Acuities: from Building to Reporting

1. Acuities: from Building to Reporting By Barry Wood, RN Clinical Analyst Providence Health and Services, Oregon Region September 2007

2. Assumptions - To get the most out of this presentation, you will need to have the following: Some knowledge and comfort working within the Flowsheet builder tool. HED is in use, 7.6sp1 or higher Basic knowledge of Business Objects

3. Starting off in the wild, wonderful world of Flowsheet Building. While we are concentrating on ACUITIES, charges can be dealt with in exactly the same way. Acuities can be built / charted at two levels. Directly against a result (anything you chart, including an annotation), or at the legend level, within a legend group. I have accidentally done both at the same time, but can’t think of a real world setting for this.

4. Two entry methods to the WAC table Top-down builders can get there through the configuration tables Dictionary access to the Workload, Acuity, Charges table.

5. Result level Legend level Caveat to top-down builders: The result or legend group must be saved prior to entering the WAC table or you will be wasting your time

6. Multi-facility entry for Respiratory Therapy nebulizer treatment, both acuities and charges Code Seq = Unique group identifier – attaches to result or legend code Fac ID = Where is the patient Dept ID: CCDFLT=all departments His_Code = SIM code or acuity value His_Code_Desc = free text description of what this code seq is for Coding system = Is this a charge or an acuity? Selection method = always set as D, though I guess we could build as credit Perf_Group = group security of the person charting. Usually “All” but sometimes constrained to the actual group. Recommendation: separate code_seq per result/type of legend. Don’t share them very much, even though you can. This will keep you out of trouble later!

7. Recommendation: use the Description field to your advantage. Tell yourself what this really is. In this case, Out Patient in Bed charges, I also included the HCPCS codes.

8. At the result level. • If anything is charted, multiple items charted, even just an annotation, then a single acuity is generated. Only exception is the data type for QUANTITY, which sends the numeric entry amount (X times the money). At the legend level • Only works when you have a choice list (exclusive or multiple choice). Acuity generated only when specific legend is charted. • In a multiple choice setting, this allows several acuities to be sent against a single result.

9. Chart_outbound • His_charge • Outbound_history Chart_Outbound • When charting within HED, each session will have at least 1 row entered into this table. If there is more than one row, then charges/acuities are involved. The “-2” tells us that this session was via HED (“-1” is legacy charting). Each actual code_seq will then have it’s own line. • Result_seq is the unique identifier for this specific charting instance/result for this patient. • Config ID is the result configuration that was charted upon • Code_seq -> this is the important piece for charges and acuities. • We’ve also go a lot of patient and staff identifiers happening here.

10. Chart_outbound • His_charge • Outbound_history His_charge Now comes some of the really fun part. This is where HL7 messages are triggered to be crafted and sent out. The first column “xaction_op” is written with a capital letter “A”, and once the system has built the outbound message, it switches the letter to lowercase. However, here at Providence, we don’t want to send acuities outbound, so we have a special trigger (see below) that makes the “a” lowercase before the HL7 building routine hits. XA type is the fast way to see if this is an acuity or financial type entry. To be written to this table, it has to go through the logic of the WAC table to see if there is matching criteria. The procedure “charge_proc” is about 26 pages of SQL script, all deciding if something fits to write to this table. This table is purged after the information is about 3 days old, so we can’t use this table for data mining. CCDBA.INSERT_HIS_CHARGE BEFORE INSERT ON HIS_CHARGE FOR EACH ROW BEGIN IF :new.xa_type = 'A' THEN :new.xaction_op := lower(:new.xaction_op); END IF; END;

11. Chart_outbound • His_charge • Outbound_history Outbound_history Here’s the table that involves a lot of our data mining from an acuity perspective. It has all of the appropriate patient and staff information, along with the charge codes, acuity amounts, label_seq’s, etc. These entries stick around until the patient is discharged and purged (based on your facilities settings). The second picture shows the table on the same patient with charting modification. Notice the CREDIT entries, followed by the new DEBIT entries.

12. Business Objects . . .What you have all been waiting for OUTBOUND_HISTORY.CHARGE_CODE

13. All of the pre-built objects can be found within: PATIENT universe Patient Results class Charges and Acuity, Workload Values subclass

14. Example of Report

15. Two very powerful options are available to get our report to give us the information we need: • Formula Bar • Report Manager

16. Building Custom Report Variables Right-click on “Variables” to get options Name this something that will make sense to you later… Changing the alphanumeric field to a numeric field

17. Getting the right sums with the quantity: Variable name “TotalCode” Formulas: Staff Acuity: =Sum(<TotalCode>) Acuity Running Total: =RunningSum(<TotalCode>) The object “Charted by” was made a master (section). As built, the “Staff Acuity” is purely per staff member. The Running Total continues to build to the end of the report, with the last staff member displaying the actual total.

18. Some of the simpler formulas, you can free-hand directly from the toolbar. However in this instance, I right-clicked in the TotAcuity column, chose calculations, and it gave me what I needed. The Running Total I had to manually add. The nice white space to the left of the Acuity Totals is really full of table cells. Click and drag to highlight them, then turn off their boundry lines. Makes the report just a bit nicer to view and scan for your users. There are no breaks in this particular report, even though it looks like it.

19. Filters We have several staff groups that document Acuities. As this is an RT report, I am filtering into the report only those items charted by members of the RT group.

20. Formatting tricks ="Printed: " +FormatDate(CurrentDate() ,"mm/dd/yy") Dates don’t like to be paired with text, so you have play with them a bit. If you wanted a time along with the date, simply add HH:mm or hh:mm to the end of the date string. The upper case HH makes it military time. ="Report Name (filtered): " + DocumentName() This is a great standard to put on all your reports, helps when users need troubleshooting. I’ve even started putting version numbers on my report names.

21. Questions? barry.wood@providence.org