Keeping Your Order Sets in Order - Parallon …info.parallontechnology.com/hubfs/pts-muse-presentation...Keeping Your Order Sets in Order International MUSE Conference May 30 – June

© 2016 PARALLON TECHNOLOGY SOLUTIONS, LLC. ALL RIGHTS RESERVED

Tina Joyce – Clinical Consultant

Keeping Your Order Sets in Order

International MUSE Conference May 30 – June 2, 2017

TechnicalServices

SupportServices

StaffingServices

MEDITECHServices

We provide EHR implementations, IT help desk, application support, IT managed services, hosting, technical staffing and strategic IT consulting services to hospitals, outpatient facilities, and large physician groups nationwide.

Who We Are

3

Presenter

Presentation Notes

With a team of over 400 clinical, financial and technical professionals, we have implemented EHR systems in more than 300 facilities. We offer staffing and remote support services for all major EHR acute and ambulatory platforms as well as their ancillary applications.

4

• When was your facility’s last Physician order set review?• Does your facility run an order set audit trail report?• Does your facility have a designated person to maintain

order sets?• How can you make order entry easier for the Physician?

Key thoughts:

Revisiting Your Current Order Sets

5

Report Writer Archive Report Information:

• This report is designated to evaluate usage within CPOE• The mnemonic for each order set will include CPOE count• Audit report can be downloaded from MEDITECH Knowledge

Base Website

MEDITECH ARTICLE ID 44671

Presenter

Presentation Notes

.

6

Run Audit Report of Most Used Order SetsMEDITECH Article ID 44671

Presenter

Presentation Notes

.

7

Tricks of the Trade With OE Order Sets

Create Reflex Sets within OE Order Sets:

Presenter

Presentation Notes

.

8

Example of Reflex Set:

.

Presenter

Presentation Notes

.

9

.

.

10

.

.

Presenter

Presentation Notes

.

11

.

Presenter

Presentation Notes

.

12

Presenter

Presentation Notes

.

13

Adding Reflex Sets to OE Procedures for Preferred Order Sets

Create O.E. Procedure Create O.E. Category Build Query Build CDS Add Query Add Response Select reflex order

14

Build Query

15

Build CDS

16

17

Add CDS

18

19

Reflex Built Will Prompt the Following:

20

Physician Enters Assigned Mnemonic

.

21

Add Associated Sets to Order Sets

.

22

Example of Associated Set:

.

23

Create Order Sets Within Pharmacy

24

..

25

Pharmacy Order Set Look Up

26

.

.

27

Adding Order Set Tracking

• A CDS can be created to track your order sets• It can be built to add any information of order set Facility

wants documented• If your Facility/Corporation uses Standard order sets, this is an

excellent tracking tool for maintaining them!

28

Example of Order Set Maintenance:

29

Detail of Order Set Tracker

.

30

You Must Build as an OE “Category” First

31

Then Build as an OE “Procedure”.

32

Customer Defined Screens in OE

• Add CDS to your Customer Defined Screens in OE • Care Area Screen• Department Screen• Physician Screen• Emergency Dept. Screen

33

Tip for Copying and Pasting Attributes When Building Customer Defined Screens• Click F1 key• Scroll to end of attribute and Click F2 key• Buffer choices will appear, choose 5) then paste

34

Printing OE Report

• For report auditing• History of Order Set built• Most recent revisions• Last reviewed

35

36

Example of OSD Tracking Report:

37

You Can Build NPR Customized Reports to Track OE Order Sets

38

NPR Reports for OE Tracking

39

Example of NPR Report Set Up:

40

Example of Order Set Tracking Report:

41

Locating Medications Orders Built Within OE Order Sets

42

NPR Report Created to Locate Medications in OE Order Sets

43

Example of NPR report:

Order sets containing Zofran injection

44

Notice OE Order Set Mnemonic Appears

45

• Keep OE order sets in alignment Example: Lab orders, Nursing orders, Dietary Orders, Medication Orders

• Always use same nomenclature header for each CategoryExample: MEDICATIONS, NURSING ORDERS, RADIOLOGY, LAB ORDERS, etc.

• Have Pharmacy and Nursing both involved in order sets decisions

• Allow your Physicians to review their order sets for revisions, additions and satisfaction

• Emphasize Physicians to use order sets

Suggestions for Physician Adoption:

46

Planning Before Implementation

• Governance matters: Establish a plan of action with decision-making

• Preparation and Advance Planning• Support• Managing Change• Consequences

47

Tina Joyce, Clinical ConsultantParallon Technology Solutions

490 Metroplex DriveNashville, Tennessee

[email protected]

Questions or Comments?

mailto:[email protected]

THANK YOU!


With Introduction to DMD and CMS

MEDITECH 6.15 Lab Build: Multiple vs. Single Database

June 1, 2017

2

PRESENTED BY:

Dennis Majeski, MT (ASCP)Senior Consultant

Parallon Technology Solutions490 Metroplex DriveNashville, Tennessee

[email protected]

TechnicalServices

SupportServices

StaffingServices

MEDITECHServices


Who We Are

4

Presenter

Presentation Notes


5

MEDITECH 6.15 Lab Build: Multiple vs. Single Database

• Facility Configuration• Database Configuration• Corporate Management Software (CMS)• Dictionary Management Desktop (DMD)• LIS Parameters• Customer-Defined Dictionaries• LAB/BBK/MIC Dictionaries

6

Facility Configuration - ADM

Admissions (ADM)/Medical Record Index (MRI)

o Multiple Facilities• MIS (Management Information System) Parameter• User access

o Single MPI (Master Patient Index)

Presenter

Presentation Notes

Facility refers to ADM/MRI facility A single ADM database with multiple facilities can link to multiple B/AR, ABS, and clinical databases; or ADM patients from multiple facilities can be sent to a single ancillary database, with no separation of patient data. There is always a 1 to 1 ratio for ADM to MRI databases. A single ADM database can support multiple facilities. ADM will prompt for a facility at sign-on, and will only let users access patients belonging to that facility. If a user has access to only one facility, the facility will default in, and the user will not be prompted. The single database allows a MPI lookup (soundex search) on all facilities, so that a user may have access to existing demographic information from any facility. All standard reports and statistics are by facility. However, NPR reports can be created to include patients from more than one facility. A single MRI database(with one MPI) can support multiple facilities in one of two ways: Shared Medical Records: If multiple facilities use the same unit # prefix, then their medical records are shared, else they are independent. A shared medical record assumes that there is one physical Medical Records Department, and all MRI functions are combined. There is one external unit number for patients with shared records, regardless of the facility to which they are admitted(one unit number wheel). Independent Medical Records: Each facility is assigned a unit # prefix which can be considered as corresponding to a physical Medical Record department. If the medical records are independent, then although there is just a single internal urn for each patient, there are multiple external unit numbers, and functions such as incomplete records are maintained separately for each facility (separate unit number wheels).

7

Facility Configuration - LAB

• ADM Facilities• Access – MIS• Registering a patient; ADM and LAB• Access - LIS

Presenter

Presentation Notes

A single ADM database can support multiple facilities. ADM (or LAB) will prompt for a facility at sign-on, and will only let users access patients belonging to that facility. If a user has access to only one facility, the facility will default in, and the user will not be prompted. When accessing the Laboratory application, if a user has access to multiple facilities, they will then be prompted for a facility. If a patient is entered in the Admissions Module, he/she will be associated with the facility defined upon accessing the Admissions Module. The same applies when entering a patient via the Laboratory System, which can allow users to branch over to the Admissions module for patient registration. When doing patient lookups, etc., users will have access to all patients in all facilities, unless restricted in the LIS Shared Access Dictionary. The Laboratory System allows you to define Laboratory sites, where tests are performed. This is a distinct Laboratory feature, and is not part of the multi-facility functionality. However, Laboratory sites do come into play when restricting access to patients by facility.��In the LIS Shared Access Dictionary, users are given access to Laboratory sites. If one site, such as Main Lab, performs tests for all facilities, then users should not be restricted to one facility; they should have access to all facilities, so that they can perform testing on all patients. If, however, there are two sites that perform tests for different facilities, you can restrict users at each site to access only certain patient facilities.

8

Facility Configuration - LAB

Facilities• Hospital/LAB• Blood BanK Unit• Blood Bank Donor• LAB Census• Proficiency Testing• Pathology History

Presenter

Presentation Notes

Types of facilities: each can be configured to send data to billing, EMR, ELR

9

Database Configuration

Multiple vs. Single Database

• Single facility, single database• Multiple facility, multiple database• Multiple facility, single database

*Note: All NPR modules must be configured the same way; ITS, LAB, PHA

10

Database Configuration - LAB

Multiple Laboratory Databases• Separate database for each lab (facility)• Required if multiple ADM databases• Multiple lab databases = Single OM databases

Presenter

Presentation Notes

This option would involve setting up a separate Laboratory database for each of the laboratories. This is always required when you have multiple ADM databases. Multiple LAB databases also require multiple OE databases, but a single LAB database can be linked to multiple OE databases.

11

Benefits of multiple LAB database• Separate sets of dictionaries for each laboratory• Separate set of parameters for each laboratory• Separate specimen numbering wheels for each laboratory

Restrictions of multiple LAB database• Multiple labs perform tests on same specimens; enter into each lab• Results of specimens processed in separate labs cannot be combined on

one hard copy patient report• Separate historical result files created; no delta or historical checking

across laboratories• Multiple Order Entry databases needed, OE cannot send orders to

multiple Laboratory databases


Presenter

Presentation Notes

Restrictions: If more than one laboratory processes the same specimen, the users would have to enter the specimen into separate databases--for example if one lab does only routine testing and sends the specimen to one of the other labs for other testing.��* If a patient has specimens processed in different laboratories, the results of those specimens could not be combined on one hard copy patient report.��* Separate historical result files would be created, therefore no capability for delta or historical checking across laboratories would be available.��* Multiple Order Entry databases would need to be set up. OE cannot send orders to multiple Laboratory databases.

12

Single Laboratory Database• One laboratory database• Use Lab Site functionality to separate facilities• Single lab database can be linked to multiple OM databases


Presenter

Presentation Notes

This options involves the set up of one laboratory database, but using the functionality of sites to separate the individual specimen processing and specimen drawing areas.

13

Benefits of Single LAB Database• Shared specimens only have to be entered once• One set of Test dictionaries maintained• Specimens reported on one patient report• Order Entry; multiple database or single database• One patient historical file; reporting and delta checking

Restrictions of Single LAB Database• One set of parameters; agreement by all laboratories• One set of dictionaries; agreement by all laboratories• One specimen numbering wheel for all laboratories


Presenter

Presentation Notes

Benefits of Single LAB Database�* If specimens are shared across laboratories, they only have to be entered once and can be processed in the individual specimen sites.��* One set of Test dictionaries can be maintained and different methods and normal ranges can be defined for each site.��* If specimens are processed across laboratories, they can be reported on one patient report.��* Order Entry can be set up as either multiple database or single database. One laboratory database can accommodate either situation.��* One patient historical file would be built, and therefore all work across laboratories would be accessible for reporting, and delta checking.

14

CMS Configuration

LIVE STD HCIS

UNV HCIS

TEST STD HCIS

TEST Facilities

HCIS

LIVE Facilities

HCIS

LIVE RingTEST Ring

Presenter

Presentation Notes

UNV resides in TEST HCIS LIVE STD propagates to LIVE facilities and TEST STD TEST STD propagates to TEST facilities Strong recommendation is to test in TEST before activating in LIVE

15

• Used for building and maintaining dictionaries within the MEDITECH EHR

• MEDITECH™ 6.1x• Create and manage one master set of dictionaries• Transmit those dictionaries to other sites• Schedule and deploy dictionary updates• Single HCIS or multiple HCISs; multiple databases and facilities• Standardized corporate content and facility specific

dictionaries

Corporate Management Software (CMS)

Presenter

Presentation Notes

MEDITECH's Corporate Management Software is a powerful set of tools used for building and maintaining dictionaries within the MEDITECH EHR. The CMS software allows organizations using 6.1x to create and manage one master set of dictionaries and to transmit those dictionaries to other sites across the enterprise as well as conveniently schedule and deploy dictionary updates. CMS provides tools for building, sharing and managing standard dictionaries across a single HCIS or multiple HCISs and across HCIS configurations with multiple databases and facilities. Using CMS, individual facilities can take advantage of standardized corporate content while still maintaining autonomy over facilityspecific dictionaries.

16

MEDITECH’s recommendation for each dictionary andincludes the Applied CMS Settings that will be set upon delivery in CMS.

Corporate Management Software (CMS)

17

CMS Controls

Completely CMS Controlled/Fully Locked Down

• No new entries to be built or edits to be made at the Target level

• Changes made directly in the Standards ring; propagate to Target HCISs

• Testing should be done in the TEST HCISs to validate this change

Presenter

Presentation Notes

Edit Controls from: Info Systems; CMS; Dictionaries; Edit Controls Fully Locked: Dictionaries that are set up to be fully under CMS control do not allow any new entries to be built or edits to be made at the Target level. However, if the change that is being made in this type of dictionary needs to be tested for any reason, then we recommend that it is first done in Sandbox. Otherwise, if it does not need to be tested, the change can be made directly in the Standards ring, which will then propagate that change to the Target HCISs. Testing should be done in the TEST HCISs to validate this change

18

CMS Controls – Fully Locked Down

The following dictionaries managed by the LIS Application are recommended to be completely

locked down:

● LIS Bill Code ● BBK Bar Code Symbology ● MIC Workcard

● LIS LOINC Term ● BBK Bar Code Field

● LIS Workload Category ● BBK Bar Code Term

● LIS Workload Code ● BBK Donor Group ● PTH Findings Entry Screen

● LIS Workload Function ● BBK Donor Prompt

● LIS Workload Section ● BBK Donor Questionnaire

● LIS Workload Subsection ● BBK Donor Schedule ● LIS Internal Reports

● LIS Task List ● LAB Grid Format

● LIS Task Prompt

● LIS Task Schedule

19

CMS Controls

Partially Under CMS Control/Partially Locked Down

• Certain fields must always propagate from Standards• Some fields may or must be edited in the Target HCISs• Edits to fields not fully under CMS control may be made at the

Target level (custom flags set on fields edited at Target level)

• Testing and validation of change the TEST Target HCISs

Presenter

Presentation Notes

Partially Locked: Partially controlled dictionaries are set up so that. Again, if necessary, the change can be made and tested first in the Sandbox ring. Once the change is approved, the entry can be built in Standards. This will then propagate any fields that are set up to do so to the Target HCISs. Edits to any fields that are not fully under CMS control may be made at the Target level, as applicable. This will set custom flags on any fields that are edited at the Target level, which prevents this change from being overwritten by subsequent edits for this dictionary entry in the Standards HCIS. Testing and validation of the change should be conducted in the TEST Target HCISs.

20

CMS Controls – Partially Locked Down

The following dictionaries managed by the LIS Application are recommended to be partially

controlled:

● LIS Barcode Set ● BBK Antibody ● Antibiotic ● PTH Data Section

● LIS Canned Text ● BBK Antigen ● Department ● PTH Department

● LIS Collection Category ● BBK Blood Type ● Organism ● PTH Findings Category

● LIS Container ● BBK Department ● Procedure ● PTH Medical Terms

● LIS Default Collection Category ● BBK Entry Screen ● Procedure Prompt ● PTH Prompt

● LIS Form ● BBK Product ● Source ● PTH Questionnaire

● LIS Lab Site ● BBK Product Group ● Source Category ● PTH Specimen Type

● LIS Label Format ● BBK Source/Destination ● Specimen Description ● PTH Worksheet

● LIS Label Printer ● BBK Test ● Worksheet ● Shared Dictionaries

● LIS Marker ● BBK Transfusion Reaction ● Shared Dictionaries

● LIS Method ● BBK Unit Location

● LIS Order Group ● BBK Worksheet ● LIS Report Header Group

● LIS Sample Type ● Shared Dictionaries ● LAB Result Format

● LIS Species ● LAB Test Header

● LIS Specimen Type ● MIC Result Format

● LIS Test View Group ● MIC Susceptibility Format

● Shared Dictionaries ● Shared Dictionaries

21

CMS Controls

Not Under CMS Control/Set Up to Never Propagate

• Built at the Target level• Testing and validation in the TEST Targets

Presenter

Presentation Notes

No Lock: Dictionaries that are not subject to CMS control or that are set up to never propagate from Standards must be built entirely at the Target level. Therefore, for any new entries or dictionary edits, the build will begin in the Target rings. If necessary, the change can be made and tested first in Sandbox. If this is not necessary or if this change has been approved in Sandbox, then the dictionary change can be made directly in the Target HCISs. Once this has been done, it is recommended that testing and validation occur in the TEST Targets.

22

CMS Controls

The following dictionaries managed by the LIS Application are recommended to be completely

target controlled, meaning that they will never propagate from the Standards ring:

● LIS Access ● BBK Calculation ● PTH Concepts

● LIS Client/Location ● BBK History Backup Client ● PTH Quick Text

● LIS Collection Method ● BBK QC Material ● PTH Recipients

● LIS Defaults ● PTH Search Profiles

● LIS Desktop Preferences ● PTH Statistics Profiles

● LIS Phlebotomy User Group ● MIC Calculation

● LIS Provider Group ● MIC QC Material ● LIS Report

● LIS Recipient ● MIC Search Profile ● LIS Report Format

● LIS Rule ● LIS Documents

● LIS Route ● MIC Procedure Header

● LIS Selection Profile ● BBK Result Format

● LIS Statistics Profile ● BBK Test Header

● LIS Storage Area ● PTH Report Format

● LIS Telecom Site ● PTH Data Section Format

23

CMS ControlsThe following dictionaries cannot be CMS controlled. All parameters (system and custom) should be manually maintained and match between all HCIS's to ensure standardized processes.

• LIS System Parameters• BBK System Parameters• PTH System Parameters• LIS Custom Parameters• BBK Custom Parameters• PTH Custom Parameters• LIS Picture (MIS Picture)• LIS Web Outreach User

24

CMS ControlsElement Segment

Presenter

Presentation Notes

Dictionaries can be opened by the following: DPM – entire dictionary Segment – Group of Elements Element – Single fields

25

Data Management Desktop (DMD)• Standard Ring• Access dictionaries by Module• Build and edit dictionaries at STD or TEST• Shows if dictionary was delivered with STD content• Available during initial build and major updates

Presenter

Presentation Notes

Explain how to access DMD from MEDITECH menu. Use screen shots to point out where you can select to build at STD vs. TEST (Target). Point out info on DMD. Build is done in actual dictionaries; linked into from DMD.

26

LIS System Parameters

A. Enter the bill date that should be sent to Patient Accounting for recurring or outpatient accounts.S - account service date C - specimen collection date

B. Enter the outbox recipient towhich users want to send theLAB charge information.

C. Enter the facility for which users want to send orders, LAB results, or BAR charges toanother vendor.

CB

Presenter

Presentation Notes

Billing information can be configured in the LIS System Parameters. Single database would have to share settings with the exception of Charge Recipient which can be selected per facility.

27

LIS Customer-Defined Parameters

Page 5: Page 7:

Presenter

Presentation Notes

Page 5: Enter the facilities to which pre-admission patients are assigned. If you do not enter a facility, the cursor does not stop in the next field and you cannot define a location for such patients. Page 7: Enter any facility that should be suppressed entirely or that should be suppressed for certain patient types in Order Management (OM).

28

BBK Customer-Defined ParametersPage 3:

Page 4:

Presenter

Presentation Notes

Page 3: For orders originating in OE, enter the BBK prefixes for which you want to specify a time during which a test can be added to existing specimens. If tests should never be added to any existing specimens with a certain prefix, do not identify this prefix at this field. For each BBK prefix, enter the number of hours before or after order collection time during which a test can be added to a specimen with this prefix. Page 4: The system automatically prints the report you enter here for any transfusions that occur in Patient Care System (PCS) if you have set up the Facility and Printer fields in the BBK Customer-Defined Parameters. Enter the facility in which the Transfusion Reaction Alerts print. Enter the printer to which you want the Transfusion Reaction Alerts to print. No PTH CDP’s reliant on facility or lab site.

29

A-L: M-Z:LIS Shared Dictionaries

Presenter

Presentation Notes

Highlighted routines will be presented in more detail in the following slides.

30

LIS – Access Dictionary

Page 3:

Presenter

Presentation Notes

Enter the mnemonics of all lab sites to which this group will have access. Users will not have access to any sites not defined here.

31

LIS – Client Location Dictionary

Page 1:

Presenter

Presentation Notes

Enter the mnemonic of the lab site with which you want to associate this device if you are using a UNV client.

32

LIS – Collection Category DictionaryPage 2:

Presenter

Presentation Notes

Enter the location sort number with which you want to begin this range of locations. The MIS Location (associated with this number) appears. If a patient is in an MIS Location listed in this range (determined at this field and the To Location field), the system uses the entry in the Coll Category By Location field to determine the collection batch.

33

LIS – Default Dictionary

Presenter

Presentation Notes

For this field, enter a site for which you want to define a site-specific default response.

34

LIS – Label Format and Label Printer Dictionaries

Label Format• Create unique formats for facilities as needed.

Label Printer • Create separate label printer entries for each facility• Enter printers associated with each facility in corresponding

entry

35

LIS – Lab Site Dictionary (Page 1)

Presenter

Presentation Notes

Performing Site: To define this site as a performing site, enter Y. If you enter N, the system does not evaluate this site as a valid performing site. At least one lab site that is defined as a performing site must be assigned in the LAB Test Dictionary, BBK Test Dictionary, and MIC Procedure Dictionary (in the Lab Sites field). Site Code: Enter a 1 to 3 character identifier for this lab site. This code appears on reports to indicate the site at which a test was performed. Ref LAB: Enter Y if this lab site is a reference lab. Otherwise, enter N. Reference labs only receive specimens. They do not send them out. The cursor skips the Final Site and Thru Sites fields if this is a reference lab. Reference labs are final sites.

36


Presenter

Presentation Notes

Final Site: Enter the mnemonic of the lab site to which specimens must be sent for processing. Leave this field blank if specimens should be sent directly to a final site and not routed through intermediary sites. (Note: The destination cannot be the same as the site of origin.)

37


Presenter

Presentation Notes

Orders to Recipient: Identify the outbox recipients of the site batch orders from this site. Results to Recipient: Identify the outbox recipients of the LAB results.

38

LIS – Recipient DictionaryEntries in the Recipient dictionary are pulled from MIS Connections.Interfaces may be defined specifically for facilities:• Billing• Reference Lab• Public Health• Medinet; between facilities

LIS – Telecom DictionaryReports will need to be created for each facility and associated to separate Telecom Sites if multiple performing sites are defined; Lab Sites.

Presenter

Presentation Notes

Recipients to be used in Lab Site dictionary.

39

LAB – Test Dictionary (Page 3)

BBK – Test Dictionary (Page 3)

MIC – Procedure Dictionary (Page 3)

Presenter

Presentation Notes

Enter mnemonic of performing lab sites

40




Presenter

Presentation Notes

Unique collection instructions can be entered for separate lab sites (can be printed on collection labels)

41


Presenter

Presentation Notes

Result group needed for each lab site if using one database with multiple facilities

42

LAB – Test Dictionary (Page 5)BBK – Procedure Dictionary (Page 5)

Non-Numeric

Presenter

Presentation Notes

Result group needed for each lab site if using one database with multiple facilities

43

LAB – Test Dictionary (Page 5)BBK – Test Dictionary (Page 5)MIC – Procedure Dictionary (Page 4)

Profile or

Group

Presenter

Presentation Notes

Different profiles can be designated for separate facilities when single database is being used for multiple facilities.

44




Presenter

Presentation Notes

Single database – all methods need to be built and can be designated for separate facilities as defined in the lab site dictionary.

45

BBK Dictionaries• Antibody• Antigen• Blood Type (Page 2)• Product (Page 6)• Source/Destination (Page 2)

MIC Dictionaries• Antibiotic (Page 1)• Organism (Page 1)• Source• Specimen Description

Presenter

Presentation Notes

BBK Ab, Ag and Product - Enter the mnemonics of the lab sites you want to include or exclude from the search. BBK BT - Enter the mnemonic of the outside lab site that will reference this blood type via an interface. This prompt accepts multiple entries. Enter as many lab sites as apply to this blood type. BBK Source/Destination - Enter the mnemonics of the lab sites you want to include or exclude from this source. MIC Ab - Enter the mnemonics of the outside lab site that reference this antibiotic via Medinet. MIC Org - Enter the mnemonics of the outside lab sites that references this organism via Medinet. MIC Source - Enter the mnemonics of the lab sites to include or exclude from the search criteria. Leave this field blank to include all lab sites. MIC Spec Desc - Enter the mnemonics of the outside lab sites that references this specimen description via Medinet.

46

MIC – Prompt Dictionary (Page 1)

BBK – QC Material (Page 2)MIC – QC Material (Page 2)

Presenter

Presentation Notes

MIC Prompt – Lab Site - Enter the LIS lab sites that have corresponding reference or result codes that you want to edit. Name - The system displays the name of the associated LIS Site. Ref Code - Enter the code used to refer to this procedure when an outside lab orders it done in your lab. Res Code - Enter the code used by an outside lab to refer to this procedure when it sends results back to your lab. QC – Lab Site - Use this field to define site-specific default methods for different sites. If any sites use a different default method for this test than the default method specified in the Default Method field above, identify those sites. If all sites use the general default method specified in the Default Method field above, leave this field blank. Dft Method - Identify the site-specific default method to use for this test at this site (entered in the LIS Site field corresponding to this field). The entry must be one of the methods defined (in the Method field in the BBK QC Material Dictionary) for this test.

47

Report Dictionary (Page 2)

Presenter

Presentation Notes

Enter the mnemonic of the primary lab site at which the tests for specimens on this report are performed.

48

Summary: HCIS Configuration Considerations

ADM: Facility(es)/Database(s) LAB: Facility(es)/Database(s) OM: Facility(es) CMS DMD LIS Parameters: System/Customer Defined Dictionaries

49

Dennis MajeskiSenior Clinical Consultant


[email protected]

QUESTIONS ?

50

Contact Us

BOOTH1034

(855) [email protected]


http://www.parallontechnology.com/

THANK YOU!


A Journey Towards CPOE Pediatric Optimization

Does it really take a village?

International MUSE Conference May 30 – June 2, 2017

TechnicalServices

SupportServices

StaffingServices

MEDITECHServices


Who We Are

3

Presenter

Presentation Notes


4

Objectives

• Identify potential risks with pediatric medication ordering

• Describe steps to mitigate risks during the process of ordering pediatric medications

• Describe a build process for medication ordering to support CPOE with the pediatric patient in mind

Presenter

Presentation Notes

I should emphasize that this build, the examples are from Magic 5.67.

5

Why the Emphasis on Pediatric Ordering?

• Pediatric medication orders are at a higher risk for errors• Dosing is NOT “one dose fits all”• Math errors due to calculations with weight based dosing (WBD)• Suspensions often have to be prepared from other oral or IV

formulations• Dilutions may be required to facilitate measurable amounts

6

MAD Dosing

• On top of that, children are less tolerant of medication errors due to variations in enzymatic pathways and other pharmacokinetic considerations.

• Metabolism• P450 activity is 50% of adult levels, decreased hydroxylation activity

leads to decreased metabolism, increased hepatic enzyme activity between 2-4 years of age

• Absorption• Gastrointestinal (pH – acid output maturity related to postnatal age, GI

motility decreased, lower levels of GI flora), percutaneous

• Distribution• Increased body water, lower levels of body fat, decreased plasma

protein binding, immature blood brain barrier

Presenter

Presentation Notes

Absorption – Gastrointestinal pH- gastric acid output maturity is related to postnatal age and approaches adult values by 3 months of age GI motility- neonates have a delay in gastric emptying time, adult values are reached at 6-8 months of age GI contents- develops rapidly within the first year of life, underdeveloped flora can increase absorption of drugs (digoxin) – Percutaneous Absorption is increased in the newborn due to immature epidermal barrier and increased skin hydration during the first 2 weeks of life Increased surface area to weight ratio increases percutaneous absorption Distribution – Body Water • Neonates are 85% body water compared to 55% in adults • Vd is increased for drugs that distribute to aqueous parts of the body (aminoglycosides) – Percutaneous • Total body fat is 1% in a 29 week neonate • Total body fat is 15% in a full term baby • Total body fat is 20-25% in 2yo toddler • Fat content tends to increase between 5-10 years followed by a decrease through age 17 • Vd is increased for drugs that are highly lipid soluble – Plasma Protein Binding • Neonates have decreased plasma protein which increases unbound concentrations (ex. Phenytoin may only be 70% bound in a neonate compared to 90% in an adult) – Blood Brain Barrier • An immature BBB due to incomplete CNS myelination results in increased CNS drug penetration Metabolism – Neonates have decreased activity of many enzyme pathways, that is why drug dosages are decreased for neonates P450 activity is 50% of adult levels Decreased hydroxylation activity leads to decreased metabolism of phenobarbital, phenytoin, lidocaine Children have increased hepatic enzyme activity between 2-4 years of age. This may be due to large liver size compared to total body weight. Doses are increased during this time for theophylline, phenytoin, and phenobarbital

7

Patient Safety Goals... (#goals)

JCAHO NPSG3-Improve the safety of using medications• Goal 3b: Standardize and limit the number of drug

concentrations available in the organization• Labeling Medications (revised NPSG.03.04.01)

Joint Commission. "NPSG. 03.04. 01. National Patient Safety Goals: Hospital Accreditation Program." (2015)

8

Why? • No Standardization of concentrations =

Increased risk for errors

• Non-streamlined ordering = Increased risk for errors

• Calculation errors resulting at the point of…• Dosing (ordering)• Dilution (preparation)• Administration

Ultimately, it comes down to patient safety.

9

Current State

• There is a void of medications with a pediatric specific formulation.

• Manufacturers are working to meet the demand for pediatric medications in ready-to-use formulations.

• Common hospital practice is to take an adult medication formulation and dilute it to an acceptable pediatric concentration.

10

Current State

When looking up a med for ordering, the provider cannot easily identify the medications with pediatric specific order strings.

Presenter

Presentation Notes

The Provider wants to order oral Clindamycin and selects the suspension.

11

Slip of the Mouse

Presenter

Presentation Notes

Provider intends to order the 3.3 mg/Kg Weight based order string but the mouse has a mind of it’s own and grabs the 300mg TID string above it. Click, Click, Pager, Question,…file. And now we have an errant order string en route to the patient. Now I know that in the current hospital environment, there are no over taxed nurses. All our nurses have plenty of time to focus… So there is no way this could slip by our exceptional nursing teams. Same with the pharmacy staff. Luckily, the phone never rings in the pharmacy right in the middle of the order review, so the pharmacist would catch this dosing or formulation issue. Clear as day! Of course there is that chance that the swiss cheese will all line up…BOOM! RISK – Pediatric order strings intermingled with adult order strings.

12

The Journey BeginsFirst step is to standardize the concentrations of common pediatric medications.

Presenter

Presentation Notes

Note: This is a journey…and this is our experience… We utilized a panel of SME to identify drugs used in the pediatric populace, define a literature based acceptable concentrations for each drug, and for the various routes (IM, IVP, IV,…) This group developed the Pedi IV Concentration Chart The SME group also prepared, validated a listing of strings to be used for the project.

13

First step is to STANDARDIZE THE CONCENTRATIONS of common pediatric medications.

Presenter

Presentation Notes

Standardizing available medication concentrations will decrease the risk of calculation errors. (of course this is true for the adult populations as well as the pedi population.)

14

Drug Dictionary Focus

Goal is to identify and utilize existing entries or, if needed, build new entries for each medication used in the pediatric environment.

Presenter

Presentation Notes

Build entries AS IF the product was commercially made. Dilutions in the form/concentration in the most Ready-to-use formulation. Again there may be different concentrations based on route of administration (IM vs IVP) Note: site strength is “MG” or Weight… Ideal for Pedi dosing is Weight/Volume “Mg/Ml” (500 MG vial would be better as 2 Mg/ML) Again – if existing concentration is on the Pedi IV Concentration Chart …Use that first, build as last resort.

15

New Drug Build

Presenter

Presentation Notes

Table on top is an example of NEW drugs that we built for a hospital to facilitate WBD for pediatrics. Our team would build the skeleton, just enough for the mnemonic to be usable for the build. The local team would complete the dictionary entry with billing codes, add appropriate rules, address the ADM interface if exists. The mnemonic would remain INACTIVE until the site changed to ACTIVE.

16

Syringe Carrier

“SYRINGE” to facilitate weight based dosing with a rate for IV

Presenter

Presentation Notes

One of the first items we looked for in the PHA drug dictionary, is an entry that can be used as Syringe Carrier. This carrier entry added to allow IV OE build – to allow prediluted medications (often prepared in the pharmacy) to be ordered Facilitates weight based dosing – OE QuickScript

17

Fake fluids, much?Syringe Carrier Build

Presenter

Presentation Notes

This is an example of a Fake fluid build “SYRINGE” is a separate drug build in PHA drug dictionary. “1 EACH” will allow for the WBD calculation

18

Pre-Assessment FileThe Pre-Assessment file contained:

1. Locations Tab2. Large Volume IV (LVIV) Tab3. Critical Care Drip (CCD) Tab4. MED Order Type (IV=N) Tab5. IV Order Type (IV=Y) Tab6. Pedi IV Concentration Chart7. Current PHA Drug Dictionary Extract

Presenter

Presentation Notes

Our remote team would use the Current PHA Drug Dictionary Extract to map the SME developed order strings. The hospital team would use the mapped files to validate or change as desired for the build. Pre-Assessment work also included, a gap analysis of available client developed standard Admin Criteria, standard ROUTES, UNITS Of Measure, Directions

19

Locations Tab

Presenter

Presentation Notes

Locations specific for Pediatric strings identified at this step. Does this site have specific nursing units for Pediatrics or neonates? Or is this site a ED only for Pediatric care? Are there areas that would need strings excluded or included specifically…

20

Premixed Large Volume IV (LVIV)

Premixed LVIVs built in OE QuickScripts dictionary

Presenter

Presentation Notes

Built in OE QuickScripts This was typically a smaller file. Quick turnaround from the site back to the build team.

21

Compounded Plain LVIV

Compounded Plain LVIV using site specific mnemonics built in PHA Order Strings dictionary

Presenter

Presentation Notes

NO additional additives like electrolytes other than NaCl and Dextrose

22

Compounded LVIV Medications

Compounded LVIV meds built in PHA Order Strings

Presenter

Presentation Notes

This is a split view of the file. Additional columns available for additional additives

23

Compounded LVIV Medications

Presenter

Presentation Notes

Allow for build with String comments, Label comments, and Location Include/Exclude

24

Critical Care Drips (CCD)

Presenter

Presentation Notes

Critical Care Drips built in OE QuickScripts

25

Critical Care Drips

26

Critical Care Drips

27

Critical Care Drips

Presenter

Presentation Notes

Recommended String comments for standardization across the site, along with existing Admin Criteria listings

28

Pre-Assessment MED Order Type

Include strings from Master File and the pre-existing site strings

Presenter

Presentation Notes

This is the heart of the build. The Build? column is where the site would communicate with the build team to build a string or not. Rows with Blue Text indicated an ED string Pre-exist strings are the sites current strings at the time of PreAssessment Green highlight in the Min Rec Con reflect values found on the Standard Pediatric Concentrations file

29

Pre-Assessment MED Order Type

Location…

Location...

Location!

Presenter

Presentation Notes

Build with locations Include or Exclude Powerful tool to limit what displays on the selection screen. Also a Risk area for duplication

30

Pre-Assessment IV Order Type

Include strings from Master File and the pre-existing site strings

31


Fluid or carrier fields

Presenter

Presentation Notes

The fluid carrier, where appropriate, would be listed in the Fluid Mnemonic column. Many of the pedi specific formulations/concentration are prepared in the pharmacy department and sent up in syringes. Ergo, the evolution of the fake fluid entry. “SYRINGE” – “fake” fluid to support IV route administration and not interfere with WBD calculations

32


Indicate locations to Include/Exclude the strings

33

Standardize Nomenclature

Use “PEDS” and “NICU” prefix to identify and group pediatric/neonatal strings

Presenter

Presentation Notes

A key to this build is to identify specific naming or ‘tags’ The ‘tags’, in this example “PEDS” or “NICU” or the trailing “ED” will confirm to the provider that specific strings are available on that mnemonic We will see this play out as we journey though the build.

34

Name Calling

Presenter

Presentation Notes

WE utilized the Gen Equivalents for pre-existing mnemonics in order to not affect any historical data Use Primary Display Name or the ID/Display Name for mnemonics created specifically with Peds Concentrations. Again this would be only for NEW drug mnemonics created for this Peds project. Reminder the Naming is associated with the mnemonic. The Location associated with the strings ultimately does the filtering of the strings.

35

Filtered by Location

Presenter

Presentation Notes

This is Page 2 of the OE Quick Scripts dictionary entry for the azithromycin. Adding the “INCLUDE” Locations will allow this specific string to show only for patients IN those locations.

36

Slip of the Mouse (Revisited)

Isolate pediatric specific order strings into a single ordering group by using ‘tags’ when

entering orders.

37

CDS and Admin Criteria

CDS built and added to Admin Criteria for CCD ordering

Presenter

Presentation Notes

Customer Defined Screen Critical Care Drips

38

Admin Criteria to OE Strings & Drug Dictionary

Presenter

Presentation Notes

Admin Crit may also be added on Pg 2 of the OE Quickscripts dictionary Pg 8 on the DD

39

Provider’s View of Admin Criteria

40

And the results???

Add a graphic here. Drum roll, please. Or something like that

41

Look Up by GENERIC

Presenter

Presentation Notes

Providers educated to begin searches with “PED” or “NICU” and then the generic or brand name. This moves the separation or filtering of the Pedi specific to this level.

42

Available Strings

43

Look Up by TRADE

44

Oral Medication Order Strings

Presenter

Presentation Notes

PEDI specific Oral Medication strings These are presented based on the patient location and the Include/Exclude location built on the string on Page 2 of the OE Quick scripts dictionary

45

Injection: Look Up by GENERIC

46

Available Strings

47

Level of Effort

Presenter

Presentation Notes

Remote team did all Pre-PreAssessment work and build. Facility resource validated all work pre- and post build, remediated missing ROUTES on drugs issues and updated required info on the NEW drugs created for this project For us…using a remote Pharmacy team, RPh and analysts…the Village people… Include resources for 40 sites and equate to 1 site. Work effort Who would be best – dedicated team to build

48

Getting Around in the Village

Presenter

Presentation Notes

The Local team would also have the responsibility to finish the new drug build and activate those drugs when the build is complete.

49

Speed Bumps in the Village

• For the multi-site (multiple hospital) group build – the various scopes of practice required differing levels of need

• Automation – How to deal with drugs, RN pulls and dilutes

• Medical staff buy-in – How to package this improvement

Presenter

Presentation Notes

Different Scopes – Full service line: ED with PICU, NICU etc… vs Just ED Pyxis – ceftriaxone… What steps would be needed to initiate. PreAssessment of current build. Auto Dispense Machines like Pyxis? How to dispense after hours for the hospitals without a 24/7 pharmacy? **establish policies/procedures? NDC Update issue. Weight/Volume build in the approved Pedi concentrations. DUR warnings – new med built from VIAL entry. Question if the warnings would translate correctly?

50

Mark Milnes, PharmDSenior Consultant


[email protected]


51

Continuing Education Disclosure Statements

• Participants must attend the entire session in order to earn contact hour credit. Verification of participation is noted by the completed and submitted evaluation.

• Planners and presenters have declared they have no financial relationships which would influence the planning of this activity. If any are discovered during the course of the activity, an announcement will be made to inform the learners.

• No commercial support has influenced the planning of the educational objectives or the content of this activity.

• If there were any commercial supports provided for this activity, they would be used for events not related to continuing education.

• There is no endorsement of any product by the provider or ANCC associated with this activity.

• It is expected that no presentation relates to products governed by the Food and Drug Administration, But, during the course of this activity, if there is a discussion related to such products, FDA-approved and non-approved uses will be disclosed to participants.

MUSE International is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

52

Contact Us

BOOTH1034




THANK YOU!


Are you leaving anything at the bedside?

Lost Charges = Lost Revenue

International MUSE Conference 2017: May 30 - June 2

Presenter

Presentation Notes

WELCOME TO PRESENTATION

TechnicalServices

SupportServices

StaffingServices

MEDITECHServices


Who We Are

3

Presenter

Presentation Notes


4

During this presentation we will discuss:

• Are you capturing all the charges you can?

• Unique methodology to implement

Presenter

Presentation Notes

IN THESE DAYS OF DECREASED REIMBURSEMENT IT IS VERY IMPORTANT TO CAPTURE ALL THE CHARGES YOU CAN. THE DIFFERENCE BETWEEN CAPTURING MANY OR ALL CHARGES COULD BE THAT OF A FTE OR MAYBE MORE

5

Overview• BAR – Reports that show rejections and how to correct them• UBC – Omnicell, Pyxis, etc. Unreconciled Temporary Patients

and how to fix this issue• PHA- Interface errors• Scan rates-reports, etc.• Proper Barcoding• Reporting• Pricing• Charge Types• Charge Formulas

Presenter

Presentation Notes

THERE IS NOT ONE SPECIFIC TYPE THAT MATTERS MORE THAN OTHERS BUT I WILL TRY TO SHOW YOU MANY DIFFERENT TYPES AND EVEN IF YOU PICK UP ON ONE OT 2 THIS COULD BE A CONSIDERABLE SAVINGS FOR YOU AND YOUR FACILITY.

6

B/AR Rejections

• Monitor on a Daily Basis• Make every effort to re-process within 72 hours• Be wary of the time frame in your particular State

Presenter

Presentation Notes

THIS IS IF YOUR FACILITY USES BAR… IT IS A GOOD PLACE TO START OFF . AND IS RELATIVELY EASY TO DO

7

B/AR Rejections

8

B/AR Rejection Report

Presenter

Presentation Notes

THIS SHOULD BE DONE ON A DAILY BASIS OR AS FREQUENTLY AS POSSIBLE

9


Presenter

Presentation Notes

BAR WORKS IN BATCHES FOR THE ERRORS, THAT IS EVERYTHING PROCESSED IN A CERTAIN TIME FRAME

10


Presenter

Presentation Notes

YOU WILL HAVE TO LIST THE REJECTION BATCHES BEFORE YOU CAN DO ANY PROBLEM SOLVING

11


Presenter

Presentation Notes

THIS REPORT IS RUN FOR A WEEK BUT IF AT ALL POSSIBLE RUN ON A DAILY BASIS.. THIS IS BAR NOT PHA BUT WE FOUND OUT THAT PHA NEEDS TO TAKE THE INITIATIVE BECAUSE IF NOT IT MAY FALL IN THE CRACKS.

12


Presenter

Presentation Notes

PLEASE NOT THE REASON FOR THE BAR REJECTION- INVALID TRANSATION SERVICE DATE. THIS IS A VERY COMMON REASON AND WILL APPEAR FREQUENTLY. WHAT WILL CAUSE THIS?

13


• Doing your homework before you can fix it• Note: Rejection reason says “invalid transaction service date”• Why and how?• Extenuating circumstances• Be sure to rectify promptly

Presenter

Presentation Notes

NOW THAT YOU HAVE THE CORRECT INFORMATION YOU ARE READY TO “FIX” THE ISSUES

14

How to Process Rejection Batches

15


Presenter

Presentation Notes

SCREEN SHOTS OF MEDITECH

16


17


18


Presenter

Presentation Notes

WHEN YOU RUN THIS REPORT REMEBER TO EDIT AND FIX BEFORE YOU DELETE

19


Presenter

Presentation Notes

ONCE AGAIN MOST REJECTIONS WILL HAVE INVALID DATES OF SERVICE

20

Rejection Batches

• If you cannot fix or edit, then delete• You do not want the clutter in case someone else goes back

further in their search

21

Unreconciled Temporary Patients

• What are they?• Why they are important• How to fix• What happens after you fix?• Monitoring users

Presenter

Presentation Notes

PATIENTS THAT COME IN YOUR E.R OR O.R. WITHOUT A NAME. REASONS MVC,TRAUMA,ETC. WHEN YOU FIX IN OMNICELL/PYXIS, THE DATE YOU FIX TRANSACTION GOES INTO MEDITECH AS THE DATE FO SERVICE.. WHAT CAN THIS CAUSE AND ISSUES.

22

Unreconciled Temporary Patients

Presenter

Presentation Notes

YOU WILL HAV TO FIX THE JOHN DOE BECAUSE IT IS A CONTROLLED SUSBSTANCE.SOME FACILITES LIKE THE ONE PICTURED HAVE A NAMING CONVENTION FOR THE DOE’S AND DEPENDING ON THE SETP UP MAY OR MAY NOT MERGE…

23

Pharmacy Interface Errors

Issues:• Orders not crossing interface

• Steps to correct

• Reprocessing these errors• Steps to correct

24

How to Process Interface Errors

25


26

Interface Errors

• Should be resolved on a daily basis• If you have non drug items in your Omnicell/Pyxis, you will

get an interface error every time one is removed from the cabinet

• Can this be easily resolved ?• Yes – set up a dummy drug in MEDITECH• Be sure mnemonics are the same in order to stop these

errors

27


28

Actual Interface Error

29


• In this case, you would only have to acknowledge to clear the error. But, why?

• When to print the error

Presenter

Presentation Notes

YOU SHOULD PRINT ERRORS WHEN THEY CANNOT BE IMMEDIATELY RESOLVED: THEN YOU CAN INVESTIGATE THE CAUSE AND REPROCESS

30


• If this had been an interface error that needed to be fixed, you would type in an “R” for reprocess and make desired changes

• What happens when you do this?

Presenter

Presentation Notes

WHAT DATE CROSSES TO MEDITECH ?

31

Scan Reports

• Scanning the patient and medications for charge capture happens ONLY when your facility uses:

Billing on Administration

NOT

Billing on Dispense

32

Scan Reports

Presenter

Presentation Notes

WE WILL NOW LOOK AT 3 TYPES OF SCANNING REPORTS

33

Scan Reports

34

Scan Reports

Presenter

Presentation Notes

THIS IS THE FIRST TYPE OF SCAN REPORT

35

Scan Medication Detail Report

36

Scan Medication Detail Report

37

Scan Medication Summary Report

Presenter

Presentation Notes

THIS IS THE SECOND TYPE OF SCAN REPORT

38

Scanned Medication Summary Report

Presenter

Presentation Notes

PLEASE NOTE LOCATIONS AS WELL AS MEDICATION SELECTED

39


Presenter

Presentation Notes

GOOD QUESTION HERE IS WHY WERE MEDS NOT SCANNED.. AND SINCE THI FACILITY IS BILL ON ADMIN THEY WERE NOT BILLED…

40


41

Scanned/Not Scanned Report

Presenter

Presentation Notes

THIS IS THE THIRD TYPE OF REPORT

42


Presenter

Presentation Notes

PLEASE NOTE ALL THE FIELDS ARE CUSTOMIZABLE

43


44


45


Presenter

Presentation Notes

PLEASE NOTE SCAN RATES.. WHAT IS ACCEPTABLE?

46


Presenter

Presentation Notes

NOTE SCAN RATES

47

Proper Scanning Success

• GOAL = Minimum 95%• Poor scan rates = Lost revenue• Review nursing processes• Be sure scanners are accurate and functional

Presenter

Presentation Notes

REPOROGRAM SCANNERS.. THIS IS ONE OF THE EASIEST STEPS…SHEETS TO SCAN .. WHO WILL DO IT..

48

Proper Barcoding and NDC Numbers

• CMS (Centers for Medicare and Medicaid Services) • Requires all hospitals to submit an NDC number with each

drug for patient care

Presenter

Presentation Notes

BE SURE ALL YOUR NDC’S ARE IN ORDER

49

Barcoding/NDC Number Tips

• Are you scanning every med that enters your pharmacy?• Have you been performing FSV updates in a timely fashion?• Have you been making corrections as needed?

Presenter

Presentation Notes

WHY SCAN EVERY MED? BEFORE YOU START DO UBC AND ALL OF PHARMACY… ITEMS FALLING THROUGH CRACKS

50

PHA Drug Dictionary

Presenter

Presentation Notes

PATH TO NDC NUMBERS

51

PHA Drug Dictionary

52

PHA Drug Dictionary: Field Definition

53

PHA Drug Dictionary

NDC #• This number needs to contain 11 digits with no slashes• Becomes part of item description for Materials Management• Lookup is provided by FSV and available only if 1B is defined

in the FSV allergies in the MIS Parameters

54

PHA Drug Dictionary

10 Digit #• Displays ten digit number provided by FSV• Edits allowed but not protected• If 11 digit NDC number is modified, 10 digit automatically

updated

55

PHA Drug Dictionary: Field Understanding

56

PHA Drug Dictionary

• Billing Unit of Measure• In this field enter the Unit of Measure that is sent to billing

(BAR)• F2: International Unit• GR: Gram • ML: Milliliter• UN: Unit/Each (Unit per Each)

Presenter

Presentation Notes

If this field is left blank the system looks to the PHA CDP “Use Dft Billing Unit of Measure and Multiplier to determine if the default unit of UN is used.

57

PHA Drug Dictionary

Multiplier:

A multiplier is used to calculate the order amount that is defined in the “Billing Unit of Measure” field.

Presenter

Presentation Notes

The multiplier value defines what to multiply the order size by, in order to maintain the order amount that is defined in the Billing Unit of Measure field. NOTE: for medications identified as Fluid, the Dispense size is used for calculation. For example a drug with an order size of 5 MG must be sent to BAR with the Billing Unit of Measure as 1 ML. The multiplier would be 0.2. I f 10 mg of this same drug was ordered 2 ml would be sent to BAR,

58

PHA Drug DictionaryWhat this means and why/why not do it?

59

PHA Drug Dictionary

Presenter

Presentation Notes

FDB no longer supplies AWP information but they allow for a hierarchy in the FSV parameters to populate Unit AWP ( and Unit cost and Price)

60

PHA Drug Dictionary

61

PHA Drug Dictionary: What and Why

Presenter

Presentation Notes

ALTERNATE NDC NUMBERS.. EVERY MED NEEDS TO BE HERE:NOTE ALT IS 1O DIGIT AND BILLLING IS 11…ALTERNATE NDC 10 DIGIT IS USED FOR SCANNING PROJECTS

62

Charge Types and Charge Formulas

• Charge Types:• How do they work and why?

• Charge Formulas:• Who/What determines• Benefits or not?

Presenter

Presentation Notes

The Charge Formula Dictionary contains the formulas used to calculate prescription charges when a medication is ordered. The formulas may begin with a pricing basis from the Drug Dictionary (ex. AWP, Unit Price) Charge formulas give the flexibility to create different methods of charging for medications. The charge can be adjusted through percent markups, handling fees, minimum and maximum levels as well as creating site defined charge tables. Charge tables consist of any number of price ranges, each of which can have a different type and amount of adjustment

63

Charge Formulas

Presenter

Presentation Notes

Path to charge formulas

64

Charge Formulas

65

Charge Formulas• Percent Markup• Minimum Charge

Presenter

Presentation Notes

PLEASE NOTE PER CENT MARKUP AND MINIMUM CHARGE AND WHY? EX INCREASE MARKUP BY 10% VERY EASY TO DO. PLEASE NOTE THIS IS FOR A CONTROLLED SUBSTANCE

66

Charge FormulasPer Cent Markup and Minimum Charges: Why?

Presenter

Presentation Notes

THIS IS FOR AN INPATIENT DRUG

67

Charge Types

68

Charge Types

69

Charge Types

Presenter

Presentation Notes

PLEASE NOT EVERY CHARGE TYPE MUST HAVE A CHARGE FORMULA AND YOU CAN HAVE MULTIPLE CHARGE TYPES USE THE SAME CHARGE FORMULA IF DESIRED

70

Charge TypesAttached on page 8 of the Drug Dictionary

71

Surgery or other Outpatient areas

• How are you capturing these charges?• Paper documentation• Better Solution• Increased revenue

Presenter

Presentation Notes

For these areas when using paper documentation many things may fall between the cracks. This billing is not done in real time either. An ideal solution is a UBC (Omnicell or Pyxis) for outpatient areas. AND Anesthesia workstations in the OR suites for Anesthesiology. Since these are Outpatient area and if most of your surgeries are Outpatient you can bill for all these medications and increase revenue by lots. Examples…

72

Summary

• BAR – Reports that show rejections and how to correct them• UBC – Omnicell, Pyxis, etc. Unreconciled Temporary Patients

and how to fix this issue• PHA- Interface errors• Scan rates-reports, etc• Proper Barcoding• Reporting• Pricing• Charge Types• Charge Formulas

73

David BurgstahlerSenior Applications AnalystParallon Technology Solutions

490 Metroplex DriveNashville, Tennessee

[email protected]


74

Contact Us

BOOTH1034




THANK YOU!