The TSWF CORE form is intended to be used for adult patients in all primary care areas (Family Medicine, Internal Medicine, Flight Medicine, etc).

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CORE Recent Changes

  • 44 changes for SEP – DEC 2018 update

Sep-Dec 2018 Changes

  • Clinical Clue “Check JLV for care provided at a site utilizing MHS GENESIS, VA site, or on-boarded health information exchanges.”
  • Added “Are you deploying in the next 6 months? Yes/No/I don’t know”to the AD only section
  • Revised Neck PE
  • Added Pre- and Post-procedure pain elements
  • Defaulted Well Female Tab PE ribbon to open, not a ribbon anymore
  • Added menopause to obsolete terms.
  • Added hysterectomy to obsolete terms.
  • Added “Pregnant for ____Weeks Based on LMP” to obsolete terms.
  • Added hysterectomy to obsolete terms.
  • Removed buttock/perianal area from the auto-neg.
  • Updated CVD link verbiage: calculator changed to estimator
  • Updated 10-yr CVD Risk Assessment verbiage in the preventive services section for all patients.

HPI TAB

  • Added an additional check box to the top of the current Medication Reconciliation area that reads [ ] Patient is not taking medications at this time
  • Moved “Have you received any type of care since your last visit with this clinic?” from screening tab to HPI tab.
  • Consolidated preventive services ribbons into 3 ribbons.
  • Added additional information to BRCA testing in the preventive services section.
  • Updated the preventive services Osteoporosis screen verbiage.
  • Added ACC/AHA CVD risk estimator link to the preventive services area

    http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/.

SCREENING TAB

  • Updated verbiage to Zika Risk Assessment starting age. “All females under age 49 and all males”
  • Updated verbiage for tobacco cessation. “Consider IBHC referral for tobacco cessation as a part of standard evidence-based team healthcare.”
  • Removed Joint Commision heading from “Have you received any type of care since your last visit with this clinic?”
  • Revised travel history screening layout.
  • Removed Hysterectomy from the Female ONLY data section.
  • Removed Menopause from the Female ONLY data section.
  • Added clinical clue to Female ONLY data area “Record hysterectomy and/or menopause in HPI tab”.
  • Removed Copy Forward ability from “Pregnant for ____Weeks Based on LMP”.
  • Removed BMI field.
  • Added clinical clue “If BMI >30, consider lifestyle screening/counseling, see Exit/CCP tab. Obesity reference material is located in TSWF Metabolic CPGs AIM form. Consider coding E66.09 for obesity, E66.01 for morbid obesity in A/P module.”
  • Revised tobacco pack year description and reorganized layout.

PE TAB

  • Updated the PE group term ‘Throat’ to ‘Oral Area’.
  • Made the PE medcin term edema part of the normal.

BH/Other Screening TAB

  • Added the SIPS-B.
  • Moved GAD-2 under additional screeners.

ROS TAB

  • Added ROS term to “Common ROS” Recent Weight Gain
  • Added ROS term to Gastrointestinal “Melena”
  • Added ROS term to Endocrine “Polyuria”
  • Added “nipple discharge” to ROS group breast
  • Added speech difficulties to ROS group Neuro

MSK TAB

  • Added PE term to Shoulder “O’Brien test”
  • Added tooltip(hover over) to the PE shoulder grouping “Click here to navigate to other Shoulder exam terms”.
  • Replaced motion in the knee exam findings with “range of motion”.
  • Added medcin terms for lateral/medial to knee exam findings.
  • Made the PE medcin term edema part of the normal.

EXIT CCP

  • Added to Chronic Conditions Self-Care Management: under Self-management Resources “[ ] Communications via secure messaging”
  • Added “Yoga” “Tai Chi” and “Mindfulness” to the Pain Treatment History, Interventions list
  • Removed link to secure messaging

History

  • 1st AIM form developed
  • One-stop shop
  • Integrates with other forms

The CORE AIM form was the first AIM form developed by the Tri-Service Workflow team, along with its associated workflow. Born out of the frustration of trying to document in AHLTA, the proliferation of different documentation templates, and the multitude of policies and guidelines for clinical documentation, the CORE was created to be a “one-stop shop” where both providers and the clinical support staff could complete the vast majority of their documentation. The CORE form consolidates and standardizes documentation requirements from many disparate sources (inspection agencies, DoD policies, generally accepted clinical guidelines, etc.), and serves as the basis for many of our other forms, like the various Clinical Practice Guidelines (CPG) AIM forms. The CORE works seamlessly with these other forms, allowing staff to use the form that works best for a particular visit without disrupting the form workflow.

Form Lead

TSWF-CORE Form Lead
Dr. James Neville

Tri-Service Workflow is dedicated to serving those who serve. Our innovations bring the team care we exemplify to help you in your patient care.