The Office of Geriatric Extended Care (OGEC) approved the paper-based
required of extended care service are inconsistent. Some facilities use
the VA Form 10-7108, VA Form 10064a (Patient Assessment Instrument) or VA
Form 1204 (Referral for Community Nursing Home Care), while other sites
use various other assessments or consults. OGEC seeks to standardize the
process of assessment as well as the data set in order to establish a
basis upon which program evaluation and quality performance can be
Four clinical reminder dialogs collect data regarding the need for
long-term care services in a standard format across VHA. This provides
GEC Referral as the preferred method for assessing and screening patients
a mechanism for clinicians to administer comprehensive long-term care
assessments, stores the information within the patient medical record and
allows clinicians to notify local OGEC staff. The screening data is
collected as health factors and is stored in the V Health Factor file.
There is no cohort or resolution logic associated. The four reminder
dialogs are GEC Referral Social Services, GEC Referral Nursing Assessment,
GEC Referral Care Recommendations, and GEC Referral Care Coordination. An
M-based option routine accompanies these reminders that extracts the data
and makes it available for ad hoc reporting.
for long-term and extended care services. As part of the Long Term Care
Initiative and the Veterans Millennium Health Care and Benefits Act,
Public Law 106-177, OGEC identified this tool as the means to standardize
long-term care assessments and to prepare for the national collection of
data regarding long-term care needs in the veteran population.
Current VHA methods of assessing patients to determine the level of care
are intended only as TIU templates and do not need to be assigned to the
CPRS Cover Sheet. Due to potential complications with reporting and
duplicate entries, it is recommended that the GEC dialogs not be added to
the Reminders drawer/Cover sheet. The Referral was designed for
inter-disciplinary use with dialogs created for separate services.
However, a single user may perform them all. With only a few exceptions,
each section of the dialogs is mandatory and is marked with an asterisk
(*). The completion of all four dialogs constitutes a discrete episode
of the GEC Referral.
The VA-GEC REFERRAL SOCIAL SERVICES, VA-GEC REFERRAL NURSING ASSESSMENT
and VA-GEC REFERRAL CARE RECOMMENDATIONS dialogs comprise the clinical
screening. The VA-GEC REFERRAL CARE COORDINATION dialog is used
administratively to record the arrangement of and funding for extended
care services. These dialogs may be performed in any order local
practices dictate. However, it is expected the screening portion will be
completed prior to the coordination of services. When the screen is
complete, a consult order should be placed to the service responsible for
A. GEC Consult Order
Most sites have either an individual or service responsible for arranging
and coordinating extended care services. To accommodate local business
practices and flexibility, sites may associate any consult service (or
menu) they already have in place. If none exist, the sites may create a
consult or establish some alternative practice to ensure that both
services are arranged and that the VA-GEC REFERRAL CARE COORDINATION
dialog is completed.
A placeholder for this consult is included at the end of the VA-GEC
The GEC Referral is comprised of 4 reminder dialogs: VA-GEC SOCIAL
REFERRAL SOCIAL SERVICES, VA-GEC REFERRAL NURSING ASSESSMENT and VA-GEC
REFERRAL CARE RECOMMENDATIONS dialogs. It must be substituted or deleted
at the time of installation.
Since nationally created orders do not map to local orderable items,
orders do not pass through Reminder Exchange. Installation of the
Referral will prompt for a resolution of this dialog element. Resolution
will consist of either replacing the order with a locally created order,
SERVICES, VA-GEC NURSING ASSESSMENT, VA-GEC CARE RECOMMENDATIONS and
deleting the element or skipping the step.
Consult quick orders are existing functionality that are probably in use
at your site. It is also possible that an order has already been created
that could be used. To determine this, the installer should contact the
CPRS CAC prior to installation and determine if an order is available.
If it is, installation will only require entry of the Fileman name-space
of the order at the prompt. If it is not, follow the steps in the CAC
VA-GEC CARE COORDINATION. These dialogs are designed for use as TIU
During installation you will be presented with the following prompt:
REMINDER DIALOG entry VA-ORDER GEC REFERRAL CONSULT does not
EXIST, what do you want to do?
Select one of the following:
D Delete (from the reminder/dialog)
P Replace (in the reminder/dialog) with an existing entry
Q Quit the install
templates to enter data regarding the need for extended care. Data
The installer should select P (Replace with an existing entry), and enter
the name of the existing quick order provided by the CAC using Fileman
name. [NOTE: The same quick order may be used on each of the dialogs].
1. The CAC should first determine if a Consult Service exists for
the management of extended care services. If it exists, this service can
be used for the quick order and you can proceed to step 2. If one does
not exist, the CAC will need to create a Consult Service by using the
entered via the dialogs are captured as health factors to be used for
[GMRC Manager] option [GMRC SETUP REQUEST SERVICES].
a. Recipients of the consult notifications should be GEC staff
responsible for coordinating extended care service (or any
2. The CAC should create a consult quick order using the [ORCM MGMT]
option [ORCM MENU]. This order should be associated to the Consult
Service in the Consult to Service/Specialty field of the quick order.
3. The CAC should then provide the name of the consult quick order
to the installer. The installer will then perform the installation and
enter the name of the order at the prompt as above.
local and national reporting. The software includes a new report menu
VI. GEC Interdisciplinary Notes
The GEC Referral dialogs are intended for use as TIU templates. It is
also expected that they will be used as part of a TIU Interdisciplinary
(ID) note. This will require new TIU Document Definitions or the
association of existing titles to the dialogs. This project does not
stipulate the titles to be used, preferring to allow the sites to use
those titles that would best suit their business practices. However, the
Office of Geriatrics Extended Care requests that the parent ID note title
that may be used for local analysis.
"GEC EXTENDED CARE REFERRAL"
To create a TIU Document Definition, perform the following steps:
A. Access the TIU IRM MAINTENANCE MENU.
B. Select TIUF DOCUMENT DEFINITION MGR.
C. Select Create Document Definitions or Edit Document Definitions.
D. Select class and create title.
To associate reminder dialogs with TIU templates, perform the following
II. GEC Health Factors and their use.
A. Make the GEC Referral dialogs eligible to be used as a template
by using the parameter: TIU TEMPLATE REMINDER DIALOGS.
B. Associate the dialog to a TIU Document Definition.
1. Go to Shared Templates
2. Click "New Template."
3. Enter a name.
4. Select the Template Type as Reminder Dialog.
5. Pick a GEC dialog from the Reminder Dialog field.
II. GEC Health Factors
6. Under Shared Templates, pick Document Titles.
7. In the Associated Title field, pick the Document Definition
created or designated for this dialog.
8. Click Apply.
(*You will require the Clinical Applications Coordinator User Class.)
VII. GEC Referral Reports
The software includes a new set of reports that provide a variety of GEC
health factor perspectives. The reports are released as an option within
The GEC Referral project distributes a large set of national health
the Clinical Reminder namespace and may be assigned as necessary. The
option is [PXRM GEC REFERRAL REPORT] and may be added to the PXRM
MANAGERS MENU. The reports capture data elements for reporting and
tracking use of the GEC Referral Screening Tool. The reports may be
generated in formatted or delimited output. The Summary (Score) report
provides summary (calculated) totals from specific sections of the
screening tool identified by the Office of Geriatrics Extended Care.
VIII. GEC Reminder Terms
Phase I of the GEC Referral project distributes a set of terms that will
factors. They may be identified by the GEC name-space and constitute the
be used with Phase II. Since Phase II has not yet been initiated, the
functional requirements and design have not been identified. However, it
is expected to include the national roll-up of GEC screening data using
the Generic Extract Utility released concurrently with Clinical Reminders
v2.0. To allow the greatest degree of flexibility in design, one
reminder term is released for each GEC Referral health factor. The terms
are mapped to the health factors on the VA-GEC REFERRAL reminder
dialogs. The terms will be installed silently and reside dormant until
Phase II of the GEC Referral project is implemented. The reminder
definitions used with these terms will be deleted via post-install
foundation of the GEC Referral project. They establish a standard set of
routine after installation.
The Office of Geriatric Extended Care (OGEC) will establish a web site to
provide training on the GEC screening tool. This training module is
being developed with assistance from Employee Education Service and built
by ImageITS, a private firm. The module will consist of an interactive
tutorial and reference material. OGEC will coordinate the training
initiative and serve as the custodian of the web site's content.
Facilities may contact OGEC to obtain the website's URL or for more
screening data, to be used across the Veterans Health Administration, and
will be rolled-up nationally in Phase II.
The Health Factor and V Health Factor files include factors and
categories. For this project, each section of the Referral is correlated
III. GEC Status Indicator.
to a health factor category. Once entered, the data is stored in the
Patient Care Encounter files. The structure of these underlying files
has a direct impact on the design of the GEC software. Extracting,
viewing and managing this set of data requires the GEC dialogs to remain
as they are released. Consequently, the Clinical Reminders package has
been modified to prevent the GEC national reminders from being copied.
This change was made to the Reminder Dialog, Dialog Group and Dialog
Element levels. To accommodate local business practices, sites will be
permitted to add locally created health factors to the GEC dialogs. A
new List Manager screen is included to facilitate additions and any
IV. GEC Referral ad hoc reports (CPRS GUI).
subsequent edits to those Groups and Elements added locally.
-Dialog elements that have an order associated as a finding item
will continue to be an editable field using the dialog editor.
-Any local changes to the GEC dialogs will not be included with
the reports or future national extracts.
-GEC health factors are populated with a synonym for
V. GEC Referral Reminders and Dialogs.
-Sites are discouraged from using the GEC health factors
elsewhere. Phase II of the GEC project will involve national roll-up.
Since this project has yet to be started, potential extraction rules
may not be able to distinguish the data source.
-Users should not enter GEC health factors from the Encounter
form. While it is possible to do so, Patient Care Encounter only
allows one instance of a combination of the health factor, patient
and visit IEN. If one is entered via the Encounter, any subsequent
entry of that health factor from the reminder dialog will not be
available for the GEC reports. This is a consequence of the GEC report
A. GEC Consult Order.
routines relying on the health factor's Data Source.
III. GEC Status Check
There is no limit to the entry of GEC Referral data. Thus, there may be
multiple entries of the same health factors over time. Since the data is
entered via separate dialogs, extraction and viewing requires the data to
be discretely identified. The GEC software depends upon the user to
indicate when the data from a given referral should be concluded. The
referral is finalized using a new feature called the GEC Status
VI. GEC Interdisciplinary Notes.
Indicator. This indicator is presented to the user as a modal dialog at
the conclusion of the VA-GEC CARE COORDINATION dialog. It will prompt
the user to indicate the conclusion of the Referral with a Yes or NO
response and will list any missing dialogs. If YES is selected, the data
for the current episode of the Referral is closed. If No is selected,
the Indicator is displayed with each succeeding GEC dialog until Yes is
To assist the ongoing management of completing GEC Referrals, the GEC
Status Indicator may be added to the CPRS GUI Tools drop-down menu. The
VII. GEC Referral Reports (LM CHUI).
parameter to activate the Indicator is PXRM GEC STATUS CHECK. If may be
set at the User or Team level. If added to the drop-down menu, the
Indicator may be viewed at any time and used to close the referral if
IV. GEC Referral Ad hoc Reports
Two new health summary components have been created and distributed with
this software: GEC Completed Referral Count (GECC) and GEC Health Factor
Category (GECH). The first displays all GEC referral data according to
VIII. GEC Reminder Terms.
the occurrence and time limits identified. The GEC Health Factor
Category component, in conjunction with PX*1*123 and GMTS*2.7*63, permits
GEC data to be viewed by health factor or health factor category. If a
user should have access to these GEC reports, they must have access to
the Ad Hoc Health Summary type. [This can be set using GMTS GUI HS LIST
V. GEC Referral Reminders and Dialogs
The GEC reminders are comprised of dialogs and health factors only. They
have neither cohort nor resolution logic and will not become due. They