Message fromSenior Management

Today’s TopIntegrationChallenges

Jeff McGeathSenior Vice President

Collaboration BetweenHospitals and VendorsLeads to Success

Lima Memorial HospitalSmoothly Transitions to

MEDITECH 6.06

How to Optimize YourPrivacy Program

Message fromSenior Management

Call 978.539.0734 or emailSupport@iatric.com

Today’s Top Integration ChallengesJeff McGeath, Senior Vice President

I was recently asked what the top challenges are for today’s integration projectsin healthcare. It’s tough to put your finger on the "top" challenges, but themore I thought about it and talked to my Iatric Systems team, the two topchallenges for today’s healthcare integration professional became apparent.

The ability to deliver interfaces that are semantically interoperable has becomemuch more complex in the last five to seven years. Therein lies the firstchallenge, and it revolves around all of the terminology mapping process thathas to take place at interface build time. You see, we can’t just build interfacetranslations and simple maps to manipulate data in an HL7 message any longer.That is not good enough. As the market matures and regulatory pressuresincrease, emerging goals and standards require hospitals to communicate dataamong EHRs and other systems in a way that is semantically interoperable. Dueto this, integration tool sets and the interface development process aretremendously more complex.

The industry’s response to semantic interoperability has been the introductionof multiple coding systems, not only at the data level, but also the identifier

24/7, 365 days ayear.

of multiple coding systems, not only at the data level, but also the identifierlevel. Experts now need to know which codes to use and even the code value ofthe coding system being used — it quickly snowballs. Further complicationsarise because many EHR systems support localized coding, meaning onehospital can refer to a procedure or item as one name and another facility canuse an entirely different name. If these organizations try to share EHR datawithin a connected community, the clashing codes would require significantresources to resolve.

Terminology isn’t comprehensively mapped within most hospitals, let aloneacross the industry, therefore integration projects continue to be overly complexwith an increasing number of moving parts. The lack of comprehensivelymapped terminology means integration experts have to formulate additionalplans, further straining project bandwidth.

Integration resource and expert pools have grown especially thin due to recenthyperactivity surrounding healthcare reform and government regulations, suchas the HITECH Act. Further, companies constantly bring new technologies to themarket, which is great, but it continues to dilute the integration skill set.

New technology creates the second challenge facing healthcare organizationsand integration projects today — a very finite set of experienced integrationtalent. Finding true integration experts has become harder, and those availableare pulled in multiple directions.

At Iatric Systems, we have the tooling and experienced staff who have deliveredmore than 20,000 interface projects to minimize the technical challenges. Ourteams have spent the time and effort to build internal knowledge bases, codingsystem libraries, and have direct lines into staff at the federal regulatory level.

We understand your need for semantically interoperable interfaces — and weunderstand the complexity, time and talent required for successfulintegration. We have identified and addressed these challenges and worked toposition ourselves in a way to be your most trusted healthcare IT integrationpartner.

Collaboration Between Hospitals and VendorsLeads to SuccessWe recently attended the CHIME 14 Fall Forum in San Antonio, Texas. TheForum presented a wonderful opportunity to listen, learn, and contribute todiscussions concerning the challenges facing CIOs in today’s healthcare ITenvironment. Additionally, while at the Forum we were honored to accept, alongwith Memorial Healthcare of Owosso, Michigan, the 2014 CHIME CollaborationAward.

The CHIME Collaboration Award is given to the hospital and vendor who jointlycollaborate on a technology or work together to solve a problem. Read moredetails here.

Memorial Healthcare and Iatric Systems began collaboration in 2010, whenMeaningful Use was in infancy, and everyone was looking to make sense of it.The Meaningful Use Manager™ solution accelerated and greatly simplifiedMeaningful Use compliance, allowing Memorial Healthcare to qualify forMeaningful Use incentive payments — as well as facilitating improvements incare that compliance represents.

This same solution also enabled the hospital to withstand the rigors of a CMSaudit. Since 2010, this new model for tracking compliance has helped hundredsof other hospitals effectively measure, report, and defend their Meaningful Useresults.

Although hospitals and their CIOs have had several years to adjust to

Although hospitals and their CIOs have had several years to adjust toMeaningful Use, questions remain around how to interpret the rules, andunderstanding what is needed to qualify for incentive payments. Meeting thevarious Core and Menu Set objectives is still a complex process, even thoughthe requirements are more clearly understood, and sophisticated technology isnow available to help.

We develop solutions like this to help hospitals and providers solve theirhealthcare challenges for the betterment of their patients. It is especiallygratifying and effective when we can work directly with healthcare providers inthe process to make sure we are meeting their needs.

Whether you have already attested for Stage 2, or are preparing to do so in thenext few weeks, we wish you luck and want you to know that we are here tohelp.

Happy Attesting!

Lima Memorial Hospital Smoothly Transitions toMEDITECH 6.06Lima Memorial Hospital is a 329-bed medical and surgical hospital in northwestOhio and recently upgraded successfully to MEDITECH’s 6.0 platform with helpfrom Iatric Systems.

Read Lima Memorial Hospital’s story now.

"We had more than 80 interfaces to recreate, 200+ reports to rewrite, andmore than 50 physician offices to connect to our 6.06 system," explains AnnKleman, Applications Manager at Lima Memorial. "We couldn’t have done itwithout the support and knowledge of Iatric Systems."

Interfaces are running seamlessly, and their MEDITECH 6.06 system is nowconnected to numerous information systems — including CliniSync, Ohio’sHealth Information Exchange (HIE), as well as EMR systems at more than 50physician offices.

Iatric Systems Report Writing Services team recreated NPR reports andwrote new Data Repository and Report Designer reports in 6.06. "Without IatricSystems help we would not have been able to get all of our reports written inthe new M-AT language in time to go live," says Nancy Carman, SystemsIntegration Analyst.

Iatric Systems also helped Lima Memorial improve patient care and is savingthe hospital an estimated FTE by using Security Audit Manager™ to automateaudits of Protected Health Information (PHI). Read the full story to find out howLima Memorial made the smooth transition to MEDITECH 6.06 with help fromIatric Systems. Download it here.

How to Optimize Your Privacy ProgramHaving an effective privacy monitoring plan is necessary to demonstratecompliance and to protect sensitive PHI. Unfortunately, many organizationsfailed to achieve compliance during an OCR random audit because theystruggled to provide necessary documentation, had inadequate policies andprocedures in place, and were reactive in their overall program.

We invite you to attend this webinar co-hosted with our business partner,CynergisTek, "How to Optimize Your Privacy Program" on December 10th at 1pm ET. Patient privacy expert Mac McMillan will be sharing ways you canalleviate some of the technical and administrative burdens that many providersface.

Session Objectives:

OCR's findings during the random audits in regards to the HIPAAprivacy ruleThe importance of having an effective privacy programTop best practices to protect patient privacyHow to optimize your privacy program through Iatric SystemsSecurity Audit Manager and CynergisTek's Managed PrivacyMonitoring Service

Compliance CornerKay Jackson, Manager, Software Certification, and Compliance

Stage 2 Core 12 — What’s UP with that Measure?

I have been a student of Core 12 for the last two years, and I have learned thatthis measure was neither well planned by CMS, nor easy to execute for manyhospitals. CMS has issued several FAQs about this measure, and I havereferenced them at the end of this article. Let’s dissect this measure.

Point Number One: CMS did not define a timeframe of when the Transition of Care (TOC) should besent. Unlike the portal, where the medical information must be sent to theportal within 36 hours of discharge, the timeframe on this measure is silent. Myrecommendation is to send the CCD the same day that the patient leaves yourhospital. Many hospitals tell me that their discharge team does not want tostand by a printer while the CCD prints to give to the patients so they can countit for Core 12.1, and I can understand that.

Point Number Two:Depending on your patient population, your discharges may be to rehabhospitals, nursing homes, hospice, or home health. What do all of theseproviders have in common? They are not under the Meaningful Use rule, so as Isay, these providers have no incentive to secure a Direct Mailbox. When I havedebated this issue with friends at CMS, they say that is the reason they placedonly greater than 10% on Core 12 Measure 2, to allow for those types of issues.I have one hospital that made the decision to purchase the Direct Mailboxes forsome of those organizations that were not under the Meaningful Use rule, inorder to help them in meeting this measure. If you would like to do this, besure to check the Stark Amendment to verify you are within the defined rules.

Point Number Three:Third, and the most complex for me, is the fact that CMS wants hospitals totrack that the TOC/CCDA/CCD was "received" by the transferring provider. When I first started studying this measure, I thought that it was a piece ofcake, just counting a numerator. The denominator is based upon the Method*

and on discharge date, which is easy to count (*All Ed vs.OBS per CMS, eventhough it is not on the specification sheet).

So, our team started investigating where the record of the CCD being sent fromthe Core HIS System was recorded. We then realized that the "sent" CCD is notwhat CMS really wants tracked. They want to track that the CCD was"received." Ok, again, sounds easy enough, but here is where the CCD trackingturns ugly. Most HIS systems we have worked with are not tracking the "sent"in their patient audit logs, or in some cases anywhere in their HealthInformation System. Even if the "sent" action was contained in the HIS CoreSystem, CMS wants you to track that the CCD was "received," which is what thereport from the HITSP provides.

So then we started looking at how can you count what is "received," and this iswhere I just started shaking my head. The only way to track what is "received"is from the HITSP report-check. The HITSP report does not contain the patientaccount number or date of service of the received CCD to tie it back to thepatient record — no check. The Core System cannot consume the HITSP reportto provide the needed action to track for this measure, so what do we do?

My question to CMS was, how in the world can you count the "received" CCDsto report correctly for attestation? Their response was to retain the report orMessage Delivery Notification (MDN) in your records and manually count thenumerator. Wait, I thought the whole purpose of Meaning Use was usingelectronic records?

Don’t blame your Core HIS System for this mess. Many are working with HITSP vendors for a way to consume the report backinto the Core System to, as I say, close the circle for this measure. One of ourMeaningful Use customers has created a query that when they receive thenotice back from their HITSP, they place a "Y" in the field. The query says "CCDsent and MDM received" and the "Y" indicates that it was received by the HITSP,but wow lots of manual work (there is that M word again!). But, that is oneway of tracking that measure correctly because the circle of CCD is closed. Ifyou want more details on this one idea, please email me.

The last thing vendors want to say to hospitals is that you have to manuallycount this measure. Until the day that the CCD fact of receipt by the HITSP isconfirmed in the Core System, and the count can be automated, what can wedo? When that does happen is the day we can all take Core 12 off of our leastfavorite Stage 2 measure list. We are currently exploring ways to track theTrans External ID number going with the CCD to the HITSP and returned on theHITSP report and adding it to the detailed report we provide to our dashboardcustomers. My New Year's wish, besides wanting the Flexibility in Health ITReporting (Flex-IT) Act of 2014 to pass, is for the Core 12 M word to go away.

Do you know what a CCD Selfie is?

Core 12 FAQs:CMS FAQ 10660 EHR Incentive Programs: Summary of Care Meaningful UseRequirements in Stage 2

Hot off the CMS press:November 18th CMS released yet again more updates on how to handle Stage 2Core 12-yes 14 months into the Stage 2 period. The new FAQ 10660 is locatedat: https://questions.cms.gov/faq.php?faqId=10660

Report Writing TipsJoe Cocuzzo, Senior Vice President – Report Writing Services

Stop at Query if Patient is "on Coumadin" (MAGICOnly)Someone from Mid Columbia Medical Center in Oregon asked for a way to stopat a query only if a patient was "on coumadin." I am going to interpret that tomean any active PHA order for Warfarin (administration of the drug notchecked, although you could add this if needed).

Since it is tip time, I thought I would show how you can write a generic macrothat will go from any application to Pharmacy and check for an active order fora particular medication and return a flag if such an order is found. We will usethe MEDITECH MAGIC "Z.link" utility to "open" PHA.

First we need to write a fake "holder" report in "Z" or "MIS" so ourprogramming can be available from any segment. If we wrote our report inNUR, we would only be safe using the utility from NUR CDSs.

If you have ever noticed the "copying files to:" message you get when you fileand translate a report in MIS or Z, that is an indication that the translator ismaking the object code available on every segment and therefore from everyapplication.

Next we write a macro called "check"

We can make our code modular by breaking the macro into "submacros." Byending the code with a semi colon, we make it a program. When you call aprogram, you use %, then the name of the program, then one or morearguments in parenthesis, for example:

%Z.name.inversion("SMITH,JOE")

In our example, the program is %Z.zcus.is.warfarin.M.check and we are passingin the patient’s admission urn.

The program then returns a value from the last expression in the code, which inour example is the value of the variable OK. We put a 1 into OK if we find anACTIVE (status = AC) order for Warfarin for the patient we are checking.

Inside the program the first argument (in this example it is the only argument)becomes the variable A.

We test for A before having the program do anything. Since the CDS filer willcheck the code by running it with no A argument, we can avoid bogus CDS"syntax error – file as draft" issues by testing for A and skipping all the code inthe program when A is nil.

MEDITECH MAGIC has a utility program called %Z.link that will open any prefixto any data or dictionary file.

The general way you use the program is:

Save the prefixes you plan to useCall the Z.link program to open the prefix or prefixes to the data ordictionary file of the other application database. Our example calls itonce to open PHA data, then again to open PHA dictionaries.Get the data you need – typically by looping on some index and thenchecking or getting some data.Restore the prefixes the way you started.

When your are working with prefixes "yourself," it is a very good ideato test your code in the TEST system first, before using it in the LIVEdirectory. Bad programming can crash and leave records locked whenyour macro runs from a CDS.

STEP ONE – "OPEN PHA"

First we need to "open PHA." When we are in Nursing, prefixes are "open to"NUR, ADM, and MIS, but not PHA.

Z.link goes over to the PHA segment and directory and opens the prefixes andthen comes back to the segment it started from. This means that you can thenget to PHA fields and dictionaries, but you need to be careful not to try to useany PHA fields that call PHA programs or you will likely crash. This is becausethe PHA programs are only available in the PHA segment and directory (and theNPR master segment) and you might call the Z program from some othersegment.

PHA.combo.dose.and.unit is an example of a field that calls some PHA program,see the %PHA.RX program call in the VAL column that is your tip off:

STEP TWO "CHECK ORDERS"

To check orders, we need to make sure that all the PHA fields we use translateusing the one prefix (:) that we opened to the PHA data file with the Z.linkprogram. Looking at the date definition we can see that indexes translate with:, which is fine, but data fields use ? which won’t work. The @Chg.prefixtranslator macro will fix this.

This code uses an index by patient ADM urn, status, and order type, so we canput the patient’s admission urn into PHA.RX.patient, and "AC" (that is the statusof PHA active orders) into PHA.RX.status and then loop through just the activeorders for just the one patient and then check the generic of each @med to seeif we have any active orders with Warfarin. Just change the generic mnemonicto the value used at your hospital.

I try very hard to avoid writing any reports in PHA with hardcoded drugmnemonics, as these change quite often and your report will "break" becauseyou won’t add new ones. This is why I opened the PHA dictionary file as well, soI could go from the @med field on each order over to the generic to selectbased on a value which changes far less often. There is usually just one value,although nothing prevents a site from creating multiple different genericmnemonics for what is actually the same medication.

If the medication you are looking for might be a compound, split, or IV withadditives, the @med field based selection would fail. Since Warfarin is not thatkind of medication, we can just check @med’s.generic and be fine.

STEP THREE "CLOSE PHA" (put everything back or else!)

After we check PHA, we need to be very careful to restore : and &, otherwisewe will likely crash back in NUR. The "CLOSE.PHA" macro does this as follows:

We used the C(:S) "close and stack" syntax to save the value of our prefixes to"the stack".If we use C(:U) we restore the prefixes to their previous state (typically open tothe previous file).It may seem funny to use a "Close" command and have a prefix be Open, butthese two comands do just the same thing C(:U) O(:U). The advantage of usingC is that the syntax checker does not complain.

To use our utility macro from an IFE, we attach it like this:

If we select a patient with an Active PHA order for Warfarin, the cursor will stop

at the "IAT.WARED" field, because our utility program returns a value if such anorder is found.

A copy of the Z report has been added to our MAGIC report library.Z.zcus.is.warfarinhttp://www.iatric.com/Information/NPRReportLibrarySearch.aspx

Make sure you change the PHA database in the "check" macro to match YOURHOSPITAL, and the generic mnemonic to match what you use. Otherwise theutility is generic and will work at any MAGIC site.

SQL Tip — Facility Prompt by User Access

Thomas Harlan, Technical Team Lead – Data Repository at IatricSystems

One of the challenges of moving from inside MEDITECH-integrated reporting(NPR or RD) outside into the realm of DR (SQL + SQL Server Reporting Servicesor Crystal Reports)- based reporting is that you lose the benefits of beingintegrated.

A key capability lost is the ability to restrict a user to a specific facility's set ofdata when reporting. Whereas in NPR you might be prompted, for example, topick a BAR or AD database, which was facility-specific, in the world of the DRyou need to be mindful of multiple facilities and filter accordingly.

Which brings us to the question: which facility (or facilities) does the userrunning this SSRS report have access to? And then – how do we get the reportto know which facility to look at? And how does the report know who we are?

Let’s start with which user is running the report first. Inside SSRS, you candeclare a parameter (cUserID) and set that parameter to an expression

(calculated value):

=User!UserID

Which gets us the currently logged-in Active Directory user on the workstation:

IATRIC\thomas.harlan

When you are setting up this SSRS parameter, you want to make it hidden:

And set the Available Values to code to get the current AD user. Click on each ofthe Expression buttons:

And set the code in each expression to:

=StrReverse(Left(StrReverse(User!UserID),InStr(StrReverse(User!UserID),"\")-1))

Then do the same on the Default Values screen:

We do this because the format of the AD user ID is not what is stored in

MEDITECH. The AD username returned by SSRS looks like:

IATRIC\thomas.harlan

But all we have in MEDITECH is the part after the “\” character. So theexpression code returns us everything after the “\” to the end of the string:

thomas.harlan

With that shortened value, we can now call a stored procedure from the nextreport parameter (cFacilityID) to get all of the facilities where that AD user hasaccess.

In that stored procedure, we need to look at a variety of different tables, to seeif (A) we find the ID, and (B) which facility they are attached to:

Livefdb.dbo.MisPerson_JobFacilitiesLivefdb.dbo.MisPerson_JobsLivefdb.dbo.MisPerson_ProviderFacilityMainLivendb.dbo.DMisUserAdmMriFacility

Attached to this tip is a stored procedure (IatricFacilityIDFromUserID) whichwill take that AD user ID as a parameter, then check this constellation of tablesand return the list of facility ID(s), SourceID(s) and User ID/Name (forverification purposes).

After you’ve compiled that sp in your DR, you can create a new DataSet in yourreport for this new stored procedure:

Which will have three fields (we only need two, really, but the UserNameAndIDis useful to making sure you’ve gotten it working properly):

…and feed it the cUserID value as a parameter:

Note that the Parameter Value field has the parameter name we created earlier(cUserID) wrapped in brackets with a leading @. This chains our retrievedcUserID to the stored procedure to get a list of facilities. Now we connect thatto the cFacilityID parameter:

We connect to the same stored procedure on the Default Values screen(which, if you have more than one facility assigned to you, will only use the firstone in the list):

Now we can carry on with the rest of the report…

Bonus!

Attached to this tip is a template report which implements this code. It’s anexcellent idea to start from a reusable template, so you don’t have to gothrough all of the setup for standard features over and over again…

The stored procedure to get the list of MIS Locations from the FacilityID is also attached, as it’s used in the template report.

Extra Credit

If you’re not at an MT6 site, you don’t need all of the code in the storedprocedure. Just the last section where it looks at DMisUserAdmMriFacility willget you the clinical users. The Business/Financial users you’ll need to get from

the Client/Server or MEDITECH versions of the Job Table(s).

(end)

Visit our report library athttp://www.iatric.com/Information/NPRReportLibrarySearch.aspx tolook them up.

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

Read Joe’s blog posts at MEDI-Talk.

To subscribe for email notifications for new Report Writing classes, please followthis link:http://www.iatric.com/Information/Classes.aspx.

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

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