xyz company project update

8/4/2019 XYZ Company Project Update

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XYZ CompanyProject Updates

Clinical projects, HL7 interfaces

Shane Gunn

VP of Healthcare Services

Global Data Systems, Inc

6/25/2008


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XYZ Company

ABC Company

Jun. 25

Interfaces

XYZ Information Team

What we need know.

Seacoast Pathology

Pathology Results

Done continue monitoring and training XYZ to be able to look up and resubmit messages

ScImage

Meetings to discuss DICOM to HL7 data point connections from reporting from PACS

Clinical Training from ScImage and Admin Training for GDS

Clinical Workstation rollout

DEXA scan machine rollout and interface mapping and clinical workflow

Merrimack Valley Hospital

one connectivity issue (resolved)

Reporting to define better doctors for testing

MAeCh / Wellogic / AJH

Verify all mapping for clinical review and encounter forms work flow.

Schedule release dates for provider / LOC

Medic / Antek

Move all HL7 feed into the interface engine

Orders Completion Interface workflow

This would solve currently Antek billing problem from ever happening again.

North Shore Lab (We are training them, but building both sides of the interface)

Please refer to the NSL contract

ABI

Workflow and training review

HF Holter

Forms and Training

Superuser Rollout Plan.

Notify Helpdesk (included in cost)


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XYZ Company

ABC Company

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Forms

Dexa scan

Creation

Training

ENDO

Creation

Training

Allergy

Creation

Training

CT/US

Training

Cardio

Training

Installs, Upgrades and CO-LO moves

Centricity EMR upgrade and move

Docutrak upgrade and move

Adobe Capture Upgrade

Kryptiq Secure Messaging

Kryptiq Patient Portal

Kryptiq Eprescribing

Single Sign On /integration to Intranet Mass General Doctors placement in XYZ?

Intranet and XYZONLINE public integration

DTS migration and plan to spilt LAN and WAN traffic

Iguana Migration

ScImage remote access to XYZONLINE and Intranet integration

CCC- Upgrade and migration / VRI VIA citrix


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XYZ Company

ABC Company

Jun. 25

CT Image Dump

Orders build for ORU results completion to populate ScImage modality work lists

Locations of Care / Chart and Clinical Document Separation

Ultra Sound

Created LOC Ultra Sound on the same level as ALL For:

Documents Types

Ultra Sound Techs

Document Views

Created LOC for Non XYZ Patients on the same level as ALL For:

Confidential Documents (NON XYZ PTS)

Documents Ultra Sound Techs

Document Views

Documented Privileges and Preferences for all roles

CT

Created LOC CT on the same level as ALL For:

Documents Types

CT Techs

Document Views

Created LOC for Non XYZ Patients on the same level as ALL For:

Confidential Documents (NON XYZ PTS) Documents Types

CT Techs

Document Views

Documented Privileges and Preferences for all roles

Endo

Created LOC for ENDO on the same level as ALL For:

Confidential Documents (ENDO)

Documents Types

ENDO Physicians

Document Views Documented Privileges and Preferences for all roles

Going to redo do every EMR users access to make Endo have a truly separate chart and access

from all other users in XYZ. It sounds worse that it is.


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XYZ Company

ABC Company

Jun. 25

Chart Separation Breakdown

Single chart model:

All patient encounters are stored in a single chart. Clinical list items such as problems, medications,

allergies, and directives need only be entered one time. Maintaining a single chart for each patient

may be problematic when demographic data is coming from more than one practice management

system since patient identifiers as well as demographic information may differ. On the other hand,

it is usually much easier for imported lab and radiology documents to be matched to the single

correct patient chart.

Privileges for users also authorized at the new locations of care:

If a user is authorized at other locations of care, they will have all of the same privileges (including

setup privileges) at that location that they have at their home location. If a user works at more thanone location, they will need to have one location set as their home location and be authorized at the

other location(s).

The document location of care can be used to filter the chart view. When the user views thedocuments in a patients chart, they can sort them by locat ions of care. Global or personal documentviews can be created to filter the documents in a chart by location of care.

Location of care printing defaults:

The location that will be printed as the letterhead on clinical list reports, chart documents, chart

summaries, flowsheets, and registration summaries can be set to default to either the patients

home location or the users current location.

Appointment books and appointment types for US, CT and ENDO locations of care will be built to

complete the scheduling interface from Medic.

Document types:

New document types for each location of care will be created. The abbreviation entered will appear inthe summary line for the assigned documents.

Document types are data elements in Centricity EMR to facilitate database reporting. (Alldocuments assigned a document type of lab report can be easily queried.) A document type canhave a broad definition and be attached to more than one kind of document. However, be awarethat a document type used for several kinds of documents does not facilitate optimal database

reporting.

If a Crystal Report has been built to search on document types, it may need to be modified to includeany custom document types.


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Users in the new locations of care will be given the privilege to sign only certain Document Types

pertaining to their location of care. Physicians will be given permissions to sign all new document

types.

Chart Separation Breakdown Continued

New document views may be created to help physicians filter Radiology document types, Endo

document types, etc. Preferences for all users who will use the new document views will be

modified accordingly.

New Document Templates and Encounter Types will be created for the new document types.

Workflow:

The technician will complete the test, open a new Update using one of the new Encounter Types, fill

in any necessary information in the forms provided, end the Update and route it to the physician for

interpretation and signature.

Ultra Sound Data Point Research

Abdomen

Data Point Units Options GE OBS Term

Aorta length cm RO

Aorta width cm RO

Aorta height cm RO

Inferior Vena Cava clear RO

Gallbladder clear US GALL/LIV

Gallbladder wall thickness cm RO

Common Bile Duct size cm RO

Liver

increased/decreased

echogenicity,

increased/decreased size,

difficult to visualize USLIVCOM

Spleen size RO

Pancreas within normal limits RO

Right Kidney size cm KIDNY SIZE R


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Left Kidney size cm KIDNY SIZE L

Right Kidney cyst/mass size cm RO

Left Kidney cyst/mass size cm RO

Bladder volume cc RO

Bladder volume postvoid cc RO

Prostate length cm RO

Prostate width cm RO

Prostate height cm RO

Pelvic


Last Menstrual Period LAST MP

Postmonopausal years RO

Hysterectomy Yes, No HYSTERECTOMY

Myectomy Yes, No RO

Oophorectomy Yes, No OOPHORECTOMY

Oophorectomy right Yes, No RSO HX

Oophorectomy left Yes, No LSO HX

Oophorectomy bilateral Yes, No BSO HX

Oophorectomy date OOPHOR DATE

Hormone Replacement Therapy HRT HISTORY

Hormone Replacement Therapy duration years HRT DURATION

Birth Control BRTHCNTRL

IUD Yes, No IUDCONTRACEP

Uterine ultrasound Type

Transabdominal,

Endovaginal, Both UTERINE U/S

Uterus length cm RO

Uterus width cm RO

Uterus height cm RO

Uterine Fibroid #1 length cm RO

Uterine Fibroid #1 width cm RO

Uterine Fibroid #1 height cm RO

Uterine Fibroid #1 comment

heterogeneous,

retroverted,

retroflexed


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heterogeneous,retroverted,

retroflexed





heterogeneous,

retroverted,

retroflexed

Right ovary length cm USRTOVARLT

Right ovary width cm USRTOVARWTH

Right ovary height cm USRTOVARHT

Right Ovarian Cyst #1 length cm RO

Right Ovarian Cyst #1 width cm RO

Right Ovarian Cyst #1 height cm RO


Right Ovarian Cyst #2 width cm RORight Ovarian Cyst #2 height cm RO


Right Ovarian Cyst #3 width cm RO

Right Ovarian Cyst #3 height cm RO

Left ovary length cm USLTOVARLT

Left ovary width cm USLTOVARWTH

Left ovary height cm USLTOVARHT

Left Ovarian Cyst #1 length cm RO

Left Ovarian Cyst #1 width cm RO

Left Ovarian Cyst #1 height cm ROLeft Ovarian Cyst #2 length cm RO


Left Ovarian Cyst #2 height cm RO

Left Ovarian Cyst #3 length cm RO


Left Ovarian Cyst #3 height cm RO


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Free Fluid

none, small, moderate,

severe RO

Small Parts


Thyroid Right Lobe length cm RO

Thyroid Right Lobe width cm RO

Thyroid Right Lobe height cm RO

Thyroid Isthmus length cm RO

Thyroid Isthmus width cm RO

Thyroid Isthmus height cm RO

Thyroid Left Lobe length cm RO

Thyroid Left Lobe width cm RO

Thyroid Left Lobe height cm RO

Scrotum Right Epi length cm RO

Scrotum Right Epi width cm RO

Scrotum Right Epi height cm RO

Scrotum Right Testis length cm RO

Scrotum Right Testis width cm RO

Scrotum Right Testis height cm RO

Scrotum Left Epi length cm RO

Scrotum Left Epi width cm RO

Scrotum Left Epi height cm RO

Scrotum Left Testis length cm RO

Scrotum Left Testis width cm RO

Scrotum Left Testis height cm RO

Hydrocele Yes, No RO

Hydrocele length cm RO

Hydrocele width cm RO

Hydrocele height cm RO

Varicocele Yes, No RO

Varicocele length cm RO

Varicocele width cm RO

Varicocele height cm RO


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ABC Company

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Venous Duplex


Deep Vein Thrombosis right leg Positive, Negative RO

Deep Vein Thrombosis left leg Positive, Negative RO

Baker's Cyst side Right, Left

Baker's Cyst length cm

Baker's Cyst width cm

Baker's Cyst height cm

Breast


Ultrasound of Breast Right, Left, Bilateral US BREAST

Indication for Ultrasound

Palpable Lump,

Lump found on Mammogram INDC BRST US

Location of breast lump (on clock)

12, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,

11 RO

Breast lump length cm RO

Breast lump width cm ROBreast lump height cm RO

Lump distance from nipple cm RO

Blood flow within lump Yes, No RO

Existing Ultrasound Workflow

The physician orders the ultrasound and the patient is scheduled for an appointment.

The technologist enters the patients demographic info into the Zonare application. (Name, DOB, Pt

ID# from EMR [P number from Medic], Dx if available)

The technologist preps the patient and then performs the ultrasound using the Zonare z.one

machine.

The technologist views the image(s) and completes the corresponding Tech Worksheet, noting

measurement data, within or outside normal limits, and additional comments.

The ultrasound image(s) are stored on flash cards.


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The technologist gives the Tech Worksheet and the flash card to the Radiologist, who reviews the

image(s), measurements and comments, and then dictates an interpretation report.

The Radiologists report is transcribed by a transcriptionist.

The Tech Worksheet is filed into the patients chart. (Ultrasound charts are paper charts and are

separate from the electronic medical record.)

The technologist fills out the Ultrasound Order Sheet, makes any additional notes, and submits the

sheet to the billing department along with a copy of the interpretation report.

The report is scanned and indexed into the EMR, and then routed to the requesting provider.

The provider reviews the .pdf and signs the EMR document.

If the requesting provider is a non-physician, the requesting provider routes a copy of the scanned

EMR document to the primary care physician.

If the primary care physician is not a XYZ physician, a copy of the report is faxed.

No data is stored in GE Observation terms for Ultrasounds at this time.

Existing CT Scan Workflow

The physician orders the CT scan and the patient is scheduled for an appointment.

The technologist enters the patients demographic info into the Siemens application. (Name, DOB,

Pt ID# from EMR [P number from Medic], Dx if available)

The technologist preps the patient and then performs the CT Scan using the Siemens Sensation 64

CT Scanner.

The image(s) and patient data are stored in the PACS. The radiologist views the image(s) and may make measurements on the image, which are stored in

the PACS.

The radiologist dictates an interpretation report, noting any measurements taken in the Findings

paragraph.

The Radiologists report is transcribed by a transcriptionist.

The technologist fills out the Ultrasound Order Sheet, makes any additional notes, and submits the

sheet to the billing department along with the radiologists report.

The report is scanned and indexed into the EMR, and then routed to the requesting provider.

The provider reviews the .pdf and signs the EMR document.

If the requesting provider is a non-physician, the requesting provider routes a copy of the scannedEMR document to the primary care physician.

If the primary care physician is not a XYZ physician, a copy of the report is faxed.

No data is stored in GE Observation terms for CT Scans at this time.


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XYZ Company

ABC Company

Jun. 25

NEW CT /US, Endo build, Forms, interfacing and workflow training.


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XYZ Company

ABC Company

Jun. 25

Book for CT machine 1st

floor HAV.


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XYZ Company

ABC Company

Jun. 25


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XYZ Company

ABC Company

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ABC Company

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ABC Company

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XYZ Company

ABC Company

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Role Privileges

Role: US CT Doctor

ACCESS ON DEMAND NON XYZ documents

ACCESS ON DEMAND US CT documentsADD observations

ADD to problem/medication/order custom lists

Append - SIGN

CHANGE / COMPLETE / REMOVE orders

CHANGE / DELETE observations

CHANGE charts

CLASSIFY / DECLASSIFY NON XYZ documents

CLASSIFY / DECLASSIFY US CT documents

Clinical Lists Update - SIGN

CREATE / RUN / SAVE inquiries

PRINT charts

PRINT NON XYZ documents

PRINT reports

PRINT US CT documents

RUN saved inquiries

US CT - SIGN

VIEW charts

VIEW NON XYZ documents

VIEW other users' flags

VIEW patient appointments

VIEW patient registration information

VIEW US CT documents

Role: US CT Technologist

ACCESS ON DEMAND NON XYZ documents

ACCESS ON DEMAND US CT documents

ADD observations

ADD to problem/medication/order custom lists

CHANGE / COMPLETE / REMOVE orders

CHANGE / DELETE observations

CHANGE charts

CLASSIFY / DECLASSIFY NON XYZ documentsCLASSIFY / DECLASSIFY US CT documents

Clinical Lists Update - SIGN

PRINT charts

PRINT NON XYZ documents

PRINT US CT documents

US CT - SIGN (additional signature required)

VIEW charts


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XYZ Company

ABC Company

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VIEW NON XYZ documents

VIEW other users' flags

VIEW patient appointments

VIEW patient registration information

VIEW US CT documents

Role: Physician

The PHYSICIAN role will not be authorized for NXYZ location of care.

o NXYZ patients will not appear in a Pt Search by the PHYSICIAN.

PHYSICIAN will have privileges for Access on Demand USCT documents.

PHYSICIAN will not have Access on Demand privileges for NXYZ documents

PHYSICIAN will not have privileges to Sign USCT or NXYZ documents.

MEDICH requirements:

Non-XYZ patients will be registered in the NXYZ group, which creates an EMR chart with the

home LOC of NXYZ.

Scheduling a patient on a USCT schedule in EMR changes the patients home LOC to USCT,

unless the patient is NXYZ, in which case the home LOC remains NXYZ.

o Or, USCT Tech and USCT Doctor must be authorized at all XYZ LOCs in EMR.

Scheduling an NXYZ patient on a (non-USCT) XYZ provider schedule willchange the patients

home LOC.


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XYZ Company

ABC Company

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Workflow: XYZ Patient scheduled for CT

XYZ patient is scheduled for CT appointment type on the CTHAV1 schedule.

CT Tech opens the chart from the schedule.

Tech begins a new update with the CT XYZ pt encounter type.

o Document type = US CT

o Confidentiality Type = US CT

o Document LOC = USCT


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Tech fills out Clinical Info section, clicks the Technician button to insert his name and then

clicks the appropriate CT or CTA form button to insert the appropriate interpretation report.


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If the exam is done with IV Contrast, the tech completes the Contrast section of the

Interpretation form.

The tech closes the form, Ends the Update and routes it to the Radiologist.


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XYZ Company

ABC Company

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USCT Doctor opens document when it appears on his desktop.


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ABC Company

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USCT Doctor can view prior CTs, CTAs and Ultrasounds.


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USCT Doctor completes the interpretation form.

USCT Doctor closes the form, Ends the Update and Signs the document.


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Name Don C. BassettDOB 11/25/1945P# MR-000-002Date 06/24/2008 2:50 PM

Technician: USCT, Tech

CT Scan Head

ComparisonNo significant change from normal head CT done on 5/8/08.

Clinical HistoryTech enters clinical info here. This field does not have a chart translation, but will carry to the

interpretation form, where the radiologist will edit it and it will be translated to the report.

TechniqueAxial 4.5 mm images of the brain from the skull base through the vertex following the IV administration of

contrast.

Contrast type: Ultravist 370 Amount: 60 mlContrast reaction: Nausea/vomitingReaction type: mild

FindingsThe bony calvarium is intact. The visualized paranasal sinuses are normally aerated. The ventricles are

nondilated. The gray-white differentiation appears normal. There is no midline shift. There is noevidence of any mass, infarction, or hemorrhage. Following contrast injection, no abnormal enhancement

is seen. The extraaxial spaces appear normal.

ImpressionNormal contrast enhanced head CT.

Signed by Doctor USCT on 06/24/2008 at 3:14 PM


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PHYSICIAN cannot view the document, but sees the icon for confidential documents.


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To access the document on Demand, the PHYSICIAN clicks the Options menu and selects

Confidentiality Privileges.

PHYSICIAN checks off the USCT Confidentiality Type box to access the confidential USCT

document types in this chart and clicks OK.

The PHYSICIAN enters a reason for accessing that document, which is recorded and tracked

by administration, and clicks OK.


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Now the PHYSICIAN can access the USCT document while in this patients chart. (The document

will be hidden again after the user leaves the chart.)


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Workflow: Non-XYZ Patient Scheduled for CT

Non-XYZ patient is registered in Medic in the NXYZ group.

o This creates a chart in EMR with the home Location of Care: NXYZ

The patient is scheduled for a CT appointment type on the CTHAV1 schedule.

The tech opens the patient chart from the CTHAV1 schedule.

Tech begins a new update with the CT NONXYZ pt encounter type.

o Document type = US CT

o Confidentiality Type = NON XYZ

o Document LOC = USCT


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Tech fills out Clinical Info section, clicks the Technician button to insert his name and then

clicks the appropriate CT or CTA form button to insert the appropriate interpretation report.


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If the exam is done with IV Contrast, the tech completes the Contrast section of the

Interpretation form.

The tech closes the form, Ends the Update and routes it to the Radiologist.


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ABC Company

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USCT Doctor opens document when it appears on his desktop.


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Name NXYZ TestDOB 06/25/1960Date 06/25/2008 11:15 AMTechnician: USCT, Tech

CT Scan Abdomen and Pelvis

ComparisonNone

Clinical HistoryTechnologist enters clinical info here. No chart translation. This text is edited in the interpretation form by

the radiologist and will appear in the interpretation report.

Technique

AbdomenHelical imaging of the abdomen was performed from the lung bases through the iliac crests after theintravenous injection of iodinated contrast. Positive oral contrast was given as well.

PelvisHelical imaging of the pelvis was performed from the il iac crests through the symphysis pubis after theintravenous injection of iodinated contrast. Positive oral contrast was given as well.

Contrast type: Ultravist 370 Amount: 150 mlContrast reaction: HypertensionReaction type: moderate

Findings

AbdomenThe visualized lung bases are clear. No effusions. The liver and spleen are enhance normally. No

masses are seen and the spleen is not enlarged. The adrenal glands, pancreas, gallbladder and kidneysappear normal. There is no free fluid or free air in the upper abdomen. The visualized bowel loops areunremarkable. No bony abnormality is seen.

PelvisThere is no free fluid in the pelvis. The bladder is unremarkable. The bowel loops appear normal. No

evidence of bowel obstruction or inflammatory change. There are no adnexal masses and the uterus isnormal. No retroperitoneal adenopathy. No ureteral stones are seen. No abnormal enhancement is seenfollowing contrast injection.

ImpressionNormal abdomen and pelvis CT with contrast.

Signed by Doctor USCT on 06/25/2008 at 11:19 AM

________________________________________________________________________


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PHYSICIAN will not be able to see the NXYZ patient in a patient search because he is not

authorized at the NXYZ location of care.

PHYSICIAN will not have Access on Demand to NXYZ patients charts.

If the NXYZ patient is referred to a XYZ physician after seeing the radiologist, the patient is

scheduled in Medic and the charts home LOC changes to that of the scheduled physician.

The physician can now see that patients chart, but will not be able to see the NXYZ

document, but they will be alerted to its existence by the confidentiality icon.

An administrator has the privileges to change the properties of the document, including the

Confidentiality Type, to allow the PHYSICIAN unrestricted or On Demand Access as needed.


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