VA-WH MAMMOGRAM SCREENING (128)    REMINDER DEFINITION (811.9)

Name Value
NAME VA-WH MAMMOGRAM SCREENING
PRINT NAME Mammogram Screening
DO IN ADVANCE TIME FRAME 2M
IGNORE ON N/A S
SEX SPECIFIC FEMALE
CLASS NATIONAL
SPONSOR VHA National Center for Health Promotion and Disease Prevention (NCP) and VHA Office of Women's Health
USAGE CR
EDIT HISTORY
  1. EDIT DATE:   2013-07-16 10:23:30
    EDIT BY:   USER,SEVENTEEN
    EDIT COMMENTS:   
    Exchange Install
    
DESCRIPTION
The VHA recommends that:
    * A change in the age range from 40-69 to 50-74 to match updated
  ----    --------------             ----------  ------------ ----------
  611.5   GALACTOCELE                10/01/1978                   X
 
 Range 611.71-611.72  Adjacent Lower-611.6  Adjacent Higher-611.79
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  611.71  MASTODYNIA                 10/01/1978                   X
  611.72  LUMP OR MASS IN BREAST     10/01/1978                   X
 
      clinical guidance
 Range 611.9-611.9  Adjacent Lower-611.89  Adjacent Higher-612.0
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  611.9   BREAST DISORDER NOS        10/01/1978                   X
 
 Range 675.10-675.14  Adjacent Lower-675.04  Adjacent Higher-675.20
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
    * Inclusion of women ages 40-49 in the cohort if the woman had 
  675.10  BREAST ABSCESS PREG-UNSP   10/01/1978                   X
  675.11  BREAST ABSCESS-DELIVERED   10/01/1978                   X
  675.12  BREAST ABSCESS-DEL W P/P   10/01/1978                   X
  675.13  BREAST ABSCESS-ANTEPART    10/01/1978                   X
  675.14  BREAST ABSCESS-POSTPART    10/01/1978                   X
 
 Range 757.6-757.6  Adjacent Lower-757.5  Adjacent Higher-757.8
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
      discussion with her provider about the pros and cons of screening
  757.6   CONG BREAST ANOMALY NEC    10/01/1978                   X
 
 Range 922.0-922.0  Adjacent Lower-921.9  Adjacent Higher-922.1
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  922.0   CONTUSION OF BREAST        10/01/1978                   X
 
 Range 793.8-793.8  Adjacent Lower-793.7  Adjacent Higher-793.80
 
      and made a decision to start screening before age 50.  A new
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  793.8   ABNORMAL FINDINGS-BREAST   10/01/1978  10/01/2001       X
      reminder, VA-WH DISCUSS BREAST CA SCREEN WOMAN 40-49 is distributed
      to prompt that discussion. 
    * Modification of taxonomy VA-BREAST TUMOR 
    * Addition of health factors that can be used by providers to indicate
      that screening is not clinically indicated because the patient is
    * Women between the ages of 50 and 74 have a mammogram every two
      unlikely to benefit from screening due to an estimated life
      expectancy of less than 5 years or sever comorbidities. 
    * Addition of branching logic to the dialog
 
US Preventive Services Task Force (USPSTF) also recommends that women age
50-74 have a mammogram every 2 years.
 
This reminder does not apply to women who have had a bilateral mastectomy.
 
Evidence of mammography performed will satisfy this reminder for 1 to 
      years
2 years depending on the screening frequency specified by the clinician. 
The clinician can alter the screening frequency for individual patients,
based on prior results, patient and family history, and discussions with
the patient.
 
Mammograms completed may be documented as one of the following and will 
resolve this reminder:
    Radiology result
    Women's Health procedure result
    Health Factor (Historical outside Mammogram result)
    * The decision to start regular screening every two years with 
    PCE CPT procedure code 
    Completed consult order for outside procedure
 
Screening will be resolved for 90 days or until results are recorded to
indicate the mammogram has been completed:
    Ordering a mammogram
    Health factor documenting a mammogram order
    Patient declined a mammogram 
    Clinician deferred a mammogram
 
      mammography for average risk women ages 40-49 should be an
Clinicians may manage follow-up screening to occur every 4 or 6 months or 
every 1 year when a prior mammogram was unsatisfactory or abnormal, or if
they feel screening should take place more often than 2 years based on 
the patient's history, risk or strong patient preferences.
 
A code for breast cancer or prior abnormal mammogram (VA-WH HX BREAST 
CANCER/ABNORMAL MAM) changes the frequency to q1 year for 5 years as a
safety features so that patients with these diagnoses are not lost to
follow-up.  
       Note: The term VA-WH HX BREAST CANCER/ABNORMAL MAM comes
      individual decision and take the patient's values into account
             mapped with the previously distributed VA-BREAST TUMOR and
             VA-MASTECTOMY taxonomies mapped to this term. This term uses
             computed finding VA-WH MAMMOGRAM ABNORMAL IN WH PKG to search
             for the existence of any abnormal results in the WH Package.
             This 1 year frequency is subsequently overridden if any other
             frequency is chosen by the clinician.
 
In the 2013 update, the taxonomy VA-BREAST TUMOR was edited to exclude 
codes that do not represent 
breast cancer.  The following codes were deleted:
      including values about specific benefits and harms
This taxonomy was updated in 2013 to include only those codes that 
represent cervical cancer or CIN.  
The following codes/ranges were deleted:
Range 217.-217.  Adjacent Lower-216.9  Adjacent Higher-218.0
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  217.    BENIGN NEOPLASM BREAST     10/01/1978                   X
 
 Range 610.0-610.9  Adjacent Lower-608.9  Adjacent Higher-611.0
 
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  610.0   SOLITARY CYST OF BREAST    10/01/1978                   X
  610.1   DIFFUS CYSTIC MASTOPATHY   10/01/1978                   X
  610.2   FIBROADENOSIS OF BREAST    10/01/1978                   X
  610.3   FIBROSCLEROSIS OF BREAST   10/01/1978                   X
  610.4   MAMMARY DUCT ECTASIA       10/01/1978                   X
  610.8   BENIGN MAMM DYSPLAS NEC    10/01/1978                   X
  610.9   BENIGN MAMM DYSPLAS NOS    10/01/1978                   X
The main changes with the 2013 update of this reminder include:
 
 Range 611.0-611.0  Adjacent Lower-610.9  Adjacent Higher-611.1
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
  ----    --------------             ----------  ------------ ----------
  611.0   INFLAM DISEASE OF BREAST   10/01/1978                   X
 
 Range 611.5-611.5  Adjacent Lower-611.4  Adjacent Higher-611.6
 
  Code    ICD Diagnosis              Activation  Inactivation Selectable
FINDINGS
  1. FINDING ITEM:   WH BR CA 40-49 WANTS SCREENING
    WITHIN CATEGORY RANK:   0
    CONDITION:   I PXRMAGE<50&(PXRMAGE>39)
    INTERNAL CONDITION:   I PXRMAGE<50&(PXRMAGE>39)
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   2Y
    USE IN PATIENT COHORT LOGIC:   OR
  2. FINDING ITEM:   VA-WH MAMMOGRAM UNSATISFACTORY IN RAD/WH PKG
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  3. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN FREQ - 4M
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  4. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN FREQ - 6M
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  5. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN FREQ - 1Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  6. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN FREQ - 2Y
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  7. FINDING ITEM:   VA-WH HX BREAST CANCER/ABNORMAL MAM
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
  8. FINDING ITEM:   VA-WH MAMMOGRAM ORDER
    STATUS LIST:
    1. STATUS:   ACTIVE
    2. STATUS:   PENDING
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-90D
  9. FINDING ITEM:   VA-WH BILATERAL MASTECTOMY
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
  10. FINDING ITEM:   VA-TERMINAL CANCER PATIENT
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN PATIENT COHORT LOGIC:   AND NOT
    BEGINNING DATE/TIME:   T-1Y
  11. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN IN WH PKG
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  12. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN IN RAD PKG
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  13. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN DONE
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  14. FINDING ITEM:   VA-WH BREAST CARE ORDER HEALTH FACTOR
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-90D
  15. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN NOT INDICATED
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    USE IN RESOLUTION LOGIC:   OR
  16. FINDING ITEM:   VA-WH MAMMOGRAM SCREEN DEFER
    NO. OF FOUND TEXT LINES:   0
    NO. NOT FOUND TEXT LINES:   0
    REMINDER FREQUENCY:   4M
    USE IN RESOLUTION LOGIC:   OR
    BEGINNING DATE/TIME:   T-4M
FUNCTION FINDINGS
  1. FUNCTION FINDING NUMBER:   1
    FOUND TEXT:   
    Mammogram result is the most recent finding.
    
    LOGIC:   ($P(FN(1),".")'<($P(FN(2),".")))&(FN(1)>0)
    MINIMUM AGE:   50
    MAXIMUM AGE:   74
    REMINDER FREQUENCY:   2Y
    FUNCTION STRING:   ($P(MRD(4,5,6),".")'<($P(MRD(7,8,9,10),".")))&(MRD(4,5,6)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  2. FUNCTION FINDING NUMBER:   2
    FOUND TEXT:   
    Mammogram screening every 4 months specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   4M
    FUNCTION STRING:   (MRD(8,11,12,13,14)=MRD(11))&(MRD(11)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  3. FUNCTION FINDING NUMBER:   3
    FOUND TEXT:   
    Mammogram screening every 6 months specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   6M
    FUNCTION STRING:   (MRD(8,11,12,13,14)=MRD(12))&(MRD(12)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  4. FUNCTION FINDING NUMBER:   4
    FOUND TEXT:   
    Annual mammogram screening specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   18
    REMINDER FREQUENCY:   1Y
    FUNCTION STRING:   (MRD(8,11,12,13,14)=MRD(13))&(MRD(13)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  5. FUNCTION FINDING NUMBER:   5
    FOUND TEXT:   
    Mammogram screening every 2 years specified for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    MINIMUM AGE:   50
    MAXIMUM AGE:   74
    REMINDER FREQUENCY:   2Y
    FUNCTION STRING:   (MRD(8,11,12,13,14)=MRD(14))&(MRD(14)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  6. FUNCTION FINDING NUMBER:   6
    FOUND TEXT:   
    Mammogram screening not clinically indicated for this patient.
    
    LOGIC:   (FN(1)=FN(2))&(FN(2)>0)
    REMINDER FREQUENCY:   0Y
    FUNCTION STRING:   (MRD(8,11,12,13,14)=MRD(8))&(MRD(8)>0)
    NO. FOUND TEXT LINES:   1
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
  7. FUNCTION FINDING NUMBER:   7
    FOUND TEXT:   
    The most recent mammogram result in the Radiology or Women's Health 
    package was unsatisfactory. The mammogram needs to be repeated.
    
    LOGIC:   ($P(FN(1),".")=($P(FN(2),".")))&(FN(2)>0)
    REMINDER FREQUENCY:   1D
    FUNCTION STRING:   ($P(MRD(4,5,6,7,8,9,10),".")=($P(MRD(10),".")))&(MRD(10)>0)
    NO. FOUND TEXT LINES:   2
    NO. NOT FOUND TEXT LINES:   0
    FUNCTION LIST:
    1. FUNCTION NUMBER:   1
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    2. FUNCTION NUMBER:   2
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
    3. FUNCTION NUMBER:   3
      FUNCTION:   MRD
      FUNCTION PARAMETER LIST:
TECHNICAL DESCRIPTION
Technical Description:
     
         * If Function Findings determine that an information finding 
           exists that alters the baseline frequency to 4M, 6M, 1Y or 2Y,
           the baseline frequency will be overridden.
     
       VA-WH MAMMOGRAM SCREEN IN WH PKG 
           No mapping necessary. This term represents mammogram results 
           documented in the Women's Health (WH) Package. The term is 
           mapped to the VA-WH MAMMOGRAM IN WH PKG computed finding which 
           only uses WH findings that are normal or abnormal.  
     
    This reminder is recommended for use by clinicians at Primary Care 
       VA-WH MAMMOGRAM SCREEN IN RAD PKG 
           Mapping will be necessary.  This term represent Mammogram 
           results documented in the Radiology package.  Map local
           radiology procedures that represent the following procedures:
              MAMMOGRAM BILAT 
              MAMMOGRAM UNILAT 
              MAMMOGRAM SCREEN 
           Each finding should have a condition added to exclude 
           unsatisfactory results.  
     
    Clinics (PACT/Primary Care, Medicine, GIMC, Geriatric, Women's) and
       VA-WH MAMMOGRAM SCREEN DONE 
           Some mapping may be appropriate. This reminder term will use 
           the previously distributed VA-MAMMOGRAM/SCREEN taxonomy to 
           find ICD DIAGNOSIS or CPT coded results.
     
           Use the new WH MAMMOGRAM OUTSIDE health factor to document 
           Mammogram results completed outside the VA when the Mammogram 
           results are not documented in Radiology, Women's Health or 
           Consult packages.  
     
    any other specialty clinics where primary care is given to female
           Map local findings, such as consult orders related to 
           Mammogram Screening.  Use appropriate condition logic to 
           indicate Mammogram screening has been completed.  
     
       VA-WH BREAST CARE ORDER HEALTH FACTOR 
           Use the health factors distributed with the reminder term if 
           they are appropriate for your facility to track breast care
           orders.  
 
           This reminder term represents the action taken from the dialog 
    patients.
           to indicate the clinician intends to place an order related to 
           mammogram screening. The health factor date will be used to 
           calculate the resolution frequency, instead of the Start date 
           related to the order actually placed.  
     
           The following are health factors distributed with this term: 
              WH ORDER MAMMOGRAM SCREEN HF (Use this if an order menu is 
              referenced as the quick order, or use for a quick order 
              for mammogram screening to radiology or consults) 
     
     
 
       VA-WH MAMMOGRAM SCREEN NOT INDICATED 
           Use the findings distributed with this reminder term or map 
           any local findings that indicate a Mammogram screen is not
           indicated for this patient.
     
           This term is distributed with mapping to the following 
           health factors: 
              INACTIVATE BREAST CANCER SCREEN (distributed with the 
                   first version of the Clinical Reminder package in 1996 
    If the mammogram is done in the private sector or at another VAMC 
                   to inactivate the BREAST CANCER reminder).  
              WH MAMMOGRAM SCREEN NOT INDICATED 
              VA LIMITED LIFE EXPECTANCY 
           and the taxonomy: 
              VA-TERMINAL CANCER PATIENTS 
               Updated March, 2013 to include 2 new health factor which
               both inactivate the reminder for 5 years: 
               WH BR CA SCREEN N/A 5 YRS-LE<5YRS 
               WH BR CA SCREEN N/A 5 YRS-COMORBIDITIES
     
    facility, there are three ways the results can be documented to 
           Use in National VA-WH MAMMOGRAM SCREENING reminder: 
           This term is used in WH reminders to inactivate Mammogram 
           screening until a clinician overrides the inactivation by 
           selecting a health factor that is used by function findings 
           with frequencies of 4M, 6M, 1Y or 2Y. Begin date of T-6M has
           been added to HF.VA LIMITED LIFE EXPECTANCY and 
           TX.VA-TERMINAL CANCER PATIENTS so screening will come due
           again if the patient lives longer than expected or if the
           patient has been misdiagnosed.
     
    satisfy this reminder:
           Sites may prefer to use local LIMITED LIFE EXPECTANCY health 
           factors and add their health factors to other reminder 
           terms which cause the Mammogram Screening reminder to be 
           due without requiring a clinician to select a finding to 
           reactivate the reminder. (e.g., Add the local life expectancy 
           health factor for "LOCAL LIFE EXPECTANCY 6M" to the VA-WH 
           MAMMOGRAM SCREEN NOT INDICATED term).  
            
       VA-WH MAMMOGRAM SCREEN DEFER 
           Use the WH MAMMOGRAM DEFERRED or WH MAMMOGRAM DECLINED health 
        * Results, with interpretation, can be entered and verified in 
           factors distributed with this term or add any local health 
           factor representing that mammogram screening should be 
           satisfied for one week.
          
       VA-WH MAMMOGRAM UNSATISFACTORY IN RAD/WH PKG 
           Mapping will be necessary for Radiology. This term represent
           Mammogram results documented in the Radiology and WH packages.
           Map local radiology procedures that represent the following
           procedures:
              MAMMOGRAM BILAT 
    This reminder is based on VHA Clinical Guidance, Performance measures
          the Radiology package.
              MAMMOGRAM UNILAT 
              MAMMOGRAM SCREEN 
           Each finding should have a condition that checks for
           unsatisfactory results.
           
           No mapping is necessary for WH.  Use the VA-WH MAMMOGRAM IN
           WH PKG computed finding and the value "UNSATISFACTORY" to
           find unsatisfactory results documented in the WH package.
 
 
        * Results, with interpretation, can be manually entered into the 
INFORMATION FINDINGS: 
    ---------------------
    The following are informational reminder terms that are used in 
    Function Findings to alter the baseline Age/Frequency.  If the most
    recent resolution finding is a documented result, the frequency for
    the next Mammogram screen will be based on these reminder terms. If
    more than one of these findings are recorded at the same date/time,
    the finding that makes the reminder due most often will prevail.  See
    the Function Findings section below for frequency logic.   
    
          WH package.
       VA-WH MAMMOGRAM SCREEN FREQ - 4M 
           Use the WH MAMMOGRAM SCREEN FREQ - 4M health factor 
           distributed with this reminder term, or add any local findings
           that indicate mammogram screen should occur every 4 months.
     
       VA-WH MAMMOGRAM SCREEN FREQ - 6M 
           Use the WH MAMMOGRAM SCREEN FREQ - 6M health factor 
           distributed with this reminder term, or add any local findings
           that indicate mammogram screening should occur every 6 months.
 
        * Summarized results can be entered as a historical entry (health 
       VA-WH MAMMOGRAM SCREEN FREQ - 1Y 
           Use the WH MAMMOGRAM SCREEN FREQ - 1Y health factor 
           distributed with this term or add any local health factor that
           indicates mammogram screening should occur every year.
       
       VA-WH MAMMOGRAM SCREEN FREQ - 2Y 
           Use the WH MAMMOGRAM SCREEN FREQ - 2Y health factor 
           distributed with this term or add any local health factor that
           indicates mammogram screening should occur every two years.
     
          factor or CPT code) in the patient record.
       The following reminder terms are "information only" terms that are 
       not used to alter the frequency of the reminder, but provide
       information that may be helpful to the clinician.
     
     
       VA-WH MAMMOGRAM ORDER 
           Map local orderable items that represent mammogram related 
           orders (e.g., Consult order to Women's Health Clinic).  
           Use the conditions that indicate the order is not completed, 
           discontinued, or cancelled. This reminder term represents 
 
           orders pending completion.
     
    FUNCTION FINDINGS: 
    ------------------
    Function Findings (FF) will be used to determine the frequency of 
    this reminder. FF logic has been set up to differentiate between
    completed results and findings that represent different frequencies
    (4M, 6M, 1Y, 2Y).  
    If more than one of the frequency findings are recorded at the same
    date/time, the finding that makes the reminder due most often will
    Setup of Women's Health package before using this reminder: 
    prevail.  The frequency can be changed by entering a new frequency
    with a more recent date. 
     
       FF1 
          Determines whether a mammogram result is the most recent 
          finding and defaults to the baseline frequency of two years.
 
       FF2 
          Determines whether a finding exists for VA-WH MAMMOGRAM SCREEN 
          FREQ - 4M and changes the screening frequency to every four
    ===========================================================
          months (4M).
 
       FF3 
          Determines whether a finding exists for VA-WH MAMMOGRAM SCREEN 
          FREQ - 6M and changes the screening frequency to every six
          months (6M).
 
       FF4 
          Determines whether a finding exists for VA-WH MAMMOGRAM SCREEN 
          FREQ - 1Y  and changes the screening frequency to every 1 year
    Although this reminder has been developed to include an interface with
          (1Y).
 
       FF5
          Determines whether a finding exists for VA-WH MAMMOGRAM SCREEN 
          FREQ - 2Y and changes the screening frequency to every two 
          years (2Y).
 
       FF6 
          Determines whether the most recent finding is VA-WH MAMMOGRAM 
          SCREEN NOT INDICATED and changes the frequency to 0Y, which 
    the Women's Health (WH) package and to use/update Mammogram results
          will stop the reminder from being due until new activity 
          occurs.
 
       FF7 
          Determines whether the most recent finding is VA-MAMMOGRAM 
          UNSATISFACTORY IN RAD/WH PKG and changes the frequency to 1D,
          which will make the reminder due immediately until new activity
          occurs.  
     
          Branching logic is used in the reminder dialog so that the 
and US Preventive Services Task Force recommendations for breast cancer
    stored in WH for managing breast care and the next breast treatment
          clinician is prompted to reassess frequency periodically if a
          prior clinician selected frequency rather than the baseline
          frequency is controlling the reminder.  The branching logic also
          prompts clinician to reassess the need for continued screening
          for patients who are older than 74 years.  Continued screening
          may be indicated in some cases based on prior abnormal results.
          The reminder VA-BL WH MAMMO REVIEW FREQ and a new HS
          object:|MAMMOGRAM FREQUENCY| are also distributed with this
          patch for this purpose.
 
    need, clinical use of the Women's health package is not required in
    2.  Use the Reminder Dialog edit option to define the national 
        reminder dialog finding items which should be updated during CPRS
        GUI reminder processing.
     
        Review dialog elements in the national reminder dialog and change 
        any national health factors to local health factors, if 
        necessary.   It is not unusual for local findings to be used
        in your national dialogs.
        Any local findings used in the national dialogs should be mapped 
        to the appropriate national reminder term.
    order to use this reminder.  However, use of the Women's Health
     
    3.  Alternately, use the Reminder Dialog options to copy the national 
        dialog, dialog elements, and dialog groups to make local 
        changes.  
     
        Add local dialog elements with local Order Dialogs for additional 
        ordering options for the clinicians. Many sites have clinicians
        order a consult to a service that provides mammograms.  If your
        site does this, copy the reminder dialog to a local reminder
        dialog, then add the local dialog element for the consult order 
    package is required in order to use the associated mammogram Review
        to the reminder dialog so this practice can continue.
     
    4.  If your site chooses not to send letters via the WH package 
        (sending letters is part of the Review Results reminder, not this 
        reminder, copy the appropriate national dialog components to local
        components and remove the findings related to WH notifications.
    results reminder- This screening reminder and the associated and
    review results reminder dialogs will update the WH package at the same
    time clinical care is recorded in CPRS GUI, thus eliminating the need
    for dual data entry.
     
    In order for this reminder to interface with the Women's Health (WH) 
screening.  In its first release in 2005, this reminder replaces the
    package, the Women's Health package must be installed and 
    maintained.  Please refer to the CPRS Integration: Women Veterans
    Health (WVH) Install & Setup Guide for detailed instructions.
     
    The following is a subset of some of the specific features of WH that 
    must be in place in order for this reminder to work in conjunction 
    with the Women's Health package as it was orginally designed: 
        * Female veterans should be entered into the WH package.  
        * WH parameters should be set up to automatically import mammogram
          Radiology reports into the WH package when they are verified in
following national reminders relating to mammograms and breast cancer
          the VistA Radiology package. 
        * The WV NOTIFICATION PURPOSE letters should be customized to
          reflect site information and the correct letter content for each
          type of letter. 
        * The WV NOTIFICATION PURPOSE treatment need and treatment need
          date offset should be defined if appropriate. These new fields
          will be used to update Women's Health data when purpose of
          notifications are selected by clinicians from reminder dialogs.
        * The reminder dialog definitions should reference the appropriate
          WV NOTIFICATION PURPOSE.
screening:
     
    Setup of reminder/dialog before using this reminder: 
    ==================================================== 
    1.  Use the Reminder Term options to map local representations of 
        findings: 
     
    PATIENT COHORT FINDINGS: 
    ------------------------
    The following reminder terms determine whether the reminder applies 
    to the patient.
     
     
       WH BR CA 40-49 WANTS SCREENING 
          This is a new term distributed with the 2013 update of this
          reminder which includes women ages 40-49 in the cohort of this
          reminder. The health factor WH BR CA 40-49 WANTS SCREENING is
          pre-mapped and is health factor is generated in the dialog of
          the new reminder: VA-WH DISCUSS BREAST CA SCREEN WOMAN 40-49.No
          other health factors need to be mapped to this term.
 
       VA-WH BILATERAL MASTECTOMY 
            VA-*BREAST CANCER SCREEN 
           This term will use the VA-WH BILATERAL MASTECTOMY taxonomy to 
           find coded bilateral mastectomies. The health factor WH 
           BILATERAL MASTECTOMY distributed with this term may be used or 
           add any local health factor that represents the patient had a 
           bilateral mastectomy and no longer needs mammogram screening.  
 
       VA-TERMINAL CANCER PATIENT 
           No mapping necessary.  Use the VA-TERMINAL CANCER PATIENTS
           reminder taxonomy distributed with this term.
      
            VA-MAMMOGRAM 
    RESOLUTION FINDINGS: 
    --------------------
    The following reminder terms resolve the reminder.  These resolution
    terms are defined with a "Use in Resolution Logic", but no Frequency.
    Frequency for this reminder will be determined by Function Findings 
    (FF) logic, which examines the most recent findings:
 
         * If Function Findings determine that the most recent finding 
           is a result, the baseline age and frequency will be used.  
         
INTERNAL PATIENT COHORT LOGIC (SEX)&(AGE)!FI(1)&'FI(2)&'FI(3)
PATIENT COHORT FINDINGS COUNT 5
PATIENT COHORT FINDINGS LIST SEX;AGE;1;2;3
INTERNAL RESOLUTION LOGIC (0)!FI(4)!FI(5)!FI(6)!FI(7)!FI(8)!FI(9)!FI(10)!FI(16)
RESOLUTION FINDINGS COUNT 8
RESOLUTION FINDINGS LIST 4;5;6;7;8;9;10;16
AGE FINDINGS COUNT 9
AGE FINDINGS LIST 1;9;FF1;FF2;FF3;FF4;FF5;FF6;FF7
INFORMATION FINDINGS COUNT 5
INFORMATION FINDINGS LIST 11;12;13;14;15
WEB SITES
  1. URL:   http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm
    WEB SITE TITLE:   US Preventive Services - Breast Cancer Screening
    WEB SITE DESCRIPTION:   
    Web Site Title:  US Preventive Services Task Force Screening for Breast 
    Cancer web site.  
    
  2. URL:   http://vaww.prevention.domain.ext/Screening_for_Breast_Cancer.asp
    WEB SITE TITLE:   VHA Breast Cancer Screening Guidance
  3. URL:   http://www.prevention.domain.ext/docs/VANCP_BreastCancerFact.pdf
    WEB SITE TITLE:   Clinician Guide Fact Sheet
# OF GEN. COHORT FOUND LINES 0
# GEN. COHORT NOT FOUND LINES 0
# GEN. RES. FOUND LINES 0
# GEN. RES. NOT FOUND LINES 0
BASELINE AGE FINDINGS
  1. REMINDER FREQUENCY:   2Y
    MINIMUM AGE:   50
    MAXIMUM AGE:   74
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
  2. REMINDER FREQUENCY:   0Y
    MAXIMUM AGE:   49
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
  3. REMINDER FREQUENCY:   0Y
    MINIMUM AGE:   75
    NO. OF AGE MATCH LINES:   0
    NO. OF AGE NO MATCH LINES:   0
# SUM. COHORT FOUND LINES 0
# SUM. COHORT NOT FOUND LINES 0
# SUM. RES. FOUND LINES 0
# SUM. RES. NOT FOUND LINES 0