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Chronicle User Manual - ADA ERP

1. Dimmed inactive elements Chronicle attempts to guide your data entry by only allowing you to enter data into areas that are applicable to what you re documenting For data areas that aren t applicable or that are conflicting Chronicle will dim those elements so that you don t enter erroneous data For example when entering clinical data test results if you check the box indicating that you don t know the date of the test then the Date Performed text box will dim indicating that it is inactive and you can t enter a date If you uncheck the don t know date check box the Date Performed text box will un dim and you ll be able to enter a date Edit pencils Throughout the Chronicle interface a small yellow pencil always indicates something that can be edited When an item has an edit pencil to the left of it clicking the pencil will allow you to edit the item Help links Support submissions Every page in Chronicle has a Help link near the upper right corner of the page There are also help links within most popup windows throughout the site Clicking any of these Help links will display useful information and instructions relevant to the task that you are working on Be sure to consult these Help links if you re unsure about some feature of the system If after consulting the Help link and this User Manual you still require assistance there is a Support link at the top right of every page You can use this to submit support requests to ADA
2. Log In and Log Out Browser requirements Chronicle can be accessed using any modern Internet browser although some browsers offer an improved experience and are recommended This is the list of browsers that are confirmed to work with Chronicle On a Windows based PC e Internet Explorer version 7 0 and above e Firefox version 3 0 and above On a Apple Macintosh e Safari version 3 0 and above e Firefox version 3 0 and above Your computer s display resolution should be set for 1024x768 or higher If you log into Chronicle and some parts of the interface are cut off or seem to continue off the edge of the screen then your resolution might be set too low To change your display resolution when using Windows XP follow these instructions http windows microsoft com en US windows xp help setup change monitor resolution http windows microsoft com en US windows7 Change your screen resolution To change your display resolution when using Apple OS X follow these instructions http support apple com kb HT2490 412 Logging in To being using Chronicle enter this domain name into your web address bar https edu chroniclediabetes com TIP You can bookmark this address for quick access in the future This will bring you to the login page Enter your Username and Password and click Secure Login If you enter an incorrect username or password you will be notified that the information was incorrect If you believe you entered th
3. Filter Reports allows you to view a subset of your patient population that meets a defined set of criteria Filter Reports can be created customized and then saved for quick recall If the Filter Report that you would like to view has already been defined select it from the drop down box and click the link to load the selected report This will allow you to view the various steps that were used in creating the report If all of these steps are correct you skip to Step 5 and run the report To alter any of the steps click the edit pencil above the step s information If you do make changes to an existing report you can save the changes by clicking the Save link at the top of the page To create a new report click the Create new Filter Report link in the left navigation pane This will load each of the steps that make up a filter report In this example we ll assume that you would like to get a list of all of your elderly female patients with an Alc above 8 For Step 1 you will give the report a name Click the Update Report Name link to open the Report Name window If you choose to save this report the name you give it will be what is displayed in the drop down box for future access so give the report a unique logical and succinct name For example you might name this report Elderly female high A1c For Step 2 you will set up the filters that will define the subset of patients in the report Click the Select Filters link to open the Adva
4. among all of the educators at your site and among all sites in your program so changes you make to it are available to everyone within your program You can access and manage this list from a number of locations from the Provider Physician section of a patient s General Information page from within the Create New Patient window or when identifying a Provider for a new Test Result under Clinical Data and Labs The Select Provider window will display a list of the current providers To add a new provider to the list click the Add Provider button to bring up the Create New Provider window Only the First Name and Last Name are required however additional information you enter here can be used in other sections of Chronicle For example Chronicle can generate letters that are addressed to patients providers If you have multiple providers working at the same site you can create that site using the Provider s Site interface Click the Se ect Site link to the right of the Provider s Site text box to bring up the Select Provider Site window Add a new site by clicking the Add Site button and entering the site s information Once you ve created the site you can assign the provider to that site by clicking on the site s listing and then clicking the Se ect Site button After you ve entered all of the information for the new provider click Save Changes to close the window You can then select the new provider from the list and click Se ect Provi
5. 2 are selected meaning that in this example Age Gender and HgbA1c will be checked and thus will be included as columns in the resulting report To add additional columns to the report check the box next to the desired information e g Patient Name Home Phone When you have selected all of the data that should appear as columns in the report click the Select Report Fields button to close the window Note that the Step 3 box will update to show the data fields that you just selected Step 4 allows you to define the date range of patents to include in the report You can limit the report to only include patients who were seen by an educator within a specific date range For example if you set the date range to be the last three months then only patients with an education session will be included in the report By default the range is within the last year but you can enter other ranges If you d like the report to include all the patients in the system check the box for Option 2 When all of the steps have been defined you can preview the resulting report by clicking the Preview Report Results link This will open a results window showing the results of your report Note that it may take a number of seconds for this window to open and load depending on the complexity of the report you defined You can close this window when you are done looking at the preview To export and download the report click the Export Report Results to Excel link whi
6. ATT After you have entered the information click Save Changes You ll notice that the new class session is added to the list If your class will be meeting four times you ll repeat this process four time to define the four sessions If you need to change any of the information about the session click the editing pencil to the left of the session name After you have defined the class sessions you ll notice that they are listed in the Class Schedule box with a number and a color to the left of each session These colors and numbers will be used in the other tables below as column headers to represent the sessions Editing or deleting an existing class session If you need to delete a session e g if a session had to be canceled click on the red delete icon to the right of the specific session that you d like to delete After you confirm the deletion the session will be removed If you d like to edit an existing session e g if a session had to be rescheduled or you want to rename it click on the edit pencil to the left of the specific session that you d like to edit which will open the Update Session window Make any necessary changes and click the Save Changes button Entering and editing the class roster Every class has one or more patients each of whom is listed on the class roster To add patients to a new class begin by clicking the Update Roster button which will open the Update Class Roster window This window uses Chroni
7. ERR A RR FR RR Ri Re E TR e 8 Generating Patient Eettets oie eun da oh daca wen a R TR a nnne a alae adv oe ior e x e E RAI a ERR 9 Patient RE POMS ordures terre reete prr vide rr ER E cals cede vdeo FM IER deka ede we EM ARR Se awe RE PRI E OP er ES 9 Snapshot Repotd scere e e vere cce ea rae o o P eae o o P v E Y 10 Diabetes Self Management Education Record Repot sssssssssseneen nnne 10 Managing patient cCohoEts 5 cs hare dep re i caved AREETA KARAER AE P seek leva es a REN PR oe verra enda 10 Viewing an individual patient s records ce ccce cece eee emnes 10 General Information ciere cez cese eden e Rr dr NIENTE RR AAIEN ER AEREE EN A a RR ELA TEEAR EN E TERAT CEA 10 Resetting a patient s username or password ccc cec cece eee eee nen nee emen nns 11 Modifyirig a patient s PHYSICIANS cocer Ye ces x o ces RE E A 11 Managing a patient s referrals csse eene meses messen nnn 11 Managing a patient s educational sessions sess enne nnn 11 Managing a patient s Collorts cc DRE OR a X ENTE ex RR d x RT ce AR Pea 12 DSME ASSESSMENE er 12 Health Status i5 eee rece xlv ced eee oe Xe Reb e Ed ea n be d aay eon ori E 12 Behavior Change Ob Jectives e eee he x x e ex e Y EHE X ee e Y ex ER Yd Pu e v e n t 12 Adding a new baseline Behavior Change Objective ssssessssssssseeen nmn 13 Updating the status of an existing ODjECtIVE ieee cec
8. Education tab To quickly access a patient s existing class click on the Edit pencil to the right of the class name This will open the class s Diabetes Education and Progress Record DEPR For more information about editing the DEPR see the sections Adding a New Class Documenting a DSME class and Documenting patient follow ups under Class Administration If you d like to simply create a new class click on the link Click to create a new class above the Education Summary box Managing a patient s cohorts If a patient is a member of any cohorts these will be displayed in a list at the bottom of the patient s General Information page Next to each listed cohort is an Edit link that allows you to quickly edit the name of the cohort and the patients that are in that cohort DSME Assessment Clicking the DSME Assessment tab from the left navigation pane displays a page with information about the patient as it relates to diabetes health All of the information on this page will be populated by responses the patient gave on their initial patient self assessment PSA The Health Risk Assessment HRA completed date at the top will reflect the date that the patient completed the PSA If the patient did not complete a PSA then this page will not contain any information and can be filled out manually based on the information you gather from the patient Any of the information on this page can be edited by clicking on the Edit pencil to th
9. Note that the format of the results will be specific to the type of test E g HBA1c requires a numerical value whereas Flu Vaccine simply lets you indicate it was performed e Date Performed The date that the test was performed If you are unsure about the date that the test was performed enter an approximate date and check the date is approximate box to indicate that uncertainty If you don t know the date at all check the do not know the date checkbox to indicate that you don t know e Source of data Each data point entered into Chronicle is required to have its source indicated as well Select the source from the drop down list If the source of the data isn t listed in the drop down you can indicate it as Other Select Other verified if the data source is considered reliable Select Other unverified if the data source suspect or unknown e Notes Any additional notes about this specific test result e Provider Click the Select pencil to open the Select a Provider window Select a provider and then click Se ect Provider If the provider who provided the test result is not already in the database you can add them by following the instructions in Primary Provider and PCP Management under Other Administrative Tasks When you have entered all of the information click the Save Changes button to save the test result If the value you just entered is the most recent value for that test then the new value will be displayed in
10. educational sessions e Documented assessments of individual patient comprehension both pre and post education and also at follow up All education is referred to as a class even if the education was conducted 1 on 1 A 1 1 DSME event is just considered a class that has only one person in it All classes consist of one or more educational sessions A patient can be in zero one or more classes In Chronicle all classes are documented in a tool called the Diabetes Education and Progress Record DEPR View complete list of classes The Class List page gives you a list of all of the classes currently entered at your site Note that if you already have a class record open you will have to click on the Return to Class List button to return to the full list The list of classes is shown in groups of 25 Use the navigation at the top right of the classes list to page through all of your classes To search for a specific class enter into the Search box any part of the class s name Click on the X to the right of the search box to clear the search and see the full class list In each class row listed in the Class List is a link to Generate Letters This will allow you to generate a letter for everyone in the class This function is discussed in detail in the section Generating Patient Letters Clicking on a single class line will open that class s record Creating a new class or new 1 1 IMPORTANT If you are assigned to multiple sites within
11. in the left hand list to move them to the right hand list Conversely to remove a patient from the letter list click on her name in the right hand list to move them back to the left hand list Once you have the all the patients for whom you want letters in the right hand list click the Preview Letter button If this preview looks correct click Download Letters in the upper right corner You will be prompted to save the letter file to you computer Once this file has been saved to your computer you can open it in Microsoft Word or other text editing application where you can edit it apply your letterhead and print it If you d like to create a new letter or if you d like to edit an existing letter click the Launch Letter Manager link either from within the Letter Wizard or from the left navigation pane in a patient s record This will allow you to modify the letters that you site has stored in Chronicle For details about editing and managing letters see the section Letter Management under Other Administrative Tasks Patient Reports There are a number of preconfigured reports that you can generate for a patient Select the desired report from the drop down box and click the Generate button This will open the selected report in a new window Reports can be printed out using your computer s normal printing method Snapshot Repot This report gives an overview of the data about a specific patient The left column contains lists of t
12. main middle section of this page will be empty and the full list of Available Tests will be displayed on the right side of the page As test values are documented those values will be displayed in the main middle section and the test will be removed from the Available Tests lists Each listing in the main middle section lists a test and the most recent results for that test By clicking on a specific test line the listing will expand down so you can see a complete history of results for that test If there are multiple historical test results recorded for a test then clicking on a specific test result will expand that result down and reveal additional details Tip When a patient completes an initial patient self assessment PTA they are able to enter test results for a few of the tests Adding a new clinical data or lab test result After you have gathered clinical data or lab results for a patient you can enter both the most recent values as well as historical values into Chronicle To enter a test result for a test that doesn t have any previous data begin by clicking on the test s name in the Available Tests lists Alternatively if the test already has one or more previous results and you re going to be adding another test result click the Add Results link to the right of the test s name Doing either of these will bring up the New Lab window Enter the following information Test result This is the result of the specific test
13. not have access to the email account that you previously registered with Chronicle you ll need to contact your Program Coordinator and have the password reset manually Switching between sites Each educator can be assigned to one or more Chronicle sites Each of those sites has its own patient population and classes When you are logged into Chronicle you can only see the information patients education sessions etc for a single site The name of the site that you re actively viewing is shown in the lower right corner of the window Even if the program coordinator for your program has assigned you to multiple sites you can only see the information for one site at a time To see information for a different site that you are also assigned to you must switch to viewing that site To do this click on the name of the current site in the lower right corner of the window which will bring up a box displaying the names of all the sites that you are assigned to Click on the name of the site that you would like to view This will switch you to that site Note that the patient list and education list have changed to show the information for this site When you log out of Chronicle the system remembers which site you were viewing last and will return you to that site the next time you log in If you are currently only assigned to a single site then you are not able to switch sites Nothing will happen when click on the name of your site in the lower righ
14. patients has started or completed the online PSA that status will be indicated here Alternatively if you manually entered a date that the Health Risk Assessment HRA was completed on the top of the patient s DSME Assessment page then the PSA status will be shown as Completed If the patient did not start or complete the PSA and you didn t enter a date that the HRA was completed then the status will be shown as Not Started Exporting a patient list for a class After setting up the class you might want to export that list of patients into an Excel format Once you ve export the list you could then use the functionality in Microsoft Word to do a mail merge and create letter or mailing labels for the class Below the Class Roster and Attendance box is a link to Export Patient List Clicking this link will prompt you to download an Excel file that contains information about each patient on the class roster Sending letters to every patient in a class After setting up the class you might want to send welcome letters to every person in the class These letters can contain information about the upcoming class as well as individualized information for each patient If you re already within a class record you can click the Generate Letters link below the Class Roster and Attendance box Alternatively if you re on the Class List page you can find the row for desired class and click the Generate Letters link This will bring up the Let
15. the center table Adding multiple clinical data or lab test results using a Lab Sheet If you are going to be entering multiple clinical data or lab test result values that all share the same common information you can use a Lab Sheet to speed the entry Click the New Lab Sheet link in the upper right above the Available Tests lists This will bring up the New Lab Sheet widow Enter the common information at the top of the window and then fill out the all of the clinical data or lab test results that you have Note that all of the data entered on the Lab Sheet will share the same Common Information Also when the Lab Sheet is saved the individual test results are all stored individually they re not stored as a single lab sheet Thus using a Lab Sheet is really just a way to automate the process of adding multiple individual clinical data or lab test results Editing or deleting an existing test result Typically you won t need to edit or delete an existing test result new test results should be documented by adding a new clinical data or lab test result not by editing existing results The only time you should edit existing test results would be if you made a mistake entering the information or if you needed to add missing information To edit an existing test result begin by clicking on the test in the main middle section which will expand the test down to reveal the historical results Click on the specific test result that you d like to edit
16. to education This will typically be very low e Objective Status Since this is the initial start of this objective select Baseline e Objective Update Date Enter the date that you negotiated this objective with the patient e Barriers for this objective were addressed Check this box if you discussed barriers towards meeting this objective when you met with the patient e Notes optional Any other information that you d like to document specific to this patient s objective When you have completed this information click the Save Changes button to add the objective This will add the objective to the Behavior Change Objectives page with the objective area listed in bold and the baseline objective status listed a line below Updating the status of an existing objective After you have followed up with a patient and have gathered information about one of her objectives you can document this by adding a new Objective Update to the objective Begin by finding the objective name that you set up during baseline Then click on the Update this Objective link to the right of the objective name which will open the Add Update Objective window Note that the Objective Plan and Expected Outcome are already pre populated with the information that was entered at baseline If any of these have changed you can edit the information to reflect the changes You are required to enter a new Assessed Objective Achievement to indicate how the patient has prog
17. which will expand that individual result and then click the Edit pencil icon This will open the Edit Lab window where you can make any necessary corrections and click the Save Changes button If you had previously entered an erroneous test result you can delete the test result Click on the specific test result that you d like to delete and then click the red Delete icon and confirm the deletion in the following box Medications Clicking the Medications tab from the left navigation pane displays a page that lists all of the medications that the patient is taking or was taking in the past Each listing in the center table lists a medication and the most recent information about that medication By clicking on a specific medication line the listing will expand down to reveal a complete history of Medication Change Events for that medication Clicking on a specific Medication Change Event will cause it to expand down and reveal any notes for that event Adding a medication After you have gathered the medications information for a patient you can enter both the patient s current medications as well as historical medication or medication change events into Chronicle To enter a new medication click the Add New Medication link near the top right of the Medications page to bring up the Start New Medication window This box allows you to enter a new medication for this patient The Quick List on the right contains medications that you ve pre
18. Chronicle User Manual Version 2012 04 19 Chronicle User Manual eter iat elated ele aed eigen 1 GIOSSARY MEE 3 General terminology and conventions in Chronicle manual ccceeee cece e eee eee e tense tenet enn 3 Eog In and LOG QULA ep M M M Seles IM E Lp I Le M e M ILE EE TE 5 Browser equiremeltits a eer Ee REPRE av A ERR t vex nde T RR EM REX NI M ne EN EE M Re UEpEV M n da Es 5 lWerciellatoil or EEUU 5 Recovering a forgotten username or password cessssssssesssseee enm 6 Switching between sites orici RARE ERR hes AIA FRERE RER E PR ERERRRERORRINRRY AR CIAA CAPTAREA 6 IWere cllafopo U nite EE 6 Patient AdministratiOn cioe eczema pera cta eer dec adebladectasebe guia ERR adda De eir n EAT ballon ed ea DERE 7 Creating a New Patient oe Lee trece aereum ae reser dk ce dale aie RE ea EEEE n been BER nex E YER RR Rue 7 Patient login and password creation csse 7 Patient s Primary Provider and PEP sieurs enion a senses se seen 7 Assigning the patient to a Cohort eiciser nieras tren iser LEE AAEE ECAs EREE EE EEE ae 7 Creating a patient referral ccccceeesceeeseeeeseeeseeeeeeeesseeeseeeeseeeeaeeesseeeeneeesenenantesgenesneneges 8 Saving the Patients csse cciam ee oce Ex eed xeu epe eK EA Geb aleve i n LA dak ee e o o degen 8 Patient List VIG Wu deer esee rer tealv ais err eir re Rr dale aie AM erre e t ais EE rig re n EX t RE Renee Ms MEA RES 8 Patient Filters 21 esee Ee Reg rx x GEH RR Pea x ee e NR Car RN RR
19. This window lists all of the providers that are currently entered for your site To select a provider click on the provider s name and then click Se ect Provider If you later want to un select the provider click the red Unassign link to the right of the Primary Provider PCP text box For more information about adding providers and managing the provider list see the section Primary Provider and PCP Management under Other Administrative Tasks Assigning the patient to a Cohort Each patient can be assigned to one or more cohorts Cohorts are not related to educational classes they are simply a way to categorize patients into groups of similar patient types For example you might set up an Insulin Starts cohort and assign all such patients to it so that you can maintain an ongoing list When initially creating a new patient you can assign her to a cohort Click the click the Se ect pencil to the right of the Assign to Cohort text box to bring up a list of all cohorts that have been created at your site and select the cohort from the list If you later want to un select the cohort click the red Unassign link to the right of the Assign to Cohort text box For more information about adding cohorts and managing the patients in each cohort see the section Managing patient cohorts under Patient Administration Creating a patient referral If the patient was referred to your site and you would like to record that referral you can docu
20. a class met for four sessions you might have taught Using medications safely during the second class session You would have documented this in the Lesson Plan for session two If patient Nancy Henderson missed session two and you don t update the Attendance table to indicate this then Nancy s education record will show her as having had education on Using medications safely during the second session However if you update the Attendance table to show her absence then her overall education record will not include Using medications safely unless she made up the education by attending another class or session that covered it By default all patients are marked as ATT attended for each class session If all of the patients on the roster did attend each session then no further updating to the attendance list is required However if some patients were absent then you ll need to update the attendance list To begin click on the General Information tab in the left navigation pane The Class Roster and Attendance table lists each patient and their attendance status under each of the colored session columns To update this information click the Update Attendance link above the table which will open the Update Class Attendance window Each patient on the class roster is listed and there is a column for each of the class sessions Under each session column is listed the attendance status for each patient To change a patient s attendance status for a cla
21. a patient status from the Patient Status drop down will limit the list to show only patients of that status Selecting a cohort from the Limit results by Cohort drop down will limit the list to show only patients in that cohort Click on the X Clear Filters link to the right of the boxes to clear the search or filter and see the full patient list In each patient row listed in the Patient List are links to create a Snapshot Repot or to Generate Letters These functions are discussed in detail in the sections Generating Patient Letters and Snapshot Repot respectively Clicking on a single patient row will open the complete record for the patient Patient Filters The Patient Filter allows you to view a subset of your patient population that meets a defined set of criteria Filters can be created customized and then saved for quick recall If the patient filter that you would like to view has already been defined select it from the drop down box and the patient list will update to show only the patients meeting the defined criteria From here you can interact with the patient list normally scroll through the list click a patient to open the patient s record etc or you can export the filtered patient list into an Excel file by clicking the Export Results link To return to the full list of patients click the Clear Filters link To create new patient filter first click the New Filter link to open the Advanced Patient Filter window Here
22. an use the calendar widget to enter the date Begin by clicking the calendar icon to the right of the date box This brings up a mini calendar To select a specific year click on the currently selected year to display a list of all years then select the desired year from the list To change months use the left and right arrows at the top of the calendar to change months Finally click the specific day of that month This will close the calendar widget and copy the selected date into the date box
23. at template When you are done managing the templates click Finish and Close Window to return to the Class List Creating a new Class from a Class Template To create a new class form an existing class template select the class template from the dropdown list in the Class Templates section of the left navigation pane then click Create Class From Template This will open up the Create Class from Template window with all of the information from the template already populated into the class Here you can add any additional information making sure that all required fields with red underlines are completed Note that if your class template included one or more sessions you will need to fill in the session date for each session When all the class information is correct click Save Changes which will create the class and automatically open the class to the General Information page Next you can follow the normal class creation process by updating the patient roster For information about editing the patient roster and documenting the education see Entering and editing the class roster and Documenting a DSME class Reporting In addition to the static patient reports described in Patient Reports under Patient Administration Chronicle provides a powerful way for educators to extract data about their patient populations Filter Reports Filter reports To access the filter reports section click on the Reports tab in the top navigation bar
24. ate will share the same Class Type Education Format Location and Language and Instruction Method but will differ on the Education Materials provided then fill out all of the common fields The Class Sessions tab allows you to define the sessions that each class will have In our example the class template will have three sessions on Monday at 9AM Check the check boxes to the left of the first three sessions For each session give it a name intervention type duration time and a note All of these are optional in the template and can be added later when you re creating the class The Educator Time tab allows you to define how much time each educator will contribute to each of the sessions The Lesson Plan tab allows you to define which educational topics will be covered during each of the sessions The Class Note tab allows you to enter a note that will apply to all patients in the class All of the information on all of the template s tabs is optional but will speed the creation of classes in the future Also any information you enter in the template can be later modified after you have created the class When you are done entering all of the information for the class template click Finish and Close to return to the Manage Templates table If you ever want to edit an existing template click on the template s name and click Edit Selected Template Note that editing a template does not modify classes that were previously created from th
25. below those tabs bar is a box where you can generate Patient Reports Select a report from the list and click the button below to generate that report Below that is the Generate Letter box You can select a letter from the list and click the button below to generate that letter General Information Clicking the Genera Information button from the left navigation pane displays general information about the patient Any of the data on this page can be edited by clicking the pencil above that section of information Resetting a patient s username or password When you add a new patient to Chronicle the system automatically sets up a username and password for the patient By default the username and the password for a new patient are the same For example if you add patient Nancy Johnson if her username might be nancyjohnson12 then her password will also be nancyjohnson12 Thus if the patient hasn t logged into Chronicle patient portal yet then you can just tell them to use the same thing for their username and password The first time the patient logs into Chronicle they are required to change their password If the patient later forgets what they changed the password to you cannot retrieve it for them instead you need to reset it for them Again you cannot retrieve a patient s password you can only reset it To reset a patient s password on the General Information page in the Login Information box click the pencil next to the Web Log
26. ch will prompt you to save the report to you computer ERP Site Report The ERP Site Report is designed to provide a report that shows cumulative data for your site in all of the areas necessary for ADA ERP recognition This includes demographic data about your site s patient population educational information behavioral outcomes and program outcomes Since you can run this report at any time it allows you to assess how well your site is gathering the data necessary for ADA recognition Additionally your program coordinator can log into the ADA ERP portal and run this report for any site in your program or cumulatively for all the sites in your program To generate an ERP Site Report click the ERP Site Report link in the left navigation pane This will provide you a window where you can define the report period for patients that should be included in the report The report period defines which patients should be included in the report Based on the report period there are two ways that a patient can be included when calculating the values in the report e If the patient had education A patient will be included if she attended any class session during the report period I e if the patient was on the roster for any class session where the session s date in within the report period and the patient s attendance is marked as ATT for that session e If the patient had a behavior change objective added or updated A patient will be include
27. cle s standard patient selector The column on the left Recently Added Patients lists all of the patients that were recently added to your site The column on the right Current Roster lists the patients that are members of this class Alternatively you can search for a specific patient on the left To add a patient to this class find her name in the left column and click on her name This will move the patient from the left column to the right column thereby adding the patient to the roster for this class To remove a patient from this class s roster click on the patient s name in the column on the right When you re done click the Save Changes button to close the window For more information about using Chronicle s patient selector see the section Patient selection interface under Other Administrative Tasks After you have entered the patient roster you ll notice that they are listed in the Class Roster and Attendance box with the word ATT meaning attended listed in each of the session columns Chronicle defaults to attended since it is assumed that at the time patients are scheduled they are planning to attend every class session If some patients do not attend a class session you can document this via the Update Attendance window For more information about documenting attendance see the section Documenting patient attendance under Class Administration Also displayed in the Class Roster and Attendance box is each patient s PSA Status If the
28. d if she has any behavior change objectives added or updated recorded during the data period If a patient did not have an educational session or a behavior change objective within the data period then that patient will not be included when calculating the values in the report The report has the following sections e Total number of participants during data period This is the total number of patient that were included when calculating the report based on the report period criteria explained above If a patient was included in the report because she had either a clinical data point or a behavior change objective but did not have an class session then she will be counted as Education not documented and the patient s Chronicle ID will be listed at the bottom of the page for your reference e Average hours of DSME received by participants during data period These numbers are calculated based on the length duration of all attended class sessions divided by the total number of class sessions e Age of participants receiving DSME during data period These numbers are based on individual patient demographics Diabetes type of participants receiving DSME during data period These numbers are based on individual patient demographics Race ethnicity of participants receiving DSME during data period This information is based on individual patient demographics Special needs of participants receiving DSME during data period This informa
29. d click the Save Changes button If you had previously entered an erroneous medication you can completely delete the medication from the patient s record Click on the specific medication that you d like to delete and then click the red Delete Medication icon and confirm the deletion in the following box Recording a stop medication event If a patient is no longer taking a medication that they had previously been prescribed you can document this information by recording a stop medication event Begin by clicking on the medication s name in the main medication table Then click the Stop Medication link to bring up the Stop Medication window Enter the date on which the patient stopped taking the medication and any associated notes When you have entered all of the information click the Save Changes button to save the stop medication event You ll see that the medication has been removed from the Current Medication table down into the Stopped Medications table Creating a new custom medication If a patient is taking a medication that is not already in the database you can manually add the medication to your site s medication database so that it will be available for future use Begin by trying to add the medication to a patient s record click the Add New Medication button to bring up the Start New Medication window Type in the Trade Name and if the medication isn t already in the medication database you ll be presented with no matc
30. der to close the window If you need to edit an existing provider select the provider from the list and click Edit Selected Provider Make any necessary changes and click Save Changes Letter Management Chronicle can store numerous letter templates that can be used to generate letters for your patients To manage those letters launch the Letter Manager by clicking the Launch Letter Manager button from within a patient s record or when on the Education tab by clicking the Generate Letters link for a class and then clicking Launch Letter Manager From here you can edit an existing letter create a new letter or delete an existing letter To begin editing an existing letter select the letter from the Chose a letter to load drop down list at the top of the wizard That will load the letter template in the main text area Edit the text of the letter using normal text editing steps type delete etc To format text select a section of text and use the formatting bar directly above the main letter area to boldface italicize underline justify or indent the text To insert a custom tag e g current date patient s name etc that will be replaced when the letter template is merged with patient data start by positioning the cursor i e move the blinking vertical cursor bar where you would like the tag to go Next click on the Insert Custom Tag menu and then select the tag you would like from the menu This will insert a yellow tag into the le
31. dministrative Tasks ied ive eee eee eeu SR nee n Y nex SER Er en EY Y ssa REESE ne Rein 29 Primary Provider and PCP Management sssssssssesee eese need 29 Letter Management cere reete ede a eis Ere Ud esu E dee 29 Patient selection interface eeesseseiseeisseeeseeee sehn annehmen assa a seda asas aae a area nnne 30 Date ENV side p wxeni e eI a se prex E E RAN EUR Wate ERR ETIAIN a re nR MER A EAA peewah edie 30 Glossary Site Under ADA recognition a recognized program may have or more sites associated with it ADA has two different site types either multi site or expansion site For the purposes of Chronicle there is no difference between these types all sites are the same A site consists of a number of patients and those patient s educational documentation Each patient is associated with one and only one site A patient cannot be associated with multiple sites An educator can be associated with one or more sites Initial Patient Self Assessment PSA A screening questionnaire that can be completed online by the patient prior to receiving DSME Diabetes Education and Progress Record DEPR The documentation tool used to record all information about a class including the class s patient roster attendance topics covered and educator time spent with the class Patient follow up information is also stored in the class s DEPR General terminology and conventions in Chronicle manual Collapsing and expand
32. e information incorrectly you can re enter your username or password If you don t remember your username or password click the Forgot your username or password link and follow the instructions under Recovering a forgotten username or password to reset your password After five consecutive login failures your account will become suspended for five minutes If this happens wait five minutes and then you can attempt to log in again Please note that each Chronicle user has a unique user account with his or her own username and password This account is used to document everything you do in Chronicle so for security and HIPAA compliance it is important that you never log in using another person s account information never share accounts and never give your account information to anyone else If you suspect that someone else has information about your account credentials you should ask your Program Coordinator to change you password immediately Once you have logged in you ll notice your name will be displayed in the lower left of the screen and your site s name will be displayed in the lower right of the screen Recovering a forgotten username or password If you forget your username or password click the Forgot username or password link on the login page This will allow you to enter your email address and have an encrypted link emailed to you Click this link to be taken back to a page where you can reset your password If you do
33. e right of the section name If you do fill out the HRA on behalf of the patient you can enter the date that you completed the HRA into the yellow box at the top of the DSME Assessment page Once this date has been entered the HRA PSA is considered complete Health Status Clicking the Health Status tab from the left navigation pane displays a page with information about the patient as it relates to their current and recent health status All of the information on this page will be populated by responses the patient gave on their initial patient self assessment PSA If the patient did not complete a PSA then this page will not contain any information and can be filled out manually based on the information you gather from the patient Any of the information on this page can be edited by clicking on the Edit pencil to the right of the section name Behavior Change Objectives Clicking the Behavior Change Objectives tab from the left navigation pane displays a page that lists all of the patient s behavior change objectives including a full history for each objective At the top of the page are two Personal Goals which are questions asked of the patient during the PSA Below that the Objectives section allows you to document how the patient s objectives and her adherence to those objectives change over time You begin by adding a new baseline objective to the patient s record and indicating an achievement level When you next follow up with the
34. ent on each class session The table lists all of the educator associated with your site Note that if there is an educator or other staff member at your site that is not listed in the table you will need to ask your Program Coordinator to add or associate the staff member using the ADA ERP portal For each educator that contributed to the class check the box to the left of their name Then under each session that they contributed fill in the number of minutes under the appropriate session column Note that you can have more than one educator contributing to a class session and each educator can contribute to more than one session Once the first educator s times have been entered repeat the process for each additional educator that contributed time When all of the educators have been entered and all of their time contributions documented click the Save Changes button to close the window Documenting patient follow ups When it s time to conduct patient follow ups e g 3 6 months after a DSME class Chronicle provides a concise way to document patient adherence to the learning objectives and progress towards their established behavior change objectives Follow up documentation is done on a patient by patient basis within the class DEPR as recommended by the ADA The DEPR for the class a patient was in can be accessed one of two ways If you re already within the main Education section of Chronicle you can select the appropriate class from the Lis
35. f you only know the approximate date that the patient started on the medication click Date is approximate If you don t know the date at all click Do not know start date and don t enter any date e Frequency Enter the frequency with which the patient takes the medication e g b i d Note that the box will auto complete the entry with common abbreviations as you type If the frequency is not listed you can just enter it into the Frequency box e Notes Enter any additional notes related to the medication s start If the medication that you just entered is one that you believe you ll be using frequently you can add it to the Quick List by clicking the link Add medication to favorites link next to the medication s name This will add the medication to the Quick List and give it a solid star meaning that it will remain in the list until you decide to un favorite it You can un favorite a medication in the Quick List by clicking the solid star making it an empty star Note that the medication will likely remain in the list for some time since the list shows all recently used medications In the future you can quickly load a medication from the Quick List by simply clicking on the medication in the list When you have entered all of the information click the Save Changes button to save the new medication Recording a medication change event If a patient s prescribed medication regiment changes e g the dosage or frequency of a medicat
36. formation click Save Changes You ll notice that the Class Information box is updated with the information you entered Defining Class Schedule Each class consists of one or more class sessions Each class session occurs at a specific date and time and can have specific educational topics documented as being taught during that session For example if the class you are creating will meet four times e g every Monday at 10AM for four weeks you ll define four class sessions These sessions will be listed in the Class Schedule box Initially this list is empty for new group classes 1 1 classes will list the initial session you defined when you set up the 1 1 To add a new class session click the Add Session link above the Class Schedule box which will bring up the Create New Session window This session should have a descriptive name Examples of session names could be Initial assessment Introduction and MNT or simply First session You can also enter the date and time that the session will occur which will allow the system to include this scheduling information when you generate a letter to the patient Finally you must enter the type of intervention DSME or MNT and duration length in minutes and hours of the class session Optionally you can enter a Session Note that will apply only to this session and will only appear on a patient s record if the patient attended this specific session e g if the patient s attendance is listed as
37. g or deleting an existing class session esses 20 Entering and editing the class roster sssssssssseeeeseeeesee nennen nana nhan ena anna nhanh nn 20 Exporting a patient list fora class eic e e ERR RR RE XNRAERREVAN ERRARE ANE taeda 20 Sending letters to every patient in a class 2 ieee cece nnn tae 21 Doc menting a DSME la55 5 rete torio oce e eROE Ie OO e e PROF EQ roro ee PROFERRE 21 Defining the lesson plan for the ClaSS ccc mI emnes nene enn nnn 21 Documenting individual patient educational progress barriers and support plan 21 Documenting additional comments and notes ssssssssssssssseee nemen nene nnn nnn 22 Documenting patient attendance ssssssssssssssssssssees eese emen meses nen nn 22 Documenting educator time spent with class ssssssssssessseeee emen nnn nns 23 Documenting patient follow ups erreira aaae E nmn nma nna anna area sea anna sna ananas 23 Managing and using Class Templates sssssssesssseessseee nensem seen 24 Creating a new Class Template ie ooe e Berar tir ENA esee nnns nans nna nma sn aa sna anna nna 24 Creating a new Class from a Class Template ssssssssessseeessee enne 25 REPOMIAG EMIT 26 Filter reports avv ARES Sy as ovate vie seas dana ri aes bene Se Baas Wie as PAARE RR Dex RN RM PAARE RR dea YTEAA 4d IA 26 ERP Site RE POM ore ona ele ete estat tele ter a odd ial as erc eU E Sere Li a atte S 27 Other A
38. he patient s current medications recent interventions topics that were covered during the educational sessions and the patient s goals and their change rate The right column of the report contains clinical data with historical values listed in a table and a graph displaying the change over time Diabetes Self Management Education Record Repot This report contains the information that was documented for the patient s educational session s This includes the pre assessment and post evaluation of the patient s ability in the nine ADA topic learning objectives class methods and materials barriers and DSMS plan All of the educational information included in this report will represent the most current information documented in Chronicle For example if the patient attended multiple education sessions over a period of years the information on this report will display the information from the most recent sessions Managing patient cohorts Cohorts can be assigned when you first create a new patient or you can add and remove patients from cohorts afterwards When on the Patient List page click the Manage Cohorts button located near the upper left of the window This will bring up the Manage Cohorts window with a list of all of the cohorts currently set up at your site If you d like to add a new cohort click the Add Cohort button and give it an identifiable name You can select patients from the list to be in the cohort This window u
39. hes but will have an option to click Add a new medication named name Clicking this option will bring up a link that says Click to add name as a custom medication Clicking that will add the medication you entered as a new medication in the database From then on it will be available to all your site s educators in the medication s list in the future Contact History Clicking the Contact History button from the left navigation pane displays a page that allows you to record and view contacts that have been made or attempted with the patient Initially patients don t have any contacts To document a new contact event click New Contact Event which will open the Patient Contact History window Enter a date for the event select the Reason for Contact and the Result of Contact If the results was Did not reach select the Reason for not reaching If there is any other information that you d like to record you can enter it in the Notes box When you are done click Save Changes This will add the contact event to the list of events for the patient You can also edit or delete existing contact event using the Edit and Delete links Notes Clicking the Notes button from the left navigation pane displays a page that allows you to record and view free text notes about the patient Initially patients don t have any patient specific notes To add a new patient specific note click Add New Note which will open the Add Edit Note window Enter a date for
40. in heading You can then reset the password or enter a new password for the patient It is highly recommended that you reset the password since this ensures that the patient will be able to change it when she next logs in To do that simply check the Reset patient s password box and click Save Changes If instead you would like to manually enter a new password for the patient uncheck the Reset patient s password box and enter the same new password info each of the two boxes Modifying a patient s Physicians Each patient can have two providers assigned to her This information can be entered when you initially enter the patient into Chronicle or you can enter or modify the information on the patient s General Information page To change this information or to add it if it hadn t already been set click on the Assign pencil above either the Primary Physician PCP or Physician Responsible for Diabetes Management box This will bring up the list of all providers associated with your site Select a provider from the list and click Se ect Provider If the patient s provider has not yet been entered into Chronicle you can click Add Provider to enter the information For more information about this process see the section Primary Provider and PCP Management under Other Administrative Tasks Managing a patient s referrals Each patient can have one or more educational referrals documented in their record These referrals are listed on the patien
41. ing hiding and revealing menu items Chronicle s interface has many menus lists and data fields that can often be collapsed and expanded or hidden and revealed These collapsible elements will have a disclosure triangle like or V icon to the left of the element name Clicking a collapsed disclosure triangle will cause the to change to a V and the collapsed hidden data will be expanded revealed Conversely clicking an expanded disclosure triangle V will cause the W to change to a and the expanded revealed data will become collapsed hidden Italics text Words in this manual that are in italics font refer to words that are part of the Chronicle interface such as buttons menus and links Underlined text Phrases that are underlined in the manual refer to other sections of the manual Pop up windows in Chronicle interface Many data entry and editing windows pop up above the normal Chronicle interface These don t actually open a new window in your browser Instead they float above with the normal Chronicle interface dimmed out in the background For example when click a pencil to edit information or when adding clinical data When these pop up windows are present you can t access the Chronicle interface below However you can move the pop up window by dragging it by the orange title bar the top of the pop up window Moving a pop up window my help you see other parts of the page that the popup window was obscuring
42. ion that they are on is modified you can document this information by recording a medication change event Click the Record Medication Change Event link to the right of the medication s name which will bring up the Record Medication Change Event window Here you can enter the date that the medication change event took place Then enter the new dosage and frequency for the medication and any notes that you d like associated with the change of this medication When you have entered all of the information click the Save Changes button to save the medication change event You ll see that a new line will have been added under the medication s listing Editing or deleting an existing medication or change event Typically you won t need to edit or delete an existing medication or change event changes in medication should be documented by adding new medication change events The only time you should edit existing medication events is if you made a mistake entering the information and needed to correct it To edit an existing medication or change event begin by clicking on the medication s listing in the center table which will expand the medication listing down to reveal all of the existing change events including the start event Click on the specific change event that you d like to edit which will expand that individual event and then click the Edit pencil icon which will open the Edit Medication Change Event window Make any necessary changes an
43. ist To change any of these filters click the Update Filters link If you would like to save this patient filter so that anyone from your site can quickly select it from the drop down in the future click the link that says Click here to save your changes and give the filter a descriptive name To return to the full patient list click Clear Filters Generating Patient Letters Chronicle allows you to generate custom letters for individual patients or multiple patients at a time The Letter Generation Wizard can be launched from a number of locations within Chronicle including from the main Patient List within an individual patient s record and also within the Education pages If you click the Generate Letters link from within the Patient List the Letter Wizard will be launched For Step 1 select the letter you d like to create from the drop down list For Step 2 select the patient s from the patient selection tables that you would like to receive the letter The table on the left contains a list of Recently Added Patients at your site You can scroll through the patients or search for a specific patient using the search box The table on the right contains a list of the selected patients A customized letter will be generated for each of the patients in the right hand list By default the patient you were viewing when you evoked the Letter Wizard will already be in the recipients list To add more patients to the list click on the patient s name
44. ment that referral here Check the checkbox at the top of the Referra section to enable the referral fields Enter the date of the referral document who the Referring Provider was or if it was a self referral and record a reason for the referral Note that documenting the patient s referral is not required or could be added at a later time For more information about adding and managing a patient s referrals see the section Managing a patient s referrals under Patient Administration Saving the patient If you change your mind and decide not to add the new patient you can click Cance Changes to stop adding the new patient without saving any of the information you ve entered After you have completed all of the information click the Save Changes button in the lower right of the window This will add the patient to your site and will open the patient s record You ll be on the General Information page of the patient s record Patient List view The Patient List gives you a list of all of the patients currently enrolled at your site Note that if you already have a patient record open you will have to click on the Return to Patients List button to return to the full list The list of patients is shown in groups of 25 per page Use the navigation at the top right of the patient list to page through all of your patients To search for a specific patient enter into the Search box any part of the patient s name and hit Enter Selecting
45. nced Patient Filter window where you can add the following three filters to arrive at the desired subset e For the first filter select Demographics from the first drop box and Gender from the second drop box In the third drop box select Is from the list In the fourth drop box select Female from the list This completes the process for defining the first filter e To add a second filter click the green button In the first drop box select Demographics and then select Age from the second drop box In the third drop box select Is greater than from the list In the fourth box enter the value 75 This completes the process for defining the second filter To add a third filter click the green button In the first drop box select Clinical Data and then select HbAic from the second drop box In the third drop box select Most recent value is greater than from the list In the fourth box enter the value 8 This completes the process for defining the third filter When you have all of the filters defined click the Save Filters button This will close the Advanced Patient Filter window and will update the box under Step 2 to show the filters you just defined Step 3 is where you can define what fields the data report should include The report that is generated is like an Excel table where each row is a patient record and each column is filled in with the information you select in this step By default the values you defined as filters in step
46. nd the lesson plan for the class Once a template is defined you can quickly create new class based on this template and then just customize the unique elements of the class e g add patients to the roster set the session dates etc Multiple templates can be set up and used as needed Creating a new Class Template Since documenting both a group class and a 1 1 education are done though the DEPR the process is very similar First make sure you re on the Class List page To create new class template first click the Manage Templates link in the Class Templates section of the left navigation pane This will open the Manage Templates window which contains a list of all of the templates that have been created at your site To add a new template to the list click the Add New Template button Give the template a name that clearly describes the type of class this will be used to create For example if you have a standard monthly class that consists of three sessions taught on Monday mornings at 9AM you might call the class Monthly 3 Mon AM sessions You will now be on the tab where you can define the General Information for the class Fill as much information out on this tab as will be common to all classes created with this template Nothing is required other than the Template Name but the more information you fill out the more information will be pre populated when you create the class For example if all classes created with this templ
47. or the patient Click on the Education tab to show the educational assessment page for the first patient At the to of the page is the Education Plan for the patient Click Edit Education Plan to enter the information Below that is the Patient Education Record All of the ADA learning objectives are listed and each objective that you previously indicated on the Lesson Plan page will be active un dimmed If you previously indicated on the Lesson Plan page that all of the objectives were covered then all of the objectives will be active on the patient s Education page For each topic you need to specify a Pre Assessment and a Post Evaluation for this individual patient Begin by clicking the Edit Education link above the Patient Education Record table which will open the Update Patient Education window This window displays each of the nine topics and has two colored tables for Pre Assessment and a Post Evaluation scoring Note that any topics not indicated as having been taught in the Lesson Plan will be grayed out and you won t be able to record any assessment For each of the nine areas that you did teach you should check a box in the Pre Assessment and Post Evaluation columns to indicate this patient s level before and after education Rate each topic on the scale of 1 to 4 using the color key at the top of the window for reference You can also enter any Comments related to the patient s progress toward that specific objective When you ve com
48. otted line under the text field The Date of Birth field uses Chronicle s normal date entry text box and calendar widget to make date entry quick and accurate For more information about entering dates in Chronicle see the section Date Entry under Other Administrative Tasks Patient login and password creation When you create a new patient Chronicle offers to automatically create login credentials login name and password for the patient These login credentials can be used by the patient to log into the patient component of Chronicle and complete their initial patient self assessment PSA By default Chronicle will create a login name that contains the patient s first name last name and some random numbers Chronicle also creates a password that is identical to the login name The patient is required to change their password when they first log into Chronicle To have the login credentials automatically created leave the box checked next to Auto Generate Login Information If you d like to create your own login name and password simply uncheck the Auto Generate Login Information checkbox and fill in the fields with the desired login name and password Patient s Primary Provider and PCP Each patient can have a primary provider or primary care physician designated for them To select the patient s primary provider click the Se ect pencil to the right of the Primary Provider PCP text box which will bring up the Se ect Provider window
49. patient you can update the objective s status recording the patient s new achievement level By doing this you create a historical record of the patient s progress toward achieving their behavior change objectives To the left of each objective is a disclosure triangle either or W Clicking anywhere on the objectives line will expand the objective to reveal all of the historical objective updates that have been recorded Additionally each objective update has a disclosure triangle and clicking anywhere on the update line will expand the update to reveal details about the update Adding a new baseline Behavior Change Objective After you have met with a patient and negotiated one or more Behavior Change Objectives you can document each objective To begin click the Add New Objective button which will bring up the Add Update Objective window Enter the following information e Behavior Change Objective Area This is a drop down list of the seven objective areas defined by the ADA Select the area that best matches the patient s chosen objective e Behavioral Change Objective A description of the specific objective e Plan real world how to get to your objective A description of the action the patient will take to move towards this objective e Expected Outcome A measurable outcome can be used to judge the patient s progress toward the objective e Baseline Objective Achievement The patient s achievement level of this objective prior
50. pleted this click Save Changes to close the window You ll notice that the Patient Education Record table is updated with the new information TIP You can quickly enter a single score for all of the topics by clicking on the number at the top of the column For example if a patient was assessed at a level of 1 Needs instructions for each of the nine topics you can click the blue 7 at the top of the column This will place a check mark into each of the boxes in that column You can then modify the score for an individual topic by checking other boxes if the assessment for that topic is different For example if the patient just needed review of Using medication safely click the box under the green 2 column to change the assessment for just that topic After all of the educational progress pre and post for this patient has been documented click on the Edit Identified Barriers link to open the Update Identified Barriers window Enter any barriers and click Save Changes to close the window Finally click on the Edit Support Plan link to open the Update DSMS Plan window Enter the patients DSMS plan and click Save Changes to close the window Note that you should not fill out anything under the Follow Up tab at this time this is only used at follow up e g three or six months after DSME At this point the documentation of DSME for this individual patient is complete You can click the gt to the left of this patient s name to collapse the
51. ressed Enter the Objective Status to indicate if the objective was Continued Modified or Discontinued The Objective Update Date is the date that you spoke with the patient and got the updated progress information After indicating if barriers were addressed and adding any optional notes click the Save Changes button to add the status update to the objective Viewing and editing an existing objective status The Behavior Change Objectives page shows the patient s objectives with each status update to the objective listed below the objective name To view details of an objective status click the button to the left of the status update listing This will reveal the details of that status update To hide these details click the W button Typically you won t need to edit an objective status updates to an objective should be documented by adding a new objective status update The only time would be if you made a mistake entering the information or if you needed to add missing information To edit an objective status begin by clicking on the Edit pencil to the left of the status line which will open the objective status window Make any necessary changes and click the Save Changes button Clinical Data and Labs Clicking the Clinical Data and Labs button from the left navigation pane displays a page that lists all of the most recent clinical data and lab information for the patient For a new patient with no clinical data or labs documented the
52. s patient s level at follow up Rate each topic on the scale of 1 to 4 using the color key at the top of the window for reference You can also enter any Comments related to the patient s progress toward that specific objective When you ve completed this click Save Changes to close the window You ll notice that the Patient Follow Up Record table is updated with the new information After all of the educational follow up reassessment for this patient has been documented click on the Edit DSMS Plan link to open the Follow Up DSMS Plan window Enter the patients DSMS plan and click Save Changes to close the window The other aspect of follow up documentation is recording each patient s progress with their selected behavior change objectives To document this follow the instructions Updating the status of an existing objective under Behavior Change Objectives under Patient Administration Managing and using Class Templates Classes can be created from scratch or can be created form a class template that you can set up In this section we will cover setting up a class template and using that template to create a class For detailed information about creating a class from scratch see the section Creating a new class or new 1 1 above Class templates allows you to set up a template for a typical class including the general information for the class the class session structure the educator time spent during each session a
53. ses Chronicle s standard patient selector The column on the left Recently Added Patients lists recent patients The column on the right Patients in cohort lists the patients that are members of this cohort To add a patient to this cohort find her name in the left column and click on her name This will add the patient to this cohort To remove a patient from this cohort find her name in the right column and click on her name to remove it from the cohort When you are done click Save Changes to have the new cohort added to the list To add or remove patients from am existing cohort or to change the name of the cohort select the cohort from the list and click Edit Selected Cohort This brings up the Edit Cohort window with the name of the cohort that you re editing in top text box You can rename the cohort by editing the existing name After you are done adding or removing patients from the cohort click the Save Changes button For more information about using Chronicle s patient selector see the section Patient selection interface under Other Administrative Tasks Viewing an individual patient s records When you are in the Patient List you can click on an individual patient row to open that patient s record After you ve opened a patient record you ll initially be in the General Information section You can navigate through the various sections of the patient s record by clicking the tabs in the left navigation pane Just
54. ss session e g if they missed a class session select the appropriate attendance status from the drop down menu under that session s column Use the Key at the top of the window for reference Use the status of N A Not Applicable for a patient that did not need to attend a class session For example if a patient misses a session in January s four session class she might complete her education by attending just one of the sessions in February s class Thus the other sessions in February are not applicable to the patient Repeat this procedure of updating the status for each of the class sessions that were missed When you are finished editing the class attendance you can save and close the window by clicking Save Changes Documenting educator time spent with class Chronicle allows you to track the time that each educator provided during each class session Note this Educator Time section of the class record is optional and is not used to calculate time for future ERP Application submissions All ERP Application submission time data is calculated from the session length defined for each sessions listed under the Class Schedule To document this information first click on the General Information tab in the left navigation pane Above the Educator Time Spent box click on the Update Educator Time link which will bring up the Update Educator Time Spent window Here you can specify which educators contributed to the class and how much time they sp
55. sub menu for this patient You can the click the gt on the next patient that you d like to document and repeat the procedure you just completed Continue repeating this procedure for each patient in the class until you ve documented education for all of them Documenting additional comments and notes Each class DEPR has a section for additional information that you d like to document but that didn t fit under any of the other documentation areas To access this click on the Class Notes tab and then on the Update Class Notes link This will display a large text box You can type anything into this box that you d like to document This text box can be updated added to and edited in the future Note that Class Notes are for notes that apply to the entire class of patients If you d like to record a note for an individual patient you can enter those under the Patient Notes in the individual patient s record See Notes under Patient Administration for more information Documenting patient attendance Chronicle s ability to track patient attendance integrates with the Lesson Plan making it easy to document which patients received education on each objective Since the Lesson Plan defines what educational objectives were taught during each class session an accurate attendance record of which patients were present at each class session is important to in order to maintain an accurate record of what education each patient received For example if
56. t corner of the window Logging out When you are finished using Chronicle or if you re going to be away from your computer you should log out of Chronicle You log out by clicking the Logout link in the upper right corner of the screen This will log you out of the system You should then close your browser window to ensure that the Chronicle session is completely over Note for security purposes Chronicle will automatically log you out after 30 minutes of inactivity Patient Administration To access the patient administration section click on the Patients tab in the top navigation bar This will display a list of all of the patients currently enrolled at your site Note that if you already have a patient record open you will have to click on the Return to Patients List button to return to the full list Creating a New Patient IMPORTANT If you are assigned to multiple sites within your program then be sure that you are viewing the correct site before adding a new patient New patients are added to the site that you re currently viewing For more information about witching between sites see the section Switching between sites under Log In and Log Out To create a new patient at your site click on the Create New Patient button to bring up the Create New Patient window This window is divided into a number of sections that allow you to enter information about the new patient Some information is required and is indicated by a red d
57. t View to open the DPER However a quicker way to access a patient s DEPR is from within the main Patients tab To access the correct DEPR for the patient on whom you d like to document follow up first click on the Patients tab and open that patient s record If you were already on that patient s tab ensure that you re on the patient s General Information page from the left navigation menu Under the Education Summary are listed all of the classes the patient participated in Typically there is just one class unless the patient participated in more than one class To launch the DEPR for that class click on the Edit pencil icon to the right of the class s name This will take you to the DEPR for that class In the DEPR window you will see the list of patients in the left Navigation menu Click on the to the left of the patient you want to document which will expand the menu items under the patient Click the Follow Up tab to view the Patient Follow Up Record and then click the Edit Follow Up link to open the Update Patient Follow Up window First select your name for the Clinician Signature drop down list unless someone else conducted the follow up enter the Date of follow up and select the Follow Up Method Below that are listed the Topic Learning Objectives that were covered during this class Note that objectives that were not covered in this class are dimmed For each objective check the appropriate Reassessment box to indicate thi
58. t ern eme emen 13 Viewing and editing an existing objective status ssssssssessseessseen nemen 13 Clinical Data and Labs 3 5 ecrire ore RI rcx Sex RR ERR TErR UE ON Dex RE ER TE TR UE LX EXT RR FR HER UR 13 Adding a new clinical data or lab test result csssssssssssessseessseeenn nemen nnns 14 Adding multiple clinical data or lab test results using a Lab Sheet cese 14 Editing or deleting an existing test result cece teeter ee emnes 15 Medications ee EE 15 Adding a Medication inva ose conden ee a RE d ee ORE RED AQ EY UP CORE UR PRA 15 Recording a medication change EVEN ccc emen mese nene nnn 16 Editing or deleting an existing medication or change event ssssssssseee eene 16 Recording a stop medication event sieraad e ate eoet Eear A AERIENE nna nea nn nn 16 Creating a new custom medication essssssssessssessseeee ene 16 Contact HISTORY creo les t E e n a 17 Mene n 17 class Admihistratior oio eer iere iei nme OE ume E EO RE IE Porra E Sed APR Tora mei E Pese S 18 View complete list of classes rer eate eren ERE RR RETE ER ERE NERO CUR Ok a E XR MERE nin A 18 Creating a new class or new T 1 eese teinte ir D IRR Te IER e DE ER RETI IER TA IF RD FARE DNI R IN IER EA 18 Enteririg Class Information iere xin ess eink dentin dale ect teia ident tule PERI RI CRURA estes 19 Defining Class Schedles iiir RR RENE aad AA AAA OETA AAAA DEAA 19 Editin
59. t s Genera Information page To enter a referral manually or to modify one that was already entered click the Add Referral link above the Referrals box This will bring up a window where you can enter a date for the referral document who the Referring Provider was or if it was a self referral and record a reason for the referral Once you ve entered all of this information click Save Changes to have it added to the patient s record To edit an existing referral click the pencil to the left of the referral Click the red sign to the right of an existing referral to delete it from the patient s record Managing a patient s educational sessions All of the educational sessions that a patient is enrolled in will be displayed on their General Information page under the Education Summary box Each class or 1 to 1 is listed with the individual class sessions listed below the class s name Each class session lists the date of the class session the name of the session and the patient s attendance status for that session Note that the patient s attendance status for all class sessions that have a scheduled data in the future will always be displayed as Scheduled After the day of the class session has passed the attendance will displayed will reflect the patient s actual attendance status The Education Summary box also allows you to quickly access a patient s existing class information or create a new 1 1 without having to first change to the
60. ter Wizard window and all of the patients on the class roster will be included in the Patient to receive letters list Follow the instructions in Generating Patient Letters under Patient Administration to complete the generation of the letters Documenting a DSME class The DSME documentation process adheres closely to the recommendations and requirements of the American Diabetes Association Documentation is built around the nine learning objectives allowing you to specify if and when each of these objectives will be covered during the course of DSME Chronicle then allows you to record a Pre Assessment and a Post Evaluation of the patient s achievement level towards each of the objectives Chronicle also provides a way to track patient attendance as well as educator time spent with the class The instructions below describe the steps of documenting a complete DSME session All of these steps are normally completed after the education has occurred with the exception of Defining the lesson plan for the class The lesson plan can be defined either before or after the education occurs Defining the lesson plan for the class The lesson plan allows you to specify which of the nine learning objectives was covered during the class and during which class session each objective was covered Begin by clicking the Lesson Plan tab in the left navigation pane The Lesson Plan page lists each of the learning objectives with nothing listed under the Da
61. ters The patient selector consists of two columns The column on the left Recently Added Patients is a list of all of the patients that are currently in the system The column on the right is specific to the patient subset e g class or group that you re managing and will list the patients that are members of the subset To search for a specific patient enter into the Search box any part of the patient s name which will display a list of matching patients As you continue to type the list is refined When you see the patient that you want to add you can click on the patient with your mouse or select it using your arrow keys and then hit enter Clicking on a patient from the Recently Added Patients list or from the Search list will add the patient to the column on the right and thus the subset When you re done click the Save Changes button Date Entry There are two ways to enter dates into Chronicle which apply to all date fields The first and usually quickest is to type the date directly into the date box using the format M D YYYY So for February 18 1938 you would type 2 18 1938 Note that you do not need to have a leading 0 for single digit days and months e g you don t need to type 02 18 1938 although you can if you would like Also note that you do need to enter the full four digits of the year e g you can t type 2 18 38 but must enter the full 2 18 1938 As an alternative to directly typing the date you c
62. tes of Instruction column Click the Edit Lesson Plan link near the top right which will open the Update Class Lesson Plan window The nine objectives are listed and to the right under the heading Dates of Instruction are one or more colored columns representing each of the educational sessions that were defined previously Note that if there aren t any colored columns displayed then you need to go back to the General Information page and follow the instructions Defining Class Schedule under Creating a new class or new 1 1 For each objective that was covered check the check box to the left of the objective under each session column where that topic was covered If you covered the objective during more than one session you should check each column where it was covered Every topic that was covered at any point during this class should be checked at least once Any topic that does not have a check under any of the session columns is considered to have not been taught during this class Documenting individual patient educational progress barriers and support plan The documentation of educational progress for everyone in the class is done on a patient by patient basis Note that all of the patients in a class are listed under the Patients heading in the left navigation pane and each patient has a to the left of their name Click the next to the first patient that you want to document This will reveal the Education and Follow Up tabs f
63. the note and type the note into the Notes box When you are done click Save Changes This will add the note to the list of notes for the patient You can also edit or delete existing notes using the Edit and Delete links Below the patient specific notes are both class wide notes and session specific notes These are notes that are recorded for classes that the patient is in Each class that the patient is in will be listed and any class wide notes will be displayed Also any session specific notes will be displayed for all the sessions that the patients attended e g if the patient s attendance is listed as ATT For more information about creating class wide notes see Documenting additional comments and notes under Documenting a DSME class Class Administration To access the class administration section click on the Education tab in the top navigation bar This will display a list of all of the classes currently entered at your site Note that if you already have a class record open you will have to click on the Return to Class List button to return to the full list In Chronicle the term Class can be though of as a container that has information including General information about the class A schedule of one or more educational sessions Aroster of patients enrolled in the class e An attendance list of patients who attended or were absent for each class session Alesson plan documenting what was taught at each of the
64. tion is based on individual patient demographics Site DSME method s This information is based on the types of classes documented Behavioral Outcome s These numbers are calculated for patients that have at least two assessed values a baseline and at least one objective update for a behavioral outcome For example if you have 200 total patients seen during the report period and the report lists 50 under Patients for Nutritional Management that means that out of those 200 patients 50 had Nutritional Management listed as a behavioral outcome and had a baseline evaluation and as least one update made to that objective Then for each of those 50 patients the highest objective update values is used and an average assessment is calculated Program Outcome s These numbers are calculated for patients that have at least one result for a clinical data area For example if you have 200 total patients seen during the report period and the report lists 75 0 150 200 under Actual for Alc that means that out of those 200 patients 150 had at least one A1c value recorded This means that 75 of the patients during the data period had an Alc value recorded Other Administrative Tasks There are a number of administrative tasks that apply across multiple sections of Chronicle which are detailed below Primary Provider and PCP Management Your Chronicle site maintains a list of the providers related to your program This list is shared
65. tter which will be replaced with the corresponding data when the actual letter is generated After you ve made the changes to the letter be sure to click the Save button to save your changes An existing letter can be renamed i e change the name of the letter as it appears in the dropdown menu by clicking the Rename button If you d like to create a new letter there are two ways you can do it If the letter is going to be similar to an existing letter you can use that existing letter as a starting point Select the existing letter from the drop down list and then click the Duplicate button and give the new letter a new name This will create a new letter that you can edit and save when complete Alternatively if you want to create the new letter from scratch click the New Blank Letter button and give the new letter a name This will create a new blank letter that you can edit and save when complete To get a preview of a letter click the Preview button which will generate a sample letter that you ll be prompted to download to your computer for viewing To delete a letter select the letter from the drop down list and then click the De ete Letter button Patient selection interface Chronicle uses a standard patient selector in instances when a subset of patients needs to be selected from the entire patient population For example the patient selector is used when defining the patients who are in a class a cohort or who will receive let
66. ve Changes This will open the Diabetes Education and Progress Record DEPR for the class You ll notice that the Genera Information tab is selected in the menu on the left On this Genera Information page of the DEPR there are a number of sections that need to be completed for the class documentation which are described below To start adding a new 1 1 education click on the Create New 1 1 Session button to bring up the Create New 1 1 Session window Note that before creating a 1 1 session for a patient the patient must already have been entered into Chronicle see Creating a New Patient Begin typing the name of the patient who will be in this 1 1 Note that you need to have already added this patient to Chronicle After you ve typed the first three characters of the name a list will display all matching patients You can continue typing the name until you see the name of the patient at which point just click on the patient s name to select it Next enter a name for the new 1 1 class Choose a logical name that will allow you to uniquely identify the 1 1 when you see it in a list of all classes You can select any name that makes sense to you and your office staff Examples for class names could be Initial visit indicating the first time that you will be seeing the patient You don t need to include the patient s name as part of the name since Chronicle will automatically show the patient s name in the list of all classes Indicate the Class T
67. viously marked as a favorite marked with solid stars as well as other popular or recent medications marked with empty stars The boxes on the left allow you to select a medication that isn t already in your Quick List To add a new medication that isn t in the Quick List enter the following information e Medication start typing the name of the medication in the trade name box Once you ve entered the first few letters a list will appear with matching medications As you continue to type the list is refined When you see the medication that you want to add you can click on it with your mouse or select it using your arrow keys and then hit enter If your medication isn t in the list e g if you re entering an herbal supplement you can add it to the database by clicking the first entry in the list that says Add a new medication named name Clicking this option will bring up a link that says Click to add name to add it as a custom medication to the database See the section Creating a new custom medication for more information Otherwise just select your medication from the list by clicking on it e Dosage Strength When you click into the Dosage Strength box all of the predefined dosages for that medication will be displayed in a list Select the dosage from the drop down box If the dosage you want is not listed you can just enter it into the Dosage Strength box e Date Enter the date that the patient started on the medication I
68. you are able to define a number of criteria that will be used to display the patients that meet all of the criteria For example let s say you want to see all of your elderly female patients with an Alc above 8 you can add the following three filters to arrive at that subset e For the first filter select Demographics from the first drop box and Gender from the second drop box In the third drop box select Is from the list In the fourth drop box select Female from the list This completes the process for defining the first filter To add a second filter click the green button In the first drop box select Demographics and then select Age from the second drop box In the third drop box select Is greater than from the list In the fourth box enter the value 75 This completes the process for defining the second filter e To add a third filter click the green button In the first drop box select Clinical Data and then select HbAic from the second drop box In the third drop box select Most recent value is greater than from the list In the fourth box enter the value 8 This completes the process for defining the third filter When you have all of the filters defined click the Save Filters button This will close the Advanced Patient Filter window and will update the patient list to only show patients that meet the defined criteria In the left navigation pane will be displayed the Selected Filters that are currently defining the patient l
69. your program then be sure that you are viewing the correct site before adding a new class New classes are added to the site that you re currently viewing For more information about witching between sites see the section Switching between sites under Log In and Log Out New classes can be created from scratch or can be created form a class template that you can set up In this section we will cover creating a class from scratch For detailed information about setting up and using class templates see the section Managing and using Class Templates below Since documenting both a group class and a 1 1 education are done though the DEPR the process is very similar However the way to start the process is slightly different First make sure you re on the Class List page To add a new group class to your site from scratch click on the Create New Group Class button to bring up the Create Group Class window Enter a name for the new class Choose a logical name that will allow you to uniquely identify the class when you see it in a list of all classes You can select any name that makes sense to you and your office staff Examples for class names could be June 2011 Monday AM indicating a class that has multiple sessions occurring on Monday mornings in June You must also indicate the Class Type Comprehensive or Post program and the Education Format which in this case will be Classroom Group After you have entered the class name click Sa
70. ype Comprehensive or Post program Then enter the date and optionally time that the 1 1 session will be occurring If you will be meeting with this patients for multiple sessions just enter the date and time of the first session Finally enter the Duration and Type of Intervention DSME or MNT Note that if you aren t sure about any of these fields e g if you are not sure how long the session will last just fill in the anticipated values You can always change the information later TIP Entering the Session Time is optional but if you do enter it and then generate a Welcome letter for the patient then both the upcoming session date and time can be listed in the letter After you have entered all of the information for the 1 1 click Save Changes This will open the Diabetes Education and Progress Record DEPR for the 1 1 You ll notice that the Genera Information tab is selected in the menu on the left On this General Information page of the DEPR there are a number of sections that need to be completed for the class documentation which are described below Entering Class Information After the class is initially created you can enter additional details to the Class Information box Click on the Edit pencil above the Class Information box to open the Update Class Information window You can enter the education location and language and select the relevant Instruction Methods and Education Materials After you have entered the in

Chronicle User Manual - ADA ERP

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