Demographic

Best Practice Data Mapping                                                                                                                                  

Gender

Open > Demographics screen > Sex

 

Ethnicity

Open > Demographics screen >Drop down list for Aboriginal / TSI



When 'Other' is chosen, BP gives additional options for ethnicity. Only one option can be chosen:



 

DVA

Open > Demographics screen > DVA No. has a value

 

Age

Open > Demographics screen > DOB

 

Last Visit / Activity

After entering notes on the 'Today's notes' tab, the visit will appear on the 'Past Visits' tab

CAT will check the most recent date in the list

 

Visits flagged as Type = Non Visit are excluded.

 

Last Visit = the most recent date recorded

Active = 3 or more visits recorded in the last 2 years

 

Note: The past visits screen in Best Practice can be used by practices to record non clinical contacts, for example, when a recall letter is sent. These contacts must be flagged a type Non Visit to be excluded by CAT.

 

 

Postcode

Open > Demographics screen > Postcode

 

Family History

Main Patient Screen > Family & Social History
any information entered on this form will be counted as family history information

Allergy

Main Patient Screen > Allergies / Adverse Drug Reactions Box

Allergy Recorded

An Allergy Item is present  

No Known Allergies

The ‘Nil Known’ check box is checked  

Nothing Recorded

No Allergy Items are present and the ‘Nil Known’ check box is unchecked

 

Smoking

Main Patient screen > Open > Alcohol and Smoking History > Tobacco

Daily Smoker

Smoker = Smoker is selected

 

Irregular Smoker

This option is not captured in Best Practice

 

Ex Smoker

Smoker = Ex-Smoker is selected

 

Never Smoked

Smoker = Never smoked is selected

 

Nothing Recorded

Smoker has nothing selected

 

Review Date

This will be the date something in the ‘Family & Social History’ section is changed. It is not possible to isolate Smoking changes.

Alcohol

Main Patient screen > Open > Alcohol and Smoking History > Alcohol

Frequency = days a week patient usually drinks alcohol

Drinker

Frequency = any except Never

 

Non Drinker

Frequency = Never

 

Nothing Recorded

Alcohol tab has nothing selected

 

Review Date

This will be the date something in the ‘Family & Social History’ section is changed. It is not possible to isolate Alcohol changes.

Measurements

/Pathology *

Best Practice Mapping

 

BMI

Patient Record >Main Patient Screen > Observations screen

 

Waist

Patient Record >Main Patient Screen > Observations screen

 

Birth weight

For the Maternal Health Care report, CAT can extract the birth weight of the child from two sources. One is the child's record, which needs the weight entered and the date backdated to the child's birthday - this will be picked up under the 'Patient Record' report.

For the Mother's Antenatal report the birth weight of the child has to be recorded in the mother's record. Under the 'Past Pregnancy' on the 'Obstetric History' tab after adding the pregnancy outcome, BP will show a field for the birth weight of the child born.


BSLF

Patient Record >Main Patient Screen > Observations screen

OR

Patient Record > Main Patient screen > Enhanced Primary Care > Diabetes Cycle of Care screen.

OR

Pathology HL7 results with LOINC codes 14771-0, 14996-3

 

Cholesterol

Lipids data :

Patient Record > Main Patient screen > Enhanced Primary Care > Diabetes Cycle of Care screen.

OR

Pathology HL7 results

OR manually entered result

 

HDL

LDL

Triglycerides

Creatinine

Patient Record > Main Patient screen > Enhanced Primary Care > Diabetes Cycle of Care screen.

OR

Pathology HL7 results

OR manually entered result

 

Urinary creatinine

Pathology HL7 results with LOINC code 14683-7

 

Microalbumin

Patient Record > Main Patient screen > Enhanced Primary Care > Diabetes Cycle of Care screen.

OR

Pathology HL7 results

 

ACR (Microalbumin Creatinine Ratio)

 

Listed in the BP database as an ACR result (with the BP pathology code 17)

OR one of these LOINC codes: 32294-1,30000-4,9318-7,14959-1

OR one of these result names: Alb/Cre, Alb/Creat, Albumin/Creatinine, Albumin/Creatinine Ratio, Urinary Albumin/Creatinine Ratio, Urinary Albumin/Creat Ratio, Microalbumin Ratio

OR manually entered result

 

HbA1c

Patient Record > Main Patient screen > Enhanced Primary Care > Diabetes Cycle of Care screen.

OR

Pathology HL7 results

OR manually entered result

OR

Additional test name ‘Blood haemoglobin A 1 c’

BP

Patient Record > Main Patient screen either

- opening the Observations screen, or

- opening the Enhanced Primary Care > Diabetes Cycle of Care screen.

 

Respiratory - Spirometry

Clinical > Respiratory function

OR

Today’s Notes >History and Examination > Respiratory > Calculator > FEV1 and FVC

Please note that currently on POST results are extracted by CAT4

INR

 

Clinical > INR Manager

Physical Activity

Clinical > Physical Activity Prescription

The prescription must be printed for it to be saved.

A selected ‘current physical activity level’ of moderate or active meets the physical activity guidelines, otherwise they do not meet the guidelines.

We report Inactive as sedentary, Moderate and Active as sufficient.

 

FOBT

 

Pathology HL7 results with LOINC code 2335-8, 27396-1, 14563-1, 14564-9, 14565-6, 12503-9, 12504-7, 27401-9, 27925-7, 27926-5, 57905-2,56490-6,56491-4,29771-3


or with test names Faecal Occult Blood ,Faecal occult blood screening, Faecal Occult Blood Test, FOB, FOBT, Occult blood – faeces, Stool occult blood test, OCCULT BLOOD, faecal human haemoglobin, Insure FOBT, FOBT1, FOBT2, FOBT3, FOB1, FOB2, FOB3, Faecal Occult Blood1, Faecal Occult Blood2, Faecal Occult Blood3, BOW, IFOBT, OCCULT BLOOD (OCB-0), OCCULT BLOOD (OCB-1), OCCULT BLOOD (OCB-2), OCB NATIONAL SCREENING, FHB, FAECAL BLOOD, %FOBT%, %OCCULT%, Faecal Immunochemical Test,
FAECAL HAEMOGLOBIN

FOBT test orders are extracted with any of the test names above. The % indicates a wild card search which will pick up any test name with FOBT or OCCULT in the name.


eGFR

 

Pathology HL7 results with LOINC code 33914-3

OR

Calculation (Refer Clinical Audit User Guide – Part 2 Functionality)

 

Pap Smear

Best Practice Mapping

 

Female Patient Record >

Main Patient Screen > Cervical Smears tab

(Manual entry or Pathology HL7 results)

Recorded

A smear test is listed

Smear Date

Date of most recent entry

Best Practice Pap Smear HL7 Mapping

TEST NAME

 

Best Practice automatically recognises HL7 items as pap smear results if they are this list.

 

CCSR

CERVICAL CONVENTIONAL SMEAR

CERVICAL CYTOLOGY

CERVICAL SMEAR

CERVICAL SMR

CYTOLOGY GYNAECOLOGICAL

CYTOLOGY GYNAECOLOGICAL (PAP-0) 

GYNAE CYTOLOGY

GYNAECOLOGICAL CYTOLOGY

GYNEA CYTOLOGY

NON SCREENING PAP

NON SCREENING SMEAR 

PAN-O

PAP

PAP (BALLARAT)

PAP (GEELONG) 

PAP NS

PAP SMEAR

PAP SMEAR (PAN-0)

PAP SMEAR +/- THIN PREP

PAP SMEAR OLD 

PAP SMEARS 

PAP TEST

PAP-0 (PAP SMEAR)

PAPFU

PAPR 

PAPR NS 

THIN PREP ONLY

THINP

VAG SM

VAGINAL SMR

VAULT CYTOLOGY

VAULT SMEAR

 

Practices should check the test names appearing in the results tab and advise PCS if there is a test name that should be added to this list.

Pap Smear Ineligible

Best Practice Mapping

 

Cervical Smears screen - tick-box ‘Not Required’ checked

Coded condition of Hysterectomy: see Diagnosis Codes Screening Tests

Mammogram

If you are not receiving your results electronically, you will have to enter the test results manually using one of the names specified in the mapping guides. Please check the links below for details. Also please note that CAT4 can't pick up mammogram test from your conditions or past history list - it has to be a test name!



Mammogram results are not sent electronically in all states, but if test names are entered manually into the results tab CAT4 will pick up that the test has been done. The following test names are recognised:

  • Breast Mammogram Screening
  • Bilateral Mammography
  • Ultrasound Breast Bilateral
  • Wesley Breast Clinic Consultation Report
  • Mammogram
  • Mammogram-normal
  • Breast Mammography
  • Mammography - Bilateral
  • Mammogram Breastscreen NSW
  • Screening Mammogram - BreastScreen Queensland


To manually add a mammogram result click on the 'Add' button under the 'Investigation report' tab, then enter one of the test names from above and complete the other fields. CAT4 will only extract the test name and date but no outcome/result.


Disease

Best Practice Mapping

Condition

Past History screen > Checks the condition selected on history items, where Conditions are selected from a coded list.

 

Refer to Appendix C-1 for a list of conditions mapping to each CAT condition.

 

Medications

Best Practice Mapping

Medication

Current Rx screen > Checks the Drugs listed as current medications, where Drugs are selected from a coded list.

 

Refer to Appendix C-2 for a list of medications mapping to each CAT medication.

 

 

Medication Count

Current Rx screen > Counts All Drugs listed as current medications

 

My Health Record status

To update a patient's MHR status from unknown the 'My Health Record' menu needs to be accessed in BP. If no one has clicked on 'My Health Record' then CAT4 will list the status as 'unknown'.


 

* Refer to pathology note at the start of this manual and Appendix