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Problem Reconciliation section

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The Problem Reconciliation section presents a list of active problems that must be reconciled. Problem information populates from the following sources and methods:

  • CCD problems - imported into myAvatar via one of the CCD import methods.
  • CWS Problems - entries made within the Problem List form.

Perform the reconciliation of the CCD imported items, and potentially anything already captured in the CareRecord in the Problem List form for the client. Depending on the source of information for the problem, the following actions will be supported.

The Problem Reconciliation Grid header contains the following:

  • Reason for Reconciliation - user-defined dictionary that can be defined in Dictionary Update (File: CWS, Data Element #80200) that is used for data collection purposes only.
  • Group Like Items - Select the Group Like Items field to group similar items in the Problems grid. Duplicate problems will be grouped together and highlighted in yellow.
  • Known Problems - will default based on the value entered into the Problem List in the Problems to Record prompt. If the value of that is set to Yes then the Known Problems field will be set to Yes. If there is no value yet set in Problem List, then this field will be blank and will require a response. This information is used for the Meaningful Use Measures reporting.
    • Yes will automatically be selected if there are active problems on record. 
    • Select No if no active problems.
  • Preview Items for Reconciliation - Selected after all actions you wish to proceed with are selected. This will present the Problem View Screen that will display all of the items that will be reconciled within the session.
  • View Final Active Problem List - Launches a view of all active problems assigned to the client. 

Prerequisites:

  • Associate the user-defined values with the Problem Status extended attribute (80410) SNOMED Code-Status with the appropriate standard values that will populate on the CCD. At least one Status value must be defined with the (80410) SNOMED Code-Status dictionary as Active. This is necessary to view problems within Clinical Reconciliation.

CCD Problems

In the Action column the following actions are available:

Create New

  • Creates a new entry in the client's Problem List in CWS. The SNOMED code received in the CCD should match a SNOMED code in myAvatar . When this action is chosen and Preview Items for Reconciliation selected, click Reconcile to create a new problem entry in the myAvatar CWS Problem List form.
  • ​The following information will be pulled from the CCD and saved into the Problem List form:
    • Status
      • The status code in the CCD must match the value in myAvatar . This is accomplished by mapping the user-defined Status values with the Problem Status dictionary extended data element, 80410 - SNOMED Code - Status.
    • Problem Code
    • Date of Onset
    • Date of Resolve
    • System Notes - Display of filing history, such as user, date and time.
    • Last Reconciliation ID

Creating a CCD problem will also update the CCD data records stored in myAvatar tables. The following information will be updated:

  • Last Reconciliation ID
  • Reconciliation Action Code

Create New (and Remove from List)

  • This action is identical to Create New except that the original item that was being used for reconciliation will be removed from the list when the Clinical Reconciliation screen refreshes.

Defer

  • Delays acting on the problem information until the next session. The problem will display the next time you perform problem reconciliation.

  • The CCD record in the CCD SQL table will also be updated.

    • Last Reconciliation ID

    • Reconciliation Action Code

Remove From List

  • Permanently deletes the problem record from the database (CCD temporary storage).

CWS Problems - Problem List Form

Continue

  • Indicates that you want to retain the CWS Problem List record. The following information will be updated:
    • Last Reconciliation ID
    • System Notes
  • If no action is selected, this will also result in keeping the problem record in myAvatar CWS.​

Discontinue/Inactivate

  • Automatically inactivates a problem that was recorded in the Problem List form. The following information will be updated:
    • Problem Status dictionary
    • Last Reconciliation ID

Problem Reconciliation - Preview grid

The Preview Grid is where all of the reconciliation work is determined. You can assign actions and New Problems to Add within this grid or discontinue existing items. This is the worklist for you until you decide to Preview Items for Reconciliation and complete the process.  

Columns

  • Action
    • The available actions correspond to the source of information (displayed in the Source column).
    • Select the action to be applied. Depending on the action, specific fields will become enabled and required.
  • Source
    • Displays the source of the information. This will either display CCD Imported or Problem List to provide you with the information to understand the records you will reconcile. 
  • Problem
    • Displays the problem description, and associated SNOMED code.
  • New Problem to Add
    • Avatar will attempt to match the SNOMED code received on a CCD to a SNOMED code defined in myAvatar . If a match is made then this will already be populated with the corresponding Problem/SNOMED code. You can easily create new Problems received on a CCD faster with this advanced logic.
  • Start Date
    • Displays the problem start date.
  • Last Updated
    • Displays the last date the problem information was updated.
  • Details
    • Click to display a screen that displays an overview of the problem information.
  • Practitioner
    • Displays the practitioner who is associated with the problem.
  • Reconciliation

Duplicate problems are highlighted in yellow.

  1. In the Reason for Reconciliation field, select the reason for reconciliation. This is for data collection purposes only.
  2. Select the Group Like Items box to group similar items in the Problems grid. Duplicate problems will be grouped together and highlighted in yellow.
  3. In the Known Problems field, enter a value if one has not already defaulted from the Problem List.
  4. In the Action column, select the action.
    Depending on the source of the problem, different actions will be available:
  • Create New – creates a new problem in the Problem List form.
    New Problem to Add – enter the SNOMED code to create. This list populates from (Micromedix, and from problems in the Problem List)
  • Create New (and Remove from List) - This action is identical to Create New except that the original item that was being used for the reconciliation will be removed from the list when the Clinical Reconciliation screen refreshes.
  • Discontinue – discontinues a problem in the Problem List form.
  • Defer – delays acting on the problem.
  • Remove from List – removes the problem from the list. Indicates the problem as invalid.
  1. Click Preview Items for Reconciliation to open the Clinical Reconciliation -  Problem Preview screen.
  • This screen allows reconciling problems that have been selected to be acted upon (an action selected in the Action column). If you change your mind and wish to remove items from the list, you can do so within this screen before proceeding with the reconciliation. 
  1. After problems have been reconciled (in the Clinical Reconciliation -  Problem Preview screen), click View Final Active Problem List to view the Final Active Problem List screen.