diastolic Blood Pressure field is not shown on the module flowsheet.
Show Dosing Table Always	TEXT	TEXT TEXT
Show Goal INR On Provider Summary	TEXT	TEXT TEXT
Show Goal INR Range In Flowsheet	Provides the option to show or hide the Goal INR Range field on the AntiCoag module flowsheet.	True (default) - the Goal INR Range field is shown on the module flowsheet. False - the Goal INR Range field is not shown on the module flowsheet.
Show Heart Rate In Flowsheet	Provides the option to show or hide the Heart Rate field on the AntiCoag module flowsheet.	True (default) - the Heart Rate field is shown on the module flowsheet. False - the Heart Rate field is not shown on the module flowsheet.
Show Heart Rate On Provider Summary	TEXT	TEXT TEXT
Show Height In Flowsheet	Provides the option to show or hide the Height field on the AntiCoag module flowsheet.	True (default) - the Height field is shown on the module flowsheet. False - the Height field is not shown on the module flowsheet.
Show Height In Module	TEXT	TEXT TEXT
Show Hold Notes In Flowsheet	TEXT	TEXT TEXT
Show Indication For Therapy Comments In Flowsheet	Provides the option to show or hide the Indication For Therapy Comments field on the AntiCoag module flowsheet.	True (default) - the Indication For Therapy Comments field is shown on the module flowsheet. False - the Indication For Therapy Comments field is not shown on the module flowsheet.
Show Indication For Therapy In Flowsheet	Provides the option to show or hide the Indication For Therapy field in the AntiCoag module flowsheet.	True (default) - the Indication For Therapy field is shown on the module flowsheet. False - the Indication For Therapy field is not shown on the module flowsheet.
Show Indication For Therapy On Provider Summary	TEXT	TEXT TEXT
Show INR Complications In Flowsheet	Provides the option to show or hide the INR Complications field on the AntiCoag module flowsheet.	True (default) - the INR Complications field is shown on the module flowsheet. False - the INR Complications field is not shown on the module flowsheet.
Show INR Date In Flowsheet	Provides the option to show or hide the INR Date field on the AntiCoag module flowsheet.	True (default) - the INR Date field is shown on the module flowsheet. False - the INR Date field is not shown on the module flowsheet.
Show INR In Flowsheet	Provides the option to show or hide the INR date on the AntiCoag Module flowsheet.	True (default) - the INR field is shown on the module flowsheet. False - the INR field is not shown on the module flowsheet.
Show INR Relative To Range In Flowsheet	TEXT	TEXT TEXT
Show Medication Interaction List	TEXT	TEXT TEXT
Show New Recommended Total Weekly In Flowsheet	TEXT	TEXT TEXT
Show New Total Weekly Dose In Flowsheet	TEXT	TEXT TEXT
Show Next Appointment Field	TEXT	TEXT TEXT
Show Next Appointment In Flowsheet	Provides the option to show or hide the Next Appointment field on the AntiCoag module flowsheet.	TEXT TEXT
Show Next Appointment In Patient Instructions	TEXT	TEXT TEXT
Show Next INR In Flowsheet	TEXT	TEXT TEXT
Show Next Lab Visit On Patient Instructions	TEXT	TEXT TEXT
Show Non Compliance Risk In Flowsheet	TEXT	TEXT TEXT
Show Overdue INR In Flowsheet	TEXT	TEXT TEXT
Show Patient Instruction In Flowsheet	TEXT	TEXT TEXT
Show Physician In Patient Instructions	TEXT	TEXT TEXT
Show Recommendation On Provider Summary	TEXT	TEXT TEXT
Show Reviewing Provider Field	TEXT	TEXT TEXT
Show Reviewing Provider In Flowsheet	TEXT	TEXT TEXT
Show Skip Friday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Monday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Saturday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Sunday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Thursday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Tuesday Dose In Flowsheet	TEXT	TEXT TEXT
Show Skip Wednesday Dose In Flowsheet	TEXT	TEXT TEXT
Show Split Pills In Flowsheet	TEXT	TEXT TEXT
Show Start Of Therapy In Flowsheet	TEXT	TEXT TEXT
Show Supervising Physician In Flowsheet	TEXT	TEXT TEXT
Show Systolic Blood Pressure In Flowsheet	TEXT	TEXT TEXT
Show Tablet Strengths In Flowsheet	TEXT	TEXT TEXT
Show Treatment Duration In Flowsheet	TEXT	TEXT TEXT
Show User In Flowsheet	TEXT	TEXT TEXT
Show Weight In Flowsheet	TEXT	TEXT TEXT
Show Weight In Module	TEXT	TEXT TEXT'

Module Outputs

The Output table is a summarized version of the information entered. Towards the bottom of the output table, there are three buttons:

• Show Summary: This button can be selected at any point during data entry to view the summary of information in the output table.
• Commit: By selecting this, the information will be saved to the patient's chart and added to the flow sheet.
• Commit and Print: This button will save the information to the patient's chart and prompt the user to print out a Patient Instructions print out.

AntiCoag Patient Instructions - Print Out

The print out is an instructive form the patient can use as a reference between visits. The print out contains the following fields:

• Date of INR Test: The date recorded in the module as the date of their current test
• Your INR Results: The patient’s current INR value
• Your Goal INR Range: The INR range they should fall into
• Total Dosage per Day: The amount of milligrams per day the patient should be taking.
• Patient Instructions: Any additional instructions given to the patient
• Next Lab Visit for INR: The date of their next visit.

INR Follow Up Tasking

Tasks are generated when a patient's INR visit is past due. There are two task driven workflows and configurations to potentially adopt within the AntiCoagulation Module.

INR Overdude Date

Configuration Prerequisites

• Configuration Option - Late INR Task Priority Name
• Configuration Option - Late INR Task Type Mnemonic

Workflow Behavior

1. User enters the patient's "INR Overdue" date value.
2. Patient's INR is not performed and documented prior to the INR Overdue data value.
3. eCalcs will search the patient's chart nightly for a new INR value performed.
4. When a performed INR value is not found, a task type "INR Follow Up" will be generated.

Additional Resources

• Anticoag Module

References

https://web.archive.org/web/20140823095414/http:/www.pace-med-apps.com/CoumCalc.htm