With the release of version 11.2, Allscripts Enterprise EHRTM has the ability to define acceptable ranges for vital sign readings based on age and gender. Once this range is defined, when a vital sign is input and falls outside the defined range, users are alerted that this value is an abnormal result. The alert is shown as a red beaker, displayed next to the value in either the Health Maintenance Plan (HMP) or as bolded, red text in the Note Authoring Workspace (NAW).
While four vital signs (Systolic Pressure, Diastolic Pressure, Heart Rate, and Respiration Rate) are pre-delivered with ranges, clients can create their own ranges for any other vital sign, such as Weight. These ranges are defined solely using the SSMT tool using the RID – Reference Range content category. This means that clients do not define these ranges anywhere inside the EnterpriseTM application, instead, are only able to be defined using SSMT.
Tip: The four pre-delivered vital signs will need additional values populated as the user configures the reference ranges.
First and foremost, the organization needs to ascertain what the actual ranges will be. The NIH Clinical Center provides their guidelines of vital sign ranges. One example of guidelines they provide is Pediatric resting values. The organization should be aware of the resources should determine which guidelines to follow, whether it is the American Heart Association or NIH Clinical Center.
Once the decision has been made for which data will drive the decision to move forward and be used by the organization’s EHR, the System Administrator can begin to use those decisions to load the data to the system.
Now let us explore the basic fundamental steps to set up the Vital Sign Reference Ranges.
- First be sure to backup any data prior to making changes in SSMT.
- Access SSMT and extract the data from the RID – Reference Range content category
- Copy the data to a spreadsheet that has the cells formatted to “text”
- Edit the spreadsheet; the following are the applicable column headers:
- [A] HDRResultable Entry Code: value from the Code field in the Resultable Item dictionary
- [B] Resultable Entry Name: value from the Name field in the Resultable Item dictionary
- [C] Where Performed: can be a null value – if populated the range will apply to the resultable item specific to that preforming location
- [D] Reference Range Type: must be set to Numeric
- [E] SEX: leave blank if using for both genders, otherwise M for male and F for female
- [F] Lowest value: lowest allowable value for the vital sign to be considered normal
- [G] PanicLowValue: needs to be a unique value and at least one more than [F] and less than [H]
- [H] LowNormal: needs to be a unique value and at least one more than [G] and less than [I]
- [I] HighNormal: needs to be a unique value and at least one more than [H] and less than [J]
- [J] Panic High Value: needs to be a unique value and at least one more than [I] and less than [K]
- [K] Highest Measureable: highest allowable value for the vital sign to be considered normal
- [L] Reference Text: This can be set to indicate the text to be displayed in the Results Entry dialog screen indicating the range. So if the range from [F] to [K] is 40-90, indicate such in this field.
- [M] Answer: This field is left null.
- [N] Abnormal Flag: Does not need to be set to any value
- [O] Is Inactive (Y/N): Set to Y if setting an item to be inactivated, otherwise set to N
- [P] Create (Y/N): Must be set to Y if creating a new entry, otherwise set to N
- [Q] Age Min: beginning point for the age range; the lower number
- [R] Age Max: ending point for the age range; the higher number
- [S] Age Units: units of the age range; ex: Days, Months, Years
- Save the spreadsheet
- Be sure to clear the text box field in SSMT
- Copy all applicable rows of data from the spreadsheet and paste into the SSMT box (do not copy the header row)
- Load the data
- Return to the Enterprise EHRTM application and validate using a test patient the applicable vital(s)
While these are basic instructions to successfully set the reference ranges, the steps should provide success in loading the reference ranges. There are a few main points to reiterate in this process:
- Please back up any data prior to using SSMT.
- Pay close attention to the bullet steps for the column headers indicated above. Certain columns require certain information.
- Ensure the Resultable Item information is reflected in the spreadsheet as it is in the RID
- Keep in mind that columns [F] through [K] must be populated with unique values, that are not 0. [F] must be the lowest acceptable normal value, while [K] must be the highest. The numbers in between CANNOT be the same value!
- Set [P] to a value of Y when creating new values
- Try loading one line to begin – to ensure set up is correct.
It is important to note that this enhancement has no direct effect on Meaningful Use Core Measure 8 – Record Vital Signs. The Record Vital Signs Objective states: “Record and chart changes in the following vital signs: (A) Height (B) Weight (C) Blood pressure (D) Calculate and display body mass index (BMI) (E) Plot and display growth charts for children 2-20 years, including BMI”. The measure being “for more than 50 percent of all unique patients age 2 and over seen by the Eligible Professional, height, weight, and blood pressure are recorded as structured data”. In reviewing the measure documentation, there was no mention of measuring whether or not the vitals being recorded are being flagged as abnormal.
Allscripts Enterprise EHRTM version 11.2 offers a plethora of excellent features and this functionality certainly allows users to optimize the system and how charts are viewed. The return from defining these ranges is to provide the visual indicator that certain recorded vitals are abnormal for the patient in context. So, while there may no added benefit from a Meaningful Use standpoint, there is certainly clinical benefit to utilizing this functionality.