Home

User Guide - Orion Software Development

1. 1 1 1 2 Introduction Overview Welcome This software tool will help your cardiac and or pulmonary rehabilitation program collect and analyze outcome data The main goal of this software is to provide a standard set of measurement and analysis tools that all rehabilitation programs can easily use It is only through the standardization of collection methods that programs will be able to compare outcomes With this tool you have the ability to measure over many outcomes in five domains e Behavioral Outcomes e Clinical Outcomes e Economic Outcomes e Health Outcomes e Service Outcomes Data points in each of these areas can be collected and analyzed using this software Although you are not required to use all of the data points provided it is highly encouraged to collect as many as possible This will provide the most beneficial information on how your program is improving the overall health of its patients Features Able to collect over 75 different outcome data points Able to breakout patients by diagnosis insurance provider referring physician sex and more Analyzes data using mean change level of significance and more Generates individual patient performance reports Generates a variety of program summary demographic and continuous quality improvement reports Creates data graphs for visualizing change Tracks and helps to schedule evaluation visits Able to export data via diskette or the Internet for benchmark
2. For technical support on this product contact Orion Software Development via e E mail support orionoutcomes com e Internet http orionoutcomes com e Phone 720 494 7950 e Fax 720 494 7951 Orion Outcomes User Guide 10 10 1 62 End User License Agreement End User License Agreement IMPORTANT READ CAREFULLY This Orion Software Development End User License Agreement EULA is a legal agreement between you either an individual or a single entity and Orion Software Development for the Orion Software Development software product identified above which includes computer software and associated media and printed materials and may include online or electronic documentation SOFTWARE PRODUCT or SOFTWARE By installing copying or otherwise using the SOFTWARE PRODUCT you agree to be bound by the terms of this EULA If you do not agree to the terms of this EULA promptly return the unused SOFTWARE PRODUCT to the place from which you obtained it for a full refund SOFTWARE PRODUCT LICENSE The SOFTWARE PRODUCT is protected by copyright laws and international copyright treaties as well as other intellectual property laws and treaties The SOFTWARE PRODUCT is licensed not sold 1 GRANT OF LICENSE This EULA grants you the following right s provided that you comply with all the terms and conditions of this EULA e Installation and Use You may install and use one copy of the SOFTWARE PRODUCT on one personal
3. User Guide ORION For Cardiovascular and Pulmonary Rehabilitation Copyright 1997 2009 Orion Softw are Development N Version 3 51 Software Development Orion Outcomes User Guide Copyright 1997 2009 Orion Software Development All rights reserved No parts of this work may be reproduced in any form or by any means graphic electronic or mechanical including photocopying recording taping or information storage and retrieval systems without the written permission of the publisher Products that are referred to in this document may be either trademarks and or registered trademarks of the respective owners The publisher and the author make no claim to these trademarks While every precaution has been taken in the preparation of this document the publisher and the author assume no responsibility for errors or omissions or for damages resulting from the use of information contained in this documentor from the use of programs and source code that may accompany it In no event shall the publisher and the author be liable for anyloss of profit or any other commercial damage caused or alleged to have been caused directly or indirectly by this document Printed March 2009 in Longmont Colorado USA Contents Table of Contents Part 1 2 3 4 5 6 Part Il 1 2 Part Ill 1 2 3 4 5 6 7 Part IV 1 2 3 4 5 Part V 1 Introduction 2 Jiu PER HERES 2 Why Collect Outcome D
4. 5 1 5 5 1 5 1 5 2 5 2 1 5 2 2 5 2 3 e 60 79 e gt 80 Medication This outcome measures the percentage of the time that the patient follows their prescribed medication Choices are e lt 20 e 20 39 e 40 59 e 60 79 e gt 80 Exercise Activity Exercise Two measures are collected e Record the average number of minutes spent exercising per day by the patient This includes time in rehabilitation class as well as time at home e Record the average number of days spent exercising per week by the patient This includes time in rehabilitation class as well as days at home Clinical Outcomes Duke Activity Status Index The Duke Activity Status Index DASI measures functional status via changes in perceived exertion Estimated time for patient to complete the test is less than 5 minutes The total score for the DASI is given in units of VO2 which is a measure of oxygen uptake Orion Outcomes will automatically take the VO2 score and approximate the MET value by the following formula DASI METSs DASI_VO2 0 43 9 6 3 5 Height Record the height of the patient in inches Lipid Profiles Some guidelines for collecting lipid profiles are 1 If these laboratories have been performed prior to the start of the rehabilitation program include them in the Pre Program phase data Lipid profiles taken within the six months before the start of the program can be used for Pre Program lipid
5. and this EULA and the recipient agrees to the terms of this EULA If the SOFTWARE PRODUCT is an upgrade any transfer must include all prior versions of the SOFTWARE PRODUCT Termination Without prejudice to any other rights Orion Software Development may terminate this EULA if you fail to comply with the terms and conditions of this EULA In such event you must destroy all copies of the SOFTWARE PRODUCT and all of its component parts 3 UPGRADES If the SOFTWARE PRODUCT is an upgrade from another product whether from Orion Software Development or another supplier you may use or transfer the SOFTWARE PRODUCT only in conjunction with that upgraded product unless you destroy the upgraded product If the SOFTWARE PRODUCT is an upgrade of a Orion Software Development product End User License Agreement you now may use that upgraded product only in accordance with this EULA Ifthe SOFTWARE PRODUCT is an upgrade of a component of a package of software programs that you licensed as a single product the SOFTWARE PRODUCT may be used and transferred only as part of that single product package and may not be separated for use on more than one computer 4 COPYRIGHT All title and copyrights in and to the SOFTWARE PRODUCT including but not limited to any images photographs animations video audio music and text incorporated into the SOFTWARE PRODUCT the accompanying printed materials and any copies of the SOFTWARE PRODUCT are owned by O
6. fatigue or dyspnea MVO2 from 7 to 14 ml kg min 3 4 METs IV Unable to carry on any physical activity without symptoms Symptoms are present even at rest If any physical activity is undertaken symptoms are increased MVO2 less than 7 ml kg min 2 METSs Use in Congestive Heart Failure CHF CHF is diagnosed only if the patient has at least two different symptoms and or signs of CHF one symptom and one sign two symptoms or two signs shortness of breath easy fatigability edema orthopnea paroxysmal nocturnal dyspnea jugular venous distention rales or S3 The NYHA functional class for CHF depends upon the amount of physical activity the patient is able to perform without experiencing symptoms of fatigue or dyspnea A patient able to ascend one flight of stairs without symptoms or walk one block with a mild to moderate incline is classified as a New York Heart Association Class unless that same amount of activity resulted in excessive fatigue or dyspnea in which case the classification is Class Il If walking from the kitchen to the living room causes symptoms the patient is classified as Class Ill Symptoms occurring at rest or with minimal activity are considered Class IV Consistency in both the physician and coordinator interviewing the patient and the type of questions asked of the patient regarding his activity and symptoms is important throughout the trial Reference Diseases of the Heart and Blood Vessels Nome
7. then we are 95 sure statistically that there was a change in the mean from column 1 to column 2 Therefore your program has produced a noticeable change for this measure Skewness This measure indicates the skewness or tail heaviness of a distribution by characterizing the degree of symmetry of a distribution around its mean Positive skewness indicates a distribution with an asymmetric tail extending toward values that are more positive Negative skewness indicates a distribution with an asymmetric tail extending toward values that are more negative This measure is zero if the data are perfectly symmetric because both the mean and median both equal the point of symmetry Standard Deviation The standard deviation is a statistic that tells you how tightly all the various data points are clustered around the mean in a set of data When the examples are pretty tightly bunched together and the bell shaped curve is steep the standard deviation is small When the examples are spread apart and the bell curve is relatively flat that tells you that you have a relatively large standard deviation The standard deviation is kind of the mean of the mean and often can help you find the story behind the data Analyzing Your Data 6 2 6 2 1 6 2 2 Percent Change Percent change is not used within Orion Outcomes when comparing aggregate or program data Orion Software Development has experienced a concern with their customers regar
8. 31 Adding a Custom DU COME p 31 Part VI Analyzing Your Data 34 A CO AAS E O A 34 Skewness pa O 34 Standard Deviation siisi eie a aE E e a re aa aE Saa Saa e ree eue deer 34 Percent Change A n 35 2 Patient Reports nnnc te exe educ rua I Dx oc tiaia REMIS nm IRR OIN ida ende 35 A soosbsateisseuessesiseiceidevesssstunsiouedcecerasoicesactectostessoaetaneitintestead 35 Health Status Profile eec RE 35 3 Program Reports M 36 Average Patient Profile d nennen nee nenne 36 Cardiac Risk Factor Analysis e e a a Mene Eee EE e NE eae aeu aaae ae EEE a aaa iaai 38 Continuous Quality Im prove m nt isossa aeaa aa nene 38 Program Change Summary ennccccnncccnniconnnncnn cnn 39 Program aei en ARANA ERARIO AAA 40 Program St tistics e SaNa 41 Contents Part VII o0 A WO N Part VIII 1 Part IX Change Summary Graph rtr rere r e e eser e Yon E En Cope Up aaa Ee ES iacedaedcosogiexcesvenses saschdssecedeserss 41 0o io 1 1 AEREE 42 Choosing OULCOMES siad A AAA el dat 42 Filtering D re E TES 43 Benchmarking Reports ein eiishbelige ted 44 Understanding Your Benchmarking Reports 22us422004400nnnn0nnnnan
9. Completed Record the number of exercise sessions that the patient was involved in during the rehabilitation program Only phase 2 exercise sessions are to be counted Identifier You may use this field to record any extra information that you would like to keep on the patient You may want to store their Social Security number email address or some other type of identification number This field is not used in outcome data reporting and is not required Some facilities have chosen to use this field to record an ID that is cross referenced in their hospital s database Insurance Provider You may enter an insurance provider for your patient Doing this will allow you to breakout patients from a given provider in reporting so that you can share the outcomes of those patients with the provider If there was no specific insurance provider simply leave the field blank Maintenance Program This option should be set ifthe patient is involved in a maintenance program This is any phase 3 or phase 4 program that occurs once the patient completes the rehabilitation program Referring Physician You may enter a referring physician for your patient Doing this will allow you to breakout patients from a given physician in reporting so that you can share the outcomes of those patients with the physician If there was no specific referring physician simply leave the field blank Risk Stratification Cardiac Risk Stratification These are the gu
10. Development The contents of the floppy disks will be erased in order to make room for the data The export process assumes that your 3 5 floppy drive is labeled as drive A If it is not you may go to the Options window and change the setting to the appropriate drive Over the Internet You must be connected to the Internet to use this feature Your data will be exported over the Internet to the Orion Software Development The export uses a Secure File Transfer Protocol SFTP to send the data If you are having trouble with Internet exports it is usually because your IS IT department has a firewall or other security device blocking your transfer Orion Outcomes uses Secure File Transfer Protocol SFTP to transfer the benchmarking data SFTP uses port 22 to connect to orionoutcomes com Depending on your firewall there are a variety of options for configuring this method This will need to be done by your IT IS department There is nothing in Orion Outcomes that you can change to make it work in this case Some companies have a proxy server installed that you need to configure Orion Outcomes to work with You will need to get the proxy server information from your IS IT department or have them do the configuration for you The proxy configuration screen is in Orion Outcomes under the Tools gt Option menu on the Export tab Importing Importing Data The Import and Export Wizard is the sole mechanism that allows data to be easily moved in and out o
11. Orion Outcomes CD ROM Verify proper program setup When you run this program for the first time you will be asked to fill out the program profile forms These forms ask you to enter details about the staffing of your program as well as the components that make it up If you did not completely fill out these forms you may still do so by selecting the Activities menu on the menu bar above the Navigator Then click on Edit and Program Profile Once these forms are completed your rehabilitation program is ready for entering patient data Entering patient profiles Each patient that is involved in your program must have a patient profile A profile may be created by pressing the Edit Patient Profile button on the Navigator Select the Add a New Patient entry shown at the top of the list of patients You may now enter all of the information about the patient and their Orion Outcomes User Guide involvement in your program Should you need to edit this information again later you may retum to this screen via the same procedure except choose the name of the patient from the list of patients Collecting patient outcome data To enter the outcome data that you have just collected for a patient press the Enter Outcome Data button on the Navigator Select the desired patient from the list of patients If the name of the patient does not appear in the list you must create a profile for this patient before continuing Evaluation phases for data en
12. System Utilization ER Visits Record the number of visits that the patient has made to the emergency room since their last evaluation If this is their first evaluation consider any visits that occurred during the past year Include all visits not just those related to the cardiac or pulmonary problem Hospital Admissions Record the number of admissions that the patient has made to a hospital since their last evaluation If this is their first evaluation consider any visits that occurred during the past year Include all admissions not just those related to the cardiac or pulmonary problem Physician Visits Record the number of visits that the patient has made to physicians since their last evaluation If this is their first evaluation consider any visits that occurred during the past year Include all visits not just those related to the cardiac or pulmonary problem 29 Orion Outcomes User Guide 5 4 5 4 1 30 Health Outcomes Quality of Life Index The Quality of Life Index QLI was developed by Carol Estwing Ferrans and Marjorie J Powers in 1984 to measure quality of life in terms of satisfaction with life The QLI measures both satisfaction and importance regarding various aspects of life There is no charge placed on the use of this tool by the author More information at http www uic edu orgs qli Q When some questions don t apply what should you do for example if the client has no children A There wi
13. This report is a summary of the information about your program This information was entered during the setup of the program This report provides a summary of what facilities and components make up your rehabilitation program 40 Analyzing Your Data 6 3 6 6 3 7 Program Statistics This report gives a graphical display of some ofthe demographic breakdowns for the patients in your rehabilitation program The report includes Age shows the number of patients in 6 different age ranges Insurance Providers shows the top 10 providers and the number of patients associated with each Hometown shows the top 10 cities where in your patients are drawn from Maintenance Program shows the percentage involved versus the percentage not involved in a phase 3 or 4 program Phase Participation shows the total number of patients who have completed each of the evaluation phrases Primary Diagnosis shows each ofthe diagnoses and the number of patients associated with each Referring Physicians shows the top 10 physicians and the number of patients associated with each Risk Stratification shows the percentage of patients in each classification Sex shows the percentage of males versus percentage of females Change Summary Graph This type of report is useful for visualizing the changes in your data The data set is broken down into different categories by outcome which are graphed according to the evaluation phase The mean val
14. active Password ELI M anne 25 Administrator 25 Brandon 3 Select the row containing the user you wish to delete 4 Press the X button directly to the right of the New Record button on the toolbar Audit records pertaining to this user s activity will not be deleted You cannot delete the Administrator account Changing Your Password To change your password in Orion Outcomes follow these steps 1 Login to Orion Outcomes 2 Select the Tools menu and then Change Password 3 Enter your new password in both fields Forgot Your Password If you forget your password you should contact the person at your company that knows the Administrator password for Orion Outcomes This user can login as the Administrator and change your user password to a new value If you have forgotten the password for the Administrator account then you are stuck Contact Orion Software Development s technical support to receive instructions on how to gain access 51 Orion Outcomes User Guide 8 1 8 1 1 54 Sharing Your Data Exporting HIPAA Using the Final Rules of the Health Insurance Portability and Accountability Act HIPAA as guidelines Orion Software Development adheres to the industry best practices for the privacy and security of protected health information Orion Software Development is committed to continue providing and supporting a low cost outcomes solution in light of this new legislation with its curren
15. be the primary target areas Q What are considered the norms for a cardiac or pulmonary patient Collecting Outcome Data 5 5 5 5 1 5 5 2 A Because there are wide ranges of severity of illness in cardiac and pulmonary diseases and treatments for example clients who have had bypass surgery angioplasty valve replacement anti arrythmics etc there are no norms for cardiac and pulmonary patients although you can compare your client s scores with a large number of studies that have used the Quality of Life Index A listing of these can be found on our website at http www uic edu orgs qli The recommendation is to use the general population for your comparison since the ultimate goal is to achieve a quality of life as close to normal as possible Q In what period of time would you expect to see changes for example 6 weeks or 12 weeks A There is no answer to this question that would apply across all clients However we do know that angioplasty patients have shown significant improvement within 6 weeks after angioplasty and 3 months after bypass surgery using the Quality of Life Index The key is that there needs to be enough time for the client to see the translation of the intervention into the quality of their lives Q We have heard that the SF 36 is a better measure How does the Quality of Life Index compare to the SF 36 A The Quality of Life Index was found to be more sensitive to change than the SF 36 in a study
16. computer or other device 2 DESCRIPTION OF OTHER RIGHTS AND LIMITATIONS e Limitations on Reverse Engineering Decompilation and Disassembly You may not reverse engineer decompile or disassemble the SOFTWARE PRODUCT except and only to the extent that such activity is expressly permitted by applicable law notwithstanding this limitation e Separation of Components The SOFTWARE PRODUCT is licensed as a single product Its component parts may not be separated for use on more than one computer e Rental You may not rent or lease the SOFTWARE PRODUCT e Support Services Orion Software Development may provide you with support services related to the SOFTWARE PRODUCT Support Services Any supplemental software code provided to you as part of the Support Senices shall be considered part of the SOFTWARE PRODUCT and subject to the terms and conditions of this EULA With respect to technical information you provide to Orion Software Development as part of the Support Services Orion Software Development may use such information for its business purposes including for product support and development Orion Software Development will not utilize such technical information in a form that personally identifies you e Software Transfer You may permanently transfer all of your rights under this EULA provided you retain no copies you transfer all of the SOFTWARE PRODUCT including all component parts the media and printed materials any upgrades
17. of arrhythmia patients All the participants completed both instruments They also completed another questionnaire that specifically measured changes in arrhythmias The arrhythmia specific questionnaire was the most sensitive in detecting changes in arrhythmia and the Quality of Life Index was the next most sensitive The SF 36 was the worst of the three in detecting change in these patients For more information there is a review article that compares the Quality of Life Index with three other measures DeVon H amp Ferrans C 2003 Psychometric properties of four quality of life instruments used in cardiovascular populations Journal of Cardiopulmonary Rehabilitation 23 122 138 Custom Outcomes Using Custom Outcomes Orion Outcomes provides a large set of standardized outcome tools that are known to be valid reliable and well known across the discipline While most users find this set to be sufficient for their needs there are times when users wish to experiment with or use other outcome tools not currently supported by Orion Outcomes Custom Outcomes is the Orion Outcomes method of allowing you to collect outcome data using tools that are not supported by Orion Outcomes out of the box These outcomes are placed in an outcomes domain called Custom The custom outcomes act just as standard outcomes except that they are not benchmarked Orion Outcomes comes with 2 complimentary custom outcome fields 1 cardiac 1 for pulmonary The a
18. of the Outcomes Program Manual Heart monitor optional Chair Exclusion Criteria Patients with musculoskeletal problems that preclude walking such as intermittent claudication paralysis and pain Protocol 1 Measure and record the patient s height and weight Before the walk have the patient rest in a sitting position for 5 minutes After this rest period blood pressure heart rate SaO2 and rating of perceived dyspnea are measured for all patients Record all the data on the outcome data sheet 2 If resting SaO2 is below 8596 without supplemental oxygen or below 9096 with oxygen do not Collecting Outcome Data 5 3 5 3 1 5 3 2 5 3 2 1 5 3 2 2 5 3 2 3 perform the test Take appropriate action and reschedule testing for another day Patients on supplemental oxygen will use their oxygen at the prescribed flow rate for exercise 3 The following instructions will be given to the patients The purpose of this test is to find out how far you can walk in six minutes You will start from this point indicate marker at one end ofthe course and follow the hallway to the marker at the end then turn around and walk back When you arrive back at the starting point you will go back and forth again You will go back and forth as many times as you can in the six minute period If you need to you may stop and rest Just remain where you are until you can go on again However the most important thing about the test is that y
19. ta reete ciciireeen t eden aoc na anna dann 2 Levels of Outcome Measurement uussrsennnsnnennnnsnnnnnnnnnnnnnnnnnnnnnnnsnnnnnnnsnnnnnnnsnnnnnnnsnnnnnnn nnn 3 Make Your Outcomes Count iniret ia 3 Moving from QA to COL cocina neuen 4 GEMMA A ERAAN RASAR ARASA ER AENA 5 Installing or Removing 8 Installing the Software oot diia 8 Removing the Software ecrire cinere da add nen 8 Getting Around 10 e aa EEEE ATE TT A E 10 Patient Profile MiS Wi RR 10 Outcome Data Vie 11 Br A E PE 12 codice Ems 12 OPTIONS EE EE 13 Import and Export WIZard tret Iri Henna a Aaa an Hanne nen nn hai nennen rennen 16 Working with Patients 20 Adding New Patients 2 2 23 eere a a tidad agree 20 Deleting Patients iio ir iria 20 Entering QUtcome Data iii ic 20 Tracking Patient Vis rennen 20 Classifyirig Patients eee dedere ai ihren 21 Diagnosis eese Exercise Sessions Completed Identifier A Insurance adobe E Maintenance Program Referring Bia AAA nn TQ RIS eue dm Cardiac Risk Stratification Pulmonary Risk StratificatiOn ter
20. that you are interested in covering in the report Only patients who have an evaluation due during that period of time are shown You may choose one of the pre selected Getting Around 3 6 time intervals or enter your own custom dates Options This form allows you to enter various settings that customize the software Show Tools Options Show Tools Export Formatting SF 36 Scoring Security Lists Q4 gt Use the Following to select or deselect outcomes tools If tools are deselected the fields will not appear in the data entry screens No previously collected data will be deleted from hidden tools Knowledge Test New England Cardiac Functional Capacity Test Patient Satisfaction Quality of Life Index SF 12v2 Health Survey SF 36v2 Health Survey Shortness of Breath Questionnaire Six Minute Distance Walk Treadmill Test K KI E E Y IS El KI Ki This screen shows a list of available outcomes tools You may select or deselect to show and hide tools respectively If you are not using a particular tool in your program you may want to disable the tool so that it simplifies your data entry screens Deselecting a tool does not delete the data for the field it merely hides the data entry screens Export 13 Orion Outcomes User Guide 14 Options Show Tools Export Formatting SF 36 Scoring Security Lists Qt Mame of your 3 5 Floppy drive fa Days be
21. 1 9 2 9 3 60 Troubleshooting Updating Your Software Orion Software Development makes available free service releases of Orion Outcomes from our web site Before reporting a problem be sure that you are running the latest Orion Outcomes service release Service releases can be downloaded from within Orion Outcomes by going to the Help menu and choosing Check for Software Updates If a newer version is available you will be able to download and install it If the computer that Orion Outcomes is installed on does not have Internet access you may either e Download the service release on to a computer with Internet access and then transfer the file to the computer with Orion Outcomes on it e Purchase a replacement CD ROM from Orion Software Development s web site for a nominal fee Event Log As users perform actions within Orion Outcomes an event log is captured in order to help with troubleshooting Orion Software Development will often ask for this log file when troubleshooting a complex issue You may also find information that may be of help when troubleshooting your own issues by viewing the event log To access the event log follow these steps 1 Select the Help menu then Troubleshooting then View Event Log 2 An associated document viewing program such as Notepad will display the event log contents This file may be saved and submitted to Orion Software Development if requested Contacting Technical Support
22. ER WARRANTIES AND CONDITIONS EITHER EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY FITNESS FOR A PARTICULAR PURPOSE TITLE AND NON INFRINGEMENT WITH REGARD TO THE SOFTWARE PRODUCT AND THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES THIS LIMITED WARRANTY GIVES YOU SPECIFIC LEGAL RIGHTS YOU MAY HAVE OTHERS WHICH VARY FROM STATE JURISDICTION TO STATE JURISDICTION LIMITATION OF LIABILITY TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW IN NO EVENT SHALL ORION SOFTWARE DEVELOPMENT OR ITS SUPPLIERS BE LIABLE FOR ANY SPECIAL INCIDENTAL INDIRECT OR CONSEQUENTIAL DAMAGES WHATSOEVER INCLUDING WITHOUT LIMITATION DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS 63 Orion Outcomes User Guide 64 INTERRUPTION LOSS OF BUSINESS INFORMATION OR ANY OTHER PECUNIARY LOSS ARISING OUT OF THE USE OF OR INABILITY TO USE THE SOFTWARE PRODUCT OR THE PROVISION OF OR FAILURE TO PROVIDE SUPPORT SERVICES EVEN IF ORION SOFTWARE DEVELOPMENT HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN ANY CASE ORION SOFTWARE DEVELOPEMENT S ENTIRE LIABILITY UNDER ANY PROVISION OF THIS EULA SHALL BE LIMITED TO THE GREATER OF THE AMOUNT ACTUALLY PAID BY YOU FOR THE SOFTWARE PRODUCT OR U S 5 00 PROVIDED BECAUSE SOME STATES AND JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY THE ABOVE LIMITATION MAY NOT APPLY TO YOU Index Index A Adding a Custom Outcome 31 Adding a New
23. Microsoft Windows operating system 3 Insert the CD into your CD ROM drive The setup program should start automatically If it does proceed to step 7 4 Click the Microsoft Windows Start button point to Settings and then click Control Panel 5 Double click the Add Remove Programs icon 6 Press the Install button 7 Follow the setup instructions that appear on your screen You will have the option to install Orion Outcomes as well as view training materials on the CD ROM 8 When you run Orion Outcomes for the first time you will be asked to enter your registration information You will find your product serial number attached to the front of this document or on the back of the CD ROM case In addition you will be asked to enter the names of your cardiac and pulmonary programs The program names that you enter during this part of the setup will be the names that the benchmarking services will use for reporting your outcome data Removing the Software To remove Orion Outcomes files from your personal computer 1 Close all programs 2 Click the Windows Start button point to Settings and then click Control Panel 3 Double click the Add Remove Programs icon 4 Click Orion Outcomes on the Install Uninstall tab and then click Add Remove 5 Press the Remove All button 6 Follow the instructions on the screen NOTE This operation will not remove your outcome database from your computer You will need to manually delete it T
24. User 49 Adding New Patients 20 Administrator Account 49 Audit Trail 48 Bu Backing Up Your Data 48 Ca Cardiac Risk Factor Analysis 38 Changing Your Password 51 Choosing Outcomes 42 Count 34 D Database Location 48 Deleting a User 50 Deleting Patients 20 Diagnosis 21 Diet 24 Diet Habit Survey 24 Difference Progress 38 Difference Summary 39 Duke Activity Status Index 25 M oe End User License Agreement 62 Entering Outcome Data 20 ER Visits 29 Event Log 60 Exercise 25 Exercise Sessions Completed 21 Exporting Your Data 55 SES Filtering Data 43 Follows Prescribed Diet 24 Follows Prescribed Medication 25 Forgot Your Password 51 Gu Getting Started 5 Graphs 41 H Health Status Profile 35 Height 25 HIPAA 54 Hospital Admissions 29 Identifier 21 import from another site 57 from previous version 57 from ScottCare TeleRehab System 58 Import and Export Wizard 16 Importing Data 56 Inactivity Timeout 49 Install or remove individual components 8 Insurance Provider 21 K Knowledge 24 Kurtosis 34 ie Levels of Outcome Measurement 3 Lipid Profiles 25 Lists 12 Logging In 49 LSI TrensCenter 57 65 Orion Outcomes User Guide Maintenance Program 21 Make Your Outcomes Count 3 Mean 34 Medication 25 METs 26 Moving from QA to CQI 4 N Number of Medications 29 NYHA Functional Classification 26 O Options 13 Outcome Data View 11 Overview 2 P Patient Pr
25. applications which provide access to protected health information automatically exit after a specified period of time Orion Outcomes allows you to configure the amount of the timeout If you set the timeout to 0 it will disable the timeout 3 7 Import and Export Wizard This wizard is the main mechanism for moving data in and out of this software After selecting an action from the list you will be guided through the procedure for the transfer 16 Getting Around port and Expo Choose an action to perform port data For benchmarking Import from LSI TrensCenter Import from Quinton Q Progress Import From ScottCare TeleRehab Import from previous version Migrate From HeartWatchers COMET Description Exports the patient data over the Internet or onto a set of diskettes Cancel 17 Orion Outcomes User Guide 4 2 4 3 4 4 20 Working with Patients Adding New Patients To add a new patient to the database follow these steps 1 Select the type of program you wish to add the new patient to from the Navigator 2 Press the Edit Patient Profile button on the Navigator 3 Select the Add a New Patient entry from the top of the list and click OK 4 You must now fill in the general information about the patient about the Patient Profile View NOTE A minimum of a first and last name is required to create a valid patient record Deleting Patients To delete
26. ases for each patient and computes the difference in each measure for each patient Those differences are summarized program wide and reported on through many different statistical methods The report shows the mean standard error median standard deviation standard variance kurtosis skewness range minimum maximum sum count and statistical significance reported to the 05 level for each outcome Form 39 Orion Outcomes User Guide ES Create a Program Change Summary Report E x To create a report that summarizes the difference in outcome measurements that your patients achieve select the phases to be analyzed and specify any other parameters Display show Fields Show Outcomes Filters Order By Title Cardiac Program Change Summary Date Range Compare re Program phase data to Post Program y phase data collected during Include all dates from El to E Cancel Show Fields This tab allows you to choose which of the statistical measures listed above will be included in the report Show Outcomes This tab allows you to choose which of the outcomes will be included in the report Filters You have the option of limiting the patients that are included in the report For more information see the section on Filtering Data Order By This tab allows you to customize the order that the data will be sorted by and ordered by in the report 6 3 5 Program Profile
27. bility to add up to 46 additional outcome fields 23 cardiac 23 pulmonary is available for an additional cost Orion Software Development chose to offer this capability as an add on because only a smaller set of customers required this functionality Adding a Custom Outcome To add a custom outcome follow these steps 1 Select the Tools menu then Options 2 Select the Custom tab The window shown below will appear 31 Orion Outcomes User Guide Options Formatting SF 36 Scoring Security Lists Quinton Custom Custom outcomes are private data collection entries that you wish to make These fields will be defined and used For all patients They will not be available For external benchmarking Program Type Cardiac m To create more than one custom outcome you must purchase the custom outcomes add on module from Orion Software Development OK Cancel 3 Choose Cardiac or Pulmonary 4 Press the Add button The window shown below will appear Define Custom Field Complete all the fields to define your custom outcome Full Name Shoe Size Long Name Shoe Size Short Name Shoe Units finches Cancel 5 Enter the information in the appropriate fields Full Name This will be used as the name for the outcome when displayed in forms not reports Long Name This will be used as the name for the outcome when it is displayed on reports where moderate s
28. continuous quality improvement process which falls under hospital operations As such a patient release form is not necessary under HIPAA guidelines It is recommended that you indicate in your informed consent that PHI will be used for outcomes and benchmarking purposes For compliance with HIPAA you must choose one of the following options when submitting your data for benchmarking Limited is the suggested method Sharing Your Data Method PHI Included PHI Excluded Requirements De identified Data Set None Name First Middle Last Nickname Address Street City Zip Code State is sent E mail Phone Number Home amp Work Social Security Number Medical Record Number Account Number Birth Date except year Onset Date except year Testing Dates except year Treadmill Testing Dates except year No legal agreement required Limited Data Set City State Birth Date Onset Date Testing Dates Treadmill Testing Dates Name First Middle Last Nickname Address Street only City State and Zip Code are sent E mail Phone Number Home amp Work Social Security Number Medical Record Number Account Number Requires a Data Use Agreement between Orion and your program hospital Full Data Set All None Requires a Business Associate Agreement between Orion and your program hospital Exporting Y
29. d into the file Import Log txt that can be found in the Orion Outcomes installation directory You will be notified if errors were logged ScottCare TeleRehab To export the data from the TeleRehab System follow these steps 1 Select the report form while running TeleRehab 2 Enter the information into the report form using TeleRehab Repeat steps 1 and 2 until all information on the patient has been completed Run the TeleRehab Export Program TREXPORT EXE Select the export option ODMS from the export options dialog box Select the EXPORT function then select patient directory s to export f TREXPORT EXE has enough information to proceed with the export and can find the session files needed for export one Orion Outcomes export file will be written out with a filename of TELERHAB CSV To import the data into Orion Outcomes follow these steps 1 From the Navigator select File from the menu bar and choose the Export and Import option 2 Inside the Import and Export Wizard select the ScottCare Tele Rehab System option 3 You will be asked to locate the TELERHAB CSV file that you created in step 7 above 4 The action will be performed once you press the Finish button NOTE Any data importing problems found during this procedure will be logged into the file Import Log txt that can be found in Orion Outcomes installation directory You will be notified if errors were logged NOOO PR o Orion Outcomes User Guide 9
30. ding outcomes and the AACVPR Cardiac and Pulmonary Rehabilitation Program Certification process The current certification process requires programs to focus on and report percentage of change for program outcomes While percentage of change is useful when reporting individual patient change it is an out dated measure for internal program data and confuses clinicians who use external program comparison in the continuous quality improvement process The Joint Commission on the Accreditation of Hospital Organization moved from Quality Assurance QA to performance improvement through the process of Continuous Quality Improvement CQI in 1992 The use of percentage of change for program data is a QA measure because it provides a snapshot of program performance at a point in time As long as there is change in the right direction clinicians view their program performance and quality of care as good This is deceiving to clinicians When outcomes are compared to other programs through the benchmarking process the relative change percentage may be in the 90th percentile while the absolute change units of measure may be below the 10th percentile of benchmarked programs Since 1997 Orion Software Development has provided cardiac and pulmonary rehabilitation programs with the tools to drive performance improvement through CQI Orion Outcomes which is used in over 1500 cardiac and pulmonary rehabilitation programs nationwide provides the software and too
31. dministrator Account The Administrator is the only pre defined user account within Orion Outcomes It cannot be deleted The Administrator account is used to administer the software and should not be used for day to day operations such as data entry The Administrator has special capabilities when logged in such as e Ability to set the inactivity timeout value e Ability to create edit or delete user accounts Adding a New User To add a new user to Orion Outcomes follow these steps 1 Login to Orion Outcomes with the Administrator account 2 Select the Lists menu and then User Accounts The window shown below will appear 49 Orion Outcomes User Guide Drag a column header here to group by that column jusemame Active Password o Administrator M Hidden 25 Brandon M Hidden 3 On the toolbar just below the File menu press the New Record button The window shown below will appear New User Username Brandon Password al Re enter Password c 4 Fill out the information The password must be entered twice Press OK to complete the operation 7 7 4 Deleting a User To delete a user from Orion Outcomes follow these steps 1 Login to Orion Outcomes with the Administrator account 2 Select the Lists menu and then User Accounts The window shown below will appear 50 Protecting Your Data 7 75 7 7 6 Drag a column header here to group by that column usemame
32. dy affect something you can actually change or is the information just nice to know e Remember to develop your program with an action plan in mind and remain focused on the goal as you move forward Next decide who will be involved in the outcomes process I want to measure outcomes on phase four patients why Depending on your action plan you may want to include different groups of patients and staff Once you have decided on your objectives you can select your tools Orion Outcomes User Guide 1 5 Moving from QA to CQI Since the mid 1990 s Orion Software Development has been the leader in providing tools to measure improved quality in health care The fundamental purpose ofthis company is to assist specific health care programs in the evolution from Quality Assurance QA to Continuous Quality Improvement CQI For years the means to assess and improve quality in health care included only local medical audits followed by ongoing monitoring and simple evaluation Today Orion Software Development provides a comprehensive tool set in Orion Outcomes to provide a more positive and structured approach to continuous quality improvement in health care If health care providers can use the tools of continuous quality improvement to achieve greater efficiencies in the delivery of health care services reduce costs and improve quality they will demonstrate outstanding leadership for improving the levels of quality in their products and se
33. e 6 months from Pre Program to 1 year from Pre Program 6 months e 1 year from Pre Program to 2 years from Pre Program 1 year e 2 years from Pre Program to 3 years from Pre Program 1 year e 3 years from Pre Program to 5 years from Pre Program 2 years e 5 years from Pre Program to 7 years from Pre Program 2 years e 7 years from Pre Program to 10 years from Pre Program 3 years All patient tracking is done automatically based on the previous evaluation dates of the patient After selecting tracking on the Navigator you will see the Tracking form You are asked to enter a starting Working with Patients 4 5 4 5 1 4 5 2 4 5 3 4 5 4 4 5 5 4 5 6 4 5 7 4 5 7 1 date and an ending date All patients who have an evaluation due during this period oftime will be printed on the tracking report The telephone numbers of the patients are printed along with the name of the patient in order to create a calling list NOTE Ifa patient s testing date falls before the starting date ofthe range that you enter the patient will not show up in the report Classifying Patients Diagnosis You may choose the primary and secondary diagnosis of your patient Some ofthe most common choices are available If your patient has a diagnosis that is not on the list please select other for the diagnosis You cannot add a diagnosis to this list In addition the option of none is also available as a secondary diagnosis choice Exercise Sessions
34. ecover your work up until the point when you made your last backup To restore your data close all programs Place the backup copy of your file into the Orion Outcomes installation directory This is the only step necessary to restore your data Transfer to Another Computer Occasionally one might want to move Orion Outcomes software from one computer to another For example this could be because you received a new computer Install Orion Outcomes on the new computer using your same serial number We recommend that you do not use your original CD ROM Instead visit our web site to download the latest version of the software at http orionoutcomes com support downloads Do not start the program once you have it installed On your old computer from within Orion Outcomes go to the menu bar and choose File gt Maintenance gt Backup Database Save the database in a location that you can access from both computers such as a floppy diskette or a shared network drive Run Orion Outcomes on the new computer You will be prompted to create a new database or open an existing one Choose open existing and then select the file you backed up in the last step If you encounter a license compliance warning contact Orion for further instructions Uninstall Orion Outcomes on the old computer This can be done by opening the Windows Control Panel and clicking on Add Remove Programs Audit Trail Audit trails are lists of activities and eve
35. en in doubt leave this section empty and check with your IS IT department Formatting Getting Around Options Show Tools Export Formatting sF 36 Scoring Security Lists Qu4 gt Report Patient Name Format Doe John Print medical record information on patient report Report Date Format Windows Long Date Cancel e Report Patient Name Format You have the option of setting the format for how patient names are shown on reports Options include showing different combinations of first name middle name and last name Print medical record information on patient report Some programs are required to have medical record information on patient reports when they are archived in a medical record Report Date Format The date on which you print a report is shown in the lower left hand corner of most reports You may want to customize the data format according to your preferences There are several formats to choose from Windows Long Data Windows Short Date and Windows General Date are defined in your Windows control panel in the Regional settings In other date formats listed m is for month y is for year and d is for day Security 15 Orion Outcomes User Guide Options Show Tools Export Formatting SF 36 Scoring Security ists qu gt Inactivity Timeout o Minutes Set to 0 to disable Cancel e Inactivity Timeout HIPPA regulations require that unattended
36. es 3 Using other external sources of feedback benchmarking services to trigger evaluation and improvement of patient care and processes 4 Organizing the assessment and improvement activities around the flow of patient care and services 5 Focusing first on the processes of care and service rather than on the performance of individuals 6 Maintaining improvement over time and seeking additional improvement Outcome assessment external benchmarking and data evaluation are the components of the process by which health care is on an ongoing basis assessed and improved Getting Started Once you have installed the software on your computer you should perform the following steps to ensure the best usage of this software Before you begin using the software The first thing you should do before getting started with this software is to fully understand the outcome data collection methods outlined in the Indiana Society of Cardiovascular and Pulmonary Rehabilitation ISCVPR Outcomes Program Manual This document will act as your guide to the outcome collection process This manual was installed along with the software You will find an icon that will launch the manual on the help menu inside Orion Outcomes This manual requires Microsoft Word 97 word processing software for viewing If you do not have this software we have provided a viewer on the CD that this software came on Additional audio video tutorials have been provided on the
37. f Orion Outcomes You may import data from a variety of sources e Importing From Previous Version Sharing Your Data 8 2 2 8 2 3 8 2 4 8 2 5 e Importing From Another Site 3rd Party Software We have collaborated with other product vendors to integrate Orion Outcomes into their existing software solutions The following is a list of products that are capable of sharing data with this product e Quinton Q Tel e LSI TrensCenter e ScottCare TeleRehab System Importing From Another Site This option is only available if you have purchased the Multi Program Edition of Orion Outcomes from Orion Software Development To import the data follow these steps 1 From the Navigator select File on the menu bar and choose the Export and Import option 2 Inside the Import and Export Wizard select the Import data that was exported from another site option 3 Insert the first disk of the exported data set into your floppy drive 4 Follow the instructions on the screen Importing From Previous Version The Import and Export Wizard will help you to extract data that you collected while using a previous version of the Orion Outcomes and bring it into the more current version To import your data follow these steps 1 From the Navigator select File on the menu bar and choose the Export and Import option 2 Inside the Import and Export Wizard select the Import data from a previous version option 3 You will need to locate a p
38. g treatment and monitoring patient outcomes compromise the steps performed by therapy professionals and other staff Improvements in these processes will Introduction 1 6 result from eliminating redundant steps overly complex activities barriers to communication and so forth To carry out such quality improvement meaningful data will be necessary The usefulness of this data will depend on the use of valid performance measures and the application of reliable data collection techniques and statistical methods The ultimate goal of this coordinated comprehensive systematic process should result in a continuous cycle of assessment and improvement in patient care It is important to remember that the concept of continuously improving quality incorporates the strengths of quality assurance while broadening its scope defining the process of assessing evaluating and improving care So the process of structured monitoring and evaluation provides the foundation for continuous improvement of quality Developing methods of monitoring components of care and service and taking specific actions to improve care and service are the foundation of performance improvement Performance improvement initiative will include the following 1 Emphasizing the role of management in improving quality 2 Expanding assessment and improvement activities beyond the clinical measures and percentage of change to clinical processes that affect the patient outcom
39. hile this gives you a visual representation of the variability in the measured change it should be noted that the Hi and the Low are considered statistical outliers and are often the result of low sample size poor test administration or data entry errors If your program Avg represents a Hi or a Low you may want to contact Orion Software Development for assistance 45 Orion Outcomes User Guide 7 1 7 2 7 3 7 4 7 5 48 Protecting Your Data Database Location When Orion Outcomes was run for the first time the user was given the choice of where to store the database The location might be on your computer s hard drive or possibly on a network file server To determine the location of the database file currently in use select the File menu and choose Properties The database location as well as the number of patients will be displayed Backing Up Your Data In order to protect the patient data that you have entered in the system it is highly recommended that you make frequent backups To backup your data go to the File menu Choose Maintenance then Backup Database You will be given the option of where you want to save the database to It contains all of your patient information and outcome data You must make a copy of this file to a safe place Restoring Your Data If you happened to lose your Orion Outcomes patient data due to a hardware malfunction and you have made a recent backup copy you can r
40. his was done as an extra precaution Orion Outcomes User Guide 3 Getting Around 3 1 Navigator The Navigator is the window that has the cardiac and pulmonary type selector along with the action toolbar This window allows you to access the main functionality ofthe program For greater control use the menu bar that appears above this window amp Navigator Dun ORION Pulmonary OUTCOMES Profiles Enter contact history and other information for a patient during a phase Outcomes 5 Record the measurements taken Create detailed summaries of patient or group outcomes Create visual summaries of categorized outcome groups Find out when patients need to return for their next phase 3 2 Patient Profile View This form allows you to setup a patient record for a participant in your program Each participant must have a patient record before outcome data can be entered for that patient 10 Getting Around 3 3 amp Cardiac Patient Profile New Patient EJ New Patient Personal info Program Details Risk Evaluations Notes Outcome Data View This form is for entering the outcome data collected on a patient during an evaluation phase The tabbed pages allow quick access to each of the major outcome categories The name of the patient will appear in the upper left corner of the window In the upper r
41. hmias Severe coronary artery disease and marked exercise induced myocardial ischemia gt 2 mm ST segment depression Functional Capacity less than 5 METs 4 5 7 2 Pulmonary Risk Stratification 22 Generally accepted guidelines for the risk stratification of the pulmonary patient are currently unavailable Orion Outcomes User Guide 5 1 5 1 1 5 1 2 5 1 4 5 1 4 1 24 Collecting Outcome Data Behavioral Outcomes Diet Habit Survey The Diet Habit Survey measures cholesterol saturated fat intake complex carbohydrates and salt Estimated time for patient to complete the test is as much as 30 minutes Knowledge To administer the knowledge test follow these steps 1 The cardiac and pulmonary knowledge tests should be administered after the completion of the Health Status Questionnaire Like the Health Status Questionnaire it should not be sent home with the patient for completion Answers to the test should be placed on the Knowledge Test Answer Sheet in the Outcomes Program Manual Patients are not required to fill out the knowledge test If the patient refuses explain to them that the test is voluntary but it will provide helpful information regarding the quality of the education program provided by your rehabilitation program Do not force the patient to fill out the questionnaire The knowledge test should be filled out by the rehabilitation patient only They may not receive help from s
42. idelines for classifying the risk stratification of a cardiac patient Low Risk e No significant left ventricular dysfunction i e ejection fraction equal to or greater than 50 e No resting or exercise induced myocardial ischemia manifested as angina and or ST segment displacement 21 Orion Outcomes User Guide No resting or exercise induced complex arrhythmias Uncomplicated myocardial infarction coronary artery bypass surgery angioplasty or artherectomy Functional capacity greater than or equal to 7 METs on graded exercise test 3 or more weeks after clinical event Intermediate Risk Mild to moderately depressed left ventricular function ejection fraction 40 49 Functional capacity less than 5 6 9 METs on graded exercise test 3 or more weeks after clinical event Failure to comply with exercise intensity prescription Exercise induced myocardial ischemia 1 2 mm ST segment depression or reversible ischemic defects echocardiographic or nuclear radiography High Risk Severely depressed left ventricular function ejection fraction of 40 or less Complex ventricular arrhythmias at rest or appearing or increasing with exercise Decrease in systolic blood pressure of greater than 15 mm Hg during exercise or failure to rise with increasing exercise workloads Survivor of sudden cardiac death Myocardial infarction complicated by congestive heart failure cardiogenic shock and or complex ventricular arrhyt
43. ight corner you must select the evaluation phase for which the data was collected Select the correct phase before entering the data If you need more information on a particular field place your cursor in the field and press the F1 key 11 Orion Outcomes User Guide 3 4 3 5 12 Cardiac Patient Outcome Data B Patient Allen Bill Evaluation Phase Pre Program Behavioral Date of Test Behavioral General Beck Diet Knowledge 20 pe HOT Clinical Behavioral Compliance Follow Prescribed Diet Follow Prescribed Medications el Economic Cigarettes Smoked per Day Exercise Activity Days per Week of Exercise Minutes Exercising per Session or Lists Lists are a method for viewing sorting and grouping data in your own customized ways From the menu bar choose the Lists menu The lists have the ability to group data by multiple columns sort columns and show hide columns The lists are printable so you may create your own view of the data you are interested in Tracking This form allows you to specify the details for creating your tracking report These reports are used to schedule the upcoming follow up evaluations for your patients E Rehabilitation Program In the Multi Program Edition of this software you have the ability to choose which rehabilitation program you would like to base the tracking report on Interval You must select the time interval
44. ing Multi user and network capabilities Why Collect Outcome Data Collecting outcome data on your program is not an option anymore It is required for JCAHO accreditation and for AACVPR program certification Collecting and analyzing the outcome data from your program is also an important part of continuous quality improvement However only benchmarking among your peers will help to document the true effectiveness of your program The key to facilitating this comparison between programs is the standardization of the outcome data collection and analysis methods used If you are collecting outcome data without standardization then you have no frame of reference for how your program is performing compared to the programs of your peers This software will help you to begin to collect a standardized set of outcomes Collecting and analyzing information on the benefits your patients experience from participating in your rehabilitation program is invaluable in many ways The data can be used to e Show potential patients how successful your rehabilitation program is It can help you focus on the health benefits of behavior change education and exercise when talking to them e Focus on the clinical outcomes experienced by your patients when talking to referring physicians This will help increase your program referrals Introduction 1 3 1 4 e Demonstrate to hospital department heads and administration how beneficial the rehabilitation prog
45. is a complete comparison of your program to all programs in your state area and throughout the nation who are reporting outcomes to Orion Software Development Just below the title you will see the date range this benchmarking report covers Premium only Page 2 of the premium benchmarking report provides a color graphical representation of your program s national percentile rank for each of the measured outcomes The color coded numerical national percentile rank can be found in the table on the last few pages of the report in last column right The columns in the graph are ordered as listed in the table at the end of the report Programs that perform at the 90th percentile provide the benchmark for best practices Your program s average percentile rank can be viewed just below the report title National Percentile Summary The remaining pages of the report provide you with a comparison of measured average mean change between pre and post program for the outcomes measured in your program To the far left you will see the list of outcomes measured Outcomes are listed below the domain Behavioral Clinical Economic and Health to which they are associated Moving across the page to the right is the units of measure for Analyzing Your Data each outcome Most of these units are self explanatory If you see 1 5 this tells you that the outcome is measured on a scale of 1 to 5 NBS is the abbreviation for Norm Based Scoring In this sy
46. k factors like lipid profile hypertension exercise diet smoking diabetes obesity depression and stress is examined Orion Outcomes produces risk profiles Make Your Outcomes Count Just because you employ the best set of tools to measure and report outcomes it does not make your program great Outcome tools can put you in control of powerful information quickly and efficiently Or they can enable you to make mistakes and waste valuable resources faster than ever Outcome tools can be part of a valuable decision support system provided you use them wisely Outcomes tools and manuals provide the how of gathering information on program effectiveness but you must add the why to build the bigger picture All too often outcome measurement provides interesting numbers and elegant graphs but fails to be actionable An awful lot of outcome research is collecting dust on shelves in rehabilitation programs To avoid having your outcome data serve as bookends here are some things to consider as you build your outcomes program First understand that outcome data is a part of the continuous quality improvement process In and of themselves outcomes have no meaning without standardization and benchmarking e Ask yourself what you are going to do with the data you obtain e What decisions will be made based on this data e What actions could be taken or awided based on this information e What do you want to know at the end of this process e Does the stu
47. ll Clear All 57 Outcomes Selected 6 3 8 2 Filtering Data On reports and charts you have the option of restricting which patients are used in the analysis by selecting filter parameters To use a filter place a checkmark in the box next to it by clicking on the box Then proceed to the right side of the form to complete the details about the filter you have chosen Display Show Fields Show Outcomes Filters order By Filters are restrictions you place on a report to identify the specific patients you want to include in your report Select a parameter and then add the supporting details 1 Select a parameter 2 Add the details for this parameter Details Operation M Ocity O insurance Provider Maintenance Program Primary Diagnosis Race O Referring Physician O Risk Stratification O Secondary Diagnosis O Sessions Completed 15ex Insurance Providers 43 Orion Outcomes User Guide 6 4 6 4 1 44 Only patients covered by this insurance provider will be included in the report This allows you to create a report that you can show to the insurance providers themselves that will demonstrate the impact your rehabilitation program has had on the health of their clients Maintenance Program Choices are Involved or Not Involved If Involved is chosen only patients who are participating in a phase 3 or 4 program will be included in the report On
48. ll always be at least one question with missing data because the two employment questions are mutually exclusive We also anticipated that a few other questions such as children would not apply to everyone The scoring program for the QLI was developed in such a way that there is no need to replace missing data for items that truly do not apply Scores will be calculated based on the items answered for each person and will all range from O to 30 even with no replacement for missing data Q What does it mean that the scores are weighted A Each matched pair of satisfaction and importance questions are combined so that the scores tell you how satisfied the person is with the things that matter most to him The importance to the person determines how much impact the satisfaction rating has on the final score For example combinations of high importance and high satisfaction produce the highest scores Combinations of high importance and high dissatisfaction produce the lowest scores Things that are of little importance have a smaller impact on the score Q How do use this information clinically A You can use both the scores and items for your clinical practice To give you an idea of what scores should cause concern you can compare them with general population data For example let s say a client has the following scores Your Client s Scores General Population Mean Overall 17 9 22 1 Heal
49. ls for outcome measurement analysis and benchmarking The software written materials and training focus on using CQI to improve outcomes across five domains and reduce patient health risks Ultimately this process of performance improvement improves the quality of care provided by rehabilitation programs Each year programs going through the certification process are confused and frustrated with Orion Software because AACVPR through its state and national certification committees requests information Orion avoids providing for the reasons cited above Each year Orion Software has voiced this concern to the Program Certification and Outcomes Committees As a previous member of the outcomes committee Steve Jungbauer has advocated Cardiac and Pulmonary Rehabilitation programs should demonstrate the use of internally and externally benchmarked outcomes in the continuous quality improvement process for program certification Orion Software Development is committed to helping transform rehabilitation programs from exercise based to health risk intervention and reduction programs through the CQI process Patient Reports Patient Reports This report allows you to analyze the outcomes of a specific patient for any two given evaluation phases You must select the patient and the two program phases that you would like to compare The report will calculate the percentage change in each of the outcome data points for the given evaluation phases Hea
50. lth Status Profile The Health Status Profile report is used to summarize the health outcome changes in a patient over a given set of program phases Select a patient and one or more program phases to generate the report 35 Orion Outcomes User Guide 6 3 6 3 1 36 Create a Health Status Profile Report Allen Donald Applegate George Banter Chester Bays Turner Boehm George Bolinger Stephen Boyer Richard Brown Jay Brubaker Laurie Burley Robert Clay Evelyn Collier Bonita Program Reports Average Patient Profile Overview The average patient profile report is used to understand the base values in patient outcome data in program evaluation phases The report shows e Number of samples for each outcome in the two different evaluation phases chosen e Mean values for each outcome in the two different evaluation phases chosen e Standard Deviation for each outcome in the two different evaluation phases chosen Form Analyzing Your Data ES Create an Average Patient Profile Report E xj To create a report that summarizes your average patient profile over a given set of phases select the phases to be analyzed and specify any filter parameters Display show Outcomes Filters Title cardiac Average Patient Profile Date Range Compare re Program phase data to Post Program phase data collected during include all dates from El to E IV Limit to pa
51. n Equipment e Outcome Data Sheets Appendix D of the Outcomes Program Manual e Rolling distance marker e Stopwatch e Heart monitor e Borg Scale Appendix D page 64 of the Outcomes Program Manual e Chair Exclusion Criteria Patients with musculoskeletal problems that preclude walking such as intermittent claudication paralysis and pain 27 Orion Outcomes User Guide Protocol 1 Measure and record the patient s height and weight Before the walk have the patient rest in a sitting position for 5 minutes After this rest period blood pressure and heart rate are measured for all patients Record all the data on the outcome data sheet The following instructions will be given to the patients The purpose of this test is to find out how far you can walk in six minutes You will start from this point indicate marker at one end of the course and follow the hallway to the marker at the end then turn around and walk back When you arrive back at the starting point you will go back and forth again You will go back and forth as many times as you can in the six minute period If you need to you may stop and rest Just remain where you are until you can go on again However the most important thing about the test is that you cover as much ground as you possibly can during the six minutes will tell you the time and will let you know when the six minutes are up When say stop please stand right where you are D
52. n accordance with the accompanying written materials for a period of ninety 90 days from the date of receipt and b any Support Services provided by Orion Software Development shall be substantially as described in applicable written materials provided to you by Orion Software Development and Orion Software Development support engineers will make commercially reasonable efforts to solve any problem issues Some states and jurisdictions do not allow limitations on duration of an implied warranty so the above limitation may not apply to you To the extent allowed by applicable law implied warranties on the SOFTWARE PRODUCT if any are limited to ninety 90 days CUSTOMER REMEDIES Orion Software Development s and its suppliers entire liability and your exclusive remedy shall be at Orion Software Development s option either a return of the price paid if any or b repair or replacement of the SOFTWARE PRODUCT that does not meet Orion Software Development s Limited Warranty and which is returned to Orion Software Development with a copy of your receipt This Limited Warranty is void if failure of the SOFTWARE PRODUCT has resulted from accident abuse or misapplication Any replacement SOFTWARE PRODUCT will be warranted for the remainder of the original warranty period or thirty 30 days whichever is longer NO OTHER WARRANTIES TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW ORION SOFTWARE DEVELOPMENT AND ITS SUPPLIERS DISCLAIM ALL OTH
53. nclature and Criteria for Diagnosis 6th edition Boston Little Brown and Company 1964 Percent Body Fat Record the percent body fat of the patient This measure can be determined through a method of choice Rating of Perceived Dyspnea RPD The scale used to measure RPD is as follows 1 Mild noticeable to patient to observer 2 Some Difficulty noticeable to observer 3 Moderate difficulty but patient can continue Collecting Outcome Data 5 2 8 5 2 9 5 2 10 5 2 10 1 4 Severe difficulty patient cannot continue NOTE This measure is used for pulmonary patients only Rating of Perceived Exertion RPE 6 7 Very Very Light 8 9 Very Light 10 11 Fairly Light 12 13 Somewhat Hard 14 15 Hard 16 17 Very Hard 18 19 Very Very Hard 20 Weight Record the body weight ofthe patient in pounds Measure patients with shoes off and their choice of clothing depending upon circumstances The most important part is to weigh people the same each time Six Minute Distance Walk Six Minute Cardiac Distance Walk The 6MDW should be administered before or at the beginning of the first exercise session of the rehabilitation program and at the last exercise session ofthe program Walks should take place at about the same time of day at least two hours following a meal and should be the first activity ofthe exercise session A quiet indoor hallway that is at least 100 feet in length would make a suitable walking locatio
54. nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn 44 Protecting Your Data 48 Database LOCA ipr em 48 Backing Up Your DAA iii da 48 Restoring Your D ta n u 0 2 an aia iberia 48 Transfer to Another Computer seesseesseseesiesssseeeee enne nennen nn nn nnne nh nnnn nennt nnne nnn 48 unam R 48 Inactivity TIME OU a 49 User Authe nticat ON a eco LOG GUNG O O Administrator Account Adding a New User Deleting a User Changing Your Password Forgot Your Password aA YEN NE BIN eat aerea aeo AAA Sharing Your Data 54 I24uuil me 54 HIPAA Wu M 54 Iz CTI cmt 55 IMportiNg 2 2 2u a 56 Importing Anno A A Aa Aaaa aa aaraa aa Aaaaoi d aaae aaraa aap adada Importing From Another Site eaaa ereas aa aerar reee aE a aa Aa A aa aa a Ee aa E aa aaa aa aaa a Eaa aea EE Importing From Previous Version LSI Trens Center Quinton Q Tel ScottCare Tele Rehab ta Troubleshooting Updating Your SORW are iii A rd ta 60 Event LOG iii A aa 60 Contacting Technical Support 0 dd 60 End User License Agreement 62 End User License Agreement eese enne nennen nnn nnne nnnm enne n nnne 62 Index 65 Orion Outcomes User Guide
55. nts that are performed by users and tracked on a per user basis The following events are listed in the audit trail e Adding a patient Protecting Your Data 7 6 7 7 7 7 1 7 7 2 7 7 3 e Modifying a patient data item e Deleting a patient e Importing a patient data item e Exporting data for benchmarking The user that performs the action as well as the time of the action is recorded Inactivity Timeout HIPAA requires computer systems to have an inactivity timeout This prevents unauthorized access to patient health information when users leave the computer terminal To change the number of minutes in the inactivity timeout follow these steps 1 Login to Orion Outcomes with the Administrator account 2 Select the Tools menu and then Options 3 Select the security tab 4 Enter the number of minutes desired User Authentication Logging In HIPAA requires that all access to patient health information be audited In order to track which employees view which patient s records audit trails must be kept on a per user basis Auditing requires users to login to use Orion Outcomes so that they can be identified If all employees use a common login you will not be able to fulfill the auditing requirement of HIPAA To enable login capabilities with Orion Outcomes you must set a password for the Administrator account If the Administrator account password is set to blank nothing then the login mechanism will be disabled A
56. ofile View 10 Patient Reports 35 Percent Body Fat 26 Percent Change 35 Physician Visits 29 Program Profile 40 Program Statistics 41 Program Summary 36 Quality of Life Index 30 Quinton Q Tel 57 BR Rating of Perceived Dyspnea RPD 26 Rating of Perceived Exertion RPE 27 Referring Physician 21 Removing the program 8 Restoring Your Data 48 Risk Stratification Cardiac 21 66 Pulmonary 22 OS ScottCare TeleRehab System 58 Significance 34 Six Minute Cardiac Distance Walk 27 Six Minute Pulmonary Distance Walk 28 Skewness 34 Smoking 24 Standard Deviation 34 Support 60 zT Tracking 12 Tracking Patient Visits 20 Transfer to Another Computer 48 U Understanding Your Benchmarking Reports 44 Updating Your Software 60 Using Custom Outcomes 31 W Weight 27 Why collect outcome data 2
57. omputes the difference in each measure for each patient Those differences are summarized program wide and reported on through many different statistical methods The report shows the mean minimum maximum sum and count for each outcome Form 38 Analyzing Your Data 6 3 4 amp Create a Continuous Quality Improvement CQI Report B x To create a report that summarizes the progress in the difference in outcome measurements that your patients achieve select the phases to be analyzed and specify any other parameters Display show Fields Show Outcomes Filters Title Continuous Quality Improvement COI Report for Cardiac Program Date Range Compare Pre Program phase data to post Program y phase data collected during finclude all dates from El to E m Summarize by Month Cancel Show Fields This tab allows you to choose which of the statistical measures listed above will be included in the report Show Outcomes This tab allows you to choose which of the outcomes will be included in the report Filters You have the option of limiting the patients that are included in the report For more information see the section on Filtering Data Program Change Summary The Program Change Summary report is used to analyze the change in patient outcome data between two different program evaluation phases This report takes the outcome data from the two ph
58. ou cover as much ground as you possibly can during the six minutes will tell you the time and will let you know when the six minutes are up When I say stop please stand right where you are 4 During the walks the following words of encouragement will be provided at 30 second intervals You are doing Well Keep up the good work Good Job and You are doing fine 5 The monitor will walk behind the patient so as not to influence the patient s pace and will attempt to face the subject only when offering encouragement 6 Patients are told when 2 4 and 6 minutes stop have elapsed 7 Patients should have their oxygen saturation monitored continuously during the test If saturation levels fall below 80 stop walking and discontinue the test Record the lowest oxygen saturation observed on the outcome data sheet 8 Immediately following completion of the walking test have the patient sit down and evaluate for SaC2 heart rate blood pressure rating of perceived dyspnea and total distance walked in feet Record the results on the outcome data sheet 9 After the patient has rested for exactly five minutes measure and record their heart rate blood pressure oxygen saturation and dyspnea level on the outcome data sheet as the recovery value for this outcome Economic Outcomes Number of Medications Record the number of prescribed medications that the patient is currently taking on the given evaluation date Medical
59. our Data The main purpose of exporting your data is to share the data with other organizations that are running this same software By sharing this data your community can begin aggregating the outcome data to create sets of comparison data for benchmarking 55 Orion Outcomes User Guide 8 2 8 2 1 56 To export your data go to the Navigator Select the File menu from the menu bar and choose the Import and Export option Then select the option Exporting outcome data for benchmarking Confidentiality You will have a choice of whether or not you wish to send the patients confidential information along with their outcome data An internal identification number will substitute for the ID of the patient You will have the option of preserving patient confidentiality by not sending the patient confidential information in the export package such as First Name Last Name Address E mail Phone Number Work Number Nickname Social Security Number e Medical Record Number e Account Number Security After encrypting the exported data package it is secured with a password that can only be given by the importing software This necessary precaution is taken to prevent unauthorized access to the data during the transfer Mode of Transfer You will have the following choices for the mode of transfer after exporting your data e On Diskette The process will create a set of 3 5 floppy disks that you will mail to Orion Software
60. pace is available Short Name This will be used as the name for the outcome when it is displayed on reports where limited space is available Abbreviations are appropriate Units Enter the units of measurement This is normally something like feet inches pounds points etc 32 Orion Outcomes User Guide 6 1 6 1 1 6 1 2 34 Analyzing Your Data Statistical Terms Count The count refers to the number of samples usually patients included in the measurement This is often labeled with the letter n on reports Kurtosis This measure characterizes the relative peakedness or flatness of a distribution compared with the normal distribution Positive kurtosis indicates a relatively peaked distribution Negative kurtosis indicates a relatively flat distribution Mean The mean of a set of data is the sum of the measurements divided by the number of measurements commonly referred to as the average Significance Statistical significance is calculated using the counts means and standard deviations of the two different samples A one tailed Z test is used if each of the samples has 30 or more members For smaller sample sizes a T test is used Textbook Definition Is the mean of the sample in column 2 sufficiently different than the mean of column 1 to allow us to infer at the 596 significance level that the population mean of column 2 is not column 1 Or in Plain English If the significance box is checked
61. pouses family members or other guests If the patient does not speak English a translator may be used If the patient is unable to read the knowledge test may be given by reading the test to the patient and having them answer orally lf the patient does not understand a particular item the question may be read to them verbatim but not rephrased If a patient asks for an interpretation of a particular question do not try to explain what the question means Ask the patient to answer the question based upon what they think it means When the patient returns the knowledge test carefully check to see that the test has been completed If it is not ask the patient why the test is incomplete and encourage them to answer the remaining questions Inform the patient that they will be asked to fill out the same test at the end of the program Explain that this will give a better picture of the patient s learning over the course of time Score the test using the key provided in the Outcomes Program Manual Unanswered questions are counted as wrong Record the number of correct answers on the outcome data sheet Smoking Record the average number of cigarettes currently smoked per day by the patient Behavioral Compliance Diet This outcome measures the percentage of the time that the patient follows their prescribed diet Choices are e 20 e 20 3996 e 40 59 Collecting Outcome Data 5 1 4 2
62. profiles 2 At the completion of the rehabilitation program have these laboratories drawn and record the results as the Post Program phase data 3 These labs can be repeated at any of the other evaluation phases as well NOTE These outcomes are only measured for cardiac patients 25 Orion Outcomes User Guide 5 2 4 5 2 5 5 2 6 5 2 7 26 METs The program automatically calculates metabolic equivalents as a function of the horizontal distance walked during the six minute walk This software uses a formula published by the American College of Sports Medicine NYHA Functional Classification The New York Heart Association NYHA functional classification is most often used to characterize patients limitation from left ventricular failure Since 1973 the New York Heart Association has not Officially sanctioned the functional classification However it continues to be used widely and has a strong association with mortality that is independent of left ventricular ejection fraction Class Definition l No limitation of physical activity Ordinary physical activty does not cause undue fatigue or dyspnea MVO2 greater than 21 ml kg min gt 7 METs II Slight limitation of physical activity Comfortable at rest but ordinary physical activity results in fatigue or dyspnea MVO2 from 14 to 21 ml kg min 5 6 METs Il Marked limitation of physical activity Comfortable at rest but less than ordinary activity causes
63. ram really is for improving the health of patients in the community e Clarify for managed care groups and insurance companies the medical benefits and subsequent cost savings of treating their insured members This may gain you additional insurance coverage e Contribute to a statewide database capable of benchmarking the best practices in cardiac and pulmonary rehabilitation This information can be used to dramatically improve the performance of your program and enhance the outcomes of your patients Levels of Outcome Measurement There are three levels of outcome measurement 1 Session Daily Trending The process of trending changes in the treatment plan exercise prescription and patient condition from session to session This data is normally captured in a system such as your telemetry system 2 Program Outcomes Documenting the benefits patients receive from participation in the rehabilitation program Measures are made prior to the start of the intervention and again at the completion These measurements made me made at additional follow up periods Program outcomes measure the change the benefit and or the impact of the treatment in clinical terms health terms behavioral terms economic terms and service terms Orion Outcomes tracks program outcomes 3 Risk Profiling Risk profiling demonstrates the change in risk for future medical events and ultimately future medical cost At this level of outcome the impact of the program on ris
64. rere trente E rne ES Eee Pipes Ob eoo eon ryan dono dadas Collecting Outcome Data 24 Behavioral O tcomes inii rp rata ib 24 Diet Habit SUEVG y iuter ner trennen ee ka ALEA EUN Ee AVE aaa EE AG EVEN Ge ke YS aep eun dan 24 Orion Outcomes User Guide HMO WE ADRESSE DD LU NIIT Is 24 SMOKING ELENA 24 Behavioral COMPIIANCE P E T 24 Diet Medication Exercise Activity RS 25 BXereise EE 25 2 Glinical QUtCOME rcs E 25 Duke Activity Status Index 25 Heights dada 25 Lippi Profiles a ii 25 MES add dada 26 Six Minute Pulmonary Distance Walk u uussseesssenssnnnnsnnennnnnnnnnnnnnnnennnnnnnnnnnnnennnnnnnnnnnnnsnnnnsnnnnannnnn 28 3 Economic Outcomes erento enun rh deno ka dinh na e nn nn Ss aux mense n Ay na nn ann nA ru E err nennen 29 N mber of Medications nin netten Sea e a 29 Medical Syste mi dlrczapnlg E M 29 ER ViSIIS naar rase dle ser aad ble t Net ebene Neu 29 Hospital Admis Sions ans ae sam FE nere pe Gass ee 29 Physician Visa Op PY es ete ePi oe te en Dd nn NH e a a 29 4 HealthiOutcomies necne ete xe e IRE exe ee Kan esci aru ea ERBE Teen 30 Quality arte niin en ER lien 30 5 Custom Outcomes irn eh ere A da UERe Lea steed Reo MEI aes degeeesdasvaceinee 31 Using C stom QUtCOM ES E
65. revious copy of your database which contains all of your older data This file is usually called Outcomes mdb or odmsdt mdb 4 Follow the instructions on the screen LSI TrensCenter To export data from the LSI TrensCenter see the documentation provided by LSI To import the data into Orion Outcomes follow these steps 1 From the Navigator select File from the menu bar and choose the Export and Import option 2 Inside the Import and Export Wizard select the LSI TrensCenter option 3 You will be asked to locate the OUTCOME TXT file that you created in step 7 above 4 The action will be performed once you press the Finish button NOTE Any data importing problems found during this procedure will be logged into the file Import Log txt that can be found in the Orion Outcomes installation directory You can access this file from within Orion Outcomes from the Help gt Troubleshooting menu You will be notified if errors were logged Quinton Q Tel To export data from the Q Tel system see the documentation provided by Quinton To import the data into Orion Outcomes follow these steps 1 From the Navigator select File from the menu bar and choose the Export and Import option 2 Inside the Import and Export Wizard select the Quinton Q Tel option 3 The action will be performed once you press the Finish button 57 Orion Outcomes User Guide 8 2 6 58 NOTE Any data importing problems found during this procedure will be logge
66. rion Software Development or its suppliers The SOFTWARE PRODUCT is protected by copyright laws and international treaty provisions Therefore you must treat the SOFTWARE PRODUCT like any other copyrighted material except that you may make one copy of the SOFTWARE PRODUCT solely for backup or archival purposes You may not copy the printed materials accompanying the SOFTWARE PRODUCT 5 DUAL MEDIA SOFTWARE You may receive the SOFTWARE PRODUCT in more than one medium Regardless of the type or size of medium you receive you may use only one medium that is appropriate for your single computer You may not use or install the other medium on another computer You may not loan rent lease or otherwise transfer the other medium to another user except as part of the permanent transfer as provided above of the SOFTWARE PRODUCT 6 U S GOVERNMENT RESTRICTED RIGHTS The SOFTWARE PRODUCT and documentation are provided with RESTRICTED RIGHTS Use duplication or disclosure by the Government is subject to restrictions as set forth in subparagraph c 1 ii of the Rights in Technical Data and Computer Software clause at DFARS 252 227 7013 or subparagraphs c 1 and 2 of the Commercial Computer Software Restricted Rights at 48 CFR 52 227 19 as applicable Manufacturer is Orion Software Development 11691 Montgomery Circle Longmont CO 80504 LIMITED WARRANTY Orion Software Development warrants that a the SOFTWARE PRODUCT will perform substantially i
67. rvices and for the quality in health care In its 1991 quality assurance QA standards the Joint Commission on the Accreditation of Hospital Organizations specified a process by which the quality of care should be monitored and evaluated This process involves 1 Identifying important aspects of care and senice provided by an organization or a department 2 Using indicators to monitor important aspects of care and service in an ongoing way 3 Evaluating the care and service to identify opportunities to improve the quality of care and service 4 Taking action to improve care and service or to solve problems and evaluating the effectiveness of these specific actions This process of monitoring and evaluation is performed by most health care organizations or department to meet quality assurance activities required by the Joint Commission In the evolution to continuous quality improvement the ability of organizations and departments to assess monitor and evaluate indicators has improved well beyond peer review and medical audits Improved tools and technology have come together to quickly advance our knowledge of and experience with assessing and improving quality This is especially important in the current health care environment that stresses cost containment and concrete demonstration of quality and performance This growth in knowledge and technology to improve the quality of health care has led to a defined process of continuously impro
68. set to Entry Interval Allows you to filter the patients to only include those that have a specific number of days between the onset date and when the patient enters rehabilitation The calculation uses the onset date in the patient profile and the testing date of the patient s pre program phase Patients must have both of these value entered to be included if this filter is on The purpose of this filter is to correlate delays in beginning rehabilitation with lower outcomes performance Primary Diagnosis Only patients with the selected diagnosis will be included in the report Currently there is no way to filter reports based on the secondary diagnosis as well Referring Physician Only patients referred by this physician will be included in the report This allows you to create a report that you can show to the physicians themselves that will demonstrate the impact your rehabilitation program has had on the health of their patients Rehabilitation Program In the Multi Program Edition of this software you have the ability to choose which rehabilitation program you would like to base the report on Risk Stratification Choices are Low Medium and High Sex Choices are Male or Female Benchmarking Reports Understanding Your Benchmarking Reports On page 1 or the cover of the benchmarking report you will see the report title The report title will read either Standard or Premium Benchmarking Report The Premium Benchmarking Report
69. stem of scoring 50 is the norm Scores above 50 are better and score below 50 are not as good Column one is Your Program data This is the same data that you could generate yourself using the Program Change Summary report at your site The number in the n column indicates the number of patients with data in both the pre test and the post test for this outcome The Avg column is the average mean change in the units of measure for this outcome Between program change in outcomes should never be compared using percentage relative of change The change number may be positive or negative You must interpret whether positive or negative change is good for each particular outcome For example the distance walked in the 6MDW should be positive if fitness improves but negative change in weight is associated with good program performance The second and third column sections read the same Column section two is data from the state or area and column section three is national data The number under Count indicates the number of programs reporting pre and post data for this outcome The Avg column is the average mean change in the units of measure for this outcome in the state area or nation The standard deviation StDev is listed next and is a statistical measure of variability Moving across to the right is the Hi maximum and the Low minimum These two numbers form the range of change among programs in the state area or nation W
70. t support plan The HIPAA privacy regulations address what information is considered to be protected health information PHI In supporting the product Orion Software Development may come into contact with PHI Orion Software Development s internal policies and procedures have been updated to address HIPAA guidelines The following list contains features we will implement to safeguard health information and access to our software products User Authentication e Identity verification for each session unique user ID s and passwords e Automatic system time out after period of inactivity Auditing e Record access to patient information including read only access additions modifications or deletions to electronic information Security e Encrypted database system Code Sets e None of the required code sets are applicable Transaction Standards e None of the covered transactions are applicable Privacy of PHI e The software gives the option while preparing to benchmark to remove confidential patient information from the export package The following information can be removed from the database First Name Last Name Address E mail Phone Number Work Number Nickname Social Security Number Medical Record Number and Account Number e A unique identifier is assigned to each patient when originally created This identifier is used internally during the synchronization process at the benchmarking site Benchmarking outcomes is a part of the
71. th and functioning 114 6 20 9 Social and economic 19 1 22 9 Psychological Spiritual 119 1 22 5 Family 28 5 24 5 Scores of 19 and below usually indicate a poorer quality of life in these areas For this client would think that these scores indicate he she is experiencing a poor quality of life regarding health and functioning indicating there are significant problems here The two subscales of 19 for social and economic and psychological spiritual also indicate there are problems but not as severe The family subscale of course indicates that this client has a high quality of life in this area The total score indicates that this client is experiencing a relatively poor quality of life in general You can also compare the client s own scores with each other over time For example you can compare scores when he enters your cardiac rehabilitation program and then 3 months later Previous studies have shown that a difference of 2 3 points is a clinically meaningful difference A difference of 2 3 points in the total score of the Quality of Life Index has been associated with significant improvement in overall quality of life self image physical symptoms and general health in studies assessing change in quality of life To develop a treatment plan you can examine the individual items in the subscales indicating problems to identify the areas that have the greatest dissatisfaction and are also the most important to the client These would
72. the record of a given patient follow these steps 1 Select the type of program that the patient is in from the Navigator 2 Open the record for the patient by pressing the Edit Patient Profile button on the Navigator 3 Select the name of the patient you wish to delete from the list of patients and click OK 4 Once in the Patient Profile View window select the Edit menu on the menu bar and choose the Delete Record option The form will close and the patient data will be deleted NOTE All data for this patient is deleted permanently and cannot be retrieved Entering Outcome Data To enter outcome data for a patient follow these steps 1 Select the type of program that the patient is in from the Navigator 2 Press the Enter Outcome Data button on the Navigator 3 Select the name of the patient from the list and click OK If the patient does not appear in the list you must add the patient first 4 You may now enter the outcome data on the Outcome Data View Be sure that the evaluation phase selector in the upper right hand corner is on the correct evaluation phase for the data you have collected before you enter the data Press OK when finished Tracking Patient Visits Patient tracking allows for accurate scheduling of the upcoming evaluation dates of returning patients The patient visit schedules are based on the following durations e Pre Program to Post Program 3 months e Post Program to 6 Months from Pre Program 3 months
73. tients who have completed both of selected phases Cancel You have the option of limiting the patients that are included in the report For more information see the section on Filtering Data Report The report looks like the following 37 Orion Outcomes User Guide Cardiac Average Patient Profile Program ABC Community Hospital Date Range Included al dates a Ian Dev Mean Sev Behavioral Domain Enowledge Test 5a 27 BS 6 08 59 2208 6 17 Ggareties Snoked 32 081 2 79 32 091 2 56 Behavioral Compliance Follows Diet 32 431 0 97 32 453 0 72 Follows Medications 32 497 0 18 32 500 0 00 Exercise Activity Days per Week of Exercise 324 2 55 38 376 1 63 Minutes Exrcising per Session 1418 1483 38 Da 21 18 Clinical Domain ey pee TR 4877 Maa TA ARRA im 6 3 2 Cardiac Risk Factor Analysis This report allows you to compare an individual patient against the major cardiac risk factors The data is displayed in a more qualitative method by signifying high medium amp low for each of the risk factors 6 3 3 Continuous Quality Improvement This report will help you evaluate the levels of continuous quality improvement of your program The difference value for each outcome is reported by either month quarter or year Any patient who completes the evaluation phase which is chosen below after the to will be included in the calculation for that month This report takes the outcome data from the two phases for each patient and c
74. try are chosen in the upper right hand comer of the Patient Outcomes View window Be sure to set the evaluation phase selector in the upper right hand corner to the correct phase before entering the data Sharing your data with others Every 90 days the software will remind you to export your outcome data for benchmarking The software will walk you through sending your data by Internet or by mail You should put a Business Associate Agreement BAA in place with Orion Software Development prior to initiating a benchmarking export Orion Outcomes User Guide 2 1 2 2 Installing or Removing Installing the Software Before installing this software on your computer 1 Read the Orion Outcomes Software End User License Agreement that is included at the end of this document 2 Make sure that your package is complete It should contain e Orion Outcomes User s Manual e Orion Outcomes CD ROM e Outcomes Program Manual 3 Make sure that your computer configuration meets the following requirements e Personal computer with Pentium 75 MHz or higher e Microsoft Windows 95 or later operating system Microsoft Windows NT Workstation operating system version 4 0 Service Pack 3 or later e 8 MB RAM minimum 16 MB RAM recommended e 45 MB of available hard disk space required To install Orion Outcomes onto your personal computer 1 Before you set up the Orion Outcomes make sure that your CD ROM drive is properly installed 2 Start the
75. tween showing reminder 90 Next date For export Advance Date FTP SFTP Proxy Server Proxy Server Type Address a Port Sa Login Password cora Name of 3 5 floppy drive You have the option of setting the name of your 3 5 floppy drive that will be used during the export process For most personal computers this drive is labeled A but for some it may not be You may enter a single drive letter here if the configuration of your computer is different Number of days between showing reminder You have the option of setting the interval of days between showing reminder messages for exporting After this interval of time has passed a reminder message will appear as you start the software The only way to quiet this reminder is to perform the export operation Next data for export This is the date when you are responsible for completing your next export The date is calculated from the date of your last export plus the number of days selected in the previous option Advance Date If you do not want to submit your data for benchmarking when necessary you may press this button to increment the date forward If you do not plan on sharing your data you may want to advance the date into the far future so you are never reminded FTP SFTP Proxy Server If your IS IT department has setup a proxy server you will need to get additional configuration information from them to enable Internet benchmarking submissions Wh
76. ue of all patients is shown for each data point 41 Orion Outcomes User Guide amp Create a Change Summary Graph E E x To create a report that summarizes the difference in outcome measurements that your patients achieve select the phases to be analyzed and specify any other parameters Display show Outcomes Filters Title Cardiac Change Summary Graph Date Range Compare Post Program phase data to 10 Years y phase data collected during include all dates from El to E Cancel You have the option of limiting the patients that are included in the graph For more information see the section on Filtering Data 6 3 8 Options 6 3 8 1 Choosing Outcomes You have the option of limiting the outcomes that appear on reports you are creating All of the outcomes are presented within their respective outcome domains Place a check mark next to the outcomes you wish to print and clear the checkmark from those you do not wish to print 42 Analyzing Your Data Display Show Fields Show Outcomes Filters Order By Select the outcomes you wish to display Double click a node to collapse or expand it Behavioral eo Beck Depression Inventory Cigarettes Smoked Days per Week of Exercise Diet Habit Survey Follows Diet Follows Medications knowledge Test o Minutes Exercising per Session y Clinical Body Mass Index 2 gt 748 0 anm Mark A
77. uring the walks the following words of encouragement will be provided at 30 second intervals You are doing Well Keep up the good work Good Job and You are doing fine The monitor will walk behind the patient so as not to influence the patient s pace and will attempt to face the subject only when offering encouragement Patients are told when 2 4 and 6 minutes stop have elapsed Immediately following completion of the walking test have the patient sit down and evaluate for heart rate blood pressure rating of perceived exertion Borg Scale and total distance walked in feet Record the results on the outcome data sheet After the patient has rested for exactly five minutes measure and record their heart rate and blood pressure on the outcome data sheet as the recovery value for the outcome 5 2 10 2 Six Minute Pulmonary Distance Walk 28 The 6MDW should be administered before or at the beginning of the first exercise session of the rehabilitation program and at the last exercise session of the program Walks should take place at about the same time of day at least two hours following a meal and should be the first activity of the exercise session A quiet indoor hallway that is at least 100 feet in length would make a suitable walking location Equipment Outcome Data Sheets Appendix D of the Outcomes Program Manual Rolling distance marker Stopwatch Oxygen saturation monitor Dyspnea Scale Appendix D
78. ving quality Briefly this process suggests that health care quality can most effectively be improved by 1 Focusing on all key components of the organization or department including direct patient care management and support services 2 Coordinating continuous quality improvement processes throughout the organization or department 3 Using valid and reliable performance measures to collect pertinent data and using advance technology analyze and externally benchmark performance 4 Addressing processes and treatment that have important direct or indirect effects on patient outcomes 5 Focusing on opportunities to improve these processes rather than looking only for variance from past performance or outcomes To continuously improve the quality of patient outcomes an entire organization or department from the management to the support services and providers should be committed to a cooperative effort to improve care The opportunities to improve care will mostly be found by examining externally benchmarked outcomes that evaluate the systems and processes by which the patient care is provided Patient Care and treatment outcomes will be improved not by focusing on outliers or the exception but by looking at the processes that compose any key component of treatment in the organization For example the processes involved in rehabilitation ordering rehabilitation patient assessment preparing the individualized treatment plan providin

User Guide - Orion Software Development

Contents

Download Pdf Manuals

Related Search

Related Contents