Galen eCalcs - Module: Anticoag Module

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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.

Anticoag - Flowsheet.JPG

Input Form

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

ACInput.JPG

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.

Anticoag - Dosage Table.JPG

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 Provides the option to generate a Provider 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 Provides the option to generate a Patient Instructions document for the selected for the supervising/ordering provider. True (default) - a Patient Instructions RTF document is submitted to the chart for AntiCoag encounters.

False - a Patient Instructions RTF document is not submitted to the chart for AntiCoag encounters.
Create Task For Provider Summary Provides the option to generate a Document Verification task along with Provider Summary documents. False (default) - a Document Verification task will not be submitted to the supervising physician along with Provider Summary documents.

True - a Document Verification task will be submitted to the supervising physician along with Provider Summary documents.
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 Provides the option to require the Require INR Relative To Range field prior to saving or submission of an encounter. True (default) - the Require INR Relative To Range field is a required field in the module.

False - the Require INR Relative To Range field is not a required field in the module.
Require Next INR Provides the option to require the Next INR date field prior to saving or submission of an encounter. True (default) - the Next INR date field is a required field in the module.

False - the Next INR date field is not a required field in the module.
Require Supervising Physician Provides the option to require the Supervising Physician field prior to saving or submission of an encounter. False (default) - the Supervising Physician field is not a required in the module.

True - the Supervising Physician field is a required field in the module.
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 Provides the option to show or hide NULL Heart Rate values in the Patient Instructions document. True (default) - NULL Heart Rate values will display in the Patient Instructions document.

False - NULL Heart Rate values will not be shown in the Patient Instructions document.
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 Provides the option to show or hide the Blood Pressure values in the Provider Summary document. True (default) - Blood Pressure values will display in the Provider Summary document.

False - Blood Pressure values will not be shown in the Provider Summary document.
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 Provides the option to show or hide the Internal Comments field on the AntiCoag module flowsheet. True (default) - the Internal Comments field is shown on the module flowsheet.

False - the Internal Comments field is not shown on the module flowsheet.
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 Provides the option to show or hide the Goal INR value in the Provider Summary document. True (default) - Goal INR values will display in the Provider Summary document.

False - Goal INR values will not be shown in the Provider Summary document.
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 Provides the option to show or hide the Goal INR value in the Provider Summary document. True (default) - Goal INR values will display in the Provider Summary document.

False - Goal INR values will not be shown in the Provider Summary document.
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 Provides the option to show or hide the Height field as read-only in the module. False (default) - the Height field is not shown in the module to users.

True - the Height field is shown in the module as read-only to users.
Show Hold Notes In Flowsheet Provides the option to show or hide the Discontinue Notes field on the AntiCoag module flowsheet. True (default) - the Discontinue Notes field is shown on the module flowsheet.

False - the Discontinue Notes field is not shown on the module flowsheet.
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 Provides the option to show or hide the Indication For Therapy value in the Provider Summary document. True (default) - the Indication For Therapy value will display in the Provider Summary document.

False - the Indication For Therapy value will not be shown in the Provider Summary document.
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 Provides the option to show or hide the INR Relative To Range field on the AntiCoag Module flowsheet. True (default) - the INR Relative To Range is shown on the module flowsheet.

False - the INR Relative to Range field is not shown on the module flowsheet.
Show Medication Interaction List Provides the option to show or hide the Medication Interaction List in the module. False (default) - the Medication Interaction List is not shown in the module as read-only to users.

True - the Medication Interaction List is shown in the module as read-only to users.
Show New Recommended Total Weekly Dose In Flowsheet Provides the option to show or hide the New Recommended Total Weekly Dose field on the AntiCoag Module flowsheet. True (default) - the New Recommended Total Weekly Dose field is shown on the module flowsheet.

False - the New Recommended Total Weekly Dose field is not shown on the module flowsheet.
Show New Total Weekly Dose In Flowsheet Provides the option to show or hide the New Total Weekly Dose on the AntiCoag Module flowsheet. True (default) - the New Total Weekly Dose field is shown on the module flowsheet.

False - the New Total Weekly Dose field is not shown on the module flowsheet.
Show Next Appointment Field Provides the option to show or hide the Next Appointment date field in the module. False (default) - the Next Appointment date field is not shown in the module to users.

True - the Next Appointment date field is shown in the module to users.
Show Next Appointment In Flowsheet Provides the option to show or hide the Next Appointment field on the AntiCoag Module flowsheet. True (default) - the Next Appointment field is shown on the module flowsheet.

False - the Next Appointment field is not shown on the module flowsheet.
Show Next Appointment In Patient Instructions Provides the option to show or hide the Next Appointment values in the Patient Instructions document. True (default) - Next Appointment values will display in the Patient Instructions document.

False - Next Appointment values will not be shown in the Patient Instructions document.
Show Next INR In Flowsheet Provides the option to show or hide the Next INR date field on the AntiCoag module flowsheet. True (default) - the Next INR date field is shown on the module flowsheet.

False - the Next INR date field is not shown on the module flowsheet.
Show Next Lab Visit On Patient Instructions Provides the option to show or hide the Next Lab Visit date value in the Patient Instructions document. True (default) - Next Lab Visit date values will display in the Patient Instructions document.

False - Next Lab Visit date values will not be shown in the Patient Instructions document.
Show Non Compliance Risk In Flowsheet Provides the option to show or hide the Non Compliance Risk field on the AntiCoag module flowsheet. True (default) - the Non Compliance Risk field is shown on the module flowsheet.

False - the Non Compliance Risk field is not shown on the module flowsheet.
Show Overdue INR In Flowsheet Provides the option to show or hide the Overdue INR date field on the AntiCoag module flowsheet. True (default) - the Overdue INR date field is shown on the module flowsheet.

False - the Overdue INR date field is not shown on the module flowsheet.
Show Patient Instructions In Flowsheet Provides the option to show or hide the Patient Instructions field on the AntiCoag module flowsheet. True (default) - the Patient Instructions field is shown on the module flowsheet.

False - the Patient Instructions field is not shown on the module flowsheet.
Show Physician In Patient Instructions Provides the option to show or hide the encounter Physician value in the Patient Instructions document. True (default) - the encounter Physician value will display and indicate so in the Patient Instructions document.

False - the encounter Physician value will not be shown or indicated in the Patient Instructions document.
Show Recommendation On Provider Summary Provides the option to show or hide the module Recommendation in the Provider Summary document. True (default) - the module Recommendation will display in the Provider Summary document.

False - the module Recommendation will not be shown in the Provider Summary document.
Show Reviewing Provider Field Provides the option to show or hide the Reviewing Provider text field in the module. False (default) - the Reviewing Provider text field is not shown in the module to users.

True - the Reviewing Provider text field is shown in the module to users.
Show Reviewing Provider In Flowsheet Provides the option to show or hide the Reviewing Provider field on the AntiCoag module flowsheet. True (default) - the Reviewing Provider field is shown on the module flowsheet.

False - the Reviewing Provider field is not shown on the module flowsheet.
Show Skip Friday Dose In Flowsheet Provides the option to show or hide the Skip Friday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Friday Dose field is shown on the module flowsheet.

False - the Skip Friday Dose field is not shown on the module flowsheet.
Show Skip Monday Dose In Flowsheet Provides the option to show or hide the Skip Monday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Monday Dose field is shown on the module flowsheet.

False - the Skip Monday Dose field is not shown on the module flowsheet.
Show Skip Saturday Dose In Flowsheet Provides the option to show or hide the Skip Saturday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Saturday Dose field is shown on the module flowsheet.

False - the Skip Saturday Dose field is not shown on the module flowsheet.
Show Skip Sunday Dose In Flowsheet Provides the option to show or hide the Skip Sunday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Sunday Dose field is shown on the module flowsheet.

False - the Skip Sunday Dose field is not shown on the module flowsheet.
Show Skip Thursday Dose In Flowsheet Provides the option to show or hide the Skip Thursday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Thursday Dose field is shown on the module flowsheet.

False - the Skip Thursday Dose field is not shown on the module flowsheet.
Show Skip Tuesday Dose In Flowsheet Provides the option to show or hide the Skip Tuesday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Tuesday Dose field is shown on the module flowsheet.

False - the Skip Tuesday Dose field is not shown on the module flowsheet.
Show Skip Wednesday Dose In Flowsheet Provides the option to show or hide the Skip Wednesday Dose field on the AntiCoag module flowsheet. True (default) - the Skip Wednesday Dose field is shown on the module flowsheet.

False - the Skip Wednesday Dose field is not shown on the module flowsheet.
Show Split Pills In Flowsheet Provides the option to show or hide the Split Pills field on the AntiCoag module flowsheet. True (default) - the Split Pills field is shown on the module flowsheet.

False - the Split Pills field is not shown on the module flowsheet.
Show Start Of Therapy In Flowsheet Provides the option to show or hide the Start Of Therapy date field on the AntiCoag module flowsheet. True (default) - the Start Of Therapy date field is shown on the module flowsheet.

False - the Start Of Therapy date field is not shown on the module flowsheet.
Show Supervising Physician In Flowsheet Provides the option to show or hide the Supervising Physician field on the AntiCoag module flowsheet. True (default) - the Supervising Physician field is shown on the module flowsheet.

False - the Supervising Physician field is not shown on the module flowsheet.
Show Systolic Blood Pressure In Flowsheet Provides the option to show or hide the Systolic Blood Pressure field on the AntiCoag module flowsheet. True (default) - the Systolic Blood Pressure field is shown on the module flowsheet.

False - the Systolic Blood Pressure field is not shown on the module flowsheet.
Show Tablet Strengths In Flowsheet Provides the option to show or hide the Tablet Strength field on the AntiCoag module flowsheet. True (default) - the Tablet Strength field is shown on the module flowsheet.

False - the Tablet Strength field is not shown on the module flowsheet.
Show Treatment Duration In Flowsheet Provides the option to show or hide the Treatment Duration field on the AntiCoag module flowsheet. True (default) - the Treatment Duration field is shown on the module flowsheet.

False - the Treatment Duration field is not shown on the module flowsheet.
Show User In Flowsheet Provides the option to show or hide the User field on the AntiCoag module flowsheet. True (default) - the User field is shown on the module flowsheet.

False - the User field is not shown on the module flowsheet.
Show Weight In Flowsheet Provides the option to show or hide the Weight field on the AntiCoag module flowsheet. True (default) - the Weight field is shown on the module flowsheet.

False - the Weight field is not shown on the module flowsheet.
Show Weight In Module Provides the option to show or hide the Weight field as read-only in the module. False (default) - the Weight field is not shown in the module to users.

True - the Weight field is shown in the module as read-only to users.

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.

File:ACOutputs.png

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.

Anticoag - Print Out.JPG

AntiCoag Provider Summary

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

References

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