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Supplementary Material

Q: Explain how "Health Factors" in PCE and AICS are to be used and how this data may eventually be shared within a VISN. How are the level/severity modifiers (SEVERE, MOD and MIN) used in health factors when the health factors are not consistent with such quantification:

A:Here's a little background. The Indian Health Service used the Health Factors originally. The HEAVY, MODERATE, MINIMUM SEVERITY modifiers can be used with a health factor if clinicians wish to define their factors in a manner that makes these modifiers useful. They do not have to be used where they do not make sense.

AICS allows encounter form designers to include health factors on their encounter forms, with or without these modifiers. The health factors that are checked off by clinicians can be captured via scanning and stored in the V Health Factor file.

The initial set of health factor entries was defined by Indian Health Service. The SLC IRMFO added additional health factors based on feedback from a supporting clinical team, and the Ambulatory Care EP.   

The Health Summary package has a Health Factor component which showS the latest health factors for each health factor category. If modifiers were collected for the health factors, they would be displayed in this component. The PCE clinical reminders do not use the health factor modifier, though they do use the existence of a patient's health factor to modify the reminder criteria.

The health factor information can be viewed as risk assessment or risk factor data which could provide useful information to guide the clinician as the care giver. For example, the PCE package includes a predefined clinical reminder for determing whether tobacco education needs to be given to the patient. The Health factors distributed with PCE include the Health factor category of TOBACCO and within that category of health factors is a factor for "LIFETIME NON-SMOKER." If a clinician had a patient who never has smoked or used any form of tobacco, the reminder will not come up for the patient if the health factor for "LIFETIME NON-SMOKER" has been captured off the encounter form.

We expect to learn a lot about what clinicians really would like to do with health factors as the clinicians begin using them with the reminders.

August 1996PCE V. 1.0 User Manual133

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