Classification Tagging

A few weeks ago we introduced the Circumstances Of Admission field to help you tag your patients with any and all reasons the patient was admitted to your hospital. The reception for this field has been very positive and we thank you for your feed back. However there are still two items we want to address:

  1. How do you tag patients with what’s clinically abnormal?
  2. What if you want to use tags that are not available?

Diagnostic Classification Terminology

Very soon we will be adding two new classification tagging fields: Clinical Classifications and Categorization Of Clinical Signs. The fields will help you tag your patients with the abnormal physical exam findings by body system and what caused the abnormal physical exam findings.

So there will be 3 classification categories:

Circumstances of Admission (ex: Cat interaction, Vehicle collision, …)
— Why did the rescuer bring me this animal?

Clinical Classifications (ex: Physical injury, Neurologic disease, …)
— What are the physical exam findings by body system?

Categorization Of Clinical Signs (ex: Trauma, External parasites, …)
— What caused the abnormal physical exam findings (Clinical Classifications)?

The Clinical Classifications and Categorization Of Clinical Signs fields can be found with the Diagnosis field.

Reminder: If you want to use the Classification Tagging fields, go to Settings and choose Classification Tagging under the WRMD settings box. From the Classification Tagging settings page you can activate these new fields.

As of the date of this blog post, the Clinical Classifications and Categorization Of Clinical Signs fields DO NOT have an automatic tagging feature like the Circumstances Of Admission field does. In the future we will add that feature.

Additionally, if you want to see a list of all the terms for each category and their hierarchical organization, you can view that on the Classification Tagging settings page. We are working on a list of each terms definition that will be made available from the Classification Tagging settings page as well.

Custom Terms

The terms in each category are meant to encompass, at a baseline level, the most common situations encountered in wildlife rehabilitation. For example, the Clinical Classifications category only classifies to the body systems, not to each individual organ or body part. You may use the terms in the classification tagging fields as-is or you may now also add custom terms for specific classifications that your hospital encounters. Your custom terms must be assigned to an existing root or leaf node of the terminology hierarchy. For example, you could use the Circumstances of Admission term “Cat interaction” or add the custom term “Feral cat” under Cat interaction in order to track that detail.

That’s It!

We hope you enjoy the new fields and are having a safe year!

Flexible Analytics

With the release of the new Circumstances of Admission field we are very excited to also release a completely updated Analytics section. The older analytics section was nice but frankly kind-of rigid. It didn’t allow users to modify or tweak the graphs in order to see the information they wanted. In the updated Analytics section, all that changes. Our motivation for a new Analytics section was to answer the question:

Can the analytics be flexible enough to allow users to discover answers to their own questions?”

ps: we think the answer is yes

The Five Ws

The Analytics section has been organized around the Five Ws (Who, What, Where, When and Why). Additionally, all the filters that you can apply are designed to adjust the Five Ws so that you can narrow down the data into only what you want.

Patients (Who)

The Patients sections is all about who your patients are. Such as, what are your most prevalent patients by common name, how many patients were in your care, how many species have been admitted and a whole lot more. There are pages summarizing your patients by many different taxa categories such as, common name, taxonomic class, biological group and endemic status. There are also pages summarizing your patients by many demographic and health indicators such as age, sex, attitude, body condition, dehydration and mucus membranes. The details of each category can be viewed to see their changes in over time. There is also a taxonomy tree map to visualize your patients grouped by their taxonomic ranks.

Origin (Where)

The Origin section is all about where your patients are found at. You can see the most prevalent cities and states you receive patients from and there is now a map page that plots where your patients are found at. The map will cluster patients together within a close geographic area to help you visualize groups.

Circumstances of Admission (Why)

Perhaps the most exciting section is Circumstances of Admission; ie why are your patients brought to your hospital. There is an overview of your patients most frequent circumstances of admission and all your circumstances of admission grouped by their the root circumstance. You can also see the totals of each circumstance of admission as well as the percent of each circumstance of admission compared to each other. And of course, circumstances of admission over time to illustrate their fluctuations seasonally. And, after popular request, there is now a survival rate for each circumstance of admission including their first 24 hours of care compared to after the first 24 hours.

Disposition (What)

The disposition section is about what happened to your patients at the end of their care. There’s an overview page with the totals of each disposition as well as graphs illustrating when each disposition occurred. There are also specific graphs for released and transferred patients, include the type of release (or transfer) and the release (or transfer) rate of your survived patients. Of course you can see the survival rate of your patients and the percentage of each disposition. There is also a map that plots where your patients are released (or transferred) at.

Dates (When)

We’ve also greatly expanded your ability to modify the date range to render the analytics within. Not only can you change the date range but you can also compare to previous date ranges and group your data by different time frequencies; ie Day, Week, Month, Quarter, Year. (Grouping dates by bigger time frequencies is perfect when looking at data over large time periods)

Segment the Data

Analytic Segments

By default the graphs show data for all your patients, but what if you want to see analytics for a unique segment of your patients? For example, what if you only want to see data for your birds, or raptors, or perhaps all patients from a particular city, or even only patients that were poisoned? No problem!

Just click on the box labeled All Patients and choose which segment of your patients you wan to see.

Want to compare multiple segments of patients? Again no problem. You can choose up to three segments to create your graphs with.

Future Plans

In all honesty it is difficult to describe all the features and functionality of the new Analytics section, simply because of how much you can do with it. Even with this amazing release we are already planning improvements. Soon, we hope to allow you to save favorite graphs into one convenient place. We also want to create the ability to have even more specific segmentation; for example, render the charts for only “songbirds that also had an interaction with a cat”

We are very interested in any charts that you may generate at your own hospital. If there are any useful charts that you think we are missing PLEASE TELL US and share your charts with us ([email protected])! Additionally if you are not able to “discover answers to your own questions” PLEASE TELL US. There may be some tweaking that we need to do.

A Word of Caution

Looking at your analytics can be extremely fun and interesting, however I would like to express a word of caution. It is very easy to read to far into what the analytics are showing you. In other words, don’t let the analytics let you jump to conclusions. Let the analytics confirm, deny or improve your questions. If you see anomalies in the analytics that might indicate something important, or maybe just the result of bad data that needs correcting.

Other than that enjoy the new Analytics!

Circumstances Of Admission Tagging

Our First Goal: Keeping WRMD Simple

When we first conceptualized WRMD we set some very basic rules and milestones that we wanted to stick to. The first was that WRMD must be as simple as possible so that any wildlife rehabilitator could use it no matter their background or resources. Every time we make a change or add a new feature we still ask our selves “will this benefit our community of users or slow them down? ie: is this the WRMD way.”

Very soon we will be introducing a new feature in WRMD that officially takes WRMD into our second goal; benefitting from all the incredible data you collect on your patients!

Our Second Goal: Benefitting From The Data

In WRMD, you can collect information about who your patients are, where your patients come from, what condition they were in when admitted and what their final outcome was. However, although there are ways to record why a patient was found and admitted, it has always been a little bit difficult to do that. Definitely not in the “WRMD way.” In a forthcoming update, that will change. We are introducing a new field called Circumstances Of Admission that will allow you to tag your patients using predefined terms for any and all reasons the animal was brought in.

The new Circumstances Of Admission field can be found underneath the Reasons for Admission field with all the other Intake related data. Additionally, with each term you choose you can indicate if the circumstance is suspected or confirmed.

But That’s Not All!

You may be excited by this new field but also concerned that you now need to record in multiple places why your patients are admitted. Additionally you may be concerned that you need to go back and update all your past patients. If that’s how you feel then we agree with you.

In keeping with the “will this benefit our community of users or slow them down?” spirit, we wanted to make this new field as powerful as possible but also as simple as possible. With that being said, over the past year we have been developing and training a machine learning application to interpret what is written on your patient records in order to automatically tag your Circumstances Of Admission for you, so you don’t have to.

You and your users can still describe the reason for admission in regular human language. After you have admitted your patient, the Circumstances Of Admission classifier application will use the patients Common Name, Reasons For Admission, Notes About Rescue and Care By Rescuer fields to predict which Circumstances Of Admission tags best fit. You may still manually add or remove terms if needed.

Because of the automatic tagging, the Circumstances Of Admission field will be hidden by default. This way everything will appear the same and you won’t need train your volunteers or staff on the changes.

If you want to manually use the Circumstances Of Admission field, there is a setting under General WRMD Settings to show the Circumstance of Admission field.

Retroactive Tagging

As part of training and validating the Circumstances Of Admission classifier application, we have already tagged the majority of all patients admitted in WRMD over the past year and plan to retroactively tag past patients so that you don’t have to. The Circumstances Of Admission classifier application is not only a huge timesaver for you in realtime, it also has the amazing benefit of going back in time and automatically tagging your older patients. Additionally any imported patients can be automatically tagged in a matter of seconds.

It Gets Better!

With the introduction of the Circumstances Of Admission field we are also releasing a major update to the entire Analytics section of WRMD. One blog post is not enough to describe how powerful the new Analytics section is, but to give you an idea of our motivation, we want to answer the question: “Can the analytics be flexible enough to allow the user to discover answers to their own questions?”

In the new Analytics section you can see what your most frequent circumstances of admission are, what their survival rate is and how often they occur over time. To learn all about the new Analytics section read this blog post.

Thanks!

We really hope you use and appreciate the Circumstances Of Admission field. This was an important missing part of WRMD and one that we have been working long and hard on to make simple and amazing.

Just Some Foot Notes
  • The Circumstances Of Admission terms are based of the Clinical Wildlife Health Initiative terminology with some modification and additions.
  • A complete list of all the Circumstances Of Admission terms and their definitions will be made available.
  • The Circumstances Of Admission classifier application is still learning and it may occasionally make incorrect predictions. Please do your part and correct any mistakes for us and help teach the classifier.
  • We know that the data that you collect is amazing and powerful but we are not in the business of taking, selling or using that data without your permission and understanding.

Introducing the Prescription Formulary

Over the past few months we have been working hard on an exciting update to the Prescriptions extension. Today we are happy to share with you the Prescription Formulary: a faster and more reliable way to write your most common prescriptions.

What Is A Formulary?

A formulary is a list of medication prescription protocols that may contain information on approved dosage, route, frequency, duration and more. Formularies are a helpful tool to guide a user to prescribe a recommended and safe prescription. You might be familiarly with this formulary: https://www.amazon.com/Exotic-Animal-Formulary-James-Carpenter/dp/0323444504.

How Does the Prescription Formulary Work in WRMD?

If you are using the Prescription extension, then you are familiar with filling out each field of the prescription form to write your prescriptions. Now with the Prescription Formulary, you can define the values for a prescription that should be auto-populated when choosing a particular medication from your formulary. This will not only make it faster to write a prescription, it will also help you and you coworkers to follow consistent medication protocols.

In settings, when your Prescription extension is activated, the Prescription Formulary link will be in the Extensions box on the left column. After you click on Prescription Formulary you can click the green plus icon to add a new formula.

Next; fill out the displayed form for the formula you want to create. Remember that a formula is used to create a prescription so your formula should be named something that represents what its prescriptions would be used for. For example, if you give all cat caught song birds clavamox, you might name it Cat caught clavamox for songbirds. You can then fill out all the default values of the formula that you want autofilled in a prescription. You can also specify that you want the prescription’s dose to be automatically calculated based on the patients most recent weight. If you want the prescription to start on the same day it’s written, then check the indicating checkbox and provide the number of days the prescription should run for.

Formula for Cat caught clavamox for songbirds
Formula for Cat caught clavamox for songbirds

After you have created your formulas you will see them listed on the settings screen. You can always edit them later if they need to be updated.

Formula list
Formula list

Now For the Exciting Part!

Now on a patients prescriptions page when you type in the Drug / Medication field, WRMD will search your formulas matching the text. You can then click the formula name to fill out the prescription!

Using the formula for cat caught clavamox for songbirds

Of course, you’re not required to use a formula to write a prescription. Additionally you can modify the values of the prescription after the formula has populated the fields.

What About Veterinarians?

In addition to the Prescription Formulary we are integrating veterinarians into prescriptions. In case you did not know, WRMD allows you to keep a list of the veterinarians you work with. As a Super Admin in the settings area, click the veterinarians link under the Account heading on the left sidebar. When adding or updating an existing veterinarian you can now indicate which user the veterinarian is.

Now when writing a prescription you will see a list of your veterinarian(s). If a veterinarian is logged in and is writing a prescription, their name will be automatically selected from the dropdown list.

What Do You Think?

We love your feedback so please tell us what you think! Don’t forget to click the Ask For Help link on the top right of WRMD to reach out to us. WE ARE HERE FOR YOU.

New Reporting System

For a very long time I (Devin) have been annoyed with how reports were created in WRMD. Starting from the layout of the Reports page, through the inability to customize reports for my own needs. Well, as of today all that is changing.

We are Excited to Release a New Reporting System into WRMD

This new reporting system has some very simple goals.

  1. To simplify the processing of finding the report you want to produce.
  2. To create more flexibility around the formats of the reports.
  3. To allow you to customize what the report is reporting on.

Favorite Reports

Finding a report should not be a chore. Your most commonly used reports should be on top of the list, so we created a feature for that purpose. Reports will now be listed in groups instead of being tiled all over the screen. And, to make your life easier, you can now star a report as a Favorite! By doing this, those reports will be put on top of the list.


Report Formats

Reports can now be generated in multiple formats. The most basic format is just to see a preview of the report on your screen. When you click on a report you will be taken to a screen to preview the report and from there you can choose to print the report as a pdf or email the report. Now, many reports will have the ability to export the data directly to Excel!

Report Filters

The best part of the new reporting system are the filters. For a long time people have asked for the ability to adjust what a report, reports on. For example, limiting the date range to a specified time frame instead of an entire year or excluding certain species taxonomies if you don’t rehabilitate all classes.

A very simple example of this are the annual reports. Each annual report has a filter for a given year that it should report on.

USFWS Wildlife Rehabilitation Annual Report has 1 Filter: Year


Many reports will now have multiple filters like the Disposition by Species report!


Generated Reports

Once you create one of these reports it will be saved in the Generated Reports page for 14 days. If you think you want to permanently save this report, we suggest saving the PDF that is created to your computer.


Adding these filters were not just for our users, but also to help us manage the reports on the backend. Previously, we had to create multiple reports for what was essentially the same information but with slight variations. For example the Prescriptions Due report existed four times with slightly different pre-set filters. Now we can maintain one Prescriptions Due report but use the filters within the report itself to adjust what the report, reports on.

Still to Come…

Customized Reports: This capability will allow you to save a specified search and then report on the specific dataset you wish to see. This will be available in the near future.

Filters you suggest: If there is a filter that you would like to see added to any of the reports, that would be a valuable addition, please let us know.

We hope you appreciate this update. It has been a lot of work for the past few months and we think it’s going to be the beginning of a wonderful and powerful new feature of WRMD. If you have any feedback or suggestions then please tell us either by email or in by clicking Ask for Help in WRMD.

2018 Recap and Plans for 2019

I’ll admit it. We’ve been terrible at keeping you informed about how WRMD is doing and what updates we are making. Sorry!

2018 was another busy year for us with lots of new wildlife rehabilitation organizations signing up, some major new features added. We also traveled to meet with our users as often as we could afford it.

In 2018 WRMD admitted an incredible 231,903 patients! That is a major increase over past years. These patients were admitted in by over 500 accounts across 15 countries. Speaking of countries, we are proud to welcome organizations from South Korea, Ireland and Trinidad and Tobago!

We had some amazing milestones in 2018 that we are very proud of:

Wildlife Rehabilitation Medical Database was written into California legislation in Assembly Bill 1031. The Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund allows California tax payers to make voluntary contributions into a competitive grant program whereby California wildlife rehabilitation organizations can apply for a grant, for the purposes of the recovery and rehabilitation of injured, sick, or orphaned wildlife, and conservation education. To be eligible to grant funding “The applicant shall maintain active participation in the Wildlife Rehabilitation Medical Database.”

On October 26 2018 the 1,000,000th patient was admitted into WRMD! A Great Horned Owl from Raymond California admitted to Fresno Wildlife Rescue & Rehabilitation Services.

We (The Wild Neighbors Database Project) have been accepted as an Oiled Wildlife Care Network (OWCN) member organization. The OWCN is a statewide collective of trained wildlife care providers, regulatory agencies, academic institutions and wildlife organizations working to rescue and rehabilitate oiled wildlife in California. Over the past few years we have been developing a specialized version of WRMD to work specifically for oiled wildlife events. That project is nearing completion and we are now proud to be part of the OWCN response team if (hopefully never) an oil spill occurs in California.

Plans for 2019

In 2019 there will surely be many tweaks and updates but we do have 3 major changes to announce.

Entirely New Way to Generate Reports

Very very soon, WRMD, will have a new way to view and generate reports. In this new way, you will be able to favorite reports for quicker access and preview reports before printing, emailing or exporting them. Each reports will also have unique filters to allow you to modify them as needed. For example, in some reports you will be able to set the reporting dates or exclude certain species taxonomies. This new feature will be available in about 1 week. Expect a blog post detailing how this works.

Prescription Formulary

A commonly requested features is to allow users to maintain their own prescription formulary for common drug/medication prescriptions. This is number 2 on the to-do list. In the formulary you will be able to define a drug, dosage, concentration, route, frequency, duration and many other things. When your formulary is created, you can then choose a formula when writing a prescription to autopopulate the prescription fields. You will also be able to set the dose to be automatically calculated based on the patients last weight.

Species Notifications

Another common request is to have automatically triggered notifications if (for example) a certain species is admitted. We think this is a cool idea. These notifications could be sent by email and/or text message. We need to gather more information about how this might work and how you might use it so please tell us your thoughts.

Contributors

Lastly but not least, we would like to thank everybody that has made donations to our 501(c)(3). Your generosity is what keeps WRMD going, creating new features and answering your questions. Thank you from the bottom of our hearts.

Notes About Rescue and Freeze Patient

Hello There, It’s Been a While 🙂

We try not to make any changes during the summer because we know how busy you are but we had to make a few to resolve some issues.

Notes About Rescue

There is a new field called Notes About Rescue. You can use this field to document any supplementary information about the animals rescue such as ‘had a sibling dead/escaped‘, ‘location found is not suitable for release‘ or ‘rescuer would like to be at the release‘. Adding these notes will compliment the Reason for Admission, Care by Rescuer and Transported By fields for a complete picture of the animals life before arriving in your care.

We have noticed that this type of information may be written into the Notes About Rescuer field which should be reserved for information specifically about the rescuer. Such as “Nice person, has offed to have animals released at their property” or “Can be disagreeable, only staff should communicate with him“.

Freeze Patient

We have added the ability to freeze a patient so that it can no longer be updated. This could be very helpful for patients with pending lawsuits or if your governing agency requires no modifications be made after the patient is dispositioned. To freeze a patient go to its record and click More then Patient Settings (More was previously called Share). By default Patient Settings is only available to users with the role Super Admin or Admin.

In Patient Settings, click the Freeze this Patient to Prevent Any Further Updates button. The patient will now be frozen and a “This patient has been frozen and can not be updated.” message will be display above the patients record.

Teaser 😉

Currently Freeze Patient is the only patient setting available, however we have some neat ideas for features to add this fall. Stay tuned! If you have ideas of patient related settings, share those with us. Maybe we can plan it out. [email protected]

New Extensions and Updates

During the NWRA 2018 Symposium, we are pleased to announce some fantastic new features. You may have already seen some of them but there are few that are just RIGHT NOW being released.

Three New Extensions

Daily Exams

With this extension you may now record as many “daily” exams as you want. The form is just like the Intake Exam form on Initial Care.

Expenses

This amazing extension helps you record daily expenses for each of your patients and helps you calculate the Cost-of-Care. Each expense transaction can be categorized so you may report on (for example) how much was spent on prescriptions. You can also print out an Expense Statement for an individual patient as well as an Expense by Category report for all of your patients.

Hotline

If you are a wildlife rehabilitator, you probably receive all sorts of calls from the public. We are very proud to announce our new Hotline extension. You can now log your communications with the public as well as track the progress of an incident’s continued communications. Not only will be able to search the callers to see if they are repeat offenders but also be able to identify calls that may be about the same incident.


We want to thank Belize Bird Rescue for sponsoring the development of the Expenses and Hotline extensions. Because of their support we were able to develop these way ahead of schedule. If you ever want to visit Belize please check out the Rock Farm Guest House at Belize Bird Rescue for a fabulous Belizean experience.


Admitting a Patient Into Any Year

When admitting a new patient, you may now specify the year that patient should be added to. Of course if you change the year dropdown list the “Next Case Number” will change to reflect the year you selected.

More Recheck List Filters

On the recheck list you can now filter it to only view pending patients. Also, if you are using prescriptions extensions, prescriptions can be filtered into each patient and will only show up if the prescription is actually due on the day request.


Searching Lab Values

Previously searching lab values was difficult to do and returned inconsistent results. We’ve mad that process much more simple (and it works)!

Two New Lists On the List Patients Screen

On the List Patients screen you can click the List All Patients heading to select a different list to look at. We recently added Forgotten Patients and Patients Without a Location.

  • Forgotten Patients – shows all patients that have not been updated in the past 7 days or does not have a pending recheck.
  • Patients Without a Location – Hopefully self explanatory. Shows all patients that do not have a location on their record.


Lots of Smaller Updates and Bug Fixes

  1. Begun adding new analytics and ways of filtering the analytics.
  2. Added a taxonomy tree map in analytics.
  3. In the people section there is a tab for members.

Of course if you discover any bugs or have an idea that you think other WRMD users would benefit from then please reach out to us. We love to hear from you all and want to make WRMD as best as possible!

More Fixes and Updates

The WRMD team has been working as diligently as we can to make sure WRMD is fully functional. We wanted to touch on several fixes that we recently implemented and discuss some issues that have come up.

Recent Fixes

  1. The List Patient’s screen is loading much faster.
  2. We have added the “Save your Changes” Prompt back. This means you can not leave a page unless you save your data. There seemed to be several occasions where data was missing. When we researched it in the background it appeared to have never been saved to begin with. We, hope this prompt will fix the “missing data” issue.
  3. The feature that would not allow you to access a record because someone else was accessing it has been fixed.
  4. The Prescription Units will default to the most common used.
  5. Calculators are fixed.
  6. Date Picker… We are continuing to see if we can create a manual way to add a date as well as pick a date. This has been very complicated and thank you for you patience.
  7. The Search Rescuer Tab under the Add New Patient screen has been fixed, there was an issue with the new Permissions.
  8. There is no longer a Shortcut Extension, however we have added a permanent “Map to Address Found” to Quick Links.

Other notes

  1. Federal Report: The Nature of Injury section is filled in by the Diagnosis field, which is what we were told by the Feds to do. However Section C. “Reported Injuries/Mortalities” wants the “Cause/Nature of Injury”. This will autofill the Circumstances of Admission and the Diagnosis.
  2. Species Reconciliation: when a patient is added to the database and the Common Name is not chosen from the drop down list, the database will try to guess what you meant. If it can not figure it out it will remain an unidentified species. During this update the database attempted to reconcile many of these patients that were not identified, so you may have had a slight change in your report numbers since this update reconciled many species. If you find something funky please let us know and we will fix it.

Still to work on

  1. Shortcuts Extension: this extension included the Map to where the patient was found and the quick link to print record.
  2. Search Lab Values
  3. The ability to combine Rechecks and Medications in one report.

What Browser are you Using?

Thank you for everybody’s patience with the new update. It appears that a few users are still struggling to access their records.

We have run many tests and experiments and for the most part everything is working. If you are one of those that is still having major issues, it is probably because you have an old or obsolete Browser.

If you are using Internet Explorer you need to update to either Google Chrome or Firefox. Microsoft no longer supports Internet Explorer and has not updated it to allow for new software and never will.

If you are using rather old versions of any other browsers, now is the time to update it. Some of our new features can only run on the updated browser systems.

If you update your browser and still have issue please send us a message or email me at [email protected]

Thank you!