Informatics Innovation via Available Resources

1. Informatics InnovationviaAvailable Resources Shawn Toy, RPh April 21, 2010

2. The fundamental economic problem • Unlimited wants with finite resources • Limited hardware availability • Limited software availability • Limited knowledge of informatics systems • Limited FTEE • Including ancillary duties of assigned FTEE • Separation of OIT and VHA • Economic pressures and solutions may be separate between the two groups

3. Living within your means • Building a revised clinical informatics system requires new, and adaptable, attitudes • Class-III cannot impede system standardization • Requests for new functionalities must be categorized, stratified and placed into their appropriate position • Immediate attention is virtually impossible because the system scope exists well beyond the local level • We need to, “make due with what we got” • Which, is actually a lot

4. So, what’s in the bag • A dynamic data analysis and reporting solution • VHA FileManager (FileMan) • Data analysis andprogramming platform • Microsoft Excel • Data warehousing and analysis solutions (Databases) • Microsoft SQL Server • Microsoft SQL Server Express • Microsoft Access • National data marts via OLAP • MDX can be used by both ProClarity and MS Excel

5. A few words about Excel and Access • Microsoft Excel • Is not a statistical program • Is not a database • Is a full-featured programming platform under the hood • User familiarity helps promote Excel based solutions • Microsoft Access • Is limited in size • JET does not directly permit procedural programming • Has myriad security issues vs. SQL server • Is also a full-featured programming platform

6. A few words about FileMan • It is not evil incarnate • Is more than a means to an end • FileMan can be: • Programmed • Dynamic • Interactive • A one-stop-shop reporting tool • Weekly DVT prophylaxis reports • All patients prescribed a medication (user input) • Formatted text directly to a printer

7. Three steps is enough • Through Practice: • Most users lose interest after a process has 2-3 steps • Those that deal with data regularly have no problem • Try to delegate a multi-step process and… • Solution: • Create single step FileMan templates as Menu Options • Use a GUI based stream reader to import data • Use macros, or actual programming integrated into the stream reader process, to render formatted reports • Use it and “burn” it mentality promotes data security • The process must be easy and efficient

8. Tool #1 VHA FileMan • FileMan templates can be programmed into one-step solutions via a VistA menu option • No programmer access required • FileMan supports variables, branching, iteration • The scope of variables permits cross-record information transfer • FileMan can actually be programmed via templates • Current single-option solutions include:

9. Tool #2 Microsoft Excel • The Excel platform allows for advanced programming • Processes can be recorded and replayed (macros) • Processes and functions can be directly coded via VBA • Add-ins can be produced and easily exported/imported

10. Tool #3 Databases • My preference: SQL Server • Allows for procedural code • Works on a separate server • Is very secure via Active Directory setup • Views and stored procedures enhance security • Use ODBC to directly link MS Office programs • Single click data updates • Efficiency of querying data outside the production system • Local warehouses may not be necessary in the near future • Coding SQL is easy vs. FileMan

11. Tool #4 OLAP • Bonus: the data is ready for analysis immediately • MultiDimensional Expressions (MDX) • Can be coded in ProClarity or Excel • Allow for dynamic reports • No need for user to update anything • Just click and voilà

12. Where do we go from here? • We have the basic tools needed for informatics excellence • “We can’t” needs to be eliminated from our vernacular • Everyone has FileMan, Access, Excel and ProClarity

13. Questions