About Brillians and Decision Support (6)
No. Brillians is NOT dependent on CPRS in any way. There have been many instances where CPRS was down, but the users could continue providing patient care using Brillians.
However, Brillians depends on the VistA system to get the clinical data. If the network is down, or the VistA system is down, then neither CPRS nor Brillians will work.
No. Brillians complements and “extends” the functionality in CPRS. Clinicians use Brillians and CPRS side-by-side.
Think of Brillians as an “Add-on” for CPRS. Brillians picks up where CPRS stops.
CPRS is a front-end to the clinical data stored in the VistA database. Its primary job is to display the requested data. Therefore, CPRS is only concerned with loading, displaying and saving data but NOT with what that data means. This creates two problems:
- If the provider does not request a certain data element, he/she may never see it, no matter how significant that data element is.
- The large volume of data overwhelms the provider and hides the critical elements of information in the large body of non-significant data.
To mitigate these issues, Brillians automates data analysis and assists providers with finding the proverbial “needle in the haystack.” Therefore, Brillians significantly reduces the risk of clinical errors due to missed clinical findings. In addition, it provides problem-oriented-data-views to expedite data review, and a number of time-saving, must have clinical practice tools.
The difference between CPRS and Brillians is the same as the difference between data and information! CPRS provides raw data. Brillians provides Actionable Information.
CPRS is a front-end to the data stored in the VistA database. Its primary job is to display requested data. Therefore, CPRS is only concerned with loading, displaying and saving data and NOT with what that data means. This creates two problems:
- If the provider does not request a certain data element, he/she may never see it, no matter how significant that data element is.
- The large volume of data overwhelms the provider and hides the critical elements of information in the large body of non-significant data.
To mitigate these issues, Brillians automates data analysis and assists providers with finding the proverbial “needle in the haystack.” Therefore, Brillians significantly reduces the risk of clinical errors due to missed clinical findings. In addition, it provides problem-oriented-data-views to expedite data review, and a number of time-saving, must have clinical practice tools.
The difference between CPRS and Brillians is the same as the difference between data and information!
CPRS provides the raw data. Brillians provides Actionable Information.
Brillians is designed to provide “Cognitive Support” and “Clinician Support” to ALL clinicians. Whether you are a provider, nurse, dietician, pharmacist or anyone else dealing with the CPRS data (e.g., QM chart reviews), Brillians helps with your intellectual work, and minimizes the time and effort spent on various tasks.
How is that possible? As a professional, all your decisions are data driven. To make those decisions, you need efficient access to clinical data. Unfortunately, the siloed design of CPRS creates bottlenecks to quick data access. Brillians provides a solution for nearly every CPRS bottleneck.
Access Privileges and Opening the Brillians App (3)
Users must be authorized to have access to the Brillians App. All clinical staff, including trainees, can have access. However, the access must be explicitly granted as noted below.
New Users: If you click on the Brillians / SupraVISTA link on the CPRS Tools menu and the Application does not start, it means that you do not have privileges.
To get privileges to the Brillians App, please contact your Clinical Informatics staff (CACs). At many VAMCs, someone in the Clinical Informatics and/or other non-OIT service can grant access. At other VAMCs, access requires an OIT help ticket.
Please see details regarding How to get Access to the Brillians App
Existing Users: If you have been using Brillians but you cannot start it from the CPRS Tools menu link (or, the desktop icon) then Restart Windows (Log-off and log back in is not the same as “Restart”).
If that does not fix the issue, then it means that the Brillians installation folder is not accessible on the network. This could be a temporary network issue. Please contact your Clinical Informatics/CAC staff and/or OIT.
If Brillians is installed at your VAMC, the CPRS Tools menu has a link for Brillians either as “Brillians (SupraVISTA)” or “SupraVista” or some variation of the above. The link can be on the Tools menu itself, or on a sub-menu. Your colleagues and Clinical Informatics/CAC staff can help, if you don’t see the link.
Once you are running Brillians, please create a desktop link using the “Create Desktop Link” near the bottom of the “File” menu on Brillians’ main form.
You can start Brillians using the desktop icon even if CPRS is down (look for a green icon showing doctor’s bag with plus sign).
Please see FAQ: Application Access Privileges. It answers this question in detail.
The Brillians App may not open for one of the two reasons:
- If you are a new user, then you may not have the privileges to the Brillians App. Please see details regarding How to get Access to the Brillians App
- The Brillians App is not accessible due to a [temporary] network issue. First step is to RESTART Windows (note that just log-off and then log back in is not the same as “Restart”).
If the above issue persists after RESTARTING WINDOWS, please contact the Clinical Informatics staff or the Brillians POCs at your VAMC.
Do other uses have the same issue? This helps determine if the issue is with the VAMC’s network or only with certain workstation(s). If it is local workstation issue, it typically resolves after RESTARTING Windows (and, if applicable, reconnecting the VPN).
ADHOC VistA Data Elements (5)
No, this feature includes local VAMC’s data only. For remote data, please use the Remote Data button on top panel:
On the Main Form’s Misc tab, the user can select the type of data in the left pane. Brillians displays data in the right pane.
When accessed from a drop-down box, Brillians opens a dedicated Form. Users may review selected data item as will as other items.
You may locate it on the Main Form’s top panel, just below patient ID, and on Views Form’s top panel in the dropdown:
Also under the “Misc Data” tab on the Main Form:
Clinicians frequently need to review additional data when they are working on a certain Form, e.g., Main Form or Views Form. In CPRS, the data is scattered throughout multiple tabs. Brillians makes this data readily available.
Certain items require additional user input which is not available. This is the same as certain ADHOC health summaries.
Advisories and Automated Data Analysis (2)
Advisories are one of the most powerful features of Brillians. Advisories improve patient safety and quality of care while reducing clinician’s work.
Advisories identify the clinical abnormalities and high-risk issues by automatically analyzing clinical data when you load a patient in Brillians. Typically, Brillians auto-synchronizes patient with CPRS when user changes patient in CPRS.
The advisories are designed to “point the user in the right direction” by highlighting important issues. They do not identify every possible abnormality in the patient medical record. You can review the nature and the scope of Advisories on this page: Advisories: Logic and Scope | Brillians
The Advisories may not always mirror the USPSTF and various specialty board guidelines which may significantly differ from each other. Further, the data analysis is limited by the lack of computable data in VistA. Therefore, though advisories provide great help, it is important to understand what they are and are not.
Finally, Advisories do not substitute for good history-taking and clinical judgment on part of the clinician. Like many other tools in the clinician’s toolbox, they are just one tool to help improve patient safety and quality of care.
The advisories list may display two types of icons.
- Green-checkbox icon: This indicates which Advisories have been reviewed. During review of the Advisories, the user clicks on advisories one by one and reviews the data in the right pane. However, the user may review the advisories in any order and may not review some at all. The green-checkbox icon indicates which Advisories have been reviewed.
- A Flag icon: The user can “Flag” an Advisory for self-reminder, e.g., to review later in the visit in more detail. To do so, click in the left-most column for the given Advisory.
Both icons are TEMPORARY – i.e., they exist during the current patient session only. They are not saved for later use.
Both icons can be turned on and off by clicking on them.
Data Visualization (18)
Yes, that is recommended. See buttons in the left pane to filter lab data.
By default, Brillians Lab Review sets a filter to display abnormal labs and shows a list of labs which have been abnormal at least once in last N years (typically, 3 years)
Yes. Single click on the lab’s name in the panel on the right side of the Form:
You can also show or hide this panel (see button above the panel).
Yes. In the left pane, click on the edit button as shown in the image, and a Form will open containing instructions.
You may “drop in” your frequently used searches using the drop-down box (red circle):
Think of this as an extension of the Lab Profiles.
No. You can search using partial lab names (recommended). For example, a search for “HIV” will display all labs which have the word HIV in their name.
No, it includes local VAMC’s data only. For remote data, please use the Remote Data button on the top panel:
No, this feature includes local VAMC’s data only. For remote data, please use the Remote Data button on top panel:
On the Main Form’s Misc tab, the user can select the type of data in the left pane. Brillians displays data in the right pane.
When accessed from a drop-down box, Brillians opens a dedicated Form. Users may review selected data item as will as other items.
These are system-defined lab groups. When you select a group, Brillians sets a filter to display labs in that group.
Think of this as an extension of Lab Profiles.
It ensures accurate and efficient Lab Review.
- Displays common lab profiles with one click.
- Filter lab results in creative ways to expedite lab review.
- Review historical data about any lab with one click.
- Create personal lab profiles for commonly reviewed labs.
You may locate it on the Main Form’s top panel, just below patient ID, and on Views Form’s top panel in the dropdown:
Also under the “Misc Data” tab on the Main Form:
Clinicians frequently need to review additional data when they are working on a certain Form, e.g., Main Form or Views Form. In CPRS, the data is scattered throughout multiple tabs. Brillians makes this data readily available.
Failure to follow up on abnormal labs is common because the clinician “did not see it.” Lab Review helps the user minimize such errors.
Certain items require additional user input which is not available. This is the same as certain ADHOC health summaries.
Editing Letter Writer Templates (13)
CPRS Progress Note editor allows a maximum of 80 characters per line. If you paste text with lines longer than 80 characters, a few words of those lines will wrap to the next line creating an ugly display. Therefore, it is important that template design takes lines length into consideration. While editing a template, the character position at keyboardcursor is displayed just above the template editor.
Yes, see the buttons below the templates list. These are enabled only when a user is viewing their own personal templates.
Many lab profiles use 75+ characters. It is important to keep line length in the template as close to 79 as possible, but not exceed 80 characters. It takes some creativity:
• Change page width by changing left and right margins (button on the bottom panel). Smaller width will hold fewer
characters.
• Use a “Fixed” font. We recommend “Lucida Console.”
• Use larger font for non-clinical data so those lines take fewer characters
In the templates list, select a shared or personal template which is similar to what you want to create. Click on the “Edit…” button to modify it to create the new template.
On the “Edit Template” tab, bottom panel, locate the dropdown box and “Insert Field” button. Upon clicking the button, the selected command is inserted where the keyboard cursor is.
You can also type in, or copy and paste commands from other templates. Please ensure accuracy.
You can find many examples on the View (Reports) Form (“View’s Script” tab).
Make sure you enclose these commands in curly brackets.
Caution: Do not use “InsertQuery” command in letters or progress note templates. Those are for Queries, not templates.
Finally, there is a detailed help manual that describes how to use commands in Brillians. The same commands are used by Views, Letters and Progress Note Writer to display the clinical data.
Prepend underscore character to file name (“_”) .
(Use Shift-Hyphen key on keyboard, typically next to zero on top row of most keyboards.)
On “Edit Template” tab, bottom panel, use “Preview” button.
Note: “Preview” generates the letter on the “Review and Print” tab. After reviewing, you will need to click on the “Edit Template” tab to return to editing.
On the top panel, above the templates list, locate the “Toggle” button to switch shared and personal templates. Use the dropdown box (red circle) to display other user’s templates.
There is no arbitrary limit. However, too many personal templates may cause maintenance challenges.
It is very important that you follow a naming convention so that you can easily find your templates, including by search. See shared templates for examples—almost all have a certain prefix. List sorting is affected by uppercase/lowercase. You are prompted for file name when you save a template. You can use any file name you want.
Note: These only work for “Lucida Console”. For other fonts, you will need to ensure the display is correct when the letter is copied to CPRS.
Use Page Setup button on the bottom panel to set the following:
- Paper Size: Select “Letter” in the dropdown box.
- Page Width: Set Left and Right Margins to: “0.65 in”
- Font Name: Lucida Console (large and very readable font)
- Font Size: 11 points for all text except clinical data 10 points for clinical data inserted via {Query Command} e.g., Lab Profiles, Imaging reports, etc.
- Verify that you are getting proper layout in CPRS by pasting letter in a progress note in a test patient.
The text inside the curly brackets is treated as a command. In most cases, this is a place-holder for mail-merge. The commands can be a placeholder for predefined fields (name, address, sender’s name), or for more complex commands used for data insertion like labs, appointments, imaging reports.
Brillians automatically saves your personal templates in your personal folder. While editing, You can Preview and Save template using buttons on the bottom panel of the “Edit Template” tab.
Note: When you save a personal template, it is saved to your personal folder and will NOT overwrite a shared template
Formulary Search (10)
The Local Formulary is a subset of the National Formulary. A typical local formulary has 4,000-5,000 entries, whereas the national formulary has about 20,000 entries.
Yes. Separate search words with semi-colons. This search box is on the Local Formulary tab (first tab):
To exclude the Non-formulary items, check the box (red circle) just above the search box
You can take advantage of the naming conventions, e.g., ACE inhibitors end in “pril”, ARBs end in “sartan”.
You may find these drugs by searching for “pril” or “sartan”. Same for many other drug categories.
No. Presently, you can search local formulary only.
For other remote data, please use the Remote Data button on top panel:
This search box is on the National Formulary tab:
You must search for a drug class name, not the medication name. Once you find the desired drug class, click on it to display items in this class.
Note: Items that are in the National Formulary may not be in the local formulary.
There are two tabs on the “Formulary Search” Form.
Local Formulary is loaded directly from the VistA system and is always up-to-date and consistent with medications in CPRS.
Note: You may not see certain meds/supplies if they are intentionally “hidden” from the users in CPRS.
National Formulary is updated quarterly shortly after it is updated on the PBM website. This list is used for searching medications by VA drug class.
No. However, you can copy the item’s name and paste it in CPRS medication ordering dialog form.
Use the “Copy to Clipboard…” button on the bottom panel to copy the item highlighted in the list:
Formulary Search allows you to search VA formulary.
You can search medications and supplies without knowing their exact name.
Note: This is not possible in CPRS
There are multiple ways to open the Formulary Search feature.
- Pharmacy button on the Top Panel. (Note: This Button also opens other pharmacy related Forms.)
- Pharmacy menu on the main form.
To order a medication in CPRS, the user needs to know the medication’s EXACT name. E.g., if it is listed as “HCTZ/Lisinopril,” CPRS will not find it by “Lisinopril/HCTZ.”
Problem: When prescribing infrequently ordered or unfamiliar meds and supplies, most users can not remember the EXACT name of the meds/supplies as listed in CPRS.
A phone call to the pharmacy may take 2-5 minutes and wastes both parties’ time. In Brillians, this is instantaneous.
In Brillians, the user can search the VA local formulary using partial names. Similarly, the user can search the VA national formulary by drug class.
General (10)
Short answer: No.
The way the Windows system is designed, one app cannot slow down the other. If an App uses excessive CPU or memory, then the entire Windows system, thus ALL application, will slow down. You can verify this by looking at the CPU and memory usage in the Task Manager (that’s where you go to kill CPRS when it is frozen). The network congestion or VistA slowness are more likely causes of CPRS slowness. Nothing changes in CPRS, Brillians, or other Apps on a day-to-day basis.
What can the users do: To keep Windows healthy and up-to-speed, please RESTART Windows at least twice a week, e.g., at the end of the day on Tuesdays and Fridays. (The VA OIT recommends that you leave the computer turned on at all times.)
Note that log-off and log back into Windows does not clear the memory, device drivers, and many other accumulated internal errors like RESTART does.
Yes, users can create custom content for their specialized needs. Brillians comes with a large library of commonly needed content. However, we can not anticipate every possible scenario. Therefore, personalization is supported to the extent possible.
For example, users can:
- Create personal “Problem Oriented Views of Data.”
- Personal Progress Note Templates.
- Personal Letter Templates
- Personal content for use by the Quick Keys feature (see training video).
- Personal content for use by the Auto Notes, i.e., “Dot Phrases” (see training video).
- Lab preferences on Inpatient and Outpatient dashboards
No. You will continue to use CPRS and other clinical Apps as you always do. You will use Brillians when needed.
For each patient you see:
- Load patient in CPRS and proceed with your usual steps (e.g., greet the patient, start a progress note, etc.).
- When you change patient in CPRS, Brillians prompts to synchronize with CPRS.
- If you take no action, after a few seconds, Brillians will automatically load the patient you have in CPRS (i.e., auto-synchronize with CPRS). You may continue working in CPRS while Brillians loads and processes data in the background.
- When ready, review the Advisories and other information in Brillians.
Please note that Brillians requires no work – not even a click – to load and analyze the data. It does NOT change your workflow and does not get in your way at all. Brillians does all its work in the background and waits for you to utilize the information and tools as necessary.
No. Brillians is NOT dependent on CPRS in any way. There have been many instances where CPRS was down, but the users could continue providing patient care using Brillians.
However, Brillians depends on the VistA system to get the clinical data. If the network is down, or the VistA system is down, then neither CPRS nor Brillians will work.
No. Brillians complements and “extends” the functionality in CPRS. Clinicians use Brillians and CPRS side-by-side.
Think of Brillians as an “Add-on” for CPRS. Brillians picks up where CPRS stops.
Please see FAQ: Application Access Privileges. It answers this question in detail.
The Brillians App may not open for one of the two reasons:
- If you are a new user, then you may not have the privileges to the Brillians App. Please see details regarding How to get Access to the Brillians App
- The Brillians App is not accessible due to a [temporary] network issue. First step is to RESTART Windows (note that just log-off and then log back in is not the same as “Restart”).
If the above issue persists after RESTARTING WINDOWS, please contact the Clinical Informatics staff or the Brillians POCs at your VAMC.
Do other uses have the same issue? This helps determine if the issue is with the VAMC’s network or only with certain workstation(s). If it is local workstation issue, it typically resolves after RESTARTING Windows (and, if applicable, reconnecting the VPN).
The difference between CPRS and Brillians is the same as the difference between data and information! CPRS provides raw data. Brillians provides Actionable Information.
CPRS is a front-end to the data stored in the VistA database. Its primary job is to display requested data. Therefore, CPRS is only concerned with loading, displaying and saving data and NOT with what that data means. This creates two problems:
- If the provider does not request a certain data element, he/she may never see it, no matter how significant that data element is.
- The large volume of data overwhelms the provider and hides the critical elements of information in the large body of non-significant data.
To mitigate these issues, Brillians automates data analysis and assists providers with finding the proverbial “needle in the haystack.” Therefore, Brillians significantly reduces the risk of clinical errors due to missed clinical findings. In addition, it provides problem-oriented-data-views to expedite data review, and a number of time-saving, must have clinical practice tools.
Most VHA clinical users have two monitors attached to their workstations. Even if there is only one monitor, Brillians will play nicely with CPRS and other Windows Apps. Having two monitors improves efficiency and productivity.
If you have two monitors, then please place CPRS on your primary monitor and Brillians on the 2nd monitor. For best results, these applications should not be covering each other.
On the modern, wide-screen monitors, the navigation between multiple Apps works best if you place the Windows taskbar along the right edge of the primary monitor. This takes some getting used to but increases efficiency significantly.
Brillians is designed for clinical staff, not computer geeks. Therefore, the user interface is simple, intuitive and easy to navigate. All the features have similar layout which eases the learning curve. Therefore, users rarely need help once they become familiar with the basics.
Brillians provides extensive help in form of:
- Training Videos: These are short, 10-12 minutes long videos, especially useful to the new users. (https://www.youtube.com/playlist?list=PL7vvfldMLFFfkRxh6yz7KRgpKmyR7gKZH)
- Conventional “Help” menu on the main form provides extensive help.
- The “blue question mark icon” in right lower corner of each feature’s form. This opens a short, 1-2 page, help PDF specific to that feature.
- The clinical informatics staff and the super-users in your VAMC can assist with many common issues.
Brillians is designed to provide “Cognitive Support” and “Clinician Support” to ALL clinicians. Whether you are a provider, nurse, dietician, pharmacist or anyone else dealing with the CPRS data (e.g., QM chart reviews), Brillians helps with your intellectual work, and minimizes the time and effort spent on various tasks.
How is that possible? As a professional, all your decisions are data driven. To make those decisions, you need efficient access to clinical data. Unfortunately, the siloed design of CPRS creates bottlenecks to quick data access. Brillians provides a solution for nearly every CPRS bottleneck.
Getting Started (8)
Yes, users can create custom content for their specialized needs. Brillians comes with a large library of commonly needed content. However, we can not anticipate every possible scenario. Therefore, personalization is supported to the extent possible.
For example, users can:
- Create personal “Problem Oriented Views of Data.”
- Personal Progress Note Templates.
- Personal Letter Templates
- Personal content for use by the Quick Keys feature (see training video).
- Personal content for use by the Auto Notes, i.e., “Dot Phrases” (see training video).
- Lab preferences on Inpatient and Outpatient dashboards
No. You will continue to use CPRS and other clinical Apps as you always do. You will use Brillians when needed.
For each patient you see:
- Load patient in CPRS and proceed with your usual steps (e.g., greet the patient, start a progress note, etc.).
- When you change patient in CPRS, Brillians prompts to synchronize with CPRS.
- If you take no action, after a few seconds, Brillians will automatically load the patient you have in CPRS (i.e., auto-synchronize with CPRS). You may continue working in CPRS while Brillians loads and processes data in the background.
- When ready, review the Advisories and other information in Brillians.
Please note that Brillians requires no work – not even a click – to load and analyze the data. It does NOT change your workflow and does not get in your way at all. Brillians does all its work in the background and waits for you to utilize the information and tools as necessary.
No. Brillians is NOT dependent on CPRS in any way. There have been many instances where CPRS was down, but the users could continue providing patient care using Brillians.
However, Brillians depends on the VistA system to get the clinical data. If the network is down, or the VistA system is down, then neither CPRS nor Brillians will work.
If Brillians is installed at your VAMC, the CPRS Tools menu has a link for Brillians either as “Brillians (SupraVISTA)” or “SupraVista” or some variation of the above. The link can be on the Tools menu itself, or on a sub-menu. Your colleagues and Clinical Informatics/CAC staff can help, if you don’t see the link.
Once you are running Brillians, please create a desktop link using the “Create Desktop Link” near the bottom of the “File” menu on Brillians’ main form.
You can start Brillians using the desktop icon even if CPRS is down (look for a green icon showing doctor’s bag with plus sign).
The difference between CPRS and Brillians is the same as the difference between data and information! CPRS provides raw data. Brillians provides Actionable Information.
CPRS is a front-end to the data stored in the VistA database. Its primary job is to display requested data. Therefore, CPRS is only concerned with loading, displaying and saving data and NOT with what that data means. This creates two problems:
- If the provider does not request a certain data element, he/she may never see it, no matter how significant that data element is.
- The large volume of data overwhelms the provider and hides the critical elements of information in the large body of non-significant data.
To mitigate these issues, Brillians automates data analysis and assists providers with finding the proverbial “needle in the haystack.” Therefore, Brillians significantly reduces the risk of clinical errors due to missed clinical findings. In addition, it provides problem-oriented-data-views to expedite data review, and a number of time-saving, must have clinical practice tools.
Most VHA clinical users have two monitors attached to their workstations. Even if there is only one monitor, Brillians will play nicely with CPRS and other Windows Apps. Having two monitors improves efficiency and productivity.
If you have two monitors, then please place CPRS on your primary monitor and Brillians on the 2nd monitor. For best results, these applications should not be covering each other.
On the modern, wide-screen monitors, the navigation between multiple Apps works best if you place the Windows taskbar along the right edge of the primary monitor. This takes some getting used to but increases efficiency significantly.
When you load a different patient in CPRS, Brillians displays a small window on top of CPRS. This displays countdown to auto synchronization. At this point, there are three options.
- If you take no action, after a few seconds, Brillians will automatically load the patient you have in CPRS (i.e., auto-synchronize with CPRS). You may continue working in CPRS while Brillians loads and processes data in the background.
- Press the Control-F8 key to cancel synchronization.
- Press the Control-F12 key to immediately load the patient without waiting for the countdown.
Brillians is designed for clinical staff, not computer geeks. Therefore, the user interface is simple, intuitive and easy to navigate. All the features have similar layout which eases the learning curve. Therefore, users rarely need help once they become familiar with the basics.
Brillians provides extensive help in form of:
- Training Videos: These are short, 10-12 minutes long videos, especially useful to the new users. (https://www.youtube.com/playlist?list=PL7vvfldMLFFfkRxh6yz7KRgpKmyR7gKZH)
- Conventional “Help” menu on the main form provides extensive help.
- The “blue question mark icon” in right lower corner of each feature’s form. This opens a short, 1-2 page, help PDF specific to that feature.
- The clinical informatics staff and the super-users in your VAMC can assist with many common issues.
Help and Resources (2)
Yes, users can create custom content for their specialized needs. Brillians comes with a large library of commonly needed content. However, we can not anticipate every possible scenario. Therefore, personalization is supported to the extent possible.
For example, users can:
- Create personal “Problem Oriented Views of Data.”
- Personal Progress Note Templates.
- Personal Letter Templates
- Personal content for use by the Quick Keys feature (see training video).
- Personal content for use by the Auto Notes, i.e., “Dot Phrases” (see training video).
- Lab preferences on Inpatient and Outpatient dashboards
Brillians is designed for clinical staff, not computer geeks. Therefore, the user interface is simple, intuitive and easy to navigate. All the features have similar layout which eases the learning curve. Therefore, users rarely need help once they become familiar with the basics.
Brillians provides extensive help in form of:
- Training Videos: These are short, 10-12 minutes long videos, especially useful to the new users. (https://www.youtube.com/playlist?list=PL7vvfldMLFFfkRxh6yz7KRgpKmyR7gKZH)
- Conventional “Help” menu on the main form provides extensive help.
- The “blue question mark icon” in right lower corner of each feature’s form. This opens a short, 1-2 page, help PDF specific to that feature.
- The clinical informatics staff and the super-users in your VAMC can assist with many common issues.
Imaging Review (12)
Yes, it is possible to load multiple years. Select duration in the dropdown box and click on the “Load…” button:
Yes. See user interface on the top panel. On the top panel, click on the edit button as shown in the image.
For more, see help on “Keyword Search” feature.
Yes, that is recommended. See help on “Keyword Search” feature for more details. Search “Malign” so it matches Malignant and Malignancy.
Yes, you may search for multiple words, separating them with a semi-colon.
Use synonyms, e.g., tumor ; mass ; nodule; cancer ; malign
Note: The white space around semi-colons is ignored
Yes, abnormal studies are highlighted automatically.
The list of imaging studies is displayed on the left pane.
Click on imaging study’s name to view report.
Click on the next [highlighted] row to review “Impression”
No, it includes local VAMC’s data only. For remote data, please use the Remote Data button on the top panel:
- Click on the report’s title in the left pane, OR
- Select desired report from the dropdown above the reports’ text in the right pane.
It ensures accurate and efficient Imaging Review.
- Load ALL imaging reports in one document for the desired duration, e.g., past 5 years.
- Highlights imaging reports that needs attention per radiologists “Needs attention” flag.
- Display such report’s “Impression” with one click.
- Search all loaded imaging reports as if they are one document (e.g., instantly search for “mass; nodule; tumor”).
You are searching full text of all the imaging reports completed over past N years (e.g., past five years).
You can selected how much imaging data you want to review on the top panel.
Failure to follow up on abnormal imaging is common because the clinician “did not see it.” Imaging Review helps the user minimize such errors.
Keyword Search (10)
In the example below, WHC staff frequently searches for PAP; Mammo; HPV; Colpo
On t he Keyword Search Form (top panel), click the edit button as shown on the image below:
A Form will open. Follow the instructions on that Form. Afterwards you will be able to “drop in” your frequently used searches using the drop-down (red circle).
Yes, it is recommended that you search using partial words. For example:
Search “Colono” instead of Colonoscopy.
Search “Malign” so it matches Malignant and Malignancy.
Yes, it is possible. Separate words with semi-colon, and use synonyms.
E.g., LVEF ; Ejection Frac
Note: The spaces before and after the semi-colon is ignored.
No, it includes the local VAMC’s data only. For remote data, please use the Remote Data button on the top panel.
Keyword search only looks at the preloaded data per VAMC’s configuration. There are many other options under the “Search Docs…” button on the top panel:
For example if you are looking for LVEF, or Colonoscopy, or any other type of information, you can find it in 5 seconds, rather than 5+ minutes.
Lab Review (13)
Yes, that is recommended. See buttons in the left pane to filter lab data.
By default, Brillians Lab Review sets a filter to display abnormal labs and shows a list of labs which have been abnormal at least once in last N years (typically, 3 years)
Yes. Single click on the lab’s name in the panel on the right side of the Form:
You can also show or hide this panel (see button above the panel).
Yes. In the left pane, click on the edit button as shown in the image, and a Form will open containing instructions.
You may “drop in” your frequently used searches using the drop-down box (red circle):
Think of this as an extension of the Lab Profiles.
No. You can search using partial lab names (recommended). For example, a search for “HIV” will display all labs which have the word HIV in their name.
No, it includes local VAMC’s data only. For remote data, please use the Remote Data button on the top panel:
These are system-defined lab groups. When you select a group, Brillians sets a filter to display labs in that group.
Think of this as an extension of Lab Profiles.
It ensures accurate and efficient Lab Review.
- Displays common lab profiles with one click.
- Filter lab results in creative ways to expedite lab review.
- Review historical data about any lab with one click.
- Create personal lab profiles for commonly reviewed labs.
Failure to follow up on abnormal labs is common because the clinician “did not see it.” Lab Review helps the user minimize such errors.
Letter Writer (11)
No. The user only can add to and edit his/her personal templates. Only the administrative users can change the shared templates.
You must have a progress note or addendum open to paste in. Use right-click menu or button on bottom panel to paste.
Search the title of a template by using meaningful word(s). E.g., “work”, “Jury”, “Lab”, “disability”. Searches are by title, not by content.
On the Letters Form, use the search box just above the letter templates list on the “Select Letter” tab:
Select a template from the list and use one of the buttons on the right pane. You may also double-click on the Templates name in the list.
The display changes to “Review & Print” tab and a fully formatted letter is displayed.
You can edit and print this letter (buttons on bottom panel).
Each template is designed to automatically mail-merge the necessary data, e.g., patient’s name and address, clinical data and letter sender’s name and address, etc.
The user selects the template and clicks a button. A fully populated letter is displayed within seconds, and the user has the ability to fine-tune it if needed.
It creates “ready to use” letters with a few clicks. Brillians provides over 100 ready-to-use templates. There is a template for just about every need.
You can find the Letter Writer button on the Bottom Panel. Also on the “Clinical Tools” menu.
Like most features in Brillians, the Letter Writer opens in its own dedicated Form
Brillians automatically saves them in your personal folder. While editing, you can preview and save the template using the buttons on the bottom panel of the “Edit Template” tab.
Patients frequently request letters for: work/jury duty excuse, lab and imaging reports, disability related documentation, and many other topics. With Microsoft Word, it may take 5+ minutes. Brillians does the same in less than 10 seconds.
Medical Calculators (7)
No. Nearly all Calculators are able to automatically look-up and fill in the needed values. Click on “Calculate using Patient Data” button and instantly see the results.
On the right pane, click on the “Copy/Paste Options” button:
This opens a pop-up menu. Select the desired option:
With the calclulators you can:
- Automatically compute values that are shown as Advisories (e.g., Cardiac Event Risk, PSA Velocity,
Fibrosis-4 score). - Perform interactive calculations using patient’s data or manually entered (hypothetical) data.
For example, “What will the BMI be if the patient were to lose 20 lbs?”. For this type of scenario, you may enter your own values. In the left pane, fill in the blanks with the values you want:
On the right pane, click on “Calculate using User-entered data” button.
The Calculators button can be found on the bottom Panel. Also, on the Clinical Tools menu.
Look at top of the Calculator’s Form. Each Calculator is located on its own tab page.
As of this writing (summer 2020), the following 10 calculators are included:
- A-a Gradient
- Anion Gap & Osmolality
- BMI, BSA, Lean Wt & BMR
- Body Weights
- Cardiac Risk
- Est. Avg. Glucose
- Fibrosis-4
- GFR
- MEDD Calculator
- PSA Velocity
Clinicians frequently use many computed values for clinical decision-making. Built-in calculators make this task easy.
Presale FAQ (2)
Brillians is licensed to the VA medical center, or the VISN. There is no licensing model for purchasing a
license for the named users, or a specific number of users (e.g., for use within a given service only).
Once a VAMC or VISN decide that they would like to purchase a license, they contact the vendor at
support@supravista.com for pricing and general information like this document. Barring unusual
circumstances, we respond to emails within 24 hours. If you have not received a response with 24-48
hours, please check your Outlook Junk mail folder.
We are happy to assist with much of the documentation required by the COR to put together a package
for the contracting officer.
The vendor’s staff does not have access to the VA network or clinical data. It is neither needed nor requested. Note: This is also part of the information security– the vendor cannot lose or disclose what they don’t have!
Why? Due to VA’s information security rules, it is difficult for small vendors to get and maintain access to VA resources (e.g., network login). It is even more difficult to get access to the sensitive patient-level clinical data which a clinical App like Brillians requires.
To overcome the above limitations, Brillians depends on the knowledgeable, volunteer VA employees to configure, provide training, and support the app. Please see more details on these aspects later in this document.
As of this writing, this model has worked well for over 11 years in nearly 30 VAMCs.
Problem-Oriented Data Views (Reports) (12)
Yes. See keyword search panel on the top panel. You can search the current View’s text or the medical record:
Yes. You may click the button just above the View’s text to load the View you want.
The button changes to “Add” or “Remove” depending on the situation.
Yes. Separate search words with semi-colons. Please note that view’s are searched by title, not by their content. Look for search text box in the left pane, just below the frequent used Views list
E.g., when looking for Pain related Views, you may want pain, neurology and Ortho related Views:
No. Views include the local VAMC’s data only. For remote data, please use the Remote Data button on the top panel.
Please see the “Show/Hide Headings” button above the Views text, and the panel along the right side.
Click on a section heading to go to that section.
Views (a.k.a. Reports) expedite data visualization for the given disease, specialty or body system from 5-10 minutes down to a few seconds.
Note: This is not possible in CPRS.
The list of “Frequently used” Views displays on the left pane, just above the all Views list.
The user can add to, or remove from this list any time
Clinicians frequently review data for a given situation. In CPRS, the data is scattered on many tabs and has to be manually located.
Finding all the relevant data for a disease (e.g., Anemia), a body system (e.g., Liver) or a specialty (e.g., Urology)
may take 5-10 minutes and many clicks. Brillians finds all the relevant data within 2-3 seconds with one click and displays in a nicely formatted View.
This is to sort the desired Views to the top of the list. By convention, the specialty or body system related “Chart Review” type Views are displayed on top of the list. Subsequently, the disease specific and other Views display in alphabetical order.
Quick Keys (7)
Quick Keys can be found on the “View Alert and Login Helper” button on the bottom panel. Note: there are multiple options under this button. You can also find it on the Main Form’s “Tools” menu.
It enables users to do common CPRS tasks with one keystroke (e.g. make an addendum, add Additional Signer, sign notes). Common tasks are assigned to specific keys or key-combinations. When a user presses that key, the given task is performed with one keystroke rather than multiple mouse-clicks or keystrokes.
If the hotkey did not work:
- Make sure you are on the intended tab on CPRS.
- Try again and the key may work just fine.
- If Quick Keys stop working, click on the “Reactivate” button on user interface.
Use it for common tasks, such as processing View Alerts. Many View Alerts require making an addendum, entering a short blurb (e.g., “This request is taken care of.”) and signing the addendum. Each of these three functions requires one keystroke.
Click on the “Show More” button. It displays the full Form with various options and legend for the quick key assignment.
To avoid covering data on the screen, the user interface shows as a small window on top of CPRS. If CPRS is not active, it moves further up, off the screen.
Remote Data (VA and DoD only) (11)
Highlight the desired text and right click. Make appropriate selection on the pop-up menu.
It’s an easy 3 step process.
Based on patient’s history:
- Select the source VAMCs (you can check multiple)
- Select interval (time period) for the desired data.
- Click on “Load Remote Data” button.
Within seconds, the data is loaded and displayed on CPRS as tabs.
Data is displayed in tabs. Most tabs have a dropdown box above the text area. This allows you to directly go to the desired document (red circle on the image below).
- Tabbed interface
- Dropdown to select document
- Text of the selected document
Please use the familiar Search panel on the top panel. Note that you are searching ALL the data on ALL the tabs. Therefore, depending on the volume, it may take a few seconds.
Please use JLV for community partners data. Note that some of this data may be in VistA imaging.
Remote data functionality expedites searching the VA Remote VA. Users can download data from multiple remote VAMCs for N years and search the remote data like it is one local document.
Note: This is not possible in CPRS or JLV.
To avoid clutter, there is a second Form for the less frequently used data (e.g., Cytopathology, Microbiology, etc.). Data loading works exactly like this form. You can access it from:
1. Large + button on the bottom panel:
2. Under the “Remote Data” button on the main form.
You can find the Remote Data button on the Top Panel. Please note there are multiple options under this button.
Also, on the Search/Data menu.
Many veterans receive, or have received, care at multiple VAMCs. Often, patients refer to a discussion, lab, or procedure done at another VAMC and asks the provider to follow-up.
Problem: In JLV, finding a specific piece of data (e.g., Colonoscopy or LVEF) may take 5-10 minutes and many clicks. This is because in JLV users have to manually open and review each document. There is no global search feature. Brillians finds all the relevant data in the remote data within seconds with a few clicks.
ROI FAQ (2)
Search - Documents by Document Category (10)
Yes, they can be saved. On left pane, click on the edit button as shown in the image below:
A Form will open. Follow the instructions on that Form. Afterwards, you can “drop in” your frequently used searches using the drop-down (red circle).
Yes, that is the ecommendation. For example, “Cardio” will find any progress note title that has the word “Cardio” in it.
Yes. Separate words with semi-colons. The image below shows how to search for all notes titles that have the words “PACT” and “Emergen” in them:
No, it includes local VAMC’s data only.For remote data, please use the Remote Data button on the top panel:
You may single-click on a document title in the left pane. This will load ALL the documents by that title. You do not need to specify date range because all documents are loaded by default.
User can find and search documents titles among ALL the documents the given patient ever had in the selected category on top panel (Progress notes, consults and DC summaries). This is not possible in CPRS.
The “Search Documents by Category” button is on the Top Panel, as well as the Search menu:
Patients have complex histories and you want to review and search ALL progress notes under a given note title (e.g., Urology or Dermatology).
CPRS provides no mechanism to load ALL the progress notes with a given title. Brillians allows you to search ALL the notes titles using only the partial note titles. Note: This data is NOT limited by date range. When user clicks on a title on the left pane, full text of ALL the documents with that titles is loaded and is searchable using the keyword search on the top panel
Search - Documents by Document Title (9)
On the “Search by Title” Form (top panel), click on the edit button as shown below:
A Form opens. Follow instructions on that Form. Afterwards, you can “drop in” your frequently used searches using the drop-down (red circle).
Yes, that is the recommendation. For example, “Cardio” will match any progress note title that has the word “Cardio” in it. With this type of search you are searching documents’ titles, not the content.
Yes. Separate words with semi-colons. Specify Include words and (optional) Exclude words to define search criteria. The image below shows how to exclude Neurology when looking for Urology note titles:
No, it includes local VAMC’s data only. For remote data, please use the Remote Data button on the top panel:
User can find and search documents without knowing the documents’ exact titles, clinic location, author or exact date. This is not possible in CPRS.
Patient says: Two years ago, I went to a Cardiology clinic who told me X. I did not follow up then but I want you to find and
follow up on X.
Problem: Where to look for X? There are a large number of progress note titles for many specialties. E.g., for Cardiology,
your VAMC may have MANY note titles like “Cardio Provider”, “Cardio NP”, “Cardio X”, “CHF clinic”, “Pace-maker” and so
on.
Brillians allows you to load and search ALL the notes using only the partial note titles. Using the above example, if you search for “Cardio; CHF; pace-maker” you will find full text of all the progress notes for the specified interva
Troubleshooting (2)
Short answer: No.
The way the Windows system is designed, one app cannot slow down the other. If an App uses excessive CPU or memory, then the entire Windows system, thus ALL application, will slow down. You can verify this by looking at the CPU and memory usage in the Task Manager (that’s where you go to kill CPRS when it is frozen). The network congestion or VistA slowness are more likely causes of CPRS slowness. Nothing changes in CPRS, Brillians, or other Apps on a day-to-day basis.
What can the users do: To keep Windows healthy and up-to-speed, please RESTART Windows at least twice a week, e.g., at the end of the day on Tuesdays and Fridays. (The VA OIT recommends that you leave the computer turned on at all times.)
Note that log-off and log back into Windows does not clear the memory, device drivers, and many other accumulated internal errors like RESTART does.
Please see FAQ: Application Access Privileges. It answers this question in detail.
The Brillians App may not open for one of the two reasons:
- If you are a new user, then you may not have the privileges to the Brillians App. Please see details regarding How to get Access to the Brillians App
- The Brillians App is not accessible due to a [temporary] network issue. First step is to RESTART Windows (note that just log-off and then log back in is not the same as “Restart”).
If the above issue persists after RESTARTING WINDOWS, please contact the Clinical Informatics staff or the Brillians POCs at your VAMC.
Do other uses have the same issue? This helps determine if the issue is with the VAMC’s network or only with certain workstation(s). If it is local workstation issue, it typically resolves after RESTARTING Windows (and, if applicable, reconnecting the VPN).