Scores, Scales and Tools Navigators

Navigators help users move through a series of related activities and tasks (workflows), ensuring that related decision and documentation supports are presented in a clinically sensible order. Navigators can also be used to present information management tools (e.g., flowsheet content) in user-optimized ways. A common example is "Tools" navigators. These organize in-system scores, scales and tools to bring attention to those most relevant for the current user and to present the tools for easy use by the current user type.

External Tools

A wide range of scores, scales, prediction rules and other metrics are made available through external resources, such as MDCalc (licensed for use within AHS). Users need to re-enter clinical data to external tools, note any summative measure, and copy the result back into Connect Care.

Embedded Tools

A number of common tools are embedded within Connect Care. Ideally, these use information already in the system and minimize the need for additional data entry. The results can be integrated with decision and documentation supports using SmartTools. Embedded scores and scales can be built using flowsheet, SmartForm, Calculator or Score Rule functions.

This section focuses on how scores and scales tools ("tools") may be combined into a navigator to facilitate rapid access. There are a number of scores and scales navigators deployed or in demand. Their use is more intuitive for users when the navigators adhere to a few common style guides.

Oversight

Scores and scales tools, and any associated flowsheets, forms or rules, relate to the Connect Care Clinical Documentation Committee for matters of presentation, terminology, standards, permissions and styles. Specialty Area Councils may request and guide the work associated with a specialty-focused tools navigator but the result must still be reviewed for compliance with common design requirements.

Permission

Clinical measures, calculators, decision rules, prediction rules, algorithms and other decision support tools usually have copyright and appropriate use considerations. The Connect Care Clinical Documentation Committee can facilitate checks to see whether AHS would be permitted to use the tool in the intended way within Connect Care. For essential tools, the Committee can also facilitate licensing and resourcing options. In all cases (including tools developed within AHS), copyright protection status must be assessed and clearance must be obtained before building a tool into Connect Care.

Where AHS does not have permission to replicate a tool within Connect Care, it may be possible to add a link to an external resource that can be displayed within and Internet browser window. A "score-only" flowsheet or SmartData Element can be created to store and use this result.

Style Guides

The following recommendations are expressed in the T_IP_MD_SCORES (LVN 30444906027) navigator template, which can be used as an example to emulate.

Overall Organization

Tools navigators can build up a lot of content, with many sections and many scores or calculators. Users appreciate organizational consistency to make it easier for them to quickly recognize the purpose of a new tools navigator and to quickly find the specific tool they need.

If anything more than 10 items (sections) will be offered in the navigator, consider grouping these using navigator topics. Clinical calculators should be organized by one or more body system, ideally following the same system categories that are used elsewhere (e.g., problem lists, medications, etc.) by Epic:

  • General (medical)

  • Surgical

  • Cardiovascular (circulatory)

  • Dermatologic

  • Endocrine

  • Gastrointestinal (digestive)

  • Infectious/Inflammatory/Immune

  • Musculoskeletal

  • Obstetric

  • Neurologic (Nervous)

  • Psychiatric

  • Respiratory

  • Renal

  • Urogenital (includes reproductive)

A "General" category at the top is important because users can move their most frequently used scores to this area for personalization convenience.

An "other" category can be added (usually at the bottom) if the "General" category does not suffice.

Accommodation of different disciplines (e.g., physiotherapy, dietetics) or major clinical areas (e.g., pediatrics) is facilitated by creating unique navigators for each and using workflow engine rules to allocate the correct navigator for the current signed-on user.

Items within groups should be organized alphabetically. Items should always start collapsed (accomplished through configuration records, VCNs) to prevent any one item from taking up a lot of space (with flowsheet rows), making it difficult for users to scroll or browse to a desired item.

If a group (topic) has many sections (items), consider making the group (topic) collapsible and consider having it start collapsed through use of an attached configuration record (VCN).

Overview

A short SmartText-based section can be added to the top of the navigator to provide users with a quick sense of the navigator purpose and use. Including the following elements is helpful:

  • Clinician-friendly name of navigator with link to support information found in the Clinician Manual or a Learning Home Dashboard (use EpicACT link for LHD). Consider also linking to any summary of relevant SmartLinks/SmartText/SmartPhrases that can bring the score results into clinical documentation.

  • Brief indication of how items are organized in the navigator (e.g., groups and alphabetical).

  • Reminder about how to use the with-in navigator search function (CNTRL-F) to find items in busy navigators.

  • Link (EpicACT) to related decision support tools.

  • Link (EpicACT) to relevant sidebar resources.

  • Link (external) to any key relevant external resource.

Menu

The leftmost column of a tools navigator should be used as a navigational aid, with the available tools listed such that the user can rapidly jump from tool-to-tool.

Menu items can be controlled by specifying an abbreviation in the "Abbr" section setting. Use a best known acronym to keep the menu column tight. The full section title will display when users hover over the menu entry.

Sections

Provide a full (verbose) title for the tool in the section "caption" setting. There are many similarly-named tools and precise identification is important. Be sure to include the acronym (in CAPS and the same one used in the menu abbreviation) in parentheses at the end of the caption title.

Flowsheet-derived sections can take up a lot of space (e.g., form rendering of a flowsheet with many rows). It is best to configure sections to start collapsed (use attached configuration record, VCN).

Similarly, use configuration files (VCN) to ensure that flowsheet data presented in SmartForm format has last filed values revealed and row information showing by default. Style recommendations for flowsheet design, covered separately, highlight the importance of clear row titles, use of links to source (copyright) materials, and simple instructions for data entry.

If the tool's copyright or allowed-use provisions require, place a copyright symbol (©) at the end of the section title.

Chaining

Unless a grouped set of tools should be used sequentially, do not chain (link) score navigator sections. This helps avoid the user being (unintentionally) taken to a different score when closing the intended score.

Resources

Licenced Scores in Epic Foundation System

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