system review core concepts ilham hobba december 15, 2012 king saud university hospitals

System ReviewCORE ConceptsIlham Hobba

December 15, 2012

King Saud University Hospitals

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 2

What is Core?

The common processes or tasks that are shared multiple times across clinical domains, technical activities, or project tasks. It is those things that are required in order to get a Cerner Millennium™ application or applications installed.


What is Core?

OrganizationsSecurityLocationsAlias PoolsCode SetsEvent Codes/Event Sets

Organizations

Core Services


Organizations in Millennium

Organization: Any business entity that is affiliated with the health system.

Organization Types• Organizations are classified into different Organization Types• Each type drives functionality within the Solutions

• Examples of Organization Types:• Client Facility• Employer Insurance Company• Hospital Physician Offices

Multiple Organization Types can be used to define an organization. • Example: Cerner Hospital can be a Facility, Client, Hospital, and Employer


Organizations

Facility

Organizations

ClientIns.

Company

EmployerHospital


Organization Types

Possible “Employment/Billing” Organizations:• Employers• Insurance companies• Clients (e.g. Industrial accounts)

Employer: An organization that may be given as a place of work or health plan sponsor

Insurance Company: An organization with one or many health plans associated underneath it.


Organization Types

Client: An organization that is used to represent a specific patient population for patient numbering, billing or report distribution.

Organization is a Client if : • Charging processes occur (designation needed in

order to show is Charge Services tools)• The organization is used for client/industrial billing• Destination for Clinical Reporting


What are Core Organizations?

Possible “Patient Care” Organizations:• Hospital• Physician Office/Clinic• Home Health• Hospice• Facility

Physician Office/Clinic: Areas where health care services are given to patients who do not need to stay overnight. May include services usually provided in a Physician Office or Clinic.


Core Organization Types

Facility • An organization at which patient care activity takes place.

Organization is a facility if:• Patient care takes place• Patient registration occurs• Identifiable patient population (Charting, Security)• ProFit billing entity (one tax id)

Facilities can contain:• One Pharmacy formulary• One Order Catalog• One Charge Description Master (CDM)

Security

Core Services


Security Design

Security Risks in Healthcare• Unauthorized disclosure of patient information• Unauthorized disclosure of sensitive information

• Substance abuse treatment, abortion, mental health, HIV/AIDS, genetics

• Unauthorized disclosure of intellectual property

Security is not…• An add-on to your solutions• Built after workflow is designed• Software that protects the configuration• Recommended to be set up at an user-level


SECURITY

Vital for Access Control in MillenniumWhat Solutions Can You Access?What Tasks Can You Perform?What Data Can You View?What Organizations Do You Have Access To?


Positions Defined

Role based access to Cerner Applications

Should be based on the role the user has within scope of Cerner Solutions • Not based on job title

Position determines authorization within Cerner

NOT the same as a job class or employee title


Position Collection

Positions will be collected on Core Systems Positions DCW• Start positions are outlined on the deliverable

This deliverable is assigned to the Core team to complete two weeks prior to Design Review• Solution teams will be required to assist the client in designing their

positions based on Start content• This is to be completed on weekly calls between System Review

and Design Review• Address position integration points between solutions as they arise

The completion of this deliverable will ensure the successful design of position based security at Design Review


Encounter/Organization Security

• Broad Level of Security• Limits what Patient visits (encounters) each User can

view, based on what organization the visit occurs at.• Users are “tied” to Organizations

• Users may view information from Patient visit, if the visit occurs at an Organization they are associated with

• Users can be associated to one or many Organizations• Will specific patient populations, such as behavioral

health, need to be secured?• If yes, each applicable location will be built as a

separate facility and therefore require its own organization.


Encounter Organization Security

Information Available across all encounters/visits:Allergies Problems PowerNote Clincal NotesProceduresForm Browser (results) Histories (past medical, family, social) Immunizations Medication List (prescriptions and administrations)

Encounter/visit-specific information:PowerOrders Diagnoses Provider Relationships


Confidentiality Code Security

User associated to Facility

ANDUser assigned a Confid. Level

Patient encounter occurs at Facility

ANDEncounter assigned a Confid. Level

User has access to view patient encounter

User’s Confid. LevelMeets or exceeds

Encounter Confid. Level

If And

Then

And2 1

2 1>


Cerner Clinic Cerner Hospital C.H. Psych Unit

Encounter 1 Encounter 2 Encounter 3

Encounter/Organization Security

Dr. A Dr. CDr. B


Confidentiality Levels

Prerequisite - Encounter Organization Security

Compare user and patient encounter codes to determine access

Levels are client defined


Examples of Levels:

EncounterPsych 7

Security 5

Sensitive 3

Routine Clinical 1

7 Psych users

5 Partial Restricted/Regular Users

3 Clinical Staff

1 PMLocator Users(patient directory)User with a Confid. Level of 5 can view

any Encounters with a level 5, 3, or 1

Maximum of 4 levels recommended due to maintenance considerations

Users


Within ERM:


Without Cerner ERM

Confidentiality Codes can be sent from ADT (Registration System)

Sent in HL7 Message- PV2:22


After Encounter Org/Confid Level:


Positions Defined

Role based access to Cerner Applications

Should be based on the role the user has within scope of Cerner Solutions

Not based on job title

Position determines authorization within Cerner

NOT the same as a job class or employee title

Locations

Core Services


Locations

Generic term used to denote physical place in health care organization.

Area where Patient Care takes place.

Locations exist in the Location Hierarchy.

Any Organization that is a Facility can have locations tied to it.


Location Hierarchy

Facility (type of organization)

Room

Buildings

Nurse Unit

Bed

Cerner Hospital

West Pavilion

2 South

202

A


Buildings

Buildings Defined• A physical structure on

hospital property• “Houses” registration

locations • Drives no product

functionality (security, billing, etc.)


Room

Buildings

Nurse Unit

Bed


Nurse/Ambulatory Unit, Rooms, and Beds

Core Units Defined• Nursing Unit • Ambulatory Unit


Room

Buildings

Nurse Unit

Bed

• Rooms and Beds• Represents physical

Rooms and Beds• Hierarchy format

allows for multiple Rooms and Beds with the same name


Facility

LOCATION HIERARCHY INPATIENT

BuildingNurse Unit

Room and Beds


Facility

LOCATION HIEARCHY DAY REHAB & OUTPATIENT

Building

Ambulatory Loc


Two Sides

Core Locations

FacilitiesBuildingsNurse unitsRoomsBeds

Service Resources

InstitutionsDepartmentsSectionsSubsectionsExam Rooms


What solutions use Core Locations?Registration

Scheduling

PowerChart

CareNet

INet

Charge Services

PharmNet

ProFile

ProFit

FirstNet

Clinical Reporting

PathNet AP


Encounter/Organization SecurityControls access to patient information by organization.

Confidentiality Level SecurityAdditional function available with Encounter Org Security that can be set per facility

What solutions use Core Locations?


Registration• Patients registered to Facilities• If an inter-facility transfer needs to occur, the alias pools for those two orgs must

be set up exactly the same• Registration can filter out patients by facility

• PMLocator (Cerner’s patient directory)• Auto-discharge can be set up differently per facility (and by patient type) - but not

per building, nurse unit, room, or bed• Certain code sets can be filtered by facility

• Patient Type• Medical Service• Accommodation Code• Discharge Disposition• Discharge Location




Registration


Person Search Window

Search by location or facility

Customize encounter results window with location hierarchy fields.




Scheduling• Patients will get scheduled to a “location”, this is typically an ambulatory location. • The location and the facility can be passed into registration if the conversation is

launched from the appointment.• Relevant to outpatient process only



PowerChart • Encounter Organization level security.

• An encounter that is hidden by the use of this type of security will not be accessible on the PowerChart Visit List tab or anywhere else in PowerChart/PowerChart Office.

• Encounters will also be hidden in the Patient Search for that organization

• Locations (nurse units/ambulatory) can be used to specifically lock down patient lists on individual computers

• Set up with a default location list• Location patient lists can also be used to help organize work


Organize Patients by Location


PowerChart



CareNet Orders• Locations used for routing and printing

• Orders requisitions• Consent forms• Reports• Printed charts

• Patient location and ordering location can be used to flex order entry formats.

• Orderables can be virtualized to specific facilities• Ordering is then controlled depending on whether patient is

registered at that facility.


What solutions use Core Locations?Inet can flex views based on the patient’s location

• Patient on the left is located in the adult ICU• Patient on the right is located in the NICU



Charge Services• Any organization that will be used for charge purposes will need to be built

as an organization type of “Client”• Charges can be flexed based on a multitude of fields

• Patient location• Performing location• Facility



PharmNet• Formulary products can be flexed based on availability of products per

each facility.• If a formulary product is stocked on a floor and available via

Omnicell/Pyxis, the product can also be associated with a nurse unit/ambulatory location to indicate this.



ProFile• HIM Chart Tracking has the ability to track a paper chart based on both

user-defined locations and locations defined in the hierarchy.



ProFit• Revenue can be reported by:

• Patient location • Performing location



FirstNet• Any area where an emergency patient needs to be tracked (beds,

hallways, waiting room, etc) will need to built as a location within the emergency department

• Lab label printing can be routed to different printers in the ED based on location, if necessary

• Tracking List tabs can be organized based on location

Only displaying patients in Fast Track area



Clinical Reporting• Chart distributions and expedites can be routed by patient location, which

includes routing by facility, nurse unit, ambulatory location, or outpatient location.

• Keep in mind that if you are routing a distribution or expedite by patient location and you would like the ability to print charts to 2 locations within the ED, for instance, you would need to create 2 patient locations for the ED so that the chart can be printed to the respective device in that location.

• The location where the patient is registered to can also be printed in the chart header/footer. Again, this includes the facility, nurse unit, ambulatory location, and/or outpatient location.



Anatomic Pathology (AP)• Uses the functions of Orders for all orders placed outside the pathology lab• AP uses the functions of Charge Services and Profit to charge based on

patient location• AP uses Registration and Patient search functions• Service resources are used to route internal orders to work lists and work

queues• Processing orders are added to work queues based upon routing• Worklists and Labels are printed based on routing• Reports are sent to review queues based on routing

• Calendars and Service Areas added to benches allow internal AP orders to be sent to the proper lab if there are multiple pathology labs working from the same database.


What solutions use Core Locations?Registration

Scheduling

PowerChart

CareNet

INet

Charge Services

PharmNet

ProFile

ProFit

FirstNet

Clinical Reporting

PathNet AP

Alias Pools

Core Services


Alias Pools?

Sets of alphanumeric identifiersThese numbers are used as boundaries for checking for duplicate persons, encounters, orders, personnel, and organizations.

How are alias pools related to organizations?

Assigned at organization level


Alias Pools

Cerner HospitalCH MRN: 434-328

Cerner Clinic CC MRN: 223

PatientPete Smith

Pete checks into Cerner Hospital.

Hospital assigns Pete a MRN and a FIN

Hospital adds his SSN and

CMRN

CH MRN Pool

CH FIN Pool

SSN Pool

CMRN Pool

CC MRN Pool

CC FIN Pool

Pete visits Cerner Clinic.

Clinic assigns Pete a MRN and a FIN

Matches SSN and CMRN

Pete visits Cerner Clinic for a second

time.

Matches MRN

Adds FIN

434-328

CH3334

223

B890B2343

444-99-4421

34543CM

CH FIN: CH3334SSN: 444-99-4421CMRN: 34543CM

CC FIN: B890 CC FIN: B2343

SSN: 444-99-4421 CMRN: 34543CM


Types of Alias Pools

Person• SSN• MRN

Organization• Insurance company• Employer

Personnel• Organization Dr. #• UPIN• Provider Numbers

Encounter• FIN number• Visit number

Order• Placer order number

“Buckets” of numbersExamples of data elements that require alias


Alias Pools Association

Think of aliases in terms of the organization types rather than at the organization level.

Does every Organization need alias pools?• No, just certain types of Organizations need pools. • Define what pools will be needed for the different types

of Organizations• Occasionally, there will be an identifier that is unique to

one organization, but not apply to all others of the same type.


Alias Pools Explained

Fin Number - If patients are being registered to the organization they will always have a FIN number pool. It will be system-assigned only if a client implements Cerner ERM. If it is system assigned you can identify a start number. The FIN number is an encounter alias.

MRN - If patients are being registered to the organization they will always have a MRN pool. This works the same way as FIN as far as the start number and system assign. MRN is a person level and an encounter level alias pool. Some applications will look to the encounter specific MRN where other situations you will want to utilize person level or all MRNs. Health Plan - This is required if importing health plans. It is associated to the facility. This pool is used to store Health Plan aliases.


Alias Pools Explained cont…

Employer Code - This does not need to be associated to each Employer because this is one of the values that we know ahead of time what will be sent. The Employer Code alias pool should be tied to the main facilities.

Encounter Organization Alias - This will need to be associated to all facilities. This is required to correctly stamp the encounter table.

Insurance Code - This is the same as the Employer code. You need to have the pool built, but only need to tie to the main facilities.

SSN - This pool will be shared by all organizations that patients are registered too. Masking is typically used so the SSN displays with the proper format.

DOCDEA, DOCUPIN, External ID, and Organization Doctor - These are all personnel aliases that need to be tied to all facilities.


Shared Alias Pools

Alias pools may be shared across organizations• Social security number• Community medical record number• Community doctor number

Code Sets including Code Values and Code Value Aliases

Core Services


Code Sets - Defined

What are code sets and what do they do?• Code Sets are groupings of like sets of reference data

• For example: Gender is a code set. Male, Female, Unknown are all possible reference data elements within the Gender code set.

• Code Sets also allow you to normalize information to be used across all solutions

• For example: By using code sets, the end user will see Female in both PowerChart and FirstNet, not Female in PowerChart and Woman in FirstNet


Code Sets

Two types of code sets• Standard

• Gender, state, marital status, Units of Measure

• Solution-specific• Laboratory Code Sets (Body Site, Organisms)


Code Sets - Interfaces

Code Sets are also used to map information via an Interface

Every data element coming into or out of Cerner from a foreign system must have an alias

Think of these standard values coming in and out as descriptors• Demographic descriptors – race, religion, gender• Order Information descriptors – collection priority, mode of

transportation, and report priority


Code Sets - Interfaces

Patient =John Smith

Gender Code SetInbound Values

Foreign ADT: “M”

Foreign ADT: “F”

Foreign Lab: “1”

Foreign Lab: “2”

M = Male1 = Male

F = Female2 = Female

gender display = Male


Benefits of Code Sets

Allow for site customization of data elements• Cerner provides Start data elements for you to use

Provide for standardization or normalization of data display across all solutions• Common display values

Event Codes and Event Sets

Core Services


What is a Flowsheet?


What is a Clinical Event?

Often called a result• Result of a question• Result of a diagnostic test• Result of an assessment• Result of a consult


What is an Event Code?

Event Code: • It is the reference data element against

which each clinical event is storedResultEvent Code

Reference Data Element

Activity Data Element


More about Event Codes

Only ONE event code should ideally exist per concept. • It is not a good idea to purposely build more

than one event code that conceptually means the same thing.

• The GOAL and RECOMMENDATION is to strive for ONE event code for each result-able concept.


Event Code Integrity

Once an event code is paired with a production result, the two must be an inseparable pair forever.

Therefore, event codes that have a result against them on production patients on the clinical event table should:• NOT be changed (meaning should not be changed)• BE viewable

ResultEvent Code

Reference Data Element

Activity Data Element


Flowsheet – Event Codes

Event Code is the placeholder for result


Viewing Event codes and results?

Event codes are how results are stored in the system.

For most solutions, however, we do NOT view event codes.

Thus, we introduce the Event Set.

Event Codes need to be paired with an Event Set for viewing.

Event CodeEvent Set


What is an Event Set?

Event Set: • Event Sets are used to group/organize event

codes for viewing and printing (clinical reporting).

• The organization of event sets is hierarchical, thus called the event set hierarchy.

• No activity data is stored against an event set.


Flowsheet – Event Sets

All rows here, BOTH dark and light blue bars, are event sets.

Event Sets are What You Can See


More about Event Sets

Event Set Hierarchy: The event sets are organized in a hierarchical structure called the event set hierarchy (ESH).

Grouper Event Sets: Like event sets are grouped together into grouper event sets.

Primitive Event Set: At the lowest level of the hierarchy, there must be a connection to an event code in order for results viewing to occur. This lowest level event set is called the primitive event set.

Therefore, an event set within the ESH can be EITHER a grouper event set OR a primitive event set. It cannot be BOTH.

ESH


Diagram of the Required Event Sets

All OCF Event Sets

All Specialty SectionsAll Result Sections

All Service Sections All Document Sections

Other Results Other Documents


ESH Structure

Event Codes

Primitive Level

Child

All Service Sections

Laboratory

UrinalysisHematology

Parent

Parent

Child

Child

Parent

Parent

Child

GrouperEvent Sets

UA DipstickCBC

BilirubinUrine Dipstick

POCWBC RBC Hgb

WBC RBC HgbBilirubinUrine Dipstick POC

BloodUrine Dipstick POC

GlucoseUrine Dipstick POC

BloodUrine Dipstick

POC

GlucoseUrine Dipstick

POC

ParentChild

Parent

ChildAll Result Sections

All OCF Events


Flowsheet – Grouper and Primitive Event SetsVital Signs would be considered a Grouper Event Set while Temperature Tympanic, Respiratory Rate etc. are Primitive Event Sets. Vital Signs is the Parent of these primitive event setsThe Event Code of Respiratory Rate is tied to the Event Set Respiratory Rate There are no Event Codes tied to Grouper Event Sets


“All Results” Organization Analogy

Grouper Event Sets = Sections & Drawers

WBC, RBC & Hgb are filed into CBC. CBC goes to “Hematology” Divider in the “Laboratory” Drawer.

Event Codes = Paper

(Results of WBC, RBC, Hgb are written on different sheets of paper)

Primitive Event Sets = Files

All WBC, RBC & Hgb papers are filed into separate WBC, RBC, & Hbg files

All papers, files, dividers, and drawers are logically organized and sequenced in appropriate SIDE of the “All Results” cabinet.


“All Results” Organization Analogy

Event Codes

Primitive Level

All Service Sections

Laboratory

UrinalysisHematology

GrouperEvent Sets

UA DipstickCBC

BilirubinUrine Dipstick

POCWBC RBC Hgb

WBC RBC HgbBilirubinUrine

Dipstick POC

BloodUrine

Dipstick POC

GlucoseUrine

Dipstick POC

BloodUrine Dipstick

POC

GlucoseUrine Dipstick

POC

All Result Sections

All OCF Events

FILES

PAPER

SECTION

SECTIONS

DRAWER

FILE Cabinet

Side of the FILE Cabinet


Questions

system review core concepts ilham hobba december 15, 2012 king saud university hospitals

Documents

cerner corporation

cerner hospital

cerner millennium application

organization types client

millennium organization

different organization

employer slide

clinical reporting slide