1

The ABC’s of TIU UPLOADING

Plus, Filing errors

Missing field errors

2

Enter Upload Utility Parameters Option to use is:

TPM2 Modify Upload Parameters

This option is located: TIU Menu for Medical Records Option

TMM - TIU Maintenance Menu Option (required key TIUZMGR) TPM – TIU Parameters Menu Option

3

Settings at Red Lake, MN

Select INSTITUTION: RED LAKE HOSPITAL BEMIDJI RED LAKE 01 MN IHS 497

ASCII UPLOAD SOURCE: host file server//UPLOAD HEADER FORMAT: captioned//RECORD HEADER SIGNAL: $HDR//BEGIN REPORT TEXT SIGNAL: $TXT//END OF MESSAGE SIGNAL: $END//RUN UPLOAD FILER IN FOREGROUND: NO//

Now Select upload error alert recipients:

Select ALERT RECIPIENT: LASLEY,KARRIE//

IHS UPLOAD PARAMETERS

UPLOAD FILE DIRECTORY: f:\pub\mxtiu\//ARCHIVE FILE DIRECTORY: f:\pub\mxarch\//UPLOAD FILE NAME: tiufile.txt//

Define all of the users that will be filing all Missing Field

and Filing Error alerts.

•If you want to automate the upload process you must define these three fields.•If you are going to manually upload the files, these fields do not need to be defined plus these two fields would be set different:• ASCII UPLOAD SOURCE: remote computer• UPLOAD PROTOCOL: KERMIT

4

Setup for Progress Notes Document ClassNow edit the DOCUMENT DEFINITION file:DOCUMENT DEFINITION: PROGRESS NOTES CLASS ABBREVIATION: PN//LAYGO ALLOWED: YES//UPLOAD TARGET FILE: TIU DOCUMENT//Select TARGET TEXT FIELD: REPORT TEXT//UPLOAD LOOK-UP METHOD: D LOOKUP^TIUPUTPN//UPLOAD POST-FILING CODE: D FOLLOWUP^TIUPUTPN(TIUREC("#")) ReplaceUPLOAD FILING ERROR CODE: D PNFIX^TIUPNFIX//Select CAPTION: CLINIC CODE// ? Answer with UPLOAD CAPTIONED ASCII HEADER, or ITEM NAME, or FIELD NUMBER, or LOOKUP LOCAL VARIABLE NAME Choose from: CLINIC CODE DICTATED BY DICTATION DATE EXPECTED COSIGNER HRCN TITLE TRANSCRIPTIONIST URGENCY

These fields are the ones defined at Red Lake. See the following slides for each

upload document type and the settings for each caption field.

5

IHS UPLOAD PARAMETERS

These parameters allow you to automatically upload files to the TIU Document file.

You will need a ftp-file-transfer type software application to check for completed files at the location defined in field, Upload File Directory.

Combines all completed files into one file with an ending $END. Names it to the file name you have defined in the field, Upload File

Name. Therefore, for Red Lake it is named tiufile.txt When it has uploaded, file is moved to the location defined in field,

Archive File Directory. The file name is changed to append the date, ex:

tiu3050502.txt. If there is more than one file for the same date it appends a

time. The archive directory saves the file should you need to upload the

file again due to problems.

6

Tasked job for the IHS Parameters Option Name: BTIU UPLOAD DOCUMENTS QUEUED Menu Text: Upload Documents (Queued) TASK ID: 270439 _____________________________________________________________

QUEUED TO RUN AT WHAT TIME: MAY 10,2005@09:45

DEVICE FOR QUEUED JOB OUTPUT:

QUEUED TO RUN ON VOLUME SET: RDL

RESCHEDULING FREQUENCY: 900S

TASK PARAMETERS:

SPECIAL QUEUEING:______________________________________________________________

7

Clinic Set Up Create Visit at Check-In? YES

1. Using the Set Up a Clinic option, look at Page 4 of 4

2. Make sure that Create Visit at Check-In is set to YES

3. Make sure there is at least one default provider

4. TIU upload files to the entry in the VISIT file and not the appointment; therefore this ensures that a visit is created when the clerk checks-in the appointment.

8

Progress Notes Class Caption fields CAPTION: HRCN ITEM NAME: HRCN

FIELD NUMBER: .02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-")

CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT EXAMPLE ENTRY: 06/28/04 CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: YES

CAPTION: DICTATED BY ITEM NAME: DICTATED BY FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH EXAMPLE ENTRY: DOOGIE HOWSER CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER FIELD NUMBER: 1208 EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

CAPTION: VISIT DATE ITEM NAME: VISIT DATE FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUVDT EXAMPLE ENTRY: 042805 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

9

Progress Notes captioned fields continued

CAPTION: URGENCY ITEM NAME: URGENCY FIELD NUMBER: .09 EXAMPLE ENTRY: ROUTINE CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

CAPTION: TITLE ITEM NAME: TITLE FIELD NUMBER: .01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE EXAMPLE ENTRY: PEDIATRIC ENCOUNTER CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC EXAMPLE ENTRY: 08 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

10

About two of the fields…

Required fields If a field that is required is missing, it will attempt to file the

document but will generate a Missing Field Error Alert Clinician Must Dictate

This will determine what fields are shown should the option, Help for Upload Utility, which is not used.

Some fields the clinician does not normally need to dictate: Dictation Date – Normally this date in stored when dictated in

most Transcription Companies software applications. Transcriptionist – Would be entered by the transcriptionist that

types the document

11

Additional facts…

Clinic Code is sufficient and works better than expecting the transcription company to type the exact clinic name. The only time you would have a problem with clinic code – if the

patient has two same clinic codes for the same visit date You would then receive a Filing Error Alert and have to manually link

to the correct visit. Expected Co-signer is normally left blank but it should be defined

if ever you have students that dictate so they may designate their expected co-signer.

Someone with programmer access will need to define these two fields: Lookup Local Variable Name Transform Code

12

Discharge Summary field settings set on the Title CAPTION: HRCN ITEM NAME: HRCN

FIELD NUMBER: .02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S:X["-" X=+$$STRIP^XLFSTR(X,"-") S X=+X

CAPTION: DATE OF ADMISSION ITEM NAME: ADMISSION DATE FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUADT EXAMPLE ENTRY: 03/30/93 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

CAPTION: DICTATED BY ITEM NAME: DICTATING PROVIDER FIELD NUMBER: 1202 EXAMPLE ENTRY: DOOGEY P. HOWSER, M.D. CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDICDT EXAMPLE ENTRY: 04/03/93 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: NO

13

Discharge Summary cont…

CAPTION: ATTENDING PHYSICIAN ITEM NAME: ATTENDING PHYSICIAN FIELD NUMBER: 1209 EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST ID FIELD NUMBER: 1302 EXAMPLE ENTRY: T1212 CLINICIAN MUST DICTATE: NO

CAPTION: URGENCY ITEM NAME: STAT OR ROUTINE FIELD NUMBER: .09 EXAMPLE ENTRY: ROUTINE CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: NO

14

Discharge Summary additional facts If the dictated by and attending physician are

the same their name has to be entered in the header in both fields

Note that Discharge Summary caption field settings are done at the title level not class. The reason is that only one record is allowed per

admission

15

Consults field setting done atthe Document Class level CAPTION: TITLE ITEM NAME: TITLE

FIELD NUMBER: .01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE EXAMPLE ENTRY: SURGERY CONSULT CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

CAPTION: VISIT DATE ITEM NAME: VISIT DATE FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUVDT EXAMPLE ENTRY: 04/15/05@1300 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

CAPTION: DICTATED BY ITEM NAME: DICTATED BY FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT EXAMPLE ENTRY: 04/28/05 CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: YES

CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER FIELD NUMBER: 1208 EXAMPLE ENTRY: DOOGIE HOWSER CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

16

Consult fields cont…

CAPTION: CONSULT NUMBER ITEM NAME: CONSULT NUMBER FIELD NUMBER: 1405 LOOKUP LOCAL VARIABLE NAME: TIUCNNBR EXAMPLE ENTRY: 1234 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X="C."_X

CAPTION: HRCN FIELD NUMBER: .02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-")

CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC EXAMPLE ENTRY: 23 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

17

Example of a Progress Note Upload Document$HDR: PROGRESS NOTESHRCN: 3475DICTATION DATE: 04/20/05DICTATED BY: MICHAEL BORROMEOEXPECTED COSIGNER: VISIT DATE: 04/20/05TITLE: LETTERCLINIC CODE: 06TRANSCRIPTIONIST: SECURE, MX$TXTProgress Note dictation is typed here.$END

18

Example of a Discharge Summary upload document$HDR: DISCHARGE SUMMARYHRCN: 2101DATE OF ADMISSION: 04/15/05DICTATED BY: MICHAEL BORROMEODICTATION DATE: 4/18/05ATTENDING PHYSICIAN: MICHAEL BORROMEOTRANSCRIPTIONIST: SECURE,MXURGENCY: ROUTINE$TXTDischarge Summary dictation is done here$END

19

Example of a Consults upload document$HDR: CONSULTSTITLE: SURGERY CONSULTVISIT DATE: 04/15/05@1300DICTATED BY: MARCUS WELBYDICTATION DATE: 04/28/05EXPECTED COSIGNER: DOOGIE HOWSERCONSULT NUMBER: 12HRCN: 123456CLINIC CODE: 23TRANSCRIPTIONIST: SECURE,MX$TXT CONSULTS Text$END

•The consult number prints out on the consult request.•It also may be viewed on the Consults tab of the EHR

20

TIU Upload Menu Option

UPL1 Upload Documents This option enables the user to upload transcribed ASCII

documents in batch mode, either from remote microcomputers, using ASCII or KERMIT protocol upload, or from Host Files (i.e., DOS or VMS ASCII files) on the host system.

This is the manual option to upload documents if you are not using the IHS Parameters

UPL2 Help for Upload Utility Displays information on the formats of headers for dictated

documents that are transcribed off-line and uploaded into DHCP. Displays "blank“ character, major delimiter and end of message

signal as defined by your site.

UPL3 Display Upload Status UPL4 Reset Upload to Restart

21

UPL3 Display Upload Status

Displays last file uploaded and last attempt to find file for uploading. Can also show if upload stopped for a known reason.

Example:

**STATUS OF TIU UPLOAD**

LAST FILE UPLOADED INTO RPMS: NO FILES UPLOADED

**STATUS OF TIU UPLOAD**

LAST FILE UPLOADED INTO RPMS: Monday May 09, 2005@22:15:06

LAST SCAN FOR NEW TIU FILE: Tuesday May 10, 2005@09:15:02

22

UPL4 Reset Upload to Restart

Used if "Upload Running?" field still has date AND problem has been solved.

If the Status option displays similar to this and you are sure an upload is not currently happening then you should use the Reset option:

**STATUS OF TIU UPLOAD** LAST FILE UPLOADED INTO RPMS:   NO FILES UPLOADED LAST SCAN FOR NEW TIU FILE:     Thursday Sep 09, 2004@14:52 UPLOAD STILL RUNNING; CHECK END OF FILE MARKERSUPLOAD STARTED ON SEP 09, 2004@14:52

23

Blank Character String

This string of characters is used by the transcriptionist to represent a "blank" when a word or phrase in the dictation cannot be understood for inclusion in the transcription.

Clinicians will not be able to sign their note if the blank character string exist in the note. They must edit all blank character strings with the appropriate text before they can sign the note.

Option to define the Blank Character string: Select TIU Parameters Menu Option: Basic TIU Parameters

Field to set: BLANK CHARACTER STRING: @@@

IHS is recommending using three @@@

24

Now what?

Once you have all of your fields defined for uploading using the option: TPM2 Modify Upload Parameters

You are now ready to do an upload Are all uploads successful?

No – That is why you have defined Medical Records staff to do the Missing field and Filing error alerts

25

Error Alerts…now what?

Your Medical Records staff that are defined in the field: Select ALERT RECIPIENT

Will get alerts when a record could not file Missing Field alerts

Field marked required was missing in the header Filing Error alert

Example: The Health Record number was wrong and it did not match any patient record on your system

Example: Visit Date could not be identified due patient not having an appointment for that date with the defined clinic code in the headers.

26

Handling of these alerts need to be done in RPMS When you sign on to RPMS it will show the following:

You have 2 PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select IHS Core Option: "VA

1 FILING ERROR: HRCN: 5391 GENERAL Record could not be found or created

2. FILING ERROR: HRCN: Letter Record could not be found or created.Select from 1 to 2

or enter ?, A, F, S, P, M, R, or ^ to exit:

At this point you can either select a number or choose A for All.

27

Handling of alerts by Medical Records After choosing the VA alert

You will be asked if you wish to inquire into the patient record If you say No

This will result into taking you into the actual upload document and allows you to modify the actual upload header. When you exit it will then ask you if you want to upload the file and you can say Yes.

Make sure that you are using Screen Editor as your preferred editor Line Editor will cause problems You change this by going to TBOX User’s Toolbox

Choose Edit User Characteristics PREFERRED EDITOR: SCREEN EDITOR - VA FILEMAN

If you say Yes to inquire into the patient record It will ask you the missing items for the patient field by field.

Saying No initially may be better as you can verify the actual information and see all of the upload file.

28

Alerts additional facts…

It is not unusual should you say No initially and then after saying Yes to re-upload the document that you get a second filing or missing field alert.

Suggest that the second time you say Yes to inquire into the patient record and complete the needed field

29

Dictation guide for clinicians

Specify at the beginning of dictation the header: Progress Notes Discharge Summary Consults

30

Progress Notes fields to be dictated at the beginning of the dictation Health Record Number Dictated By Expected Cosigner (optional) Visit Date and Time Title Clinic Code

31

Discharge Summary fields to be dictated at the beginning of the dictation Health Record Number Dictated By Attending Physician (your name or a different

name) Date of Admission Urgency

Priority or Routine

32

Consults fields to be dictated at the beginning of the dictation Health Record Number Dictated By Expected Cosigner (optional) Visit Date and Time Title Clinic Code Consult Number

33

How to setup the auto printing of notes rather than using the batch print optionSelect TIU Parameters Menu Option: tpm3  Document Parameter Edit                First edit Institution-wide parameters:                                                                                                                         Select DOCUMENT DEFINITION: PROGRESS NOTES       CLASS     CLASS                         ...OK? Yes//   (Yes)                                                                                                                                   DOCUMENT DEFINITION: PROGRESS NOTES//                                           REQUIRE RELEASE: NO//                                                           REQUIRE MAS VERIFICATION: NO//                                                  REQUIRE AUTHOR TO SIGN: YES//                                                   ROUTINE PRINT EVENT(S):                                                         STAT PRINT EVENT(S):                                                            MANUAL PRINT AFTER ENTRY: NO//                                                 ALLOW CHART PRINT OUTSIDE MAS: YES//                                            ALLOW >1 RECORDS PER VISIT: YES//                                               ENABLE IRT INTERFACE:                                                           SUPPRESS DX/CPT ON ENTRY:                                                       FORCE RESPONSE TO EXPOSURES:                                                    ASK DX/CPT ON ALL OPT VISITS:                                                   SEND ALERTS ON ADDENDA: YES//                                                   ORDER ID ENTRIES BY TITLE: NO//                                                 SEND ALERTS ON NEW ID ENTRY: NO//                                               SEND COSIGNATURE ALERT: After Author has SIGNED//                               EDITOR SET-UP CODE:               If document is to be uploaded, specify Filing Alert Recipients:                                                                                                 Select FILING ERROR ALERT RECIPIENTS:                                                                                                                           Now enter the USER CLASSES for which cosignature will be required:                                                                                              Select USERS REQUIRING COSIGNATURE: STUDENT//                                                                                                                   Now enter the DIVISIONAL parameters:                                                                                                                            Select DIVISION: RED LAKE HOSPITAL//                                              CHART COPY PRINTER: MEDICAL RECORDS//                                           STAT CHART COPY PRINTER: MEDICAL RECORDS//                                    Select DIVISION:                                                               

Setup your division with your printer defined for these two

fields.You may setup the PN Class such

as this or individual titles if you want to use a different printer.

Make sure manual print is set to NO otherwise they will not autoprint.

34

QUESTIONS??