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All offers must be received by the closing date Thursday, September 10, 2020, NLT 11:59 AM EST. ATTACHMENT A Cyberseminar Transcript Date: July 13, 2020 Series: VIReC Database and Methods Seminar Session: Joint Legacy Viewer: Practical Use in a Research Setting Presenter: Amber Lane, BS; Reese Omizo, MD This is an unedited transcript of this session. As such, it may contain omissions or errors due to sound quality or misinterpretation. For clarification or verification of any points in the transcript, please refer to the audio version posted at http://www.hsrd.research.va.gov/cyberseminars/catalog-archive.cfm CIDER Staff: And hello, everyone. Welcome to Database and Methods, a Cyberseminar series hosted by VIReC, the VA Information Resource Center. Thank you to CIDER for providing technical and promotional support. Database and Methods is one of VIReC's core Cyberseminar series, and it focuses on helping VA researchers access and use VA databases. This slide shows a series schedule for the year. Sessions are typically held on the first Monday of every month at 1 p.m. Eastern. More information about the series and other VIReC Cyberseminars is available on VIReC's website, and you can view past Cyberseminars on HSR&D's VIReC Cyberseminar archive. A quick reminder to those who are just signing in, slides are available for download. This is a screenshot of a sample e-mail you should have received today before the session. In it, you'll find the link to download the slides. Today's presentation is titled JLV, Practical Use in a Research Setting, and will be presented by Amber Lane and Dr. Reese Omizo. Amber Lane has been working as a research coordinator for over five years and has been using JLV for over the last two years for eligibility screening, AE reporting, and outcomes collection. Currently, she is the project manager for a clinical trial that provides tailored e consults to infectious disease providers caring for patients with COPD and HIV to increase quality and access to specialty care. Dr. Omizo has been a primary care physician for the VA Island Healthcare Systems for 24 years. Since twenty thirteen, he has served as a physician informatics in the clinical informatics and data management office on the JLV leadership team, providing development, testing, and training support, as well as subject matter expertise in VA DoD interoperability and informatics in primary care. Thank you so much for joining us today. And, Amber, you can take over. Amber Lane: All right. Thank you so much for joining us today as we talk about how JLV can be used in research. For today, our objectives are going to be that we just want to give a quick overview of JLV, so, what it is and how it can be used. We also briefly want to just go through navigating the setup of JLV, so, how you can get access, how you can log in, how you can find those patients. And throughout most of this presentation, we are actually hoping to do a live demonstration of showing how JLV can be used practically in research tasks and also showing how JLV can be optimized for use. And then a good portion of this, we also want to leave for questions, and those questions could be general based on the information that you see today, or they could also be if you have a specific user question that you have found while you're using JLV, and you just really want to know the best way to approach it. So, just a quick note, since this is a live demonstration, this slide deck that we have that was available is just a little different than what you may actually be seeing on the screen, but we're trying to follow it very closely so that you can look back on it and follow along. So the first thing we have is a poll question. The first question is, what is your role in research and/or quality improvement? So are you investigator, PI, or Co-I? Are you a data manager, analyst, or programmer? Are you a project coordinator or other, which we ask that you please describe via the Q&A function. CIDER Staff: All right. So the poll has now been launched, and answers are coming in. We'll just let it run for a few more seconds before I close it out. Just as a reminder, if you cannot select an option, please exit out of full-screen mode, and that should allow you to select a poll answer. All right. It seems that things have leveled off, so I m just going to close the poll and share the results. So, 19% of those who answered said investigator, PI, Co-I; and then 24% said data manager, analyst, or programmer; 31% said project coordinator; 26% said other. And some of those are research associate, associate director of operations, research compliance, and RN, CSP NODES, study coordinator backup. All right. So I'll just turn things back over to you. Amber Lane: Great. And then we have another poll question. So, how many years of experience do you have working with VA data? One year or less, more than one year but less than three years, at least three years but less than seven years, at least seven years but less than 10 years, or 10 years or more. CIDER Staff: All right. And, again, that poll is now open. We are at about 70%. I'll just let that run a few more seconds before I close it out. All right. It's leveled off. I will close the poll, share the results, and 28% of those who answered said one year or less; 19% said more than one, less than three; 28% said at least three, less than seven years; 7% said at least seven, less than 10 years; and then 18% said 10 years or more. I'll turn things back over to you. Amber Lane: Okay. Great. CIDER Staff: Seems like there's a problem with the screen, so I m just going to take the screen back and then send it back over to you, okay, Amber? Amber Lane: Okay. Sounds good. CIDER Staff: All right. Let me make you the presenter. All right. Sorry about that. We ve been having a few problems with that. Amber Lane: Okay. Can you see my screen now? CIDER Staff: Yes. Perfect. Amber Lane: All right. Great. So we're just going to jump into that quick overview of JLV and then how it's used in research. So, what is JLV and why does it matter? So, JLV is a viewer, and what that means is that it collects and redisplays data from connected systems, so that happens when you launch the widgets in JLV, and that data is going to be standardized. Now within those widgets, there is information about the records and then also useful filters that you can use to find the record that you're looking for, which we're actually going to demonstrate later on. So, why is JLV going to be a big deal? So, JLV is going to be where you can get a full view of the patient's entire history, so from VistA and CPRS and soon to be the new electronic health record from Cerner called Millennium. It also is going to be the DoD sources, so, CHCS, which is basically the DoD's CPRS; AHLTA; Essentris, which is the DoD's inpatient system; and then also their Cerner platform, which is MHS Genesis. And there will be limited summaries from Community Health Information Exchange Partners. So, especially for patients that you may be trying to view records that are national, instead of having to request the individual CPRS systems, JLV is going to be able to provide all of that. So, in research currently, we are using JLV mainly for patient eligibility screening, for chart abstractions, and then also for that adverse event collection. And again, we do our research using national cohorts, so JLV allows us to see those records without having to request the individual CPRS from each of those locations. So if you ve heard of JLV, or even if you ve used JLV, you probably also have heard a few complaints, and we just want to bring those up here at the beginning. So, one of the main complaints may be that data is missing. So we just want to point out that this a viewer, so the information that's in JLV is what is coming from those other systems. So if one of those other systems is down, we're not going to be able to view the information at that time, or if the information wasn t put into that system, it's not going to be in JLV. Other common complaints is data is hard to find, longer loading times, not able to get images, and not being able to search for text in notes like you can in CPRS. So, throughout this presentation, we will be giving examples of helpful tips to hopefully navigate these issues, and then we also are going to try to address them. We can't make them disappear, but hopefully, we can help with the optimization of your use of JLV. So, also throughout this presentation, I really wanted to approach it from a real-life example, so today, we'll be approaching it as if we were screening this patient for eligibility. And our eligibility criteria, just some general ones, would be like the patient's BMI, their potassium level, and then a more specialized could be like an echocardiogram. And then the patient we'll be using today is going to be a test patient, and you can go back and use the same information and mess around with JLV as well. So we have one more poll question, and it's how experienced are you in using JLV? So, no experience; you're a beginner, so you ve used it for a few tasks; you're intermediate, have used multiple times and are fairly comfortable; and you're an expert, having used regularly if not daily. CIDER Staff: That poll is now launched. So, just as a reminder, if you cannot pick out an answer, please exit out of full-screen mode and select the answer in the window. All right. Answers are coming in quite rapidly. We'll just let that run for a few more seconds until it levels off, and, all right. Things seem to have leveled off, so I m going to close the poll and share the results. So, 44% said no experience; 31% said beginner, have used it for a few tasks; 23% said intermediate, have used it multiple times and fairly comfortable; 3% said expert, have used regularly if not daily. Turn things back over to you. Amber Lane: Okay. Great. So we're hoping that through this presentation that we will have something for everyone. Whatever level you're at, that hopefully you can pick up something that can really increase your JLV knowledge. So we're just going to go through the initial setting up of JLV real fast for those of you especially that are beginners. So, getting access to JLV. So if you work clinically, you probably already have access to JLV, and that can be launched directly from CPRS. In the top bar there, there is a button that is labeled JLV, and it opens up to that patient. However, if you're going to be using JLV for a different purpose other than clinical, you need to make sure that you have requested that specific access. So if you are doing an operations project or especially for research, there are other forms and requests that need to be put in. So, the form here is what you may expect for the research, and it has to go through the DART, which is the Data Access Request Tracker. And for more information about what you may need specifically for the access that you're requesting, you can go to the link there, and it's a really good page that has setup that gives you directions on what to expect. So then the next thing is just logging into JLV. So at this point, I m going to go ahead and switch over to kind of our live demonstration. And so if you aren t using this clinically, then to launch JLV, you can go through just typing in the website directly. So here, I m using Google Chrome, and I bookmark JLV. And so here is your log-on page. So you can log on either using your VA PIV card, or, if you are using a PIV exemption or aren t going to, don't have your PIV card, you can view these other sign-in options and sign in using the Windows authentication. So we're going to go ahead and just log on here. Now, the log-on uses your CPRS and CAPRI access code, so if you don't have your PIN number, it will send you to where you can use your access code and verification. So we'll go ahead and, so when you first open up JLV, it's going to ask you to find your patient. So there's three different ways that you can find your patients, and we'll just briefly show those at this point. So the DoD ID number is going to be the easiest. Now typically for research, before we get started, we will request information, and so in the past, we have requested like social security number, first name, last name from VINCI. However, the DoD ID number is easiest because you really just only need the 10-digit number to type in, which is unique to each patient, to find the patient. Instead of having to use, if you don't have the DoD number, you would have to use the social security number, which again, I m just using that test patient, and you would also need to use their last name. If it's a common last name, you may also have to include the first name. So that's the second way to do it, to have the full social security number and then also their last name, which I think is probably the most common way that, especially in research, that we have found patients in the past. The last way that you can find patients, let's say you only had the last four of the social security number, is you can go to the show advanced search options, and you will need the last name and the full first name and their date of birth, which again, I m using just that test patient that we had. And you have to include the birth sex as well. And the search results are going to populate down here below. Now the nice thing about JLV is when you're looking for a patient, you can also see recently viewed patients. So, say you need to stop in the middle, you can just log back in and quickly choose which patient you want to go to. So we're just going to use test patient one here. So when you open up JLV, you are going to get whatever widgets you may already have in your workspace, or if this is your first time, you can add widgets into your workspace. So, also additionally, what we'll pull up once it's loaded is the demographics and then also a platform that's going to have all the flags or important information about this patient. So the first thing when we're approaching a screening patient is that we have to find the widgets that are going to help us find our information. So if you are coming into JLV, and you are thinking about, say, finding the BMI or finding those lab results, you are going to want to have those specific widgets that have the data. So you can find the specific widgets in the widget tray here at the bottom, and so you can see that you have lots of different choices. And so when you find the widget that you want, you just drag it and drop it into one of the three columns there. So how do you know where the data is at or what widget to pick? So the source systems is actually what defines where the data will be displayed and hovering over these widgets will display the contents of what's in there, so kind of a brief description. So, for instance, for documents, it has documents and notes of all types from all VA and DoD official health IT systems of record. So, data can be in multiple of these widgets. So, for example, you could find clinical notes within the progress note widget. You could also find them in the document widget, or they could be even hyperlinked in outpatient encounters. So that makes it a little tricky to find information. However, if you think about how your site enters information, that can be really helpful to help you pick the correct widget. And that's kind of our first tip, is think about how information is collected clinically to help you decide which widget to actually pick. So, for example, with the electrocardiogram, for instance, you at your site may know that a lot of times it's documented within just general notes, and so you might try the documents widget. Or maybe it is a part of consults. They go out to the community a lot, and so you might want to check in the consult information or even the community health summaries and documents to try to find that electrocardiogram. At first, it might be a little hunting around, but once you find it, it's going to be a lot easier to just go to that widget directly to find that information. So once you ve picked your widgets, a lot of times, it's really tempting just to fill up one page entirely with all the widgets that you possibly could ever need. However, that can really slow down JLV, so what we suggest is that you only put the widgets that you absolutely need and that you use multiple tabs. So, for instance, if I was screening this patient, and I knew I wanted to find the BMI and the lab results, I might put those on one tab and just call it general. So, go ahead and add it. And so I said I was trying to find the BMI, which I know is collected by nurses at our site, so probably most likely it will be in the vitals. Or, for the potassium, most likely that's going to be in the lab results. And I m interested in finding out if they've had potassium in the last two years, so instead of having the date range be a lot wider, like two years in one widget, which will take a lot longer to load, I m actually going to repeat and put the same widget on this tab, and I m going to change the filter here to show me 2018 instead of using the two years. Go ahead and apply, and then it will pull up the lab results for that year, and we have the 2019 to 2020 here. Now I could do the same thing for the echocardiograms. So for this one, again, I may not know how they enter it in, but I might think, oh, they could send it out to the community, so I could put in the consults. I also think that they could probably scan it in, so I m going to go ahead and put it in documents. And again, documents can have a lot in it and take a long time to load, so it can be really good to set your range to be a lot shorter. So again, I m going to set this to be in the last year, just like that. And, again, JLV is a viewer, so it's pulling it from the systems, so if the systems are having any downtime, that affects our loading as well. So I m going to go ahead and change the date range on here to be the last year, which you can use these quick filters here to change the date range very quickly. So now we have our widgets set up on our workspace here, and we're going to go ahead and get screening. So these tabs are going to save, and for each patient that you open, once you have it set up, you're going to have the exact same date ranges built in every single time. So, as you can see, this took quite a bit of time to load because there's 850 records in there. So, JLV, when you're finding information, it's best to try to get it to be less than 300 records, so you really want to filter down these widgets here. And so here is just a general filter, but you can get a much better filter when you select the more button, which will actually expand the widget. And then you can really start to limit how many of these documents that you're seeing. So, again, if we're thinking about trying to find an echocardiogram, and we're trying to filter, what we might do is you want to start with kind of the biggest filter, going down to the smallest. So we might try to filter by site. So maybe they recently have done a lot at the DoD, so I might try to see if they have these scans at the DoD. And then you can go and filter again by description, so you can see here we can get the echocardiogram or EKG. Now this filter is going to be just filtering the title. It doesn t actually filter what information is within that note. And so then, now we have it down to four documents where we could then go through and see the information that's in there instead of clicking or scrolling through 700 documents. Now, the records didn't disappear. They are just filtered, so you can always go back and remove all the filters and start over again. So that is finding records initially. Now, say that you are really interested in trying to find a specific image, or seeing if a record was uploaded through an image. So you can actually search for images, and how you do that is you can just click here on the image title, and a little arrow will show up, and if you click again, all of these that have a little camera icon are going to have an image connected to it. So when you open that up, it will actually open up in VistA Imaging viewer, and it opens up in another browser where, in just another tab, so that you can see whatever it was that's uploaded. So, filtering those notes and using the image icon can really help you to find that information. So, this is a test, and so it's probably going to take a little bit to load, so I m just going to go ahead and go back to JLV. So you can either exit out of it or go to the specific, just switch over to the tab. So if this image icon is there, that doesn t mean it's just going to be a picture. It also means that it could be anything that was uploaded into either VistA Imaging or to HAIMS, which is the DoD system. And so that could include images, radiology reports, test results in PDF, or also community care results or documents. So again, this filter can be really helpful to quickly find scanned-in information regarding tests from other sites. So now, at this point, we are going to go back to trying to find out if a person has the potassium level to be in our study. So if we are quickly trying to find their level, instead of going through here and looking specifically for potassium, we can use the expanded widget, and we can again filter, and this time, we can actually build a report that allows us to quickly search for text. So the way I m going to do that is, so I m looking for potassium. I know that this is a part of the CBC, so I m just going to filter that way. Now, for the report builder, what it does is it actually takes individual reports that you select, and it can combine up to 50 of those records, and it combines them into a PDF document. So I can select a few, or I can select all of them, just like that. And then I m going to go up here to the corner, to the report builder, and I m going to, it shows you which records are in the report, and you can clear them, or you can go ahead and make it, so I m going to go ahead and build this. I m just going to call this potassium, and then I m going to say twenty-nineteen to twenty-twenty and hit okay. So now, it's going to build and combine all of those reports into one. And then once you ve combined them, you can access them for up to 72 hours. So even if you have left and have come back, it's still going to be there. So when you open it up now, it is a PDF document that you can then search. So if you hit control F, you get the search bar, and we'll just type in potassium and see if it is in there. So it doesn t look like it found it in this document, and so you can do the exact same thing in your other range. So if you open this up, and you see that this one only has 19, so it might be worth just taking all of those records. Hit report builder here, select, and then go ahead and you can build it the same way here. And again, it's just building. And, like I said, the other ones, now this also works really well for progress notes, so if you were trying to find maybe a specific one about if a patient had diabetes or a past prognosis, you could look it up specifically and combine all of those notes just for that as well, and then do the control F and do a search for that. So, that is kind of our quick tour of JLV and how you can find information in it. So just a few last things here. So, sorry. Lost my slide that I wanted. So, again, just a few helpful hints and takeaways. Choosing the proper widgets makes data easier to find. Having multiple tabs and duplicates of the same widget with different date ranges can reduce loading times. Using widget filters and image filter can help you find uploaded materials quickly. And the report builder is a great tool for searching for text in records quickly. So at this point, we actually want to go and just do the Q&A. And again, you can ask questions in general about what you saw in this presentation, or if you have questions specifically about times that you ve used JLV, please feel free to let us know those, and we're happy to answer them. So we will go ahead and get started here. So our first question is, what do you do if data is missing? And if I know that the data should be there, how do I go about finding it? And I m going to turn it over to Dr. Omizo. Dr. Reese Omizo: Thanks, Amber. So if the data is missing, and you know that data should be there, it's probably because the source system is not sending it, so a refresh of the widget may help. At times, we just may have to wait, and I'll show something here in a demo. If I could actually share. CIDER Staff: Okay. One second. Dr. Reese Omizo: Mm-hmm. Thank you. Okay. So it looked like we had a little latency in the screen refresh, so I just want to make sure everyone can see this. Is that okay? CIDER Staff: Looks good. Amber Lane: Yes. CIDER Staff: Looks good. Dr. Reese Omizo: Okay. All right. So when we have problems connecting, I'll show you this that just came up a little bit earlier. So, here, I have my tab I ve created for images, and I have this little yellow triangle for radiology reports. So if I click on this, it will show me that I have something that's not connecting as it should. So in this case, if there were something in the HAIMS system that I know I saw yesterday, and I got in today, I would not be seeing it right now because that connection is not working at the time. So, again, as aforementioned, we're just a viewer. We're kind of like the TV. So you're looking through cable stations. If you hit ESPN, you get ESPN. If it's out, there's probably something wrong with the cable feed and not the TV. So you would just refresh and hope for the best, and if not, come back later and try it again. So you notice I have really heinously long date range here, so I just wanted to do that as part of the demo. So we're actually pulling this information in real time, so we're going out to all the systems that are connected and asking them if they have radiology reports on this particular patient. Okay? So that's going to take a while, but there were only 55 in that entire date range. Now you notice I lost the triangle, so that means that I was actually able to connect to that system. Okay. Next question? Amber Lane: Can you create widgets to use in multiple patient records? Dr. Reese Omizo: Create widgets to use in multiple patients records. I m not sure I understand the question. Can you clarify? Amber Lane: So I think is there a way to use a widget across all of the patients? So that would just be in those multiple tabs. Those stay from time to time. Each patient that you go into, I believe, if I understand the question. Dr. Reese Omizo: Yeah. So your tabs and your settings, your date ranges, all of the layout, date ranges, all of that will stay. So as you switch patients, when you go to the new patient, you're going to actually have the same layout, the same date ranges. But as far as aggregating all of the data and then saying something like show me all of my diabetics who have an A1C greater than 11, that can't be done at this time. Amber Lane: Okay. Did you_ Dr. Reese Omizo: If there aren t any other questions, I can just kind of carry on. Oh, go ahead. Amber Lane: No. There are a lot of questions here. I m reading through them. Sorry. How does this work if you want to search the records for thousands of patients? Dr. Reese Omizo: For thousands of patients, you can't go across records that way. You basically would be going for a patient search. This is a patient-centric view, so when I m looking at data, when I pull up a patient's name, we're looking for information about that particular patient at all of the sites that they ve been to, including the DoD. So you're looking at a test patient, so we basically have all the folks at all the sites helping us out here. And we can get information from each of those systems about the one patient, but we cannot get information across all the databases about a specific thing across patient records. So that would be something that you would do via a larger corporate database or data warehouse. So we are not able to do data warehousing at this time. Amber Lane: Did you say that patient records from community care providers are including in JLV? Dr. Reese Omizo: Yes. So this is a tab I created for notes. So, again, it's customizable. I decided I was going to put these particular widgets on this tab, and one of them is community health summaries and documents. So if you're familiar with Continuity of Care Documents, or CCDs, these are documents that are standardized documents that are shared across health information exchanges, so we do get these from the participating sites. So you're not going to get 100%, but you're going to get quite a few. So there are elements that are included in these CCDs at some sites, and you're going to notice a lot of variability. So the Office of the National Coordinator has set that bar for participation pretty low, so you can include a lot, or you can include just a little bit of information. But all of these will be called CCDs. If I scroll down, you'll see that some of these documents have other titles. So the problem that I have all the time is that I don't know what's in these documents. You basically have to go through these from the site that you're typically interested in, and then take a look at what they include. They'll be consistent from the site itself, but they will not be consistent across the different sites. So the demo that Amber did with the report builder is actually very important, because it takes me a long time to open up each and every one of these and look through them, versus I could send them over to my report builder and build a report so, as she mentioned, I can click on any individual one, and I can send that document to the report builder, or I can send 25 at a time by clicking on that pancake plus. And when I open my report builder, it's thrown all of them in here, so I have 25 sitting in here waiting to be built into a report. So before the demo, I actually had created another report, so this has been created earlier, and it's going to sit here for 72 hours. So even if I close JLV, open up a different patient note, I come back to this patient, this thing is going to sit here for the next three days. But that current report has to do with all the things that I've just sent in here to build a report. When you're searching through your aggregated reports, you get one large PDF. Okay? Seventy-two pages here. I m going to make sure that I am actually actively in the PDF. Now I m using Chrome as the browser, so this is going to look a little different if you're using Internet Explorer, but, and notice I don't have all the controls here. I don't have that magnifying glass to search, et cetera, but I can still use find with the keyboard commands. So I'll hold down the control key and hit F, and if there's something in here that I want to find, I can find sort of the impossible. So, let's see. I knew this person had PE, so I want to look for D-dimer, and it's already showing me here that I got seven hits. So, see it highlighted here? So this looks like it's the order or procedure. I will go to the next one, and here's my result. Okay? And this something that I could copy. I'll go here, and I could copy that, and I could actually incorporate that into my note. I'll go and find the next one. So it's not a smart search. It's just looking for strings of text. So if I put in something in here that's really nonspecific, let's see if there's something like that in here. I guess not. See that? So I don't have a specific enough string of text, and I end up getting this huge number here, so that tells me I should use a different string. So I get hemoglobin A1C and find it that way. It's actually great for finding vaccines. So a lot of the community records have very good records regarding immunizations, but this is just a quick way to get through it. So I have this document that's here. Close that out, and it's going to sit there. So in this case, I built a document from these outside records. And similarly, let's say that I m looking at progress notes. So we talked about the regular widgets here that I have all crushed up, and then the expanded widgets. So I almost never use the regular widgets. I almost always expand these. So the expanded widget is actually very interesting. It looks really busy, and I think this is the thing that sort of is daunting for a lot of folks. They're like, man, this is just so much information. That's because they're looking at all the stuff down here. So you don't look at the stuff below here. First thing you do is check your date range. Right? Take a look at the number of records that have been returned, and you really want to be under 300 for all these filters to work well. And if that's not working out, you focus your date range a little more, so you get a smaller number of records. But once you have this, now you can start using all the cool stuff that you have here. It's busy because we have so many columns of information. That's the downside. The upside is that I can use those columns to filter. So I'll typically go by site if I know that I have interest in something. Let's say it's coming just from DoD records. I'll click there, and I went down to about half of the records they have. So that's been applied already. I already have this filter applied. So from this subset of 163, I can actually take a look at document types or titles. So of the 163, these are the only titles that exist in 163. So if I just want to see things like progress notes, I m now down to 156, and if want to get notes by a specific specialty, so this is just the DoD records, and this is how they send their information to us. Right? And let's say I just want to look at the pediatric cardiology notes for this patient. Okay. So doing three layers of searching, so first, step one was by site. Step two was to look at the document types. I m looking for the progress notes. And step three was just looking for the pediatric cardiology notes. I m down to just two notes. And any hyperlink will be shown with a color, usually in blue, depending on the color scheme you use, and underlined. So if I clicked here, it would take me to the actual note. So this is coming off of the DoD's AHLTA system, and we can do things here still like highlight and copy. So, typically, I will use this. I don't know if you have tickler notes at your site in CPRS, but I will gather data from the various sites, create a tickler note, and then use that note to build my progress note in CPRS when I actually see the patient. So let me go back and remove the filters again. So the reason I m going through these demos is to have people just take a look at it. It would be helpful if you could open it up on your own desktop and just kind of play along. And if you have questions, just fire away. If not, I m just going to cover a lot of the things that seem to give people problems. Amber Lane: We have a few more questions here. Dr. Reese Omizo: Okay. Shoot. Amber Lane: Can PDF reports be changed to CSB or similar formats for the report builder? Dr. Reese Omizo: Okay. So when you get a report from report builder, hang on one second. Excuse me. Okay. Once I have this report here, I m going to open it up. Okay. You can actually download that report, and you can save this to your U drive, so you have to be very careful with this. You do not want to save this report to your C drive. There are privacy reasons why you're not doing that, but you should all have a user drive, your private drive. And if you save it to your U drive somewhere, you can actually save it first, it will save as a PDF, and you can open up the PDF, and then if you have a converter, you can convert that file to other file types. Does that help? The other thing that's good is if you, so let's say that I save this to my U drive. When I save it to my U drive and I open it, I'll have all of the other Adobe Pro functions here. I can highlight. I can annotate, add comments, et cetera. So if you're working on a research project, and you actually have to share this report with other folks on your team, you can actually pass that stuff around. So again, check with your facility's privacy officer and make sure that you're doing everything sort of as you should, and make sure that you're taking that record and deleting it at a later date on a regular basis so that you don't keep anything on your U drive. Any other questions? Amber Lane: Okay. Yes, there is. Are non-VA documents that are usually uploaded into VistA Imaging available for viewing or search in JLV? Dr. Reese Omizo: Yes. So, that I will find typically in my documents widget. And just as we're mentioning that real quick, I m just going to take a little sidebar. If you open up the widget tray, and you hover over any of these, you get a little popup that tells you what's in the widget. So it's just to help. Again, the best thing is to just play with it, open up documents within the widget so you know what your partners are sharing and how they're sharing the data. So, JLV doesn t control how that happens. The source systems do. Okay. So let's get to documents. Let me move this up here. All right. So the first I do is I will go to more, because I need the expanded widget. Okay. And Amber showed this earlier. So in this document, so I have 310 documents in the document widget, and not all of them have images attached to them, but the ones that do will have this camera icon. This actually pulls data from the VA's VistA Imaging system. So if you open up VistA imaging display at your site, we're going to get a subset of those images. We'll get the scanned documents in here and some of the imaging files, but we also get information from the DoD's HAIMS system, which is their equivalent. So it really, you have to kind of play with it, open up the documents, take a look at what the site is sharing, and if you're not able to get the things that you need, best thing to do is just call up the site and get them to fax something over for you. So, getting back to the documents here. So, which documents contain images? You simply click on the column header for image, and what it does is it pushes all of the cameras down to the very bottom of the list of the 3, on first click, and on second click, it brings them to the top. So here are all those documents that contain associated scanned image. See these? These are the teleretinal and the telederm images here. And if there were any from the DoD, I would get the DoD ones as well. Okay? Any other questions? Amber Lane: What is the difference between JLV, VistAWeb, and CAPRI? Dr. Reese Omizo: Okay. All right. So, JLV connects to all of VA VistA systems, the DoD's CHCS systems, which is kind of like our old VistA, and then their AHLTA system, which is their outpatient, Essentris, which is inpatient. VistAWeb also connects and has a subset. At this point, JLV has a more robust dataset. The other problem with VistAWeb is that it does not tell you what you're not connecting to. Now on the upside, there will be times when the systems are down and not sending information to JLV, but there is a background feed to VistAWeb where you can get things from the DoD and other VA sites, so I don't discount any of it. So if you're using VistAWeb or Remote Data Views still, you can use them. VistAWeb is going to go away at many sites. It's no longer available on your tools menu for CPRS, so don't get too used to it, but I can tell you that if I m stuck, and something it not connecting in JLV, I'll check VistAWeb, and I will check Remote Data Views. So for those who don't know, Remote Data Views are a part of CPRS, and I don't have it open right now, but if you go to the reports tab at the very end, you can actually get data. Now what I can do is I can show you what those reports are, because we actually have a widget that will show those on here, those health summaries. And this is how you create a new tab. So you click on that plus sign here. It will give you the title window of the popup, and then it gives you a blank workspace, upon which you can drop your widgets. So I m going to get, see all these we have here? See that? Health summaries and reports. That guy right there. So these are the VA health summaries and reports, so this actually comes out of the CPRS reports tab. So if you're in CPRS, that little tab all the way to the bottom right is the reports tab, and we're redisplaying the same thing. Only thing is that instead of just having your health summaries and reports from your local VA, we grab everyone's. Okay? So, again, you have to use the expanded widget here. Otherwise, it makes no sense. Now, this quick filter, you can type in here. So if you want colorectal cancer screening, you can type that in there, and it's going to find it for you. So that went from however, 3,000, down to 21 pretty quickly. So it will show you the screen, it will show you the site, and it will show you the type of reminder or report that this is. Okay. Let me take that away, and we'll go down, and you'll notice that some of these national ones are things that you can see on your reports tab. So if you're looking for remote clinical data for three months, for those that don't know, in the reports tab in CPRS, if you were to click on that same thing in the reports tab, you will get a three-month summary from all the sites that have seen this patient, all the VistA sites, as well as one report from your local VA, so that's what's being created right now. So we're just replicating what's there. So if, for some reason, JLV is down, all of these things are actually available in your reports tab, exactly like this. So if you're not that familiar with that function in CPRS, please learn that, because it will definitely come in handy. See? Each site that has seen the patient will send this. So this is a VistA function. It's fantastic. All right. Any other questions? Amber Lane: Someone again just wanted more clarification on what is CAPRI. Dr. Reese Omizo: Ah. So, I am not a benefits guy, and I know that it's analogous to, so if I m a clinician, right? So CPRS is what I use to view the VistA data. If you're a benefits person, you're actually using CAPRI as your interface to look at the data in VistA that is related to VBA, the Veterans Benefits Agency. Any other questions? Amber Lane: And this was back on when we were talking about if you could save the PDF or if you could export data, someone was asking about exporting specific data elements. Dr. Reese Omizo: Specific data elements. Hm. Amber Lane: Can you export a report of specific elements as a CSB or some other format was the original question. Dr. Reese Omizo: Like, say I just wanted to export just the hemoglobin A1Cs or something like that? I could do that, right? I could get the lab results widget. I'll expand it. I only have five here, so my date range needs to be fixed. So let's go back 10 years. So I could do the 10 years, or I could use these kind of funky data range selectors like you do when you're trying to book a flight, but I find these a lot easier to use. So, here we go. Ten years. I've got 171. I could do A1C, and I got, okay. So let's say that I have like 10 of these. I could send just these over to the report builder, and then I could actually get that report made. I don't think it's the most efficient. I think the lab results widget is one of our weaker widgets, and we have some problems because the lab packages in VistA no longer let us aggregate those panels. So if you do something like a Chem-7 or a CBC, you're going to see the individual results, which are really frustrating, right? Because you can only see them line by line in this case. Okay. So, yeah, you can send that specific type of data element to the report builder. Report builder, you can build anything that you want. One of the things I was going to touch on is I m going to hop over here. Sorry. A little schizophrenic, but, getting to the notes tab. In the same way that I could use the report builder to create a report of the external Continuity of Care Documents, let me get rid of that first. Let me clear it out. I can do the same here. So let's say that, so I do a lot of cross-coverage because I m working 60% for SITMUL [phonetic 0:58:35], for the Office of Health Informatics. And if I m cross covering for someone, and I want to know what's going on for a specific problem, typically, I'll go into CPRS progress notes or notes tab and read the primary care notes. So what I can do here is I know that for our site, we use primary in the note title, and I just type that into my free text search, and I went down to 48 records. So then what I would do is I would just go ahead and send those records to report builder. Right? And when I do, and I build the report, just minimize that, when I build this report, essentially what I m doing is I m actually creating one stack of all the primary care notes. So if I had a med student getting a paper chart from back in the day, they would take all the primary care notes, kind of aggregate them so that I could look at it, maybe photocopy those, so we can talk about the problems that were addressed by the physician. So if we're talking about A1C, so if I was looking at a person's diabetic control, I could look up A1C in the lab results, and I could infer what happened by just looking at the results over time. The other way to think about it is I could look at the A1Cs in the context of management, and I could actually take those primary care notes and then create the one PDF and start looking at A1Cs in the context of the notes that someone has written. So, for instance, I could find out why someone started or stopped a specific medication just by looking at it over time. So the report builder is a very powerful tool. We have a link at the end of the presentation where you can actually get to our training videos. I think it's really worthwhile taking a look at the one for the report builder especially. So, again, I open up the PDF, control F, and I can look here, and I have A1C mentioned three times in 49 pages. So I can look and just kind of piece through it. Okay? So if A1C was mentioned in the assessment and plan of notes, I can find that this way. So it's a very handy tool when you want to look for things like that. You can look for colorectal cancer screening. Very helpful. CIDER Staff: Okay. Well, thank you so much. We are at the hour, so I just wanted to thank Amber and Reese for taking time to do today's presentation. And to the audience, if your questions were not addressed during the presentation, you can contact the presenters directly. You also can always e-mail the VIReC help desk at [email protected]. And please stay tuned for the next session in VIReC's Database and Methods Seminar series. It's going to be Monday, September 14th, at 1 p.m. Eastern. There are no seminars, VIReC seminars in August. This presentation will be Drs. Bonnie Paris and Josh Thorpe who will be presenting VA Pharmacy Data. We really hope to see you there. Thank you once again for attending. We will be posting the evaluation shortly. Please take a minute to answer those questions. Let us know if there is any data topics that you're interested in, and we'll do our best to include those in future seminars. Thank you again, everyone, and have a wonderful day. [ END OF AUDIO ]

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