April 17, 2014, 3:25 pm

MEDITECH: Heart of Healthcare

We know nurses are at the center of care—see the great content we have planned for you at this year’s Nurse and Home Care Forum.

Delivering care that centers around the patient is key to improving outcomes. Learn how you can improve care across settings with MEDITECH, including Acute, Home Care, and Ambulatory solutions. Customers are doing it every day…and so can you!

There are no registration fees for MEDITECH customers (parking included) and you’ll also be eligible to earn contact hours*.

Read more at meditech.com.

April 17, 2014, 3:22 pm

MEDITECH: Island Life

With MEDITECH’s EHR, Doctors Hospital delivers integrated care to keep patients healthier and happier.

For many people, life in the Bahamas suggests crystalline blue waters, chaise lounges, and white sandy beaches. But for the staff at Doctors Hospital, the Bahamas’ premier healthcare facility, the island locale also brings some unique challenges to their care delivery efforts.

We recently spoke with CEO Charles SealyChief Financial Officer Joanne Lowe, and Vice President of Management and Information Systems Chadwick Williamson to learn more about Doctors Hospital, and how they are using their MEDITECH EHR to keep patients healthier and happier.

Read more at meditech.com.

April 16, 2014, 5:15 pm

C/S NPR Tip & DR/SQL Tip

Joe Cocuzzo, Senior Vice President – Report Writing Services

This month we have a quick tip for NPR fans (Client/Server only) and a SQL /DR tip written by Thomas Harlan my DR Technical Team Lead.  If only we had a RD tip, we’d have a trifecta.

C/S NPR Tip: Page 1 of N via MEDITECH utility program

We recently found out that MEDITECH has a utility you can call from the footnote of a report and print a Page X of Y message on your NPR reports. The utility is called:

%Z.rw.page.count(XPOS,YPOS,STRING) where

XPOS = KB article and program say this is X dot position @300DPI, but I think it is COL

YPOS = KB article and program say this is Y dot position, but I find it to be line of page header with first line =0

STRING is an option string to use for message, default is Page XX of YY, but you could send “Pg XX with exciting conclusion on YY” if you wanted a different message.

MEDITECH has a KB article on the utility: 47296. This utility is very handy, although it is not sufficient compensation for other sins of the Print Manager in C/S (no trays, no legal size paper, no print direction, no overlay macros, and so on).

Neither MAGIC nor RD has this feature. Years ago, we showed a way to do this for MAGIC that involved diverting print output to a file and doing a search/replace and then sending the data out to the printer. Back then (before print on VIEW), this worked even when spooling or downloading, but the technique needs updating for MAGIC to cope with spooling’s multiple SAFs (one per page to support VIEW).  Stay tuned for an updated MAGIC report showing how to do Page X of Y including when spooling.

If you just stick a footnote on your report like this:

You’ll get this on your page header:

DR/SQL Revamping ADM Patient Events into Patient Flow

One of the challenges in working with data structures developed for NPR (or M/AT) in the DR is that both NPR and M/AT retrieve data via a loop, while DR expects things to be arranged so they can be fetched in a set. A good example of this is AdmVisitEvents.

AdmVisitEvents has multiple kinds of data embedded within one table, including when the patient is bedded, and then moved from room to room, and then discharged.

Inevitably you’ll need to pull an inpatient location at a point in time and there won’t be a handy field with the Location/Room/Bed where the patient was when something occurred. And when you turn to AdmVisitEvents to find that situational information… you realize that the structure of the table is just not what you want.

The immediate way to get the patient Location is to embed a sub-query into your main SQL SELECT to fetch the patient Room:

SELECT TOP 1 AVE.LocationID

FROM   Livedb.dbo.AdmVisitEvents AVE

WHERE RX.SourceID = AVE.SourceID

AND RX.VisitID = AVE.VisitID

AND  AVE.UndoneSeqID IS NULL

AND  AVE.EffectiveDateTime <= RXA.AdministrationDateTime

AND  AVE.LocationID IS NOT NULL

ORDER BY AVE.EffectiveDateTime DESC, AVE.EventSeqID DESC

(In this snippet, we’re starting from PhaRx (RX) / PhaRxAdministrations RXA) to find the patient unit at the time of a medication administration.)

This answers the immediate question — where was the patient at the time of the administration. But it has issues… first, with a sub-query structured this way, we can only get one (1) field back (LocationID), and second, we have to create a loop in SQL (which SQL does not perform terribly well) with that ORDER BY and TOP 1 structure.

If we wanted to get LocationID, RoomID, and Bed in three separate fields – we would have to do three sub-queries, each returning one field. And as we add more sub-queries, the performance of our report begins to drop off precipitously!

What we want instead is a way to get at the AdmVisitEvents data so that we can JOIN to a table where each patient flow event (a stay in a location/room/bed) is in a single row, so we can do something like:

LEFT JOIN #tFlow ADT ON ( ADT.VisitID = RX.VisitID

AND ADT.SourceID = RX.SourceID

AND RXA.AdministrationDateTime >= ADT.FromDateTime

AND RXA.AdministrationDateTime <= ADT.ThruDateTime )

That is very clean! And now any field we need from #tFlow, we can reference in our query via the ADT alias — and since no sub-queries are involved, it’s fast.

The challenge now is creating this #tFlow table when we need it. And we only want to write that code once, in a reusable way. We need either a stored procedure or a table-valued function to go process AdmVisitEvents for us and create a nice flattened temporary table we can use.

You can download a copy of IatricPatientFlow.sql from iWeb and implement it on your DR server to get a pre-packaged function to do just this. That table-valued function works like so:

  1. First we look for any patient in-house during the date range we are interested in.
  2. Then we take that list of patient visits and fetch all of their Events into a temp table. When we do that, we only look for Events with a Location, that are not un-done, are not ‘FIXED’ records, and there are some kind of Event codes that are excluded.
  3. We sweep that raw list of Events and look for events where there is a change of location or status, and we create yet another temp table that captures the start and end times of the patient being in a specific place.
  4. Finally we create our nice summary table and address some data quirks where the last patient status isn’t correct (unless we correct it… ) and extra discharge rows are discarded.

That process takes a set of Event data that looks like this:

EffectiveDateTime

NewLocationID

NewRoomID

NewBed

NewStatus

OldLocationID

OldRoomID

OldBed

OldStatus

2014-01-20 18:29:00

ED

REG ER

2014-01-21 03:22:00

IC

ICU01

1

ADM IN

ED

REG ER

2014-01-21 21:50:00

M/S

MS24

1

ADM IN

IC

ICU01

1

2014-01-22 05:17:00

IC

ICU01

1

ADM IN

M/S

MS24

1

2014-01-22 14:50:00

M/S

MS16

1

ADM IN

IC

ICU01

1

And makes it look like this:

FromDateTime

ThruDateTime

VisitStatus

LocationID

RoomID

Bed

StayInMinutes

2014-01-20 18:29:00

2014-01-21 03:21:59

REG ER

ED

MS16

1

533

2014-01-21 03:22:00

2014-01-21 21:49:59

ADM IN

IC

ICU01

1

1,108

2014-01-21 21:50:00

2014-01-22 05:16:59

ADM IN

M/S

MS24

1

447

2014-01-22 05:17:00

2014-01-22 14:49:59

ADM IN

IC

ICU01

1

573

2014-01-22 14:50:00

2014-01-26 12:15:00

DIS IN

M/S

MS16

1

5,605

At any given point in time during the stay, we can then immediately find which Location, Room, Bed, and Status. We also get a summary of the time spent in the location.

To use this, in your reporting stored procedure (you are using a stored procedure for each report, aren’t you?) you create a little on-the-fly temp table:

SELECT ADT.*

INTO   #tFlow

FROM   zcus.dbo.IatricPatientFlow( ‘IAT’      — Change to your site SourceID to test

,’IATRIC’  — Change to your facility ID to test

,’2014-01-01′

,’2014-01-31′ ) ADT

;

And then use the JOIN above to bring that data into your query.

Don’t forget to clean up afterwards at the end of your stored procedure!

DROP TABLE #tFlow ;

Performance Note: The patient flow function runs at a test site, with 1.3 million rows in AdmVisitEvents, for a month of visits, in three seconds. It could have a bit better performance after being recast as a stored procedure using temp tables (rather than variables) inside IatricPatientFlow, but then it would require more setup and cleanup code, and could not be nested as deeply as a function.

Extra Credit! You can adapt the code to break out the patient by the day, calculating their stay in each location by day, which then makes calculating Patient Day Equivalent metrics for Nursing Quality Measures very easy.

The SQL code has been uploaded to our report library as IatricPatientFlow.txt.

Visit our report library at http://www.iatric.com/Information/NPRReportLibrarySearch.aspx to look them up.

You can find additional Report Writing Tips on our website at http://www.iatric.com/Information/NPRTips.aspx, as well as information about our on-site Report Writer Training and Report Writing Services.

To subscribe for email notifications for new Report Writing classes, please follow this link:

http://www.iatric.com/Information/Classes.aspx.

For more information, please contact Karen Roemer at 978.805.3142 or email
karen.roemer@iatric.com
.

This article originally appeared in the April 2014 issue of Iatric Systems Updates! newsletter.)

April 15, 2014, 12:07 pm

MUSE 2014 Tuesday Training Workshops

MUSE is pleased to present an array of workshop topics for MUSE members
Tuesday May 27, 2014. Cost is $100 for a full day workshop, $50 per half day workshop. 
April 14, 2014, 10:38 am

MEDITECH: A Shining Moment

MEDITECH Physician Informaticist Steven Jones, MD, shares the value of an EHR over paper records, especially during a time of crisis.

Source.

April 14, 2014, 10:35 am

MEDITECH: Follow the Leader

MEDITECH is excited to be at the forefront of interoperable healthcare in 2014.

This past January, we were selected by CMS and ONC to participate in their Test EHR Program. John Valutkevich, MEDITECH manager of marketing support for EHR initiatives, was recently quoted in Healthcare IT News, where he shared some of the challenges providers are facing and his hopes for more vendor participation.

Read more at meditech.com.

April 14, 2014, 10:26 am

How will our solutions inspire care at your organization? Find out next month in the May edition of the MEDITECH Magazine, highlighting our recent CIO Technology Forum!

Our coverage includes five key initiatives that differentiate MEDITECH in the healthcare industry. You’ll also find out how our “LIVE and onstage” Continuity of Care Document (CCD) exchange demonstration turned out, between the Beth Israel Deaconess Medical Center (BIDMC) in Boston and St. Vincent Hospital in Worcester — 40 miles away!  And, catch a glimpse of our ideas for incorporating cutting edge technology such as cognitive computing (think IBM’s Watson) and genomics into the MEDITECH EHR.

 Read more at meditech.com.

April 14, 2014, 10:23 am

MEDITECH: Big Bucks

Centura Health sees a remarkable return on their EHR investment with a total savings of over $170 million.

Since implementing MEDITECH’s EHR in all 14 of their Colorado hospitals, Centura Health has seen a remarkable return on their electronic health record investment with a total savings of 171,937,695 and a total savings over costs of $60,036,671.

“We don’t need to be convinced of the value of electronic health records, because we’ve seen it for ourselves—saving $4,420,000 for a reduction in readmissions from 2012-2013, as well as $2,437,140 for reducing our medication errors in 2012,” says Centura Health Vice President of Information Technology Amy Feaster.

Read more at meditech.com.

April 10, 2014, 12:46 pm

Teaching Hospital Berkshire Medical Center Learns the Benefits of MEDITECH’s PDoc

Berkshire Medical Center (Pittsfield, MA) is a quick study when it comes to learning the value of MEDITECH’s Physician Documentation (PDoc). Shortly after going LIVE with the tool, a test group of hospitalists were documenting almost 100 percent of their progress notes in the EHR. Soon, other members of the medical staff — surgeons, specialists, residents, and physician’s assistants — followed suit, mastering PDoc in less than a year.

Read more at meditech.com.

April 9, 2014, 11:34 am

HISTalk: From Smartfood99

“Re: Meditech. First it was a 400+ hospital in NJ, now an even larger academic hospital in GA. Does Epic not control this space any more?” Phoebe Putney Hospital (GA) will upgrade from Meditech Client/Server to Meditech 6.1, with the 691-bed hospital choosing that system because of its integration and lower cost of ownership. It would be fun to talk to someone there to find out what Epic and Cerner put on the table.

Read more or comment at HIStalk.com.