Clinical Decision Rules - Using Pre-Existing Rules
Some clinical decision rules are immediately activated in MacPractice when entering specific information on the patient's record, such as the Vitals or Smoking areas on the Clinical tab. These alerts are based on the information that you enter in the patient's record, and may depend on some of the existing information entered in the patient's demographics, like their birth date and sex, and will also be affected by your localization settings and the units you are entering. If a value seems incorrect, be sure to check the patient's demographics, and check that you are entering the correct units based on your localization settings.
In the example below, the patient's vitals have been entered, and the patient's blood pressure measures in the hypertensive category.
After the vitals are added to the patient's record, MacPractice immediately prompts the user for a response. The user can then specify what action was taken, in the following example, the user offered the patient information on maintaining a healthy diet. The default responses are only Ignore and Action Taken, but you can also add additional responses.
Once the action is logged and saved, the clinical decision rule window will disappear and the user can continue entering the patient's information. Later, users can run a report based on this information in the Reports ability by selecting Clinical > User Alert Responses. You can filter this report by user to track individual responses, and you can also filter by date or date range. Expand the report to see additional information and the specific comments given per alert.
Clinical Decision Rules - Customizing Alert Messages
You can customize your clinical decision rule responses. The default responses are Ignore and Action Taken, which requires the user to enter notes, however you might decide to add additional response options to the Clinical Decision Rule window. These alert responses are universal for all users and for all alerts.
To enter new alert responses, go to the References ability and select User Alert Response Type in the sidebar. Click the triangle to the left of the User Alert Response Type node; you will see Action Taken and Ignore already listed in the sidebar. Click the plus button to add a new record. Checking the Requires Comments checkbox requires the user to enter text in the notes field if they choose the response.
Once you save, you will immediately see this new response in new clinical alerts.
Clinical Decision Rules - Creating Custom Rules
Clinical Decision Rule Alerts are presented when the criteria for a Clinical Decision Rule is met. By default, MacPractice includes Clinical Decision Rules for high and low BMI, Cessation Counseling, Hypertension, Hypotension, and high and low resting heart rates. The default Clinical Decision Rules can not be modified or deleted, but they can be disabled by unchecking the Enabled checkbox.
Additional Clinical Decision Rules can be added to create Clinical Alerts based on a patient's diagnoses, medications, procedures, age, sex, lab test results, races, ethnicities, languages, height/length, weight, BMI, date of birth, blood pressure, and allergies. In the References ability, select Clinical Decision Rule in the sidebar and click the plus button to create a new record.
The Title is the short description for the alert, and will appear as the alert title in the alert window as well as the alert report. The Description is the long description for the alert used to explain why the alert message appeared when accessing the patient record. Aside from the alert responses, the Title and the Description are the only information that your staff will see when the alert opens, so you should make sure they are clear and understandable.
Below, the Qualifications area allows you to specify what criteria are needed to trigger the alert. Alert Qualifications can be used in numerous ways by using different combinations of criteria. In order for an alert to be triggered, the patient needs to have a match on each alert row. Each alert row can have multiple items associated to it, so the patient only has to match at least one item on each row. If you need to set up an alert that will only be triggered if the patient has both items associated to him or her, you will need to make sure you specify this on two separate rows.