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Microsoft Amalga Hospital Information System (HIS)
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Manage all hospital functions with one integrated solution
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Our Vision: To improve health around the world
For more than a decade, Microsoft has invested significant time and resources into understanding the needs of healthcare organizations. We are developing solutions that encompass both the provider and the consumer to help you achieve your goals from enhancing patient care to improving the financial health of your organization. We believe the issues that Microsoft is best positioned to address focus on healthcare information management—getting the right data to the right people in the right way at the right time. That’s why we’re working to speed and advance the capture, manipulation, aggregation, and presentation of healthcare data by offering a family of integrated IT systems for the healthcare enterprise.
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The Microsoft Amalga family of Enterprise Health Systems The Microsoft® Amalga™ family of Enterprise Health Systems offers a comprehensive range of solutions to meet the needs of your health enterprise. Microsoft Amalga Microsoft Amalga, formerly Azyxxi, is the Unified Intelligence System that allows hospital enterprises to unlock the power of all their data sitting in clinical, financial, and administrative silos. Without replacing current systems, it offers leading-edge institutions an innovative way to capture, consolidate, store, access, and quickly present data in meaningful ways.
Microsoft Amalga Hospital Information System (HIS) Microsoft Amalga Hospital Information System (HIS), formerly Hospital 2000, is a state-of-the-art, fully integrated hospital information system for developing and emerging markets. The system is built around a unified Electronic Medical Record (EMR) that includes complete patient and bed management, laboratory, pharmacy, Radiology Information System and Picture Archiving and Communication System (RIS/PACS), pathology, financial accounting, materials management, and human resource systems.
Microsoft Amalga RIS/PACS Microsoft Amalga RIS/PACS is available as a stand-alone system or as an integrated component of Microsoft Amalga HIS. The fully integrated architecture of Amalga RIS/PACS means that radiologists can use a single software application to manipulate study images and access the entire patient medical record. In addition, the workstation interface is optimized for radiologist workflow, including support for predefined templates, an intuitive report editor, and voice-recognition and dictation capabilities. In addition, multi-resource appointment scheduling, image distribution, and patient billing are also included. Due to the critical nature of RIS/PACS reliability, this system supports high availability options such as duplication of the image archive for disaster recovery.
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Microsoft Amalga Hospital Information System (HIS) The Complete, Integrated Hospital Information System
Hospitals and health systems around the world share the same goal: to deliver the highest quality of care, efficiently and effectively. Healthcare organizations in emerging and developing countries have additional challenges, including how to manage highly multicultural environments, potentially explosive growth, and smaller budgets for information technology.
Flexible
Microsoft Amalga HIS delivers a complete hospital information system that is flexible, affordable, and intuitive. Developed collaboratively with physicians, pharmacists, nurses, ancillary staff, and IT professionals, the solution was designed from the ground up to meet the needs of healthcare professionals, while minimizing the cost and resources required to run global healthcare organizations.
Multicultural patients create unique patient care considerations that go beyond language differences. Does your patient require a same-sex care provider or have dietary restrictions that are religion-based? Amalga HIS has the agility to handle all of the challenges of a multicultural environment.
Complete and Integrated
Microsoft Amalga HIS features a comprehensive range of integrated functionality, making it straightforward to configure solutions that optimize business workflows. In addition, multiple business scenarios in all modules help users to address local business rules, cultural requirements, and individual end-user requirements.
With Amalga HIS, you get a complete hospital information system that manages your healthcare organization from end to end, automating and improving effectiveness for clinical, financial, and back-office operations. Because Amalga HIS was designed from the onset as a single, integrated solution, all of the systems work together without costly interfaces or custom coding. This scalable healthcare solution:
With Amalga HIS, clinicians and staff can view data in the way that is most meaningful to them. Lab and test results, for instance, can be dynamically viewed in any of the application’s multiple supported language options. This dynamic translation is available on all generated output, including clinical notes, lab results, and pharmacy labels. Adding data is equally simple, and the system provides customizable, forms-based templates for clinical notes.
Affordable Designed to meet the varied needs of all hospital departments while providing a low cost of ownership, Amalga HIS is built on a single architecture and code base. Amalga HIS runs on commodity hardware using an architecture that is simple to manage, powerful, and reliable.
• Manages all hospital functions with one affordable solution.
Intuitive
• Improves operational efficiency with an intuitive user interface and consistent, reliable data delivery.
The easy-to-use and familiar Microsoft Windows® interface of Amalga HIS reduces the user learning curve and minimizes training costs. In fact, most users can start using the system with one hour of training. Because controls and functions are common throughout the entire system, Amalga HIS users who are reassigned to other departments need little or no application retraining.
• Improves care quality and the patient experience by providing clinicians with a single, customizable view of patient data across all encounters, resulting in more informed decision making and faster throughput. • Supports paperless, integrated, seamless workflows to help increase data integrity, reduce transcription errors and duplication of data entry, and optimize patient and report turnaround.
THE MICROSOFT AMALGA HIS SYSTEM PATIENT MANAGEMENT
ANCILLARY SERVICES
SHARED MODULES
SYSTEM ADMINISTRATION
FINANCIAL MANAGEMENT
HR MANAGEMENT
Registration Admissions, Discharge, Transfer Appointment Medical Records Clinic Ward Image Management
EMR (25 Specialities) Pharmacy Laboratory Radiology PACS Pathology Operating Theatre
HL7 Messaging DICOM Protocol Scan Manager Print Forms
Security Maintenance OLAP
Patient Accounting Accounts Payable Accounts Receivable General Ledger
Payroll Rostering Time & Attendance Training
MATERIALS MANAGEMENT Inventory Purchasing
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Microsoft Amalga RIS/PACS
Clear Winners: Doctors, Administrators, and Patients The radiologist workstation is designed to optimize radiologist workflow and is customized to match radiologist preferences. Amalga RIS/PACS not only provides access to standard image manipulation tools for reading studies, but also delivers quick access to the entire patient Electronic Medical Record (EMR) from the reporting workstation. All historical studies are stored online for ready access, rather than in a “long-term” archive, improving the patient care delivery process and radiologist efficiency. The system also integrates advanced 3D and 4D imaging functionality and includes the ability to incorporate third-party image processing add-ins to assist with analysis. The integration of Microsoft Amalga RIS/PACS provides a powerful, truly seamless system that can quickly deliver high-quality data to any department. By giving staff immediate access to the data they need, hospitals can increase patient turnaround time and enhance the patient experience.
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Microsoft Amalga RIS/PACS is an integrated Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) available as a stand-alone imaging system or a seamlessly integrated component of Microsoft Amalga HIS.
Amalga RIS/PACS offers • Automatic order management that integrates information from EMR and RIS
• Intuitive Report Editor that accepts written or dictated reporting
• Automatic scanning and attachment of hard copies to study orders
• Customizable preference tabs for radiologist worklist studies
• Image manipulation tools, including 3D cursor location
• Instant Study assignment to radiologist at time of ordering
• Built-in film digitizer that delivers automatic acquisition of scanned images from non-DICOM modalities or external sources
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• Report Status Linkage that provides comprehensive patient demographic and allergy information • Integrated database that ensures patient medical information is accessible directly from the PACS • Management reports for full audit tracking, with time stamps for key RIS/PACS functions • Real-time indicator that flags critical-result reports with “Requires Attention” • Template-driven options, including reporting and voice recognition
Microsoft Amalga RIS/PACS system comprises of:
RIS • Appointment bookings • Study-acquisition workflow • Document management • Report creation from templates
Dictation
Wide-area PACS
Teleradiology
Diagnostic workstation
Voice recognition Transcription Report and image distribution
Warning system that notifies radiologists if a study that they are reporting is also being reported by another radiologist, and that sends an alert if a study in the RIS is open in the PACS
• Online Historical studies, making historical studies available for quick retrieval, regardless of study age • Unlimited Study revisions that save any or all key images, window-level settings, and image annotations with revision descriptions • CD creation for PACS studies, reports, and EMR; options include DICOM and JPEG images, reports, and all or selected portions of a patient’s EMR
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Microsoft Amalga RIS/PACS Case Study
Microsoft Amalga HIS Case Study
Changi General Hospital
Bumrungrad International Hospital
Changi General Hospital (CGH) opened in December 1996 to serve the needs of Singapore’s rapidly growing eastern region, and is the designated regional general hospital for the 750,000 Singaporeans that populate its surrounding communities.
Bumrungrad International Hospital, a 554-bed facility, was the first hospital in Asia to meet the requirements of the U.S.-based Joint Commission on International Accreditation. The hospital sees 2,500 to 4,000 outpatients a day, and more than 1,200,000 patients a year, including 400,000 foreign patients. In addition, the hospital does 262,000 radiology studies per year.
CGH has 26 wards, 790 beds, 22 specialist clinics, and 103 consultation rooms, and handles than 40,000 inpatient admissions and 327,000 outpatient visits per year. In addition, the hospital’s radiology department performs more than 210,000 studies annually. Implementation of Amalga RIS/PACS included 10 dual-monitor Diagnostic Workstations that are distributed throughout the central reporting area and reporting substations, as well as nine Clinical Review Stations. An unlimited site license for Microsoft Amalga RIS/PACS makes it possible for the hospital to distribute radiology studies and images of all types to any Internet Explorer–enabled PC on the hospital intranet.
With Microsoft Amalga HIS, Bumrungrad has achieved outstanding results. Time to retrieve medical records has been reduced from 25 minutes to mere seconds; patient waiting time has been reduced by 39 percent; outpatient pharmacy dispensing time has been reduced by 50 percent; accounts receivable days have been reduced from 15 days to 10 days; and forms stocked have been reduced from 395,616 average pieces to zero. What’s more, 10,000 square feet of medical records storage space has been transformed into a revenueproducing pediatric center.
Microsoft Amalga HIS: The Right Data at the Right Time Finally, a highly scalable, intuitive healthcare solution that manages all hospital functions in one affordable, integrated system. Customizable to each user’s needs, Microsoft Amalga improves operational efficiency across the organization, helping to lower overall costs and improving provider collaboration and the patient experience.
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Learn about how Microsoft Amalga HIS can benefit your organization: Visit www.microsoft.com/amalga22 or call 8xx-xxx-xxxx.
© 2008 Microsoft Corporation. All rights reserved. Microsoft, Amalga, the Amalga logo, HealthVault, and the HealthVault logo are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks are property of their respective owners.
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Microsoft Amalga RIS/PACS ®
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Powerful pictures and intuitive radiology workflow integrated into a single, easy-to-use system
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An integrated imaging and workflow system that gives you vision.
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Microsoft® Amalga™ RIS/PACS is an integrated Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) that is available as a stand-alone imaging system or a seamlessly integrated component of the Microsoft Amalga Hospital Information System (HIS). Amalga RIS/PACS consolidates a hospital’s entire collection of medical imaging and integrates it with sophisticated workflow for radiology. Whether integrated with the patient electronic medical record (EMR) and other hospital systems or installed as a stand-alone system, RIS/PACS gives radiologists and clinicians the tools to make fast, informed diagnoses and more confident clinical decisions. Featuring a single user interface, the award-winning Amalga RIS/PACS enables teleradiology among multiple sites to provide quick access to digital images, intuitive image manipulation and built-in diagnostic tools—all designed for the way radiologists prefer to work. The system’s wide-area PACS is built on interconnected, site-specific servers rather than a central database result in minimum downtime and easy, seamless shared access across multiple sites and teams.
Increased accuracy
Standardisation support
Integrated systems reduce transcription errors, eliminate
The format-agnostic system supports all image file types and
duplication of data and prevent overlap in reporting,
includes a DICOM work list to enable consistent DICOM data
optimising the information clinicians have to work with.
entry for image files.
Enhanced efficiency
Powerful tools at your fingertips
Fast image retrieval time, full access to a complete database
Integrated 3-D image rendering, image manipulation and
of current and historical images, advanced ability to mark up
an HL7 engine to support interfaces with third-party analysis
and display preferred image collections and fast and intuitive
tools make it possible for radiologists to work easily in one
navigation streamline clinician processes to make their work
space, without juggling multiple applications and hardware.
go faster. Substantially reduced costs Filmless digital imaging eliminates substantial supply costs, frees up staff and reduces the need for space to store and manage film records.
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Increase the value of radiology in patient care. The Microsoft Amalga RIS/PACS system intuitively responds to the day-to-day needs of your hospital’s radiology and other clinical departments, providing the sophisticated tools and support for complex processes that can help medical imaging play a more integral role in diagnosis and treatment.
SCHEDULING AND WORKFLOW
EMR INTEGRATION
DIAGNOSTIC WORKSTATIONS
REPORTS
Scheduling and Workflow
EMR Integration
Diagnostic Workstations
Reports
The Radiology Information System helps busy radiology
Faster turnaround time helps expedite patient visits, diagno-
Workstations simulate the hanging of film images for better
The intuitive RIS/PACS report editor accepts written or
departments manage their appointments and resource
sis and treatment and immediate access to the patient EMR
study and comparison, but with all the advantages of a
dictated reporting, integrating with voice-recognition
scheduling, study acquisition workflow, documents and
(when deployed with Microsoft Amalga HIS) gives doctors
digital format. Radiologists can quickly access historical and
technology or preparing compressed digital audio files for
image report creation from a single interface. Intuitive, drag-
the complete information they need to act quickly.
recent images, compile them and navigate the collection
transcribing. Templates make it possible for radiologists
and-drop design, automatic appointment recurrence, alerts
easily. They can also save a set of Dynamic Display Protocols
to select and generate standard reports almost instantly,
for resource constraints, graphical views and pre-exam alerts
to see a consistent display of images from site to site.
reducing report turnaround time. Transcribed reports
help radiology teams operate more smoothly.
Radiologists can switch back and forth quickly and easily
appear automatically in the radiologists’ work list, so they
from two-dimensional views to 3-D perspectives to further
can quickly review, approve and release the report to the
investigate an area for more accurate diagnosis.
ordering doctor.
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Advanced functionality provides flexibility. Workload sharing
Voice recognition and digital dictation and transcription
For organisations that have multiple sites and limited
The system supports all the leading voice-recognition engines
radiology resources, the wide-area PACS network allows fast,
and includes radiology-specific dictionaries to improve
easy image sharing across sites and radiology teams. With
accuracy of transcription. The system also compresses digital
multilevel security access to information, radiologists can
dictation recordings and sends them to off-site medical
share or protect reports according to their preferences.
transcriptionists.
Because the system is highly scalable, it can be easily adapted as radiology departments are added or expanded. Intelligence for clinicians
Teaching resources RIS/PACS includes a comprehensive teaching system that allows radiologists to flag interesting cases and design case
Operating theatre planning allows surgeons to mark up
studies to use for student instruction. The system enables
collections of images so they can prepare for an operation
categorisation of cases for simple retrieval, as well as the
and then call up the images they need immediately during
creation of exam questions and results analysis for self-study.
surgery. Imaging markup and manipulation helps doctors
Teaching files are created and handled according to standards
prepare for rounds or create presentations.
established by the Radiological Society of North America’s Medical Imaging Resource Centre, permitting standardised
International capabilities Displays can use any Unicode-supported language, providing flexibility for multiregion hospital systems and a diverse clinical and administrative staff.
query support, case submission and server support. Remote management Managers and administrators can access a full audit trail of all image retrievals and monitor all study movements immediately, while your hospital’s IT department can oversee file sizes, load times and workflow for server and resource optimisation. Additionally, the system is easy to manage, configure and extend, allowing for a fully scalable solution.
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Microsoft Amalga RIS/PACS A combined Radiology Information System and Picture Archiving and Communications System, with embedded imaging tools, intuitive workflow and access to a hospital’s entire library of medical images, puts the power of pictures into clinicians’ hands.
Learn more about Microsoft Amalga RIS/PACS at www.microsoft.com/amalga.
© 2008 Microsoft Corporation. All rights reserved. Microsoft, Amalga and the Amalga logo are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks are property of their respective owners.
Part No. 098-109490
Microsoft Amalga Demo System Inpatient Quality Measures with Amalga - AMI Concurrent Review - For IHI 2011 Conference Microsoft Corporation Published: February 2011
Summary This demo script will walk you through the AMI Concurrent Review workflow for the Amalga Quality Measures Manager Solution.
Table of Contents 1 2
3
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 2.1 Start Demo Laptop and log in ............................................................................................. 3 2.2 Log in to Amalga ................................................................................................................. 3 Demonstration Steps .............................................................................................................................. 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected]
© 2011 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Ability to support time-sensitive interventions and workflows across the healthcare organization that help ensure optimal adherence to quality standards, documentation and reporting of accurate data with quality measures.
Demo Scenario:
Inpatient Quality Measures with Amalga-Concurrent Review
Questions to tailor demonstration to audience pain / requirements?
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Demo Introduction / Story:
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How do you manage CMS-mandated quality measures, like those for acute Myocardial Infarction and pneumonia? Would it be beneficial for you to be able to manage the quality issues reflected in those measures while the patient is still in the hospital, rather than once they have been discharged? With the advent of publicly available performance scorecards and changes in reimbursement policies, the need for better quality measurement tools is one of the most pressing concerns facing hospitals today. Every year the number of regulated hospital quality measures increases. This imposes additional complications to an already burdensome process for reviewing and abstracting disparate core measure data. CMS mentioned in a recent payment regulation that the number of hospital quality measures could exceed 90 by 2013. (Source: CMS IPPS final rule Aug 2010) Furthermore, it is an ongoing struggle to continually track core measure data elements to respond to compliance issues with patients admitted in the hospital or in the emergency department. The Inpatient Quality Measures with Amalga(IPQMA) solution is a single application built on the Amalga data aggregation platform that helps to monitor hospital compliance with CMS Hospital Quality Measures on an ongoing and near real time basis. It aggregates enterprise-wide clinical, quality and administrative data to identify performance gaps as data is collected, empowering hospital staff to measure, and respond to quality issues more rapidly.
Role(s):
Chief Quality Officer, CNO, CMO, nurses, physicians, Quality case managers
Processes:
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Automated identification of patients who may have gaps in care, and facilitated guided review of relevant data elements IPQMA includes self-service, role-based dynamic work lists (custom user views) of ALL inpatients to whom CMS quality measures may apply This concurrent review phase of the IPQMA workflow targets guided documentation and review of the time-senstive AMI-1 and AMI-8 CMS Quality Measures for 100% of identified inpatients.
© 2011 Microsoft Corporation. All rights reserved.
HSG Customers who have implemented similar scenario:
Examples of HSG customers who have done something similar -Moses Cone Health System
IPQMA Workflow Overview:
Life-Cycle of a Quality Measure Review and Documentation Guided Abstraction
Guided Abstraction Guided Abstraction
Automated
Automated Automated
Automated
ADM
Inpatient Care and Documentation
D/C
Near Real-time Analysis Patient Admission
Inpatient Concurrent Review
Persona = Quality Care-coordinator, Unit Nurse • • • •
Retrospective Analysis
Guided Data Abstraction & Final Review
Discharge Planning Documentation Persona = Quality Care-coordinator, Unit Nurse
Manage List of Patients who likely to have a condition Track measures that are time-sensitive to admission Track actions that user took and documented Deep dive into the Patient’s complete chart
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Manage *List of Patients* who are likely to have a specific condition and are about to be discharged Track time sensitive actions before and related to D/C Guided Abstraction for clinical verification
Persona = Case Mgr Data Abstractor •
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List of Patients who are have a specific condition and are in the sample population for abstraction Abstract chart for each measure as per CMS specification
2 Demo Setup In section 2, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration. The actual demo starts at section 3.
2.1 Start Demo Laptop and log in In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials Click
2.2
Screen Shots
Log in to Amalga
Talking Points
Click Steps
© 2011 Microsoft Corporation. All rights reserved.
Screen Shots
Log into Microsoft Amalga IPQMA Console (and refresh the IPQMA database if not updated within the last 24 hours)
Double-click on the IPQMA Amalga – Console located on the desktop in the Quality Measures Manager section
Enter the provided Amalga login credentials: az-QMM and Password: passw0rd!
Click Login
3 Demonstration Steps In this section, we demonstrate how to view culture results and establish a patient’s isolation status Talking Points IPQMA supports three main workflows, each with a separate and complementary purpose:
Click Steps
“Concurrent review”, in which patients with a particular condition is reviewed to ensure that key qualityrelated tasks are addressed in their care. “Discharge review”, in which a patient that is about to be or has recently been discharged is reviewed to ensure that key quality-related tasks are addressed. “Abstracting”, in which a user ensures that all qualityrelated data is captured correctly in the patient record. This demo will cover “Concurrent Review”, which allows hospitals to address quality measures while the patient is still in the hospital and there is still an opportunity to affect qualityrelated care processes. The user is a quality nurse © 2011 Microsoft Corporation. All rights reserved.
Screenshots
responsible for proactively managing key time-sensitive quality indicators for patients in the hospital with acute MI (AMI). The two measures that will be illustrated in this demo are administration of aspirin within the first 24h after presentation (“AMI-1”) and the door-to-balloon time for percutaneous coronary intervention in ST-elevation MI (“AMI-8a”) The initial screen shown upon logging in shows all the patients currently in the hospital (including ED patients not admitted yet) who arrived in the last 72 hours and appear to have acute MI.
Point out key data columns on this screen, including the “Cur Unit” “ASA min left”< “ASA status”, and “DrToBlln” columns
The inclusion of a patient in this view is based on all of the following data: An ED diagnosis of acute MI Chief complaints that suggest acute MI, e.g. “CP”, “STEMI”, (ST Elevation MI) etc. Elevated troponin levels All the data I need to manage these two AMI quality measures is on this screen. The default sort is by arrival date/time with most recentlyarrived at the top, which helps me keep on top of things by checking the screen frequently and addressing recently-arrived patients.
Demo video time stamp 1:03
Sort by “ASA min left” column
It is easy to sort by other parameters, such as “ASA Min Left”, if I want to make sure I don’t miss patients for whom very little time is left before they will “fail” this important quality measure
© 2011 Microsoft Corporation. All rights reserved.
The “Aspirin” column lets me see details regarding administration of aspirin (or aspirin-containing medications). I can drill down to detailed medication administration data on a patient to see specifics.
Double-click on Aspirin column for Wordsworth, Fredrick Close the dialog by clicking the “x” in the upper right
Demo video time stamp 4:16 Amalga automatically determines whether aspirin has been administered and if so, computes whether it was within 24 hours of arrival and if so, automatically marks the patient as “Passed”
Point out “Passed” value in “ASA Status” column for Wordsworth, Fredrick
I could sort or filter the list by “ASA Status” to focus just on the patients who do not have the status “Passed” for this measure. Let’s turn our attention to the most recently-arrived patients, for all of whom the “ASA Status” is “Pending”.
Select row for Wu, Sheryl
For Mr. Wu, who has been here for over 3 hours, I might just have a verbal conversation with his nurse and quickly note that on this screen. Right-click on “ASA Followup” and select “Nurse Followup” to populate the QEdit field
Right-click on “Notes” field and select “QEdit Edit”
© 2011 Microsoft Corporation. All rights reserved.
type in “Spoke with RN Bates” Click OK
Of course, there are situations where there is a legitimate reason NOT to administer aspirin to an AMI patient, and IPQMA allows you to easily determine and document that. Ms. Waverly looks like she’s running out of time to get her aspirin. Let’s take a closer look.
This screen summarizes all the information about this patient and the quality measures that apply to her.
Double-click on row for Waverly, Martha J If the “Quality Measures” dialog does not appear, click on “Quality Measures Data” on the left under “Patient Details” If “AMI-1” information is not displayed in the lower pane, click the “AMI 1” row on the grid.
Demo video time stamp 6:05
Click “Audit History”
The Audit History link provides a complete record of the identity and date/time of user changes to these core measure fields and the data sources for all edits as individual transactions. If I look at her AMI-1 information, I can see that the system has already marked “Yes” under “Has Reason for No Aspirin” If I want to see why, I can do so easily. It looks like the system found some information about aspirin allergy in a free-text cath lab report!
© 2011 Microsoft Corporation. All rights reserved.
Demo video time stamp 6:20
If I want to explore that further, I can use the “search and highlight” feature in Amalga to find references to aspirin in free-text documents in the patient’s record
Click “Aspirin” under “Quality Highlights” Scroll down to “History and Physical” section and note mention of “Aspirin to Allergy” [sic] and “GI bleeding history with Aspirin” Demo video time stamp 6:45
Once I validate this information the patient will be marked as “Excluded” for AMI 1, since she falls in one of the designated “exclusion” groups for this quality measure.
Sometimes patients actually have received aspirin but the information is buried in a free-text note that would normally be missed or take a lot of time to find. If we look at Bob Rutherford, he also has only a few hours left before he will be considered to have “failed” the aspirin-in-MI quality measure.
Let’s take a look at Yuri Filosho, who appears to have failed the aspirin-in-AMI measure. Let’s assume I have reviewed Yuri’s record and found no evidence that aspirin was administered.
Click on “Quality Measures Data” to go back to that dialog Set “Aspirin Received at Arrival” to “No” Enter “Patient has aspirin allergy and is also on Coumadin” in “AMI 1 Comment” field Click “Save”
Double-click on “Aspirin” for Rutherford, Bob Point out nothing on “Meds Administered” tab indicating that ASA was given Click on “Aspirin” tab Scroll down to ED report Point out note in ED report “ADMINISTERED ASPIRIN BY EMS 325 MG” Click on “Quality Measures Data” to go back to that dialog Set “Aspirin Received at Arrival” to “Yes” Type “ASA given by EMS” in “AMI 1 comment Click “Save” and point out status changes to “Passed” Select row for Filoshi, Yuri
© 2011 Microsoft Corporation. All rights reserved.
Demo video time stamp 8:11
I’m going to mark him as “missed” so I know that I’ve reviewed him, but I’m also going to contact his physician just to check whether aspirin might have been administered in the ED and somehow not documented.
Right-click on “ASA Followup” and select “Missed”
Right click on “Notes” column and select “QEdit Edit”
type “Will follow up with MD” click “OK”
© 2011 Microsoft Corporation. All rights reserved.
Let’s turn now to the other measure I’m interested in, the door-to-balloon time for STEMI patients. This key quality indicator should be less than 90 minutes in most patients with STEMI. I’m going to sort by Chief Complaint to get a set of STEMI patients conveniently grouped to review.
Click on “Chief Complaint” column twice to sort pts with CC = “STEMI” to the top. Point out the “DrToBlln” column showing door-toballoon times. Double-click on name for Knoffler, Christian then click on “Cath Lab” under “Quality Highlights” Scroll down and point out highlighted text showing key events with time stamps
Demo video time stamp 10:14
Note that the “door to balloon” time is automatically calculated by Amalga based on free-text data in the cath lab report! I can see a summary of the extracted data if I want. I see here the key events that Amalga has “discovered” in the cath lab report. I can review this information to confirm that the calculation is correct.
Click on “Clinical Documentation” under “Patient Details” then click on the “CathLab” tab
Demo video time stamp 10:36 I can see the automaticallycalculated “PCI Minutes” interval representing the door-to-balloon time on the quality measures screen. We can see that Mr. Graf appears to have had a longer-thanacceptable door-to-balloon interval. Let’s check a few things, with the aid of Amalga, to see if this was really a lapse in quality care. Amalga can show me free-text notes highlighted with keywords relevant to possible legitimate reasons for a delay in PCI. Having (with the help of the search and highlighter tool) discovered this information, I can note it on the Quality Measures Data screen.
Click on “Quality Measures Data” under “Patient Details” Click the “x” in the upper right to close the Patient Details screen Double-click on Graf, Steve W to open Patient Details screen Click on “PCI Delay Reason” Scroll down to ED report and note the line about needing to undergo intubation, which is considered by CMS a legitimate reason for delay in PCI.
Click on “Quality Measures Data” to display that screen. Click on row “AMI 8a” on the grid to display relevant data Note pt marked as “Excluded” Click “x” in upper right to
© 2011 Microsoft Corporation. All rights reserved.
Demo video time stamp 12:06
close the dialog
I can use the “Concurrent Review Status” column to keep track of my work as I review all these patients.
Enter “Yes” for “PCI Delay Reason” and “Yes” for “ECG Interpretation,” and “Pt intubated in ED” under “AMI 8a Comment” Click “Save”
Scroll to right to show “CCR Status” column Right click on a row and select “Not Tracking”
If there is a patient on the list who doesn’t below there, i.e. they don’t actually have an acute MI, I can designate them as “Not Tracking” and take them off the list. I can always go to the master list to get them back if I take a patient off by mistake. I can also document the anticipated discharge date and time, if known, to assist with discharge planning.
Show “Anticip D/C Dt” column and demonstrate modifying/populating with a QEdit.
This concludes the IPQMA Concurrent Review demonstration.
© 2011 Microsoft Corporation. All rights reserved.
The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2011 Microsoft Corporation. All rights reserved.
© 2011 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Inpatient Quality Measures with Amalga - AMI Discharge Planning Review - For IHI 2011 Conference Microsoft Corporation Published: February 2011
Summary This demo script will walk you through the AMI Concurrent Review workflow for the Amalga Quality Measures Manager Solution.
Table of Contents 1 2
3
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 4 2.1 Start Demo Laptop and log in ............................................................................................. 4 2.2 Log in to Amalga ................................................................................................................. 4 Demonstration Steps .............................................................................................................................. 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected]
© 2011 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Ability to support time-sensitive interventions and workflows across the healthcare organization that help ensure optimal adherence to quality standards, documentation and reporting of accurate data with quality measures.
Demo Scenario:
Quality Measures Manager- Discharge Planning Review
Questions to tailor demonstration to audience pain / requirements?
•
Demo Introduction / Story:
•
•
•
•
•
How do you manage CMS-mandated quality measures, like those for acute Myocardial Infarction and pneumonia? Would it be beneficial for you to be able to manage the quality issues reflected in those measures while the patient is still in the hospital, rather than once they have been discharged? With the advent of publicly available performance scorecards and changes in reimbursement policies, the need for better quality measurement tools is one of the most pressing concerns facing hospitals today. Every year the number of regulated hospital quality measures increases. This imposes additional complications to an already burdensome process for reviewing and abstracting disparate core measure data. CMS mentioned in a recent payment regulation that the number of hospital quality measures could exceed 90 by 2013. (Source: CMS IPPS final rule Aug 2010) Furthermore, it is an ongoing struggle to continually track core measure data elements to respond to compliance issues with patients admitted in the hospital or in the emergency department. The Inpatient Quality Measures with Amalga (IPQMA) solution is a single application built on the Amalga data aggregation platform that helps to monitor hospital compliance with CMS Hospital Quality Measures on an ongoing and near real time basis. It aggregates enterprise-wide clinical, quality and administrative data to identify performance gaps as data is collected, empowering hospital staff to measure, and respond to quality issues more rapidly.
Role(s):
Chief Quality Officer, CNO, CMO, nurses, physicians, Quality case managers
Processes:
• •
•
Automated identification of patients who may have gaps in care, and facilitated guided review of relevant data elements IPQMA includes self-service, role-based dynamic work lists (custom user views) of ALL inpatients to whom CMS quality measures may apply This concurrent review phase of the IPQMA workflow targets guided documentation and review of the time-senstive AMI-2, 3, 4 and 5 CMS Quality Measures for 100% of identified inpatients.
© 2011 Microsoft Corporation. All rights reserved.
HSG Customers who have implemented similar scenario:
Examples of HSG customers who have done something similar -Moses Cone Health System
IPQMA Workflow Overview:
Life-Cycle of a Quality Measure Review and Documentation Guided Abstraction
Guided Abstraction Guided Abstraction
Automated
Automated Automated
ADM
Automated
Inpatient Care and Documentation
D/C
Near Real-time Analysis Patient Admission
Inpatient Concurrent Review
Persona = Quality Care-coordinator, Unit Nurse • • • •
Manage List of Patients who likely to have a condition Track measures that are time-sensitive to admission Track actions that user took and documented Deep dive into the Patient’s complete chart
Retrospective Analysis
Guided Data Abstraction & Final Review
Discharge Planning Documentation Persona = Quality Care-coordinator, Unit Nurse • • •
Manage *List of Patients* who are likely to have a specific condition and are about to be discharged Track time sensitive actions before and related to D/C Guided Abstraction for clinical verification
Persona = Case Mgr Data Abstractor •
•
List of Patients who are have a specific condition and are in the sample population for abstraction Abstract chart for each measure as per CMS specification
Key AMI Proactive Measures: a) Concurrent Review – upon admission and during hospital stay a. AMI – 1: Administration of Aspirin upon admission within 24 hours b. AMI – 8: PTCA within 90 min (door-to-balloon time) for STEMI patient b) Discharge Planning Review – before or soon after patient discharge (1:10) a. AMI – 2: Prescribe Aspirin to patient at discharge b. AMI – 3: If LVSD (EF<40%), Prescribe ACEI (angiotensin II converting enzyme inhibitor or ARB (angiotensin II receptor blocker) medication. c. AMI – 4: If smoker, Give Smoking Cessation Counseling d. AMI – 5: Prescribe beta-blocker medication
© 2011 Microsoft Corporation. All rights reserved.
2 Demo Setup In section 2, we start the demo laptop and log in to start the demonstration. In section 2.1, we log into Amalga to start the demonstration. The actual demo starts at section 3.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points Click Steps Screen Shots
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials Click
2.1
Log in to Amalga
Talking Points
Log into Microsoft Amalga IPQMA Console (and refresh the IPQMA database if not updated within the last 24 hours)
Click Steps
Double-click on the IPQMA Amalga – Console located on the desktop in the Quality Measures Manager section
Enter the provided Amalga login credentials: az-QMM and Password: passw0rd!
Click Login
Screen Shots
3 Demonstration Steps In this section, we demonstrate how to view culture results and establish a patient’s isolation status Talking Points IPQMA supports three main workflows, each with a separate and complementary purpose:
Click Steps
“Concurrent review”, in which patients with a particular condition is reviewed to ensure that key qualityrelated tasks are addressed in their care. “Discharge review”, in which a © 2011 Microsoft Corporation. All rights reserved.
Screenshots
patient that is about to be or has recently been discharged is reviewed to ensure that key quality-related tasks are addressed. “Abstracting”, in which a user ensures that all qualityrelated data is captured correctly in the patient record. This demo will cover “Discharge Planning Review”, which allows hospitals to address quality measures while the patient is still in the hospital and there is still an opportunity to affect qualityrelated care processes. The user is a quality nurse responsible for proactively managing key time-sensitive quality indicators for patients in the hospital with acute MI (AMI). The four measures that will be illustrated in this demo are: AMI – 2: Prescribe Aspirin to patient at discharge AMI – 3: If LVSD (EF<40%), Prescribe ACEI (angiotensin II converting enzyme inhibitor or ARB (angiotensin II receptor blocker) medication. AMI – 4: If smoker, Give Smoking Cessation Counseling AMI – 5: Prescribe beta-blocker medication The initial screen shown upon logging in shows all the patients currently in the hospital (including ED patients not admitted yet) who have planned discharges in the next 72 hours and appear to have an acute MI.
Select AMI (Discharge List) from the View Manager
This view is sorted by Effective Discharge Date/Time; This dynamic Worklist Datascope
© 2011 Microsoft Corporation. All rights reserved.
is set to Next 72 hours or can be reset to Past 72 hours (post discharge) if desired Scroll to right of grid to show four time sensitive AMI Quality Measures On the far right there are two fields labeled Review Notes and DCR (Discharge Review) Status columns for Quick Edits This User view is filtered on incomplete DCR Status to delivery active review patient list All the data I need to manage these two AMI quality measures is on this screen.
© 2011 Microsoft Corporation. All rights reserved.
Demo video time stamp 2:31
Now let’s evaluated the Case of – Martha Waverly who was admitted for Chest Pain
Select Martha Waverly (Chest Pain)
Is patient a smoker? Go to clinical documentation dialogue box – smoking cessation (Note this was created by the IPQMA Secondary parsing from existing clinical documentation of progress or nursing notes) The record shows that this patient has Not been a smoker in past 12 months from clinical documentation so we can then update AMI – 4 After status and comments added, we SAVE this record update and then the status updates in AMI Summary Changes from Pending to Excluded Return to Amalga Grid and Refresh screen, note the patient’s updated smoking status to “N” Now confirm the notes field that this patient has an ASA allergy from the grid, but we can confirm this comment by re-entering the Allergies details and Discharge Meds tabs in the Info Box We also note that this Patient is on Coumadin in the Discharge meds list, Then update the Quality Measures Data tab for this patient Save and then Refresh the Grid Next review the Beta Blocker prescription status from the grid open patient record Go to Discharge Medication list tab © 2011 Microsoft Corporation. All rights reserved.
Demo video time stamp 5:00
Note the keyword color coding key of the medication classes. (i.e. Yellow for ASA or Coumadin, Brown for Beta Blocker, Dark Blue for ARB, Light Blue for ACEI) Copy the Metoprolol signature from the Discharge Summary medication list and Paste the prescribed medication into the Quality Measures AMI-5 comment box; SAVE Finally, check the LVSD status by using the LVF Assessment (Left Ventricular Function) Add AMI-3 Comment: LVSD as EF = 35% ARB – Losartan 25 mg daily No ACEI given due to documented allergy Save (updated status to PASSED on AMI-3) and then return to the Grid and refresh to see the updates in the dynamic worklist After the refresh can complete this patient review and Quick Edit (right click) to update DCR Status to D/C Review is done and that patient will fall off the list based on the filter settings. Only incompletely reviewed patients remain on this worklist Final note – because we are proactively completing the discharge reviews at the 72 hours prior to discharge any documentation or patient care issues can be addressed prior to discharge to not only effect a high quality compliance score but also
© 2011 Microsoft Corporation. All rights reserved.
consistently delivery higher quality care for ALL patients not just a 20 -30 sample size.
This concludes the IPQMA Concurrent Review demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2011 Microsoft Corporation. All rights reserved.
© 2011 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Inpatient Quality Measures with Amalga - AMI Abstracting - For IHI 2011 Conference Microsoft Corporation Published: February 2011
Summary This demo script will walk you through the AMI Abstracting workflow for the Amalga Quality Measures Manager Solution.
Table of Contents 1 2
3
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 2.1 Start Demo Laptop and log in ............................................................................................. 3 2.2 Log in to Amalga ................................................................................................................. 4 Demonstration Steps .............................................................................................................................. 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected]
© 2011 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Ability to support time-sensitive interventions and workflows across the healthcare organization that help ensure optimal adherence to quality standards, documentation and reporting of accurate data with quality measures.
Demo Scenario:
Quality Measures Manager-Abstracting
Questions to Tailor demonstration to audience pain / requirements?
•
Demo Introduction / Story:
•
•
•
•
•
How do you manage CMS-mandated quality measures, like those for acute Myocardial Infarction? Would it be beneficial for you to be able to manage the work of abstracting (i.e. ensuring all necessary data has been collected) in a semi-automated manner, in a fraction of the time, and with better accuracy? With the advent of publicly available performance scorecards and changes in reimbursement policies, the need for better quality measurement tools is one of the most pressing concerns facing hospitals today. Every year the number of regulated hospital quality measures increases. This imposes additional complications to an already burdensome process for reviewing and abstracting disparate core measure data. CMS mentioned in a recent payment regulation that the number of hospital quality measures could exceed 90 by 2013. (Source: CMS IPPS final rule Aug 2010) Furthermore, it is an ongoing struggle to continually track core measure data elements to respond to compliance issues with patients admitted in the hospital or in the emergency department. The Inpatient Quality Measures with Amalga (IPQMA) solution is a single application built on the Amalga data aggregation platform that helps to monitor hospital compliance with CMS Hospital Quality Measures on an ongoing and near real time basis. It aggregates enterprise-wide clinical, quality and administrative data to identify performance gaps as data is collected, empowering hospital staff to measure, and respond to quality issues more rapidly.
Role(s):
Chief Quality Officer, CNO, CMO, nurses, physicians, Quality Data Abstractors
Processes:
• •
•
Automated identification of patients who may have gaps in care, and facilitated guided review of relevant data elements IPQMA includes self-service, role-based dynamic work lists (custom user views) of ALL inpatients to whom CMS quality measures may apply This abstraction phase of the IPQMA workflow targets the task of ensuring that all quality measures data is collected completely and accurately for patients with AMI.
© 2011 Microsoft Corporation. All rights reserved.
HSG Customers who have implemented similar scenario:
Examples of HSG customers who have done something similar -Moses Cone Health System
IPQMA Workflow Overview:
Life-Cycle of a Quality Measure Review and Documentation Guided Abstraction
Guided Abstraction Guided Abstraction
Automated
Automated Automated
Automated
ADM
Inpatient Care and Documentation
D/C
Near Real-time Analysis Patient Admission
Inpatient Concurrent Review
Persona = Quality Care-coordinator, Unit Nurse • • • •
Retrospective Analysis
Persona = Quality Care-coordinator, Unit Nurse
Manage List of Patients who likely to have a condition Track measures that are time-sensitive to admission Track actions that user took and documented Deep dive into the Patient’s complete chart
Guided Data Abstraction & Final Review
Discharge Planning Documentation • • •
Manage *List of Patients* who are likely to have a specific condition and are about to be discharged Track time sensitive actions before and related to D/C Guided Abstraction for clinical verification
Persona = Case Mgr Data Abstractor •
•
List of Patients who are have a specific condition and are in the sample population for abstraction Abstract chart for each measure as per CMS specification
2 Demo Setup In section 2, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration. The actual demo starts at section 3.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points Click Steps Screen Shots
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials Click
© 2011 Microsoft Corporation. All rights reserved.
2.2
Log in to Amalga
Talking Points
Log into Microsoft Amalga IPQMA Console (and refresh the IPQMA database if not updated within the last 24 hours)
Click Steps
Double-click on the IPQMA Amalga – Console located on the desktop in the Quality Measures Manager section
Enter the provided Amalga login credentials: az-QMM and Password: passw0rd!
Click Login
Screen Shots
3 Demonstration Steps In this section, we demonstrate how to view culture results and establish a patient’s isolation status Talking Points IPQMA supports three main workflows, each with a separate and complementary purpose: “Concurrent review”, in which patients with a particular condition is reviewed to ensure that key qualityrelated tasks are addressed in their care. “Discharge review”, in which a patient that is about to be or has recently been discharged is reviewed to ensure that key quality-related tasks are addressed. “Abstracting”, in which a user ensures that all qualityrelated data is captured correctly in the patient record. This demo will cover “Abstracting”, which is the process whereby hospital © 2011 Microsoft Corporation. All rights reserved.
Click Steps
Screenshots
personnel ensure that all the data elements required for calculation of quality measures are completely and accurately reflected in the system. This process occurs post-discharge, usually after all the documentation and coding of the patient’s record for claims submission has been completed. The user is an abstractor (a hospital employee, usually with a clinical background) responsible for abstracting charts for quality measures including AMI. When performed completely by hand, this is a highly laborious process, since there are a large number of data elements, and the without the aid of a tool like Amalga, many of them are hard to find. For instance, under the CMS measures specifications, a patient is considered to have left ventricular systolic dysfunction (LVSD) if they have a measured left ventricular ejection fraction (LVEF) < 40%, or an observation of “moderately-to-severely” impaired left ventricular function. The latter observation might be buried in a free-text document such as an echocardiogram report. This often leads to a “needle-in-a-haystack” process of searching for information. This demo addresses six of the standard CMS quality measures around AMI. I am going to display my “Abstractor” view for AMI patients. This shows me patients who have been discharged in a recent month.
Change user view to “AMI (Abstractor List)”
Note the “Sample” column-This indicates whether the patient is in my “sample” population that I’ll be abstracting on. I am not required to perform “abstracting” © 2011 Microsoft Corporation. All rights reserved.
on every single patient, just a representative subset. However, as seen in the “Concurrent Review” and “Discharge Review” demos, Amalga helps ensure proper care and data capture for all patients with AMI. The columns “AMI 1”, “AMI 2”, etc. show the patient’s status with the corresponding AMIrelated quality measures.
Demo video time stamp 5:15
The “Abstractor Review” column shows me the patients for whom the abstraction process has been completed. My first patient on the list whose abstraction process has not been completed is Sussana Hilton.
Hover over “Comments” column for Hilton, Sussana
I can see in the “Comments” field that it has been noted that she has allergies to aspirin and ACE inhibitors, has LVSD, and . This was noted during her “Concurrent Review” and “Discharge Review” processes. It looks like this patient has either passed or is excluded from all the AMI measures. As an abstractor, I may want to take a closer look to make sure everything was documented properly, in accordance with the CMS measures specifications.
Demo video time stamp 7:41 Double-click on the row for Hilton, Sussana to display the “Quality Measures Data” dialog
Demo video time stamp 8:16 For instance, I can confirm that this patient really does have an allergy to aspirin rendering her “excluded” from the AMI-1 quality measure.
Point out data elements completed for AMI-1 including the “AMI-1” comment re: ASA allergy. Click on “Allergies” under “Patient Details” and show Aspirin listing
© 2011 Microsoft Corporation. All rights reserved.
I can also see that for the AMI-3 measure (ACEI or ARB for pts with LVSD), the patient has LVSD and was prescribed an ARB on discharge.
Click on “Aspirin” under “Quality Highlights” and point out note re: Aspirin allergy
Click on “Quality Measures Data” to display that dialog Click on AMI-3 on the grid to show data for that measure.
I can add to any of the comments already made on the Quality Measures Data dialog as well, if I have anything to add. Click on “LVF Assessment” under “Quality Highlights” to show documentation of LVSD.
© 2011 Microsoft Corporation. All rights reserved.
Click on “Discharge Meds” under “Quality Highlights” and scroll down to show Losartan under discharge meds.
Once I’m satisfied that the data on this patient is accurate, I can easily mark the patient as done and move on to the next one. It’s taken me 1-2 minutes to abstract this patient-A task that might have taken up to an hour without a tool like Amalga that brings all the data together in one place, helps find the information hidden in free-text data, and helps ensure that the data is captured all the way through the patient’s care experience. Once the abstraction process is complete, the data needs to be transported to CMS. This functionality is not included within Amalga IPQMA. However, the data can be manually entered into a quality measures-submission tool, or if the hospital’s quality measures-submission tool is capable of accepting inbound data feeds, Amalga may be able to transfer data to that tool for submission to CMS. Ask your Microsoft Amalga sales representative for more information.
Click “x” in the upper right to close the details dialog and return to the grid. Highlight the row for Hilton, Sussana, and right-click on the “Abstractor Review” column and select “Completed”
Demo video time stamp 9:59
© 2011 Microsoft Corporation. All rights reserved.
This concludes the IPQMA Abstracting demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2011 Microsoft Corporation. All rights reserved.
© 2011 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Quality Measures Manager - AMI Abstracting For IHI 2010 Conference Microsoft Corporation Published: November 2010
Summary This demo script will walk you through the AMI Abstracting workflow for the Amalga Quality Measures Manager Solution.
Table of Contents 1 2
3
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 4 2.1 Start Demo Laptop and log in ............................................................................................. 4 2.2 Log in to Amalga ................................................................................................................. 4 Demonstration Steps .............................................................................................................................. 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected]
© 2010 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Ability to support time-sensitive interventions and workflows across the healthcare organization that help ensure optimal adherence to quality standards, documentation and reporting of accurate data with quality measures.
Demo Scenario:
Quality Measures Manager-Abstracting
Questions to tailor demonstration to audience pain / requirements?
How do you manage CMS-mandated quality measures, like those for acute Myocardial Infarction? Would it be beneficial for you to be able to manage the work of abstracting (i.e. ensuring all necessary data has been collected) in a semi-automated manner, in a fraction of the time, and with better accuracy?
Demo Introduction / Story:
With the advent of publicly available performance scorecards and changes in reimbursement policies, the need for better quality measurement tools is one of the most pressing concerns facing hospitals today. Every year the number of regulated hospital quality measures increases. This imposes additional complications to an already burdensome process for reviewing and abstracting disparate core measure data. CMS mentioned in a recent payment regulation that the number of hospital quality measures could exceed 90 by 2013. (Source: CMS IPPS final rule Aug 2010) Furthermore, it is an ongoing struggle to continually track core measure data elements to respond to compliance issues with patients admitted in the hospital or in the emergency department. The Quality Measures Manager (QMM) solution is a single application built on the Amalga data aggregation platform that helps to monitor hospital compliance with CMS Hospital Quality Measures on an ongoing and near real time basis. It aggregates enterprise-wide clinical, quality and administrative data to identify performance gaps as data is collected, empowering hospital staff to measure, and respond to quality issues more rapidly.
© 2010 Microsoft Corporation. All rights reserved.
Role(s):
Chief Quality Officer, CNO, CMO, nurses, physicians, Quality Data Abstractors
Processes:
HSG Customers who have implemented similar scenario:
Automated identification of patients who may have gaps in care, and facilitated guided review of relevant data elements QMM includes self-service, role-based dynamic work lists (custom user views) of ALL inpatients to whom CMS quality measures may apply This abstraction phase of the QMM workflow targets the task of ensuring that all quality measures data is collected completely and accurately for patients with AMI.
Examples of HSG customers who have done something similar -Moses Cone Health System
QMM Workflow Overview:
Life-Cycle of a Quality Measure Review and Documentation Guided Abstraction
Guided Abstraction Guided Abstraction
Automated
Automated Automated
ADM
Automated
Inpatient Care and Documentation
D/C
Near Real-time Analysis Patient Admission
Inpatient Concurrent Review
Retrospective Analysis
Persona = Quality Care-coordinator, Unit Nurse
Persona = Quality Care-coordinator, Unit Nurse
• • • •
•
Manage List of Patients who likely to have a condition Track measures that are time-sensitive to admission Track actions that user took and documented Deep dive into the Patient’s complete chart
Guided Data Abstraction & Final Review
Discharge Planning Documentation
• •
Manage *List of Patients* who are likely to have a specific condition and are about to be discharged Track time sensitive actions before and related to D/C Guided Abstraction for clinical verification
© 2010 Microsoft Corporation. All rights reserved.
Persona = Case Mgr Data Abstractor • •
List of Patients who are have a specific condition and are in the sample population for abstraction Abstract chart for each measure as per CMS specification
2 Demo Setup In section 2, we start the demo laptop and log in to start the demonstration. In section 3, we log into Amalga to start the demonstration. The actual demo starts at section 4.
2.1 Start Demo Laptop and log in In this section, we start the demo laptop and log in to start the demonstration. Talking Points Click Steps Screen Shots
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials Click
2.1
Log in to Amalga
Talking Points
Click Steps
Double-click on the QMM Amalga – Console located on the desktop in the Quality Measures Manager section
Enter the provided Amalga login credentials: az-qmm and Password: passw0rd!
Click Login
Log into Microsoft Amalga QMM Console (and refresh the QMM database if not updated within the last 24 hours)
Screen Shots
3 Demonstration Steps In this section, we demonstrate how to view culture results and establish a patient’s isolation status Talking Points
QMM supports three main workflows, each with a separate and complementary purpose: “Concurrent review”, in which patients with a particular condition is reviewed to ensure that key quality-
© 2010 Microsoft Corporation. All rights reserved.
Click Steps
Screenshots
related tasks are addressed in their care. “Discharge review”, in which a patient that is about to be or has recently been discharged is reviewed to ensure that key quality-related tasks are addressed. “Abstracting”, in which a user ensures that all qualityrelated data is captured correctly in the patient record. This demo will cover “Abstracting”, which is the process whereby hospital personnel ensure that all the data elements required for calculation of quality measures are completely and accurately reflected in the system. This process occurs post-discharge, usually after all the documentation and coding of the patient’s record for claims submission has been completed. The user is an abstractor (a hospital employee, usually with a clinical background) responsible for abstracting charts for quality measures including AMI. When performed completely by hand, this is a highly laborious process, since there are a large number of data elements, and the without the aid of a tool like Amalga, many of them are hard to find. For instance, under the CMS measures specifications, a patient is considered to have left ventricular systolic dysfunction (LVSD) if they have a measured left ventricular ejection fraction (LVEF) < 40%, or an observation of “moderately-to-severely” impaired left ventricular function. The latter observation might be buried in a free-text document such as an echocardiogram report. This often leads to a “needle-in-a-haystack” process © 2010 Microsoft Corporation. All rights reserved.
of searching for information. This demo addresses six of the standard CMS quality measures around AMI. I am going to display my “Abstractor” view for AMI patients. This shows me patients who have been discharged in a recent month.
Change user view to “AMI (Abstractor List)”
Note the “Sample” column-This indicates whether the patient is in my “sample” population that I’ll be abstracting on. I am not required to perform “abstracting” on every single patient, just a representative subset. However, as seen in the “Concurrent Review” and “Discharge Review” demos, Amalga helps ensure proper care and data capture for all patients with AMI. The columns “AMI 1”, “AMI 2”, etc. show the patient’s status with the corresponding AMIrelated quality measures.
Demo video time stamp 5:15
The “Abstractor Review” column shows me the patients for whom the abstraction process has been completed. My first patient on the list whose abstraction process has not been completed is Sussana Hilton.
Hover over “Comments” column for Hilton, Sussana
I can see in the “Comments” field that it has been noted that she has allergies to aspirin and ACE inhibitors, has LVSD, and . This was noted during her “Concurrent Review” and “Discharge Review” processes.
© 2010 Microsoft Corporation. All rights reserved.
Demo video time stamp 7:41
It looks like this patient has either passed or is excluded from all the AMI measures. As an abstractor, I may want to take a closer look to make sure everything was documented properly, in accordance with the CMS measures specifications.
Double-click on the row for Hilton, Sussana to display the “Quality Measures Data” dialog
Demo video time stamp 8:16 For instance, I can confirm that this patient really does have an allergy to aspirin rendering her “excluded” from the AMI-1 quality measure.
I can also see that for the AMI-3 measure (ACEI or ARB for pts with LVSD), the patient has LVSD and was prescribed an ARB on discharge. I can add to any of the comments already made on the Quality Measures Data dialog as well, if I have anything to add.
Once I’m satisfied that the data on this patient is accurate, I can easily mark the patient as done and move on to the next one. It’s taken me 1-2 minutes to abstract this patient-A task that might have taken up to an hour without a tool like Amalga that brings all the data together in one place, helps find the information hidden in free-text data, and helps ensure that the data is captured all the way through the
Point out data elements completed for AMI-1 including the “AMI-1” comment re: ASA allergy. Click on “Allergies” under “Patient Details” and show Aspirin listing Click on “Aspirin” under “Quality Highlights” and point out note re: Aspirin allergy
Click on “Quality Measures Data” to display that dialog Click on AMI-3 on the grid to show data for that measure. Click on “LVF Assessment” under “Quality Highlights” to show documentation of LVSD. Click on “Discharge Meds” under “Quality Highlights” and scroll down to show Losartan under discharge meds. Click “x” in the upper right to close the details dialog and return to the grid. Highlight the row for Hilton, Sussana, and right-click on the “Abstractor Review” column and select “Completed”
© 2010 Microsoft Corporation. All rights reserved.
Demo video time stamp 9:59
patient’s care experience. Once the abstraction process is complete, the data needs to be transported to CMS. This functionality is not included within Amalga QMM. However, the data can be manually entered into a quality measures-submission tool, or if the hospital’s quality measures-submission tool is capable of accepting inbound data feeds, Amalga may be able to transfer data to that tool for submission to CMS. Ask your Microsoft Amalga sales representative for more information.
This concludes the QMM Abstracting demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2010 Microsoft Corporation. All rights reserved.
© 2010 Microsoft Corporation. All rights reserved.
m
Microsoft Amalga HIS
Hospital Information System 2009 Manage all healthcare organisation functions with one integrated solution
Microsoft
®
Amalga
TM
Our vision:
To improve health around the world through software innovation
For more than a decade, Microsoft has invested significant time and resources into understanding the needs of healthcare organisations. We are developing solutions that encompass both the provider and the consumer to help you achieve your goals, from better patient care to improving the financial health of your organisation. We believe the issues that Microsoft is best positioned to address focus on healthcare information management — getting the right information in front of the right people in the right way at the right time. That’s why we’re working to speed up and improve the capture, manipulation, aggregation, and presentation of healthcare information by offering a family of integrated IT systems for the healthcare business or organisation.
The Microsoft® AmalgaTM Family of Enterprise Health Systems is built on Microsoft technology, offering a comprehensive range of solutions to meet the needs of your health business or organisation. Microsoft Amalga Unified Intelligence System 2009 Microsoft Amalga Unified Intelligence System (UIS) 2009 allows healthcare businesses or organisations to unlock the power of all their information sitting in clinical, financial, and administrative databanks. Without replacing current systems, Amalga offers healthcare organisations an innovative way to capture, consolidate, store, access, and quickly present information in meaningful ways. Microsoft Amalga Hospital Information System 2009 Microsoft Amalga Hospital Information System (HIS) 2009 is a state-of-the-art, integrated hospital information system designed to meet the needs of developing and emerging markets. Amalga HIS is built around an integrated Electronic Medical Record (EMR) with complete patient and bed management, laboratory, medication management, radiology management, pathology, financial accounting, stock management, and human resources systems. Connection with Microsoft HealthVaultTM Microsoft is continuously developing new links and ideas to help partners build stronger, more connected organisations. The Microsoft HealthVault platform enables U.S. patients to collect information from healthcare providers and other sources in online personal accounts. HealthVault has the potential to help patients receive better continuity of care, even after they return home.
MICROSOFT AMALGA HIS
2 3
Microsoft
®
Amalga
TM
Microsoft Amalga Hospital Information System 2009 The complete hospital information system INVENTORY MANAGEMENT
HR MANAGEMENT
Microsoft Amalga Hospital Information System (HIS) 2009 delivers a complete, agile hospital information system that is affordable, flexible, and intuitive. Developed collaboratively with physicians, pharmacists, nurses, ancillary staff, and IT professionals, the solution was designed from the beginning to meet the needs of healthcare professionals while minimising the cost and resources required to run global healthcare organisations. Integrated and complete With Amalga HIS, you get a complete hospital information solution that helps you manage your entire healthcare organisation, automating and improving effectiveness for clinical, financial, and back-office operations. Because Amalga HIS was designed from the onset as a single, integrated system, all the components work together without costly interfaces or custom coding. This scalable, integrated HIS system: • Manages all healthcare organisation functions with one affordable, integrated solution. • Helps improve operational efficiency with an intuitive interface, and consistent, reliable information delivery. • Helps improve the quality of care and the patient’s experience by providing clinicians with a single, customisable view of all previous patient information to enable more informed decision making and faster throughput. • Supports paperless, integrated, seamless workflow to help increase information integrity, reduce transcription errors and duplication of information entries, and optimise patient and report turnaround times.
Flexible With Amalga HIS, clinicians and staff can view information in whatever way is most meaningful to them. For instance, lab and test results can be viewed in any of the system’s multiple supported language options. Dynamic translation is available on all generated output, including clinical notes, lab results, and pharmacy labels. Adding information is equally simple with customisable, form-based templates for clinical notes. Multicultural patients often have unique patient care considerations that go beyond language differences. All Amalga HIS
...
...
HUMAN RESOURCES
STOCK
MAKING ROSTERS
PURCHASING
TIME AND ATTENDANCE TRAINING PAYROLL
modules can adapt to many different business scenarios to help users address local business rules, cultural requirements, and individual end user requirements. Affordable Designed to meet the varied needs of all healthcare organisation departments and functions while providing a low cost of ownership, Amalga HIS is built on a single architecture and code base. Amalga HIS runs on standard hardware with an architecture that is designed to be powerful, reliable, and simple to manage and deploy.
ANCILLARY SERVICES
PATIENT MANAGEMENT
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...
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LABORATORY
APPOINTMENT
PATIENT FINANCE
MEDICATION MANAGEMENT
RADT
ACCOUNTS PAYABLE
RADIOLOGY
EMR
ACCOUNTS RECEIVABLE
CLINICAL DOCUMENTATION
GENERAL LEDGER
CPOE
FIXED ASSETS
Intuitive
RECORD MANAGEMENT
The easy-to-use and familiar Microsoft Windows® interface in Amalga HIS is designed to reduce the user learning curve and minimise training costs. In fact, most users can start using the system with one hour of training. Because control keys and functions are common throughout the entire system, users familiar with one set of applications can easily be reassigned to other departments with little or no application training.
FINANCIAL MANAGEMENT
SHARED MODULES
...
...
SCAN MANAGER
SECURITY
PRINT FORMS
SYSTEM ADMINISTRATION
MEDICAL RECORDS
EXTERNAL INTERFACES OLAP
Case Study
“Bumrungrad has outperformed every other listed hospital in the Southeast Asian market since implementing this system. It is a key part of our success.” Mack Banner Chief Executive Officer Bumrungrad International MICROSOFT AMALGA HIS
4 5
Bumrungrad International Hospital Profile: • 554 beds • First hospital in Asia to be accredited by U.S.-based Joint Commission on International Accreditation • More than 1,200,000 patients per year, with over 400,000 foreign patients • 3,000 to 4,000 outpatients a day • 300,000 radiology studies per year
With Amalga HIS, Bumrungrad has achieved outstanding results: • Time to retrieve medical records reduced from 25 minutes to seconds • Patient waiting time reduced by 39 percent from 28 minutes to 17 minutes per patient • Outpatient pharmacy dispensing time reduced by 50 percent from 20 minutes to 10 minutes • Accounts receivable days reduced from 15 to 10 days • Forms stocked reduced from 395,600 average pieces to none • 10,000 square feet (929 square metres) of medical records storage space converted to a revenue-producing pediatric centre
Microsoft Amalga HIS Radiology Management Integrated architecture for a seamless information system Microsoft Amalga HIS Radiology Management is available as a standalone imaging system or a seamlessly integrated component of Microsoft Amalga Hospital Information System (HIS) 2009. Clear winners: Doctors, administrators, and patients Amalga HIS Radiology Management delivers powerful, truly seamless integration between the radiology information system (RIS) and picture archiving and communication system (PACS), with the ability to quickly distribute high-quality data and images to any Microsoft Windows-based workstation by way of the Internet or the existing network of an organisation.
Amalga HIS Radiology Management offers: • Automatic order management that integrates information from the Amalga HIS EMR and RIS. • Automatic scanning and attachment of hard copies to investigation orders. • Image-manipulation tools, including 3-D cursor location. • Multiple language support that provides patient demographic and screen label information in any Unicode language. • Integrated database within Amalga HIS that makes patient medical information accessible directly from the PACS.
Amalga HIS Radiology Management can deliver quick, high-quality information to any department and facilitates easy access to patient medical information as well as order, scheduling, and report information. By giving staff immediate access to the information they need, healthcare organisations can increase patient turnaround time and enhance the patient experience. This tight integration also improves the information integrity between the RIS and PACS, which can reduce transcription errors and duplication of information entry while optimising report turnaround times. The system integrates advanced 3-D and 4-D imaging functionality and includes the ability to add third-party image processing plug-ins to assist with analysis.
• Template-driven options, including report production and voice recognition.
The radiologist workstation is designed to optimise workflow and is customised to match radiologist preferences. In addition, all previous investigations are stored online rather than having a “long-term” archive, improving the delivery of patient care and radiologist efficiency.
• Online historical studies are available for quick retrieval, regardless of the age of the investigation.
MICROSOFT AMALGA HIS
6 7
• Intuitive report editor that accepts written or dictated report production. • Customisable preference tabs for scheduled investigations. • Instant investigation assignment to a specific radiologist at time of ordering. • Warning system that provides real-time notifications to prevent radiologists from creating a report on an investigation that another radiologist is already making a report on.
• Unlimited investigation revisions that save any or all key images, windows-level settings, and image annotations. • CD creation for PACS studies, reports, and EMR. Options include DICOM and JPEG images, reports, and all or selected portions of a patient’s EMR.
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Microsoft Amalga Hospital Information System 2009: the right information at the right time Finally, a highly scalable, intuitive healthcare solution that manages all hospital functions in one affordable, integrated system. Customisable to each user’s needs, Amalga Hospital Information System (HIS) 2009 improves operational efficiency across the organisation, helping lower overall costs and improving provider collaboration and the patient experience.
Learn more about how Amalga HIS can benefit your organisation at www.microsoft.com/amalga © 2009 Microsoft Corporation. All rights reserved. Microsoft, Amalga, the Amalga logo, and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks are property of their respective owners.
Part No. 098-111321
Microsoft Amalga HIS Demo System Q1 FY09 Laboratory Microsoft Corporation Published: September 2008
Summary This demo script will walk you through the laboratory process, as managed by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which multiple patients, doctors, phlebotomists and lab technicians are involved.
Roles and Personas Role Patient1 Patient2 Patient3 Doctor 1 Doctor 2 Phlebotomist 1 Phlebotomist 2 Lab Technician 1
Name Henrik Jensen, Patient1, Outpatient Sylvie Narp, Patient2, Outpatient Lance Tomas, Patient1, Inpatient Rie Sasaki Jacek Maslinski Phlebotomist One Phlebotomist Two LabTechnician One
User Name
doctor1 doctor2 phlebotomist1 phlebotomist2 labTechnician1
Last verified version 5.4 SP6
Table of Contents 1 Demo Scenario ....................................................................................................................................... 3 2 Demo Setup ............................................................................................................................................ 3 2.1 Start Microsoft Virtual PC and Microsoft Amalga HIS......................................................... 4 2.2 Place a Lab order on Patient1, Henrik Jensen ................................................................... 4 2.3 Place a Lab order on Patient2, Sylvie Narp ........................................................................ 7 2.4 Place a Lab order on Patient3, Lance Tomas .................................................................... 8 2.5 Collect, Receive, Store the Specimen and Enter the results ............................................ 10 3 Doctor2 places a Lab order for Patient3, Lance Tomas ....................................................................... 13 4 Phlebotomist1 collects specimen for Patient3, Lance Tomas .............................................................. 18 5 Phlebotomist2 collects specimen for Patient1, Henrik Jensen ............................................................. 21 6 Doctor1 collects the specimen required for Pathology Test ................................................................. 24 7 Laboratory Technician receives the specimens ................................................................................... 26 © 2008 Microsoft Corporation. All rights reserved.
8 9 10 11 12
Lab Technician performs Pathology Test, prepares the Report........................................................... 29 Lab Technician performs Microbiology Test, enters the Results ......................................................... 31 Lab Technician performs Electrolyte Test, enters the Results ............................................................. 37 Doctor1reviews the Lab Results for patient 1, Henrik Jensen and Patient2, Sylvie Narp.................... 39 Doctor2 reviews the Lab Results for patient 3, Lance Tomas.............................................................. 41
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Demo Scenario Henrik Jensen is a 21 year old male who is visiting the Contoso Hospital Outpatient Department (OPD) for a new visit. He is in a reasonably good health condition with the exception of sore throat. He has just visited his physician Dr. Rie Sasaki, who placed a Throat C/S lab order to diagnose his throat condition. Henrik goes to the specimen collection station located on the same floor and is now in the queue. Sylvie Narp is a 47 year old female who is visiting the Contoso Hospital Outpatient Department (OPD) for a cervical cancer diagnosis. She has just visited her physician Dr. Rie Sasaki, who placed a Pap Smear lab order to diagnose her potential cancer condition. Sylvie goes to an examination room located on the same floor where the doctor is going to collect the specimen required for the Pap Smear test. Meanwhile, the condition of Lance Tomas, a 76 year old male, an inpatient patient at the Contoso Hospital Inpatient Department (IPD), has not become better. Dr. Jacek Maslinski, who is monitoring Lance’s condition, placed a CBC order earlier to diagnose his condition. He checks the results to see that the patient’s white blood cell count is very low and would like to now place Electrolyte order to check his liver condition Phlebotomist1 serves 8th floor of the hospital. He monitors newly placed orders and after seeing a few orders placed, he prepares the collection list for 8th floor. He then goes to Lance’s room to collect the specimen required for CBC. Phlebotomist2 is located at the specimen collection station to serve various patients. She calls Henrik to collect the specimen for Throat C/S order. After all the specimens are collected for all the lab orders, a lab technician sitting inside the laboratory on the 4th floor of the building receives the specimens. He then performs Microbiology test on Throat culture, Pathology examination on Sylvie’s specimen, and verifies Electrolyte results performed and entered by laboratory instruments on Lance’s blood specimen. After the results and reports are verified and published by the lab technician, Dr. Sasaki and Dr. Maslinski view the results and complete their patients’ examinations.
2 Demo Setup The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC and open Microsoft Amalga HIS. In section 2.2, Henrik Jensen visits his physician Dr. Rie Sasaki to check his sore throat. Dr. Sasaki places a Throat C/S lab order to diagnose his throat condition. In section 2.3, Sylvie Narp visits her physician Dr. Rie Sasaki for a cervical cancer diagnosis. Dr. Sasaki places a Pap Smear lab order to diagnose her potential cancer condition. In section 2.4, the condition of Lance Tomas, a 76 year old male, an inpatient patient, has not become better. Dr. Jacek Maslinski, who is monitoring Lance’s condition, places a CBC order to diagnose his condition. In section 2.5, the specimen required for the CBC order is collected, received and stored in a rack in the laboratory. The uncorrupted specimen can be used for similar orders placed in the future. Results are also entered for the CBC order. Note: This demo showcases laboratory workflows in both inpatient and outpatient worlds. The sections are ordered in a way that reflects real world scenario in which outpatient and inpatient workflows happen simultaneously. One can demonstrate sections 2, 5, 6, 7, 8, 9 and 11 together that showcase outpatient workflow and sections 2, 3, 4, 7, 10, and 12 together that showcase inpatient workflow.
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Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC and Microsoft Amalga HIS
In this section, we start Virtual PC and open Microsoft Amalga HIS Talking Points Start the Microsoft Virtual PC
Click Steps
Screenshots
Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2
Place a Lab order on Patient1, Henrik Jensen
In this section, Henrik Jensen is visiting his physician Dr. Rie Sasaki to check his sore throat. In this section, Dr. Sasaki places a Throat C/S lab order to diagnose his throat condition. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Set the location of the VPC
Click Select Location Expand Contoso Medical Center Expand Main Building Expand Second Floor Expand Medical Clinic Click OK
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Screenshots
Login to Microsoft Amalga HIS as Doctor1
In User name field, type doctor1 In Password field, type pass@word1 Click
Click on the Clinic application
Click on Clinic > Orders > Create CPOE Order
In the patient search box, type 4731, press Enter
Under the Browser panel, select the Labs tab In the Find: field, type Throat
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Select Throat C/S
In the Detail: Throat C/S panel, select the Collection tab Note: If you don’t see the tab, click > button multiple times until you see the tab
Under CPOE Order Priority, select Routine
Under Collection Priority, select Routine
Click Add
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Under the Active Orders panel, select the new order, click Submit
Unselect Close after print
Click Close
2.3
Place a Lab order on Patient2, Sylvie Narp
In this section, Sylvie Narp is visiting her physician Dr. Rie Sasaki for a cervical cancer diagnosis. In this section, Dr. Sasaki places a Pap Smear lab order to diagnose her potential cancer condition. Talking Points
Click Steps
Continue using Doctor1 session
Continue using the doctor1 instance of Microsoft Amalga HIS
Click on Clinic > Orders > Create CPOE Order
In the patient search box, type 427, press Enter
Under the Browser panel, select the Pathology tab Note: If you don’t see the tab, click > button multiple times until you see the tab Select Pap Smear
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Screenshots
Click Add
Under the Active Orders panel, select the new order, click Submit
Unselect Close after print
Click Close
Close Microsoft Amalga HIS
2.4
Place a Lab order on Patient3, Lance Tomas
Meanwhile, the condition of Lance Tomas, a 76 year old male, an inpatient patient, has not become better. Dr. Jacek Maslinski, who is monitoring Lance’s condition, places a CBC order to diagnose his condition. Talking Points Start Microsoft Amalga HIS
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Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Screenshots
Login to Microsoft Amalga HIS as Doctor2
In User name field, type doctor2 In Password field, type pass@word1 Click
Click on the Ward application
Click on Ward > Orders > Create CPOE Order
In the patient search box, type 300, press Enter
Under the Browser panel, select the Labs tab In the Find: field, type CBC
Click Add
Under the Active Orders panel, select the new order, click Submit
Unselect Close after print
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Click Close
Close Microsoft Amalga HIS
2.5
Collect, Receive, Store the Specimen and Enter the results
In this section, the specimen required for the CBC order is collected, received and stored in a rack in the laboratory. The uncorrupted specimen can be used for similar orders placed in the future. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Login to Microsoft Amalga HIS as Doctor2
In User name field, type labtechnician1 In Password field, type pass@word1 Click
Scroll down and select the Laboratory application
Click on Laboratory > Clinical > Collection by Patient
In the patient search box, type Lance Tomas, press Enter
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Screenshots
Under Specimens To Collect section, select the top row
Select the Collect checkbox
Click Save
Click Laboratory > Specimen Reception > Collection Management
Click Refresh
Click on the Collected tab Note down the specimen number for CBC
Select the specimen, click Edit…
Click on Status History
Under Change to status:, select Lab Received Click Add
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Under Change to status:, select Stored
Click Add
Click OK
Click Close
Click Close
Click on Laboratory > Core Laboratory and Resulting > Result Entry By Specimen
In the Search text: box, type the specimen number, press Enter
Under the order CBC, enter the results for Observed Value column WBC = 3.5 Neutrophil = 55 Lymphocyte = 35 Monocyte = 7 Ecosinphil = 2 Basophil = 1 RBC = 4.5 Hb = 12.5
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MCV = 82 MCH = 29 MCHC = 32 Platelet Count = 250 Leave the other components without entering the results.
For the top row WBC, click in the V column, click Verify button
Click Verify All Resulted button
If prompted, click OK
Click Save Click Close
Close Microsoft Amalga HIS
3 Doctor2 places a Lab order for Patient3, Lance Tomas The condition of Lance Tomas, a 76 year old male, an inpatient patient at the Contoso Hospital Inpatient Department (IPD), has not become better. Dr. Jacek Maslinski, who is monitoring Lance’s condition, placed a CBC order earlier to diagnose his condition. He checks the results to see that the patient’s white
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blood cell count is very low and would like to now place Electrolyte order to check his liver condition. He specifies the priority of the order as STAT to put the request at the top of the queue. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Using the Select Location link at the top, a PC is usually associated with a particular location inside a clinic or a hospital. Examples of those locations are: Reception, Patient Room, Nurse Station, Laboratory, Specimen Collection Station etc.
In User name field type doctor2 In Password field, type pass@word1 Click
Dr. Maslinski is monitoring the th patients on the 8 floor of the hospital and he logs in to Microsoft Amalga HIS. The user is presented with all the list of applications he or she is permitted to use.
Click on the Ward application
The Ward application is primarily used by nurses, doctors and other Inpatient personnel working in a hospital. Dr. Maslinski chooses the Ward application to log in initially. Dr. Maslinski opens the patient chart to view the results.
Click on Ward > General > Patient Chart
Dr. Maslinski selects Lance Tomas patient.
In the patient search box, type Lance Tomas and press Enter
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Screenshots
Talk about various tabs – demographics, overview, history, diagnosis, and appointments etc.
Click on the Review tab
Review tab is primarily used to review the orders placed earlier. Dr. Maslinski selects Review tab. The Review tab is further divided into multiple views – either by caregiver, by category, by date or by visit.
Click on the By Date tab
If a user doesn’t have access to the patient, he or she will not be able to see the results/orders. Dr. Maslinski chooses By Date view. Dr. Maslinski expands the CBC lab results to select the report.
Expand Lab Result and select the report
Dr. Maslinski then reviews the results to make a decision on the health of Lance Tomas.
Scroll down and view the results on the right-hand side
As WBC is very low, he would now like to place Electrolytes order to check the condition of the patient’s liver.
The Create CPOE Order is divided into four panels – Active Orders, Order Information, Browser and Detail Talk about the usage of these panels. Browser panel is used to browse and find an orderable. Detail panel is used to set the properties of an order before it is placed.
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Click on Ward > Orders > Create CPOE Order
While Active Orders panel shows all the orders – procedures and medications placed on a patient, Order Information panel shows the historical order information. Dr. Maslinski opens CPOE Order to place an order for Lance Tomas There are multiple ways of searching for a patient
In the patient search box, type Lance Tomas, press Enter
By scanning a bar code By entering a patient’s name By entering the HN Dr. Maslinski opens the patient information by searching using his name. The Browser panel is divided into several tabs – Labs, Radiology, and Cardiology etc. One can also select All tab to search/browse for any type of order – a procedure or a medication.
Under the Browser panel, select the Labs tab In the Find: field, type Electrolyte Select the first orderable
Dr. Maslinski browses for Electrolyte order. The Detail panel is used to set the properties of an order
In the Detail: Electrolyte panel, select the Location tab
It is also used to associate a particular order to one or more problems of a patient. The panel is further divided into tabs such as General, Location, and Contacts etc. Depending on the type of the order you select, the tabs will vary. Dr. Maslinski selects the Location tab. By default, the location of an inpatient patient will be set to the patient’s bed. One can change it in an outpatient scenario or if one wants to select a different location. Dr. Maslinski makes sure patient’s bed is selected for Lance.
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Make sure Patient’s bed: is selected
Collection tab is used to select priority, timing and also to use an existing stored specimens. Dr. Maslinski selects Collection tab.
The three possible priorities for an order are Routine, STAT and ASAP.
Select the Collection tab Note: If you don’t see the tab, click > button multiple times until you see the tab
Under CPOE Order Priority, select STAT
The collection priority is automatically selected depending on the priority of the order, but one can change that too. Dr. Maslinski selects STAT as the order priority for Electrolyte order. One can select Specimens tab to use an already existing stored specimen.
Select Specimens tab
Talk about Use Specimen checkbox, a unique feature in Amalga HIS.
After clicking Add, an order becomes an active order.
Click Add
Dr. Maslinski clicks Add as he is ready to place the Electrolyte order. This is a great location to present a reminder to a doctor or nurse, whoever is placing the order, to remind of any duplicate orders. Talk about them. A doctor or whoever is placing the orders can wait until he or she is ready to place all the orders together before submitting them.
Under Active Orders section, select the new order, click Submit
Dr. Maslinski submits the Electrolyte order.
Dr. Maslinski clicks OK on the
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Unselect Close after print
confirmation. Dr. Maslinski is done with placing the orders.
Click Close
Close Microsoft Amalga HIS
4 Phlebotomist1 collects specimen for Patient3, Lance Tomas Phlebotomist1 serves 8th floor of the hospital. He monitors newly placed orders and after seeing the STAT order and other orders placed, he prepares the collection list for 8th floor. He then goes to Lance’s room to collect the specimen required for Electrolyte. Talking Points
Click Steps
Start Microsoft Amalga HIS
th
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Phlebotomist1 serves 8 floor of the hospital.
In User name field type phlebotomist1
He logs in to Microsoft Amalga HIS.
In Password field, type pass@word1 Click
Phlebotomist1 chooses the Laboratory application to log in initially.
Click on the Laboratory application
Laboratory application is primarily used by laboratory personnel such as phlebotomists and lab technicians.
Click on Laboratory > Specimen Reception > Collection Management
Collection Management is usually used to monitor the statuses of all the orders placed. The orders are displayed and divided into different tabs. There are a several filters available too. Phlebotomist1 selects Collection
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Screenshots
Management. Click Refresh
One can auto refresh, if interested. Phlebotomist1 refreshes to see the latest orders.
As Phlebotomist1 sees the newly placed STAT order, he is ready to th make another round on 8 floor to collect the specimen.
Click Close
Collection List Generation is used to generate the collection list.
Click on Laboratory > Specimen Reception > Collection List Generation
Phlebotomist1 selects Collection List Generation One can choose any rounds to generate the collection lists
th
Under Rounds, click …
th
Phlebotomist1 selects 8 floor.
Select 8 Floor AM, click OK
Phlebotomist1 refreshes to see the selections.
Click Refresh
Phlebotomist1 then selects the entry.
Select the Selected checkbox
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Details section can be used to print the list.
Click Details
Phlebotomist1 selects Details.
If Phlebotomist1 wants to just take a print out of the collection list, he can do that. If he or she is carrying a mobile computer to collect the specimen, he can simply create the list and view the list view to complete the collection process.
Click Close
Phlebotomist1 closes the Details window. Now, Phlebotomist1 is in the patient room to collect the specimen.
Click on Laboratory > Clinics/Specimen Collection Area > Collection by Patient
Phlebotomist1 selects Collection by Patient to collect the specimen for Lance. Again, Phlebotomist1 can scan the wrist band, use the print out or use the list view on a mobile computer to select the patient.
In the patient search box, type Lance Tomas, press Enter Click OK
Phlebotomist1 selects Lance. One can simply collect the specimen or edit a given specimen properties before collecting the specimen.
Select the Collect checkbox
Phlebotomist1 collects the specimen.
Phlebotomist1 then saves the collection. The entry moves down to indicate that the collection is completed.
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Click Save
Phlebotomist1 closes the collection window.
Click Close
Close Microsoft Amalga HIS
5 Phlebotomist2 collects specimen for Patient1, Henrik Jensen Phlebotomist2 is located at the specimen collection station to serving various patients. She calls Henrik to collect the specimen for Throat C/S order. Click Steps
Talking Points Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Phlebotomist2 is situated at the collection station to serve outpatient patients who need specimen collection.
In User name field type phlebotomist2 In Password field, type pass@word1
She logs in to Microsoft Amalga HIS.
Click
Phlebotomist2 selects the Laboratory application.
Click on the Laboratory application
Collection Station Queue is usually handled by both nurses/receptionists and phlebotomists.
Click on Laboratory > Clinics/Specimen Collection Area > Collection Station Queue
While nurses/receptionists add patients to the queue, phlebotomists complete the actual collection specimen. For the purpose of the demonstration, Phlebotomist2adds the patients herself to the queue
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Screenshots
Phlebotomist2 opens Collection Station Queue Phlebotomist2 selects a work queue.
Under Work queue:, select Venipuncture
One can set up more work queues. As mentioned before a nurse or a receptionist could also add the patient to the queue, instead of a phlebotomist adding the patients.
Next to the patient search box, click …
Phlebotomist2 searches for the patient to add him or her to the queue One can scan a patient too. Phlebotomist2 searches for Henrik and selects him.
Under Search for:, type Henrik Jensen, click Search Select Henrik Jensen, click OK
Phlebotomist2 adds him to the queue.
Click Add To Queue
Once Phlebotomist2 is ready to call, he clicks Ready To call.
Click Ready TO Call
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Phlebotomist2 calls the patient Henrik.
Click Call
Phlebotomist2 then serves the patient.
Click Now Serving
Phlebotomist2 is now collecting the specimen.
Click Collect
Phlebotomist2 completes the collection process for the Throat order.
Select the Collect checkbox
Phlebotomist2 then saves the collection.
Click Save
The entry moves down to indicate that the collection is completed.
Phlebotomist2 closes the collection window.
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Click Close
Phlebotomist2 is done with patient1, Henrik.
Click Completed
Phlebotomist2 clicks Completed to release the patient from the queue.
Phlebotomist2 closes the Collection Station Queue
Click Close
Close Microsoft Amalga HIS
6 Doctor1 collects the specimen required for Pathology Test Dr. Rie Sasaki serves Sylvie in the examination room to collect the specimen required for Pap Smear test. Talking Points Start Microsoft Amalga HIS
Dr. Sasaki has placed the outpatient orders on her patients earlier in the day and is now ready to collect the specimen required for Pap Smear test.
Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type doctor1 In Password field, type pass@word1 Click
She logs in to Microsoft Amalga HIS. Dr. Sasaki selects Laboratory application
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Click on the Laboratory application
Screenshots
Dr. Sasaki launches Pathology Service Request to collect the specimen required for Pap Smear
Click on Laboratory > Pathology > Pathology Service Request
As soon as a pathology order is placed, the service request is automatically added to the list
The outstanding service request is selected automatically. Click Edit…
Dr. Sasaki sees the order and clicks Edit… to collect the specimen.
By clicking Function > Add.., the specimen collection process is marked as complete for a pathology examination.
Click Function > Add…
Dr. Sasaki confirms OK to complete the collection and closes the service request.
Click OK
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Click X button to close
Dr. Sasaki closes the Pathology Examination window.
Click Close
Close Microsoft Amalga HIS
7 Laboratory Technician receives the specimens After all the specimens are collected for all the lab orders, a lab technician sitting inside the laboratory on the 4th floor of the building receives the specimens. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
LabTechnician1 is situated inside the laboratory to receive and perform examinations on various lab orders.
In User name field type labtechnician1 In Password field, type pass@word1
He logs in to Microsoft Amalga HIS.
Click
LabTechnician1 selects Laboratory application.
Scroll down and click on the Laboratory application
Collection Management is usually used to monitor the statuses of all the orders placed. The orders are displayed and divided into different tabs. There are a several filters available too.
Click on Laboratory > Specimen Reception > Collection Management
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Screenshots
LabTechnician1 selects Collection Management. LabTechnician1 has just received the specimens, so he needs to mark those specimens as received.
Click Refresh Select the Collected tab Note the specimen numbers
So, LabTechnician1 uses collected tab to note down the specimen numbers.
In the real world, one would scan the specimen numbers or enter them directly by looking at the specimen tubes or collection containers.
Click Close
Receive Specimen is used to receive the specimens one by one.
Click on Laboratory > Specimen Reception > Receive Specimen
LabTechnician1 opens Receive Specimen. One can auto receive as soon as a specimen is scanned or specimen number entered.
Unselect the auto receive checkbox
For the purpose of demonstration, let us not auto receive the specimens.
LabTechnician1 enters the first specimen.
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In the Search text:, type the first specimen number, press Enter
LabTechnician1 manually marks the specimen as Received by clicking Receive.
Click Receive
LabTechnician1 enters the second specimen.
In the Search text:, type the second specimen number
LabTechnician1 manually marks the specimen as Received by clicking Receive.
Click Receive
LabTechnician1 closes Specimen collection window.
Click Close
As described before, Collection Management is used to manage the collections by statuses.
Click on Laboratory > Specimen Reception > Collection Management
LabTechnician1 refreshes the view to make sure that the specimens are indeed moved to the Received tab.
Click Refresh
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Select the Received tab
LabTechnician1 closes the Collection Management window.
Click Close
Close Microsoft Amalga HIS
8 Lab Technician performs Pathology Test, prepares the Report Lab Technician then conducts the pathology test and prepares the report for the doctor. Talking Points
Click Steps
Continue using LabTechnician1 session
Continue using the labtechnician1 instance of Microsoft Amalga HIS
LabTechnician1 now moves on to perform Pathology examinations.
Click on Laboratory > Pathology > Pathology Examination
In the real world, the collection will be sent to the laboratory where the examination takes place. LabTechnician1 launches Pathology Examination Again, as soon as a pathology service request is completed, the item is added to the examination list. LabTechnician1 clicks Edit… to perform the examination.
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The specimen collected is selected automatically specimen. Click Edit…
Screenshots
One can enter any notes after performing the report and send the report to any chosen personnel.
Under the Pathology Report, type the following: No dysplasia detected
As you see, the report is rich-text based. LabTechnician1 completes the examination and edits the report. The statuses and indicators can also be specified to make the report easy to grasp as soon as it is seen.
Under Status:, select Signed Out
LabTechnician1 then changes the status.
LabTechnician1 then changes the indicator.
Under Indicator:, select Normal
One can save the report as sign out as primary or sign out as final.
Click Save > Sign Out As Final
Unless the report is signed out as final, it won’t appear to a doctor or any other provider. LabTechnician1 chooses sign out as final to save the report. LabTechnician1 closes the Pathology Examination Edit window.
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Click X button to close
LabTechnician1 closes the Pathology Examination window.
Click Close
9 Lab Technician performs Microbiology Test, enters the Results The Lab Technician then performs Microbiology test on the Throat culture, enters the results and prepares the report for the doctor. Talking Points
Click Steps
Continue using LabTechnician1 session
Continue using the labtechnician1 instance of Microsoft Amalga HIS
Collection Management is usually used to monitor the statuses of all the orders placed. The orders are displayed and divided into different tabs. There are a several filters available too.
Click on Laboratory > Specimen Reception > Collection Management
LabTechnician1 selects Collection Management. LabTechnician1 uses received tab to note down the specimen numbers.
Click Refresh
In the real world, one would scan the specimen numbers or enter them directly by looking at the specimen tubes or collection containers.
Note down the specimen number for Throat C/S
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Select the Received tab
Screenshots
Microbiology Result Entry is used to enter the results and prepare the reports related to Microbiology culture examinations.
Click on Laboratory > Microbiology > Microbiology Result Entry
LabTechnician1 selects Microbiology Result Entry. One can type the accession number of the specimen number to start entering the results.
In the Accession number search box, type the specimen number, press Enter
LabTechnician1 uses specimen number to open the result entry.
Talk about different tabs – Stain, Culture, Isolates and Sensitivity
On the Stain tab, click on Add…
LabTechnician1 works on the Stain tab to add the information about stains he saw.
Select Gram’s Stain (Source Specify), click OK
Under Growth, select Few Gram Positive Cocci in Clusters
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LabTechnician1 then selects the Culture tab to select the culture results seen on Henrik’s culture.
Click on the Culture tab
Now LabTechnician1 waits for further results for 24 hours. For the purpose of demonstration, let us say enter the results now only.
Click on the Isolates tab
Select Growth of positive cocci in chain, Identification and Susceptibility test to follow
Click Add
Under Organism, click down arrow
Search for Beta, select BetaSteptotococcus Group B, click OK
Under colony count, select Colony Count >10^5 cfu/ml
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LabTechnician1 then selects the Sensitivity tab to further enter his findings about various antibiotics and their sensitivity on the culture.
Click on the Sensitivity tab
LabTechnician1 continues to add antibiotic results.
Click Add…
Click Add MIC Results
Select Chloramphenicol, click OK Under Interpretation, select R
LabTechnician1 continues to add antibiotic results.
Click Add… Select Tetracycline, click OK Under Interpretation, select S
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LabTechnician1 continues to add antibiotic results.
Click Add… Select Erythromycin, click OK Under Interpretation, select S
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LabTechnician1 completes adding antibiotic results.
Click Add… Select Vancomycin, click OK Under Interpretation, select R
Talk about the report templates. LabTechnician1 keeps the default template and edits the report for the doctor.
In the report below, scroll down and add the following text: Beta-Steptotococcus Group B. Chloramphenicol – Resistant Tetracycline - Sensitive Erythromycin – Sensitive Vancomycin – Resistant
LabTechnician1 then changes the indicator.
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Under Indicator:, select Requires Attention
One can save the report as publish as preliminary or publish as final.
Click Save > Publish As Final
Unless the report is published as final, it won’t appear to a doctor or any other provider. LabTechnician1 chooses Publish As Final to save the report. Click Close
10 Lab Technician performs Electrolyte Test, enters the Results The Lab Technician then verifies Electrolyte results performed and entered by the laboratory instruments on Lance’s blood specimen. Talking Points
Click Steps
Continue using LabTechnician1 session to move on to complete Electrolyte test.
Continue using the labtechnician1 instance of Microsoft Amalga HIS
LabTechnician1 selects Collection Management.
Click on Laboratory > Specimen Reception > Collection Management
LabTechnician1 uses received tab to note down the specimen numbers.
Click Refresh
In the real world, one would scan the specimen numbers or enter them directly by looking at the specimen tubes or collection containers.
Note down the specimen number for Electrolyte
Result Entry by Specimen is used to enter the results
Click on Laboratory > Core Laboratory and Resulting > Result Entry By Specimen
Result Entry is usually performed automatically by laboratory instruments that perform the tests such as CBC and Electrolyte. Then a lab technician can verify the results. Result Entry can also be
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Select the Received tab
Screenshots
performed manually. LabTechnician1 selects the Electrolyte specimen for Lance Tomas.
In the Search text: box, type the specimen number, press Enter
For the purpose of demonstration, LabTechnician1enters the results manually.
Under the order Electrolyte, enter the results for Observed Value column Sodium (Blood) = 150 Potasium (Blood) = 5 Chloride (Blood) = 60 Bicarbonate = 30
LabTechnician1 verifies the top row – Sodium component result entry.
For the top row Sodium (Blood), click in the V column, click Verify button
LabTechnician1 then verifies all the resulted.
Click Verify All Resulted button
LabTechnician1 then saves the result entry.
Click Save
LabTechnician1 closes the Result Entry for the specimen window.
Click Close
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LabTechnician1 closes the Result Entry window.
Click Close
Close Microsoft Amalga HIS
11 Doctor1reviews the Lab Results for patient 1, Henrik Jensen and Patient2, Sylvie Narp After the results and reports are verified and published by the lab technician, Dr. Sasaki views the results and completes her patients’ examinations. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Dr. Sasaki has placed the outpatient orders on her patients earlier in the day and is now ready to check the results.
In User name field type doctor1
She logs in to Microsoft Amalga HIS.
Click
The Clinic application is primarily used by nurses, doctors and other outpatient personnel working in a clinic.
Click on the Clinic application
In Password field, type pass@word1
Dr. Sasaki chooses the Clinic application to log in initially. Dr. Sasaki opens the patient chart to view the results for Sylvie.
Click on Clinic > General > Patient Chart
Dr. Sasaki selects Sylvie Narp patient.
In the patient search box, type Sylvie and press Enter
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Screenshots
Talk about various tabs – demographics, overview, history, diagnosis, and appointments etc.
Click on the Review tab
Review tab is primarily used to review the orders placed earlier. Dr. Sasaki selects Review tab. The Review tab is further divided into multiple views – either by caregiver, by category, by date or by visit.
Click on the By Date tab
If a user doesn’t have access to the patient, he or she will not be able to see the results/orders. Dr. Sasaki chooses By Date view. Dr. Sasaki expands and selects the Cytopathology report.
Expand the top Cytopathology Report, and select the report
Dr. Sasaki then reviews the report to make a decision on the health of Sylvie Narp.
Scroll down and view the report
Dr. Sasaki selects Henrik Jensen patient.
In the patient search box, type Henrik and press Enter Note: You will be continuing to see the By Date tab under the Review tab
Dr. Sasaki chooses By Date view.
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Click on the By Date tab
Dr. Sasaki expands and selects the Throat Microbiology report.
Expand the top Lab Result, and select the report
Dr. Sasaki then reviews the report to make a decision on the health of Henrik Jensen.
Scroll down and view the report
Dr. Sasaki closes the patient chart.
Click Close
Close Microsoft Amalga HIS
12 Doctor2 reviews the Lab Results for patient 3, Lance Tomas After the results and reports are verified and published by the lab technician, Dr. Maslinski views the Electrolyte order results and completes his patient’s examination. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Dr. Maslinski is monitoring the patients in the hospital. He placed an Electrolyte order earlier on patient Lance Tomas and is ready to check the results now.
In User name field type doctor2
He logs in to Microsoft Amalga HIS.
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In Password field, type pass@word1 Click
Screenshots
Dr. Maslinski chooses the Ward application to log in initially.
Click on the Ward application
Dr. Maslinski opens the patient chart to view the results.
Click on Ward > General > Patient Chart
Dr. Maslinski selects Lance Tomas patient.
In the patient search box, type Lance Tomas and press Enter
Talk about various tabs – demographics, overview, history, diagnosis, and appointments etc.
Click on the Review tab
Review tab is primarily used to review the orders placed earlier. Dr. Maslinski selects Review tab. The Review tab is further divided into multiple views – either by caregiver, by category, by date or by visit.
Click on the By Date tab
If a user doesn’t have access to the patient, he or she will not be able to see the results/orders. Dr. Maslinski chooses By Date view. Dr. Maslinski expands the Electrolyte lab results to select the report.
Expand Lab Result and select the latest report
Dr. Maslinski then reviews the results to make a decision on the health of Lance Tomas.
Scroll down and view the results on the right-hand side
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Dr. Maslinski closes the patient chart.
Click Close
Close Microsoft Amalga HIS
This concludes the Laboratory demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
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Final Report Agency for Healthcare Research and Quality Grant Program in Health Information Technology TRANSFORMING HEALTHCARE QUALITY THROUGH INFORMATION TECHNOLOGY Title of Project:
Metro DC Health Information Exchange (MeDHIX): Strategies for Successful Planning and Implementation of HIE Solutions in Safety Net Clinic Communities
Principal Investigator and Team Members: Thomas L. Lewis, M.D., Principal Investigator Leta Kajut, RN, BSN, MHA Project Director Charity Dorazio, BA, MA, Clinical Information Systems Director Guy Fisher, BSEE, Project Consultant for Use Case and Workflow Design Michelle Markey, Focus Group Leader and Analyst Maria-Rosa Watson, DDS, MS, DrPH, Epidemiologist/ Research Director Erin Grace, MHA, formerly Sr. Vice President, PCC Organization:
Primary Care Coalition of Montgomery County, MD 8757 Georgia Ave, 10th Floor Silver Spring, MD 20910
Inclusive Dates of Project: 9/30/2005 – 9/29/2009 Federal Project Officer: Teresa Zayas Cabán, PhD, Senior Manager, Health IT (Project Officer) Acknowledgment of Agency Support: This work received significant financial support and guidance from the Agency for Healthcare Research and Quality, its Project Officer, and staff, without whom this work could not have accomplished. AHRQ Grant Award Number: 1 UC1 HSO16130-01
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
Structured Abstract Purpose: The goal of the project is to improve medical care, particularly transitions among providers, for medically underserved populations through implementation of a multi-jurisdictional health information exchange (HIE) linking safety-net clinics, hospital emergency departments, and specialists. Scope: Safety net providers (EHR users/non-users), patients, hospitals, local government, and community organizations focused on the underserved and health disparities. Methods: Initial evaluative information used interviews and group discussions to document perceived benefits, barriers, willingness to participate, current EHR use, and desired HIE content and features. Focus groups of underserved individuals elicited opinions on risks and benefits of HIE. Provider feedback on actual HIE utility was planned post implementation. A model was designed to measure cost and sustainability from potential reductions in ED visits using medical homes and open source HIE. Results: The open source HIE links data from 14 safety-net clinics; 40 care sites; 3 jurisdictions, (110,000 patients/560,000 clinic visits), incorporating differing privacy and confidentiality standards. Only minimal deployment was achieved by the end of year 4, adversely affecting the HIE evaluation. Factors included legal concerns, shifting hospital priorities, and dwindling support for a regional approach, favoring local initiatives as more funding became available. Key words: safety-net; open source, Health Information Exchange, eChart, photo ID, multijurisdictional
1.0 Purpose The goal of the Metro DC Health Information Exchange (MeDHIX) project is to improve medical care, particularly transitions among providers, for medically underserved populations in three jurisdictions (the District of Columbia; Montgomery County, Maryland; and Northern Virginia) through the implementation of a safety net focused, multi-jurisdictional regional health information exchange (HIE). Aim 1: Implement a sustainable health information exchange linking the electronic health record systems of the region’s safety net clinics with mainstream healthcare providers to improve patient care quality, safety, and efficiency for the region’s most vulnerable populations, focused on the specific and unique needs of the uninsured population and safety net environment. Aim 2: Work with safety net clinic providers, hospital emergency departments, and specialists that are a major source of care for safety net patients to identify specific data, applications, and use cases that are of the most benefit to them. Aim 3: Broadly involve health care organizations, community groups, philanthropies, and governments across the region, focusing on education and outreach about the benefits, risks, opportunities, priorities, implementation strategies, national successes and failures, and the potential for HIE to help bring better, more cost effective healthcare to their constituencies. Aim 4: Engage ethnically, racially, and economically disadvantaged individuals and their representative organizations to better understand the factors that inhibit or promote their acceptance of HIE and the steps that must be taken to maximize trust, acceptance, and mutual benefits. Page 2 of 19
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
Aim 5: Assist safety net clinics in the implementation, enhancement, and use of EHRs, as a prerequisite for achieving signficant HIE benefits. Aim 6: Reduce unnecessary visits to hospital emergency departments. Aim 7: Provide data for public health planning, epidemiological surveillance and targeting of services to the low income uninsured.
2.0 Scope 2.1 Background This study focused on HIE, EHRs, and safety net providers for several reasons. Organizations in the DC metropolitan area representing the specific interests of the uninsured population believed that a single “Community of Interest” should be formed across the region, as: (1) the population is mobile across jurisdictions, warranting a regional view of health care for the uninsured; (2) individual safetynet providers and political jurisdictions face similar challenges; (3) funding from foundations and all levels of government is limited and must be maximally leveraged; and (4) the uninsured population and the safety-net clinic environments have significant differences from the insured, warranting a focus on the uninsured for a regional health information exchange. Of particular interest are differing privacy and confidentially laws and regulations, differing priorities and funding for health care for low-income, uninsured populations, differing philosophies, and differing views on the benefits and potential for regional collaboration versus independent projects. These differences are particularly interesting in light of a highly mobile and diverse indigent population that seeks health care across the region regardless of political or jurisdictional boundaries. For example, the D.C. Health Alliance, the city’s safety net program for low-income uninsured patients provides comprehensive primary care benefits through multiple providers. The Montgomery County model is quite different. Among the wealthiest counties in the nation, it is also the most ethnically diverse county in Maryland with a low income uninsured population in excess of 100,000 people (~10% of the population). 1,2,3 The Montgomery Cares program provides primary health care to medically uninsured, low-income adult residents of Montgomery County. This program is funded in part by Montgomery County and administered by the Primary Care Coalition (PCC) to help support the network of independent nonprofit clinics known as the Community HealthLink Clinics. These clinics are staffed by medical professionals, and are operated by their own staffs, boards, and traditions. Safety net clinics can deliver excellent primary care, but are dependent on outside resources for specialty consultations, emergency care, and hospitalization. The PCC, through its program administration role and participation in regional activities, recognized the potential benefits of an HIE that could connect safety net clinic patients to mainstream health care providers regionally and assembled a coalition of community organizations to bring the benefits of HIE to underserved individuals and their providers. 1
http://raceandhealth.hhs.gov/templates/content.aspx?ID=4949&lvl=2&lvlID=113 http://en.wikipedia.org/wiki/Montgomery_County,_Maryland 3 http://www.montgomerycountymd.gov/rectmpl.asp?url=/content/rec/gccd/index.asp Page 3 of 19 2
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
At the time this project began, there was little exposure to EHRs and virtually none to HIE in this region. Even by 2009, EHR adoption in Montgomery County for all providers was less than 19% (Dr. David Sharp, Maryland Health Care Commission). The organizational focus was to involve as many health care related organizations and interested parties as possible. For these participants, education about the benefits, risks, opportunities, priorities, implementation strategies, national successes and failures, and the potential for HIE to help bring better, more cost effective health to their constituencies were critical success factors in building support for the MeDHIX safety net oriented HIE project. Earlier work focused on implementing EHRs in non-Federally Qualified Health Center (FQHC) safety net clinics found that low acquisition and operational cost and ease of use were essential ingredients for successful adoption and use, as the free clinics in Montgomery County are far more constrained financially and technically than FQHCs. Commercial EHRs were simply not affordable. Given the costs of commercial EHRs, the clinics would invariably choose to spend their resources on direct patient care, precluding the benefits of EHRs and HIE. The evolutionary solution for the free clinics was the successful implementation of a modular, web based, open source solution (CHLCare) that provided basic capabilities with the ability to add features of particular importance to free clinics. This system is now used by 14 clinics across the region, has brought tangible benefits, built a substantial database for HIE sharing, and helped them envision the benefits of more comprehensive EHRs in the future. Building a sustainable safety net HIE involves the same considerations of low operational cost, ease of use, and flexibility for growth. As such, an evaluation of open source alternatives was an integral component of the MeDHIX HIE research project. This research was performed at free clinics, FQHC safety net providers, hospitals, local governments, and community organizations in the Washington, D.C. metropolitan area, including participating organizations in Montgomery County, MD, Washington, D.C., Northern Virginia, and Prince Georges County, MD. 2.2 Settings In year one, the primary focus of this project was the Washington Hospital Center and safety net clinics in Washington, D.C. In years 2, 3, and 4 the primary focus was on eight safety net clinics and five community hospitals in Montgomery County, MD, and one safety net clinic in Washington, D.C. For the Montgomery County clinics, annual patient volume grew from 8,521 patients (26,055 encounters) in 2005 to 21,077 (56,597) by 2009. The free clinics constitute an especially important group as they are the most financially and technology constrained class of providers, falling well below the Federally Qualified Health Centers in terms of resources and support. In one of the jurisdictions (Montgomery County), free clinics are the predominant source of medical care, as federal regulations inhibit the formation of FQHCs. 2.3 Project Participants Five categories of organizations participated in the MeDHIX HIE research and implementation project, with differing responsibilities and perspectives on the challenges of providing care for low income, uninsured diverse populations. These categories of organizations include the following and are further described below: Page 4 of 19
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
1. 2. 3. 4. 5.
Systems Integrators and Advocacy Organizations Primary Care Providers Hospitals Safety Net Clinics Local and State Governments, Philanthropic, and Community Advocacy Organizations
1. Systems Integrators and Advocacy Organizations: The Primary Care Coalition of Montgomery County (PCC) is a private, non-profit, charitable organization working with public/private partners to provide high-quality, accessible, equitable, efficient, and outcome-driven health care services for low-income, uninsured county residents. In January, 2000, Montgomery County asked PCC to develop a system of care for low income uninsured and underinsured county residents. This program has grown from 4 clinics serving two thousand people to 12 clinic organizations seeing over 21, 000 patients (56,000 visits) annually. The PCC was the AHRQ grant recipient and overall project coordinator. The District of Columbia Primary Care Association (DCPCA) works with primary care clinics and the DC Department of Health to facilitate the development and sustainability of an effective integrated health care system in the District of Columbia with a goal of guaranteeing access to primary health care. The main focus of DCPCA was helping a pilot group of DC safety net clinics adopt EHRs in preparation for HIE and promoting HIE activities in DC. The Regional Primary Care Coalition (RPCC) is an active collaboration of existing and emerging coalitions of primary care providers and health philanthropies serving the region’s low income residents in Washington, D.C., Northern Virginia, and Suburban Maryland. Their focus is advancing health equity, improving the health status of the region’s residents, and fostering the creation of coordinated, patient-centered systems of community-based primary care that make excellent, affordable, linguistically and culturally appropriate health services available to all across the region. Member organizations are located in Washington, D.C., Montgomery and Prince Georges counties in Maryland, and Arlington, Fairfax, Prince William, and Loudoun counties and the city of Alexandria in Virginia. Their role was to bring disparate groups together to share ideas and accomplishments. 2. Primary Care Providers: Primary care providers in Montgomery County included the pan Asian Volunteer Health Clinic, Community Clinics, Inc., Holy Cross Hospital Health Center, Mary’s Center, Mercy Health Center, Mobile Medical Care, Muslim Community Center Clinic, Proyecto Salud, Spanish Catholic Center, People’s Community Wellness Center, and Under One Roof. District of Columbia clinics included Bread for the City; Family and Medical Counseling Service, Inc.; La Clínica del Pueblo; Mary’s Center for Maternal and Child Care; SOME (So Others Might Eat); and Whitman-Walker Clinic. Virginia clinics included Arlington Free Clinic and Jeanie Schmidt Free Clinic. 3. Hospitals: Six area hospitals participated actively in the project: Washington Hospital Center in DC, a major tertiary care teaching hospital, and five community hospitals located in Montgomery County: Holy Cross Hospital, Montgomery General Hospital, Shady Grove Adventist Hospital, Suburban Hospital, and Washington Adventist Hospital. 4. Safety Net Clinic Patients: The patient population included in the study is low income, uninsured or underinsured, ethnically and racially diverse. 5. Local and State Governments, Philanthropic, and Community Advocacy Organizations: Numerous organizations are involved in health care at the community level. Given their limited knowledge of EHRs and HIE at the start of this project, community outreach and education were integral to our Page 5 of 19
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
work. For these participants, education about the benefits, risks, opportunities, priorities, implementation strategies, national successes and failures, and the potential for HIE to help bring better, more cost effective health to their constituencies were critical success factors in building support for the MeDHIX safety net oriented HIE project. Figure 1 illustrates only a subset of the entities that were part of the HIE communication and assessment activity: those involved in health care for low income uninsured patients in Montgomery County alone. Surrounding jurisdictions have still more. We worked with a substantial number, though not all, of the organization shown in Figure 1, as well as those in other jurisdictions, with differing degrees of intensity. Safety Net System Strategic Growth Plan
Maryland Health Care Commission
African American Health Program
Montgomery County Health & Human Ser. Dept
Medical Society
Latino Health Initiative
Community HealthLink
Care for Kids
CCACC
Core Services • Primary Care • Preventive Care
Foundations
Integrate d Referral System
Dental
Mental Health Social Service Organizations
Kaiser Permanente Comm. Pharmacy/Medbank
Safety Net Provider System •Patient Care •Enrollment •Eligibility
Health Care for the Homeless
Senior Health Ins. Assistance
City/County/State Governments
Hospitals •Inpt •ER •Labs •X-ray •Educ •Other HIV / AIDS
Specialty Care Project Access AHCN, NIH
Women’s Health
Cancer Crusade
Gaithersburg Senior Center
Health Promotion Public Schools
Behavioral Health
Health Insurers CMMC Career Transition Center Rockville Senior Center University Medical Centers
Montgomery Hospice
Emergency Assistance Coalition
2.3 Conceptual Framework The conceptual framework for safety net clinic EHR adoption and effective use is a 3 tier model. The bottom tier is focused on improving the operational and clinical effectiveness of each individual safety net clinic; the middle tier is focused on helping a group of clinics function as an integrated safety net system of care; and the top tier is focused on connecting the safety net system of care to mainstream health care providers and services. At the bottom tier safety net level, project work was considerably more broad-based than simply EHR assessment or adoption. An essential component of our methodology is to train clinic staff in the fundamentals of workflow and process redesign in accordance with models developed by the Institute for Healthcare Improvement. The goals are to develop local clinic skills in process improvement, achieve measurable improvements in productivity and quality, and redesign clinic practices for more effective use of existing and future EHRs. Page 6 of 19
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
At the middle tier, building an effective safety net system of care across multiple clinics, projects focused on sharing ideas, effective processes, and data. One group of 14 safety net clinics already used a shared, web based, open source, safety net clinic oriented basic EHR called CHLCare. Since these clinics were already sharing demographic and clinical data, they could quickly move to shared standards and models for cross-clinic quality improvement metrics, Community Pharmacy formulary; and to share services such as stress testing, diabetes education, and outpatient surgery among members based on special capabilities within a specific clinic. The top tier focused on connecting the shared safety net clinic EHR to community hospital emergency departments. Later, this work was extended to include creating photo ID cards for safety net patients to facilitate patient identify management and HIPAA compliance, an automated electronic link between a commercial laboratory service and the shared CHLCare EHR, remote eligibility verification for safety net patients at community hospitals when patients were referred for specialty care services, and a fax to PDF capability for specialists to use to send consultative reports back to the clinics for incorporation into the HER, or for hospital emergency departments to use to notify clinics that a patient of theirs has been treated.
4.0 Methods This project focused on the practical challenges of building a sustainable, useful safety net oriented HIE. The goal was not to conduct a formal assessment of patient outcomes for providers with HIE access vs. those without, to quantify HIE benefits, or to measure before and after levels of knowledge of health information exchanges by patients, physicians, or community organizations. We had hoped to be able to demonstrate a reduction in ED visits though the use of an HIE connecting safety net clinics and hospital emergency departments. We did develop a quantitative model, but were unable to obtain actual use data by the end of the grant period because of delayed implementation of the HIE. We are currently implementing that program. The sections below describe the methods used by the project team to complete each of the project aims. The methods emphasize building collaborative relationships and focused information gathering closely tied to the themes of provider priorities for data content and access, community education on the benefits, risks, and strategies for effective HIE implementation, and exploration of safety net patient perspectives on the value, fears, and risks that they see in making their data more widely available to those who provide care. 4.1 Aim 1: Implement a sustainable health information exchange linking the electronic health record systems of the region’s safety net clinics with mainstream healthcare providers to improve patient care quality, safety, and efficiency for the region’s most vulnerable populations, focused on the specific needs of the uninsured population and safety net environment. Implementation. The implementation strategy for MeDHIX consisted of three phases: •
•
Leveraging existing technology, Azyxxi, the Washington Hospital Center’s sophisticated data aggregation and display system (now Microsoft Amalga), to rapidly deploy a significant subset of capabilities to provider participants to address the issues of cross-jurisdictional, cross-enterprise health information exchange and help participants understand the value and activities assoicated with HIE deployment in the safety net environment (year 1). Tracking the expected issuance of federal standards, protocols and operating guidelines necessary for Community of Interest HIE's, such as MeDHIX, to interoperate within the Page 7 of 19
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•
evolving regional health information exchange and National Health Information Network environment, adapting phase 1 work for compatibility with those standards (year 2). Refining HIE capabilities as user requirements and technical standards evolved and extending the HIE to additonal regional participants (years 3 and 4).
Open source considerations. Two characteristics of safety net clinics led us to consider open source technology for health information exchange. Safety net clinics, in particular the free clinics that are the predominant providers in one of the jurisdictions, are quite resource poor. For them to participate in HIE and EHRs, costs must be low, with minimal technical and operational complexity, or financial requirement. These organizations also are heavily reliant on volunteers for patient care and support services. Low cost of acquisition, implementation, ongoing operations, customization, and staff training are critical and often determine whether a free clinic can adopt and effectively use an EHR or stays with traditional paper records. Open source platforms more readily lend themselves to local modifications and enhancements to meet unusual needs of safety net clinics, typically not met by commercial systems, in a cost effective fashion. Examples from our own work range from the simple to the quite complex. One clinic has 200 volunteer providers with variable schedules, ranging from once a week to once a quarter. The clinic may not know the names of the providers until the day of the clinic, thus requiring special features in the appointment component of the EHR to make appointments in advance for anonymous providers and then quickly and easily assign patients to the proper providers. A complex example is the creation of a specialty referral management system that is fully integrated with the EHR to provide seamless connectivity among the individuals in the clinics requesting the referrals and two separate charitable community organizations that manage the recruitment and assignment of specialists, make the appointments, and notify the clinics of the match. This system also manages the return of consultative reports to the EHR. Sustainability. Sustainability, a critical factor for project success, was evaluated by reviewing the operational costs, capabilities, flexability, complexity, and support requrirements of the relatively few successful HIEs. Commercial, one-of-a-kind, and open source soltions were reviewed. Exploring the use of open source software to minimize acquisition, implementation, operational, and customization costs was of particular interest given our positive experience with open source safety net EHR solutions. MeDHIX Data Disclosure Legal Considerations. The regulations governing data exchange are especially complex for MeDHIX, as the Community HealthLink consortium has member clinics in Virginia, Maryland and the District of Columbia. Varying state statutes must be evaluated and business processes adapted to address data sharing limitations. To address privacy and data sharing concerns, we engaged a Washington, D.C., law firm that had participated in the Markle Connecting for Health Common Framework project to research and reconcile the laws and regulations of three jurisdictions, with a focus on HIE for vulnerable populations. 4.2 Aim 2: Work with safety net clinic providers, hospital emergency departments, and specialists that are a major source of care for safety net patients to identify specific data, applications, and use cases that are of the most benefit to them. The objective was eliciting information from those who provide care to safety net patients about what data and features would be most useful to them in an HIE. The method was an extensive set of meetings and interviews, both individual and small groups, with safety net clinic staff, community hospital ED staff, and senior ED physicians at Washington Hospital Center representing the views of a tertiary hospital ED. Page 8 of 19
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4.3 Aim 3. Broadly involve health care organizations, community groups, philanthropies, and governments across the region, focusing on education and outreach about the benefits, risks, opportunities, priorities, implementation strategies, national successes and failures, and the potential for HIE to help bring better, more cost effective healthcare to their constituencies. PCC, DCPCA, and RPCC by design are well connected to numerous community organizations focused on health care for disadvanted populations within the DC metropolitan area. Formal and informal sessions, working groups, and individual interviews were used to explore the benefits of HIE regionally, disseminate information about the evolving concepts of HIE, and gain perspectives from a remarkably diverse group of organizations. Surveys were conducted with key stakeholders, primarily in Montgomery County, through an openended survey to assess the level of knowledge, interest, and perceived benefits and risks of HIE. The survey was administered in an interview format by phone or in person to allow participants the opportunity to share more liberally and ask questions if necessary. These participants were primarily partners and collaborators with the PCC, and the various groups interviewed are listed in the section 2.3.5. The rest of the surveys (primarily those from the Montgomery County Medical Society), were completed by participants in written format and sent to them by e-mail. To analyze these surveys, responses were categorized by question and then gleaned for salient themes. Quotations and comments were then grouped by theme and weighted according to how often participants mentioned a particular theme. 4.4 Aim 4: Engage ethnically, racially, and economically disadvantaged individuals and their representative organizations to better understand the factors that inhibit or promote their acceptance of HIE and the steps that must be taken to maximize trust, acceptance, and mutual benefits. Clinic patients participated from two perspectives. The first was through an educational process explaining the benefits and risks of sharing health information, one to one with each patient by staff at each clinic followed by the patient agreeing or not agreeing to share data. The second form of participation involved formal, moderated focus groups. The goal was to elicit detailed information about perceptions, fears, risks, confidentiality concerns, and personal experiences related to access or lack of access to medical data by providers at the time of care and the challenges that patients had in assembling their medical data. 4.5 Aim 5: Assist safety net clinics in the implementation, enhancement, and use of EHRs, as a prerequisite for achieving signficant HIE benefits. Activities included the identification of a pilot group of clinics interested in EHR adoption, a formal acquisition process, staff training, and implementation. Two distinct collaborative projects were undertaken in two different jurisdictions within the region. The goal of the first collaborative project, led by the District of Columbia Primary Care Association, was to accelerate the adoption of EHRs by Washington, D.C. safety net clinics. Phase 1 was an assessment of the “current state” of readiness of the clinics to adopt EHRs. Phase 2 was a detailed requirements analysis, harmonization of needs across the clinics, RFP development, and acquisition. Phase 3 was the selection and implementation of an EHR at six pilot clinics. The second collaborative project was the extension of the CHLCare web based, open source shared EHR to additional safety net clinics in the metro DC region. These clinics tend to be small, unable to acquire or install EHRs, and are part of a network of free clinics proving care to low income, Page 9 of 19
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uninsured individuals. Clinic sponsors include religious organizations, cultural associations, and community groups. Examples include the Arlington Free Clinic in Arlington, VA; the Muslim Community Clinic in Montgomery County; L’Ami Clinic for French speakers, a Pan Asian clinic; and the Jeanie Schmidt Free Clinic in Herndon, VA. 4.6 Aim 6: Reduce unnecessary visits to hospital emergency departments (ED). This section describes the goal and approach of a work in progress, as delayed implementation of the HIE has prevented completion of this task. In fiscal year 2009 ED charges for the five hospitals in Montgomery County exceeded $13 million for “self-pay and charity” patients, most of whom are in the low income, safety net category. Of this total, $5.7 million is in the “avoidable” category based on the Billings 4 algorithn for classifying ED visit as “primary care treatable of preventable conditions”. Communication between safety net clinics and hospital emergency departments is often incomplete and fragmented. The ED often does not know that a safety net patient is receiving care from a specific clinic and the clinic typically does not know on a timely basis that an ED visit has occurred. Lack of communication prevents both parties from instituting appropiate interventions to minimize unnecessary ED visits. We hoped to address deficits in this communication process through the use of the HIE. This collaborative program includes all five Montgomery County hospitals, each paired with one or more of six safety net clinics. The method to achieve this aim is to identify patients eligible for care at one of the safety net clinics at the time of an ED visit, enroll them in an appropriate safety net medical home clinic, and compare pre and post ED utilization using data from the Maryland Health Services Cost Review Commission (http://www.hscrc.state.md.us/). In addition to simple counts of appropriate vs. primary care preventable ED visits, we also plan to compare hospital-clinic pairings and the potential influence of demographic factors such as education level, language, proximity to a clinic, and hours of operation of the medical home clinic. The key elements for this analyis include: • Picture ID card to identify the patient and the patient’s clinic to the ED • ED access to the patient’s demographic and clinical data through the HIE • Timely access for safety net clinic staff to the ED discharge summary • Classification of an ED visit as “primary care treatable or preventable” (Billings algorithm) • ED usage history by patient before bi-directional HIE data sharing • ED usage history by patient after bi-directional HIE data sharing This first three requirements are associated with this project. The remaining three components are part of a complimentary project in collaboration with the Department of Health and Mental Hygiene and the Maryland Health Services Cost Review Commission. 4.7 Aim 7: Provide data for public health planning, epidemiological surveillance and targeting of services to the low income uninsured. Three activities were defined to meet this aim: 1. Show local public health authorities the power of data aggregation and analysis tools for public health using the Washington Hospital Azyxxi system (now Microsoft Amalga). 4
Billings J. Software for Use of the Emergency Department Classification Algorithm. In Tools for Monitoring the Health Care Safety Net. (Ed. R. Weinick, J. Billings; AHRQ Publication No. 03-0027, September 2003. Agency for Healthcare Research and Quality, Rockville, MD.http://www.ahrq.gov/data/safetynet/tools.htm. Page 10 of 19
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2. Understand the priorities of local public health officers with respect to assessing demographic, disease state, and treatment data for safety net populations. 3. Explore the potential for contributing de-identified encounter, diagnostic, and medication data on safety net patients to ESSENCE, the Maryland state bio-surveillance system 5, designed for the early detection of disease outbreaks, suspicious patterns of illness, and public health emergencies. Data from safety net providers is not currently part of ESSENCE and would complement data submitted daily by hospital emergency departments and chain pharmacies.
5.0 Results The primary goal of the MeDHIX project was to create and deploy a multi-jurisdictional regional safety net clinic oriented health information exchange to link safety net clinics to one another and to mainstream providers, with initial emphasis on hospital emergency departments and specialist referrals. We were able to create the MeDHIX HIE to link 14 safety net clinics at 40 care sites across 3 jurisdictions that can be accessed by 5 community hospitals, the Montgomery County Department of Health and Human Services, and medical specialists treating safety net patients, while incorporating differing multi-jurisdictional privacy and confidentiality standards. Deployment on a pilot basis did not begin until the end of year 4. The remainder of this section describes results associated with each of the seven aims. 5.1 Aim 1: Implement a sustainable health information exchange linking the electronic health record systems of the region’s safety net clinics with mainstream healthcare. Year 1. The technical goal for year 1 was to use existing technology, the Washington Hosital Center Azyxxi system (now Microsoft Amalga) data aggregation, display, and analysis system, to demonstrate the feasibility and benefit of exchanging data between Washington Hospital Center and at least one safety net clinic to gain experience and confidence in exchanging medical data without major up front costs or delays. A uni-directional link was established between the Azyxxi system at Washington Hospital Center and Bread for the City, a DC safety net provider. Clinic staff could enter demographic data remotely into Azyxxi’s master patient index/record locator system. When a match was found, that patient’s data was made available to the clinic. This was successfully used to look up diagnostic and treatment data on a patient who had been treated at the Washington Hospital Center but could not remember her diagnosis or how she was treated. The patient matching algorithm for safety net patients uses social security number and home address as important matching factors. Social security number was often not available or reliable and patients moved frequently leading to less certainty than expected. The thick client Azyxxi implementation was complex and expensive to install and support in safety net clinics, in contrast to a web based application that could be integrated without special equipment at low marginal cost. Year 2. Formal National Health Information Network (NHIN) standards were not yet well defined and our technical approach had to be completely rethought when the Azyxxi team left the Washington Hospital Center to become part of Microsoft, changing their focus from a safety net clinic HIE collaboration to the university medical center and large hospital market.
5
For more information see: http://www.marylandfluwatch.org/essence-surveillance and http://bioterrorism.dhmh.state.md.us Page 11 of 19
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We reviewed the small number of operational HIE’s then extant for functionality, applicability to the safety net and community hospital setting, flexibility for enhancement, and costs for implementation and ongoing operations. The Regenstrief work was impressive, but costly and not readily transferable; the Utah Health Information Network was more financially focused; and the Cincinnati Health Bridge work depended on a revenue model that was not realistic for safety net clinics. After reviewing the approach taken by the OpenHRE team as one of the original NHIN participants, we elected to employ a similar open source solution, tailored to safety net clinics and community hospitals to get the project back on track. The latter half of year 2 and the first half of year 3 were devoted to the design, development, and testing of the MeDHIX HIE infrastructure and eChart user application. The MeDHIX open source message exchange architecture and related management functions used emerging standard tools from the open source community. The eChart user views and tools were based on extensive discussions with safety net clinic physicians and staff, hospital ED physicians, senior hospital administrative and IT staff, building on the experience of similar projects. eChart capabilities include: • “eChart” clinical summary viewable from a web browser for ER and specialists based on data from the CHLCare open source shared EHR used by the clinics • Picture ID card creation for safety net clinic patients to meet patient identification and HIPAA requirements for hospital emergency departments and specialists • Quest Laboratories electronic results reporting • Community wide referral management module • Accept faxed reports from specialists and ERs for incorporation into the clinic EHR • Eligibility verification for safety net patients at point of care • Conform to multi-jurisdictional privacy regulations • Embedded privacy and confidentiality requirements in the “eChart” • Ability to print the “eChart” for non-repudiation and workflow convenience • Emergency Department Discharge Summary (when available from hospitals) • Mirth interoperability exchange platform to manage data transfer, connectivity, authentication, audit, and related functions. The eChart employs a three step “keep it simple” philosophy. The eChart does not display medications, labs, and problem lists associated with Mental Health, HIV or Drug Rehab.in the initial eChart view, with an appropriate disclaimer. To balance patient care and confidentiality protections, Step 2 permits a medically authorized user to view protected health information, after obtaining consent from the patient and documenting in MeDHIX that consent has been obtained. Should the patient not be able to give informed consent, Step 3 allows the provider to document that they have complied with the policies of their institution and then view the restricted data Year 3. With the departure of the Azyxxi team and the DCPCA focusing on implementing a common EHR in six pilot clinics in the District of Columbia, we shifted our emphasis to the safety net clinics and community hospitals in Montgomery County and one clinic with branches in both Washington, D.C. and Maryland. Montgomery General Hospital had recently provided space on its campus for a new branch of the Proyecto Salud clinic and was especially interested in using the eChart to access data on their safety net patients, as well as patients from other safety net clinics. A demonstration attended by their Vice President for Medical Affairs, the ED Director, senior nursing staff, and ED personnel was highly positive. The ED Director was pleased at the content, suggested that we should consider adding EKG tracing if the clinics were able to provide them, and observed that “I’ll have easier access to Page 12 of 19
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better data on safety net patients than I do on our insured patients.” We also learned that ED physicians were not always aware of the existence of many of the safety net clinics, with the result that patients are often instructed to return to the ED when they could be referred to an appropriate safety net clinic for follow up and continuing care. The hospital also started the process of approving the data sharing agreements. Year 4. The intent for year 4 was to implement the eChart at all five Montgomery County hospital emergency departments. The reality was quite different and illustrated the importance of shifting priorities in collaborative ventures. We demonstrated the eChart to ED staff at the remaining four hospitals. All were quite positive, with staff confirming our earlier findings that the eChart HIE would not only help them provide better acute care, but improve their safety net clinic referrals and minimize ED “bounce back”. ED staff asked for sign-on codes and training and were eager to start. However, the reality was that implementation was delayed at each hospital, but for different reasons. In one case, it took nearly a year to obtain clearance for shared data access. In another case, the hospital was in the midst of installing a comprehensive hospital information system on a time schedule set by a parent organization. Another was in the evaluation phase for replacing their hospital information system and did not have resources to spare. While discouraging, we used this delay as an opportunity to work with the safety net clinics to help them increase EHR utilization and data entry. We assisted in the opening of two new safety net clinics, increasing the number of patients who could participate in the exchange. Montgomery General registration staff began using the eChart to verify safety net patient eligibility and demographic information. We also implemented the MeDHIX fax capability for specialists to fax consultative reports for inclusion in the EHR. We began a new collaborative program in Year 4 with all 5 Montgomery County hospitals and six safety net clinics. The goal of this program is to identify patients with primary care preventable ED visits, enroll them in a medical home, and compare pre and post ED utilization and the influencing factors. The MeDHIX eChart is an essential component of this project for identifying safety net clinic patients in the ED and communicating with their clinic. Without it, the project could not have gone forward. HIE sustainability. The resource constraints of the safety net world make financial sustainabilityfor an HIE especially challenging. The resources requied for annual operations for MeDHIX are quite modest: • Commercial server hosting (Linux, MySQL, Apache, monitoring, etc.) $10,000 • User training and “help desk” support (0.25 – 0.5 FTE) $25,000 - $50,000 $10,000 - $20,000 • Reserve fund for unexpected modifications, trouble shooting, etc. • Total estimated annual cost $45,000 - $80,000 5.2 Aim 2: Work with safety net clinic providers, hospital emergency departments, and specialists that are a major source of care for safety net patients to identify specific data, applications, and use cases that are of the most benefit to them. Initial discussions were held with physicians from 6 safety net clinics and 5 hospitals, other care providers, ED staff, and hospital IT and executive staff to determine the degree of interest in HIE and perceived benefits. There was a general consensus that a safety net oriented HIE linking clinics and EDs had the potential for significantly improving care, minimizing the risks associated with duplicative diagnostic studies, and, reducing costs. We also gathered information on what data would be most valuable in the ED setting and how it should be presented. Page 13 of 19
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After the eChart software was tested, we demonstrated it to ED staff at 5 hospitals. In all cases they felt it would be easy to use for rapid access to relevant clinical data and to identify the safety net patient’s medical home clinic. Not only would this allow ED physicians to contact the patient’s physician if needed, but would minimize the risk of ED “bounce back” by ensuring that the clinic was made aware of the ED visit and received appropriate follow up information. The concept that “a little data goes a lone way” was confirmed, with the most useful health data being diagnoses, allergies, current medications, visit history and the ability to identify the patient’s primary care provider and medical home. The data most frequently asked for, but not yet available from the safety net clinics, are EKGs. Safety net clinic physicians saw considerable value in receiving an electronic notification and ED discharge summary for patient follow up, particularly for “avoidable” ED visits. This will be implemented as hospitals develop the capability for electronic transfer, or perhaps using the MeDHIX fax-to-PDF capability. This latter step will involve operational changes at each hospital. 5.3 Aim 3: Broadly involve health care organizations, community groups, philanthropies, and governments across the region, focusing on education and outreach about the benefits, risks, opportunities, priorities, implementation strategies, national successes and failures, and the potential for HIE to help bring better, more cost effective healthcare to their constituencies. In addition to numerous individual and group discussions with community groups, 54 people responded to the open ended interview survey described in the method section. Yes
Yes, with conditions
No
Unsure
Total
Community-based 9 8 0 1 0 organizations Montgomery 14 5 8 0 1 Cares (safety-net) clinics Montgomery 7 2 2 0 3 County DHHS Physician 15 7 2 5 1 members of medical society Others* 9 7 0 0 2 Total 29 (54%) 12 (22%) 6 (11%) 7 (13%) 54 *”Others” include: leaders of area foundations, a president of a chamber of commerce, a hospital CIO, a representative from the Office of Minority Health
Those in the “Yes” category cite better coordination and continuity of care and increased efficiency and cost-effectiveness. For those in the “yes, with conditions” category, the concerns were predominantly confidentiality. Community leaders who work with immigrant communities said that patients may not opt-in to HIE if they fear that certain information may be released beyond a particular provider. This concern was most strongly expressed by leaders who work with immigrant groups from Africa, where stigma for particular diseases or conditions is particularly strong. The “No” group (mostly physicians) were not convinced of significant positive impact or thought it likely that providers would bear an inordinate burden to implement. Page 14 of 19
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5.4 Aim 4: Engage ethnically, racially, and economically disadvantaged individuals and their representative organizations to better understand the factors that inhibit or promote their acceptance of HIE and the steps that must be taken to maximize trust, acceptance, and mutual benefits. Focus group methodology was used to gather the perspectives of uninsured or underinsured patients primarily living in Montgomery and Prince George’s Counties. A total of 8 focus groups were conducted with 61 participants. Focus group size ranged from 5 to 12 individuals. All groups used a trained facilitator. Two groups were conducted entirely in Spanish. Participants were a mix of native born and recent immigrants and had little or no knowledge of HIE before attending the session. The primary concerns related to the confidentiality of patient data and the security of the system. Latino patients were concerned that information might be used for non-medical purposes such as Immigration or Customs investigations. The Tuskegee experiments were referenced by African Americans as an improper use of personal medical data that could result from HIE. Some individuals were especially sensitive to the risks of inadvertent data sharing in cultures where having certain disease can lead to social ostracism. Most participants indicated that they would support sharing personal health information if they could be assured of the “absolute security and confidentiality” of their information, and if their information were not at risk of release to peers, family members, employers or commercial entities (e.g. pharmaceutical companies). Suggestions included requiring patient consent before his/her information would be shared and a system that could track access to medical records. Those who opposed sharing their health information were not convinced that it would improve their healthcare or that confidentiality could not be protected. Examples of limits that patients would place on sharing data include: “I don't want doctors or anyone else being able to view it at will. Information such as gynecology and cosmetology wouldn't be pertinent to a doctor treating me for high blood pressure. Some information should be private.” Regardless of willingness to share data though an HIE, all focus group participants emphasized the value of increased access to their own health information, describing the difficulties they faced, such as having to take unpaid time from work to collect medical records when sent to a specialist. 5.5 Aim 5: Assist safety net clinics in the implementation, enhancement, and use of EHRs, as a prerequisite for achieving signficant HIE benefits. Under the primary sponsorship of DCPCA, six safety net clinics in Washington, D.C. volunteered to be pilot sites for implementation of a common EHR: Bread for the City; Family and Medical Counseling Service, Inc.; La Clínica del Pueblo; Mary’s Center for Maternal and Child Care; So Others Might Eat; and Whitman-Walker Clinic. eClinicalWorks was selected as the vendor, with implementation activities starting in June 2007. CHLCare, the web based, open source shared EHR, was installed in additional safety net clinics in the metro DC region. These clinics tend to be small, unable to acquire or install EHRs, and are part of a network of free clinics proving care to low income, uninsured individuals. Clinic sponsors include religious organizations, cultural associations, and community groups. Clinics include the Arlington Free Clinic in Arlington, VA; the Muslim Community Clinic in Montgomery County; Page 15 of 19
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L’Ami Clinic for French speakers, a Pan Asian clinic; and the Jeanie Schmidt Free Clinic in Herndon, VA. CHLCare is now used by 14 safety-net clinics; at 40 care sites; across 3 jurisdictions. During the course of this project, the number of patients seen annually by clinics using the CHLCare shared EHR has increased from about 8,000 to over 24,000. Over 39,000 different patients were seen in the last 2 years, accounting for ~190,000 visits. The database now contains nearly ~560,000 clinic visit records on over ~110,000 culturally, racially, ethnically, and linguistically diverse patients. This information is available through the MeDHIX eChart. 5.6 Aim 6: Reduce unnecessary visits to hospital emergency departments. The goal of this program is to identify patients with primary care preventable ED visits, enroll them in a medical home, and compare pre and post ED utilization and the influencing factors. While it is disappointing that we have not yet been able to achieve sufficient usage to evaluate the efficacy and utility of the MeDHIX eChart project in reducing ED usage, we expect significant usage as part of the ED diversion project and plan to conduct an evaluation even though the formal grant period has ended. 5.7 Aim 7: Provide data for public health planning, epidemiological surveillance and targeting of services to the low income uninsured. The exploration of Azyxxi for public health data analysis did not continue beyond the transfer of the Azyxxi system to Microsoft. However, Montgomery County public health staff has had a long interest in better data and tools to analyze disease patterns in the safety net community for allocating scarce resources most effectively. Geomapping of MeDHIX HIE data began in year 4, is increasingly used, and has stimulated more requests for data and an analytical, data driven focus.
6.0 Lessons Learned and Challenges to EHR and HIE Implementation There was general consensus among hospitals that the cost/benefit for safety-net patients is likely to be substantial in improving health and controlling costs. However, there was a prevalent belief that the confidentiality risks outweighed the benefits for insured patients, who typically have existing relationships with providers who know them well and already have access to all or most of the necessary medical data. Hence the risk of unauthorized or accidental release of personal health data, even if low, outweighs the benefit. Emergency room (ER) physicians, who see both uninsured and insured patients, did not share this belief, instead observing that they would have more data on safety net patients, with the potential for safer more timely care, than for insured patients. Barriers to Implementation and Use of and HIE. Barriers to effective HIE among safety net clinics and mainstream health care providers include: more pressing safety net clinic medical priorities, limited paid staff, a heavy volunteer component, lack of technology skills in the clinics, technical complexity and cost of data interchange systems, privacy concerns, and organizational priorities by both clinics and mainstream health care providers that are considered to be much more important for access to quality care than HIE. Environmental Constraints. Environmental constraints define the boundaries of HIE as determined by each hospital, introducing additional hospital centric evaluation criteria beyond those technical factors originally anticipated. Some hospitals are reluctant to share data unless it is already being shared through traditional methods. Some prefer to be silent partners in the day-to-day operations of MeDHIX, not wanting responsibility for managing inquiries or unexpected access to their databases. Others may be reluctant to absorb the costs of deploying a separate server outside the firewall, Page 16 of 19
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preferring to delegate to MeDHIX the responsibility for hosting the databases that receive health data. Even browser choice may be controlled or prohibited, along with contract limitations imposed by HIS software vendors. Safety Net Patient ID Cards. As part of our use work with the hospitals, we unexpectedly encountered a new set of procedural, legal, and liability concerns as we as we attempted to complete the technical discussions on the details of the message exchange. Hospitals required assurance in two areas before they were willing to share data. First, positive identification of the patient; second, evidence that a patient was being seen in one of the safety net clinics, a surrogate for assuring that the patient had been informed of the clinic’s data sharing policies and received proper HIPAA counseling. Without this ability, the project could not proceed. To meet these requirements, we implemented safety net patient photo ID cards as part of the MeDHIX project. An ID card supports the process of identifying a medical home for the patient and assists in discharge planning in the ED. The ID card also identifies the patient as agreeing to the data exchange. The ID card also addressed the concerns that some physicians and hospitals had expressed about the risks or added time associated with probabilistic matching of patient records between health systems. The hospitals did not want data to be provided if there was any question that the data might not belong to the specific patient. In addition, hospital staff did not want to take the time or responsibility for reviewing potential matches and selecting records based on their individual assessment of what patient entries or data belong to the patient being seen. This process is time consuming and increases risk and liability for the hospital. HIE Governance and Operations. The transfer of Azyxxi to Microsoft was a powerful demonstration that the technical service provider should not be the governing entity. Member hospitals stressed the importance of a neutral party managing the MeDHIX infrastructure, concerned that a competitor managing the HIE infrastructure would be an obstacle to participation because of how shared data might be used. Also, there was concern that priorities for system features and operational rules would be determined by the HIE service provider, with little say by partner institutions. Differences in the perceived value of data. The value placed on different kinds of data varied considerably among providers and clinical care sites. Azyxxi used an expensive high performance workstation with a large high resolution monitor to test the value of viewing medical imaging studies remotely in a safety net setting. While remote image viewing is technically impressive, there was considerable difference of opinion as to its value and cost effectiveness in safety net clinics, where physicians placed a lower priority on seeing imaging studies given their heavy patient loads and busy safety net clinics, often preferring the radiologist’s report. Community hospitals and safety net clinics viewed exchanging basic patient data as a significant benefit for both clinics and ED physicians. EDs value a patient’s “eChart summary” as a quick guide to potential problems and the information to contact the provider if needed. Clinics value an electronic discharge summary, as they often are not aware that their patient has been seen until much later, if at all. Hospitals value the ability to refer a patient back to the primary provider to ensure effective follow up and to arrange for a medical home for those patients who do not yet have one. The information that seems to be most highly valued is care provider, visit history, problem list, allergies, and medications from the ER perspective, with the addition of lab results and ER discharge summaries for the safety net clinics. Importance of Public Education in Building Support for HIE. Discussions and interviews with community groups and focus group findings from safety net patients suggest that training and education focus on patient rights and responsibilities with regard to their medical information. Efforts Page 17 of 19
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would need to be supported by policy, resources, and incentives; confidentiality and security would need to be clearly demonstrated; HIE implementation would need to be accompanied by standards for recording and classifying medical information in the system; and specific goals should be delineated regarding what HIE is intended to accomplish and for whom. Safety net patient benefits from HIE. While our data is limited, focus group results and discussions with safety net patients and providers suggest that safety net patients will benefit even more than insured patients from an effective health information exchange. Insured patients typically have one or a small set of providers who already communicate effectively with one another for most medical problems. In contrast, safety net patients typically are seen by multiple providers at multiple sites, records are less complete, information is more diffusely scattered, and patients often must visit multiple providers to physically collect and assemble their own medical records. The challenges of providing high quality, cost effective, timely preventive and therapeutic interventions are correspondingly greater and outcomes less certain. Legal Issues and Concerns. Legal issues concerning patient privacy and access to personal health information continue to be costly in terms of delayed implementation, cost, and fear or reluctance to participate, constituting the single largest impediment to planning and implementing HIE. In spite of a growing national consensus on guidelines for sharing health information, each new organization and individuals new to current member organizations - regularly revisit concerns that had been previously resolved. Differing interpretations are sincerely held, reflecting the complexity of the underlying statutes and regulations. For the MeDHIX project, privacy and data sharing policies were especially interesting because the project spanned three distinct jurisdictions: Maryland, Virginia, and the District of Columbia. Collaboration Challenges • Project planning is challenging when tasks cross multiple organizations even for organizations enthusiastically committed to target completion dates. External and internal business and clinical priorities may preempt HIE work, slowing implementation. Causes include apprehension concerning legal liabilities, policy and business process changes, and competition between providers. These common business related delays are complicated by the fact that potential benefits from HIE are future oriented and speculative, whereas the preempting projects are either essential now or have clear near term benefits. These factors delay implementation, making project plan target dates less predictable. • Well defined expectations among participants are paramount to avoid confusion and subsequent crucial amendments to technology and business processes. This was demonstrated when the organization providing an established record locator, data aggregation and display tool changed from a web-based to a dedicated high-performance personal computer paradigm for linking the safety-net clinics to the HIE. • If the HIE operator, instead of the data providers and recipients, controls the project plan, policies, and processes, considerable effort may be required to align the needs of all users. • Measuring the impact of HIE on safety, quality, and efficiency of medical care continues to be a challenge for us. We hope to get some quantitative data through our post grant ED diversionmedical home project.
7.0 Related Activities and Future Projects Integral to the MeDHIX HIE Future plans include data exchange with the DC RHIO and inclusion in CRISP, the newly established Maryland statewide HIE project. Further information on the DC RHIO project is available at http://dcpca.org/index.php/Health-Information-and-Technology-Initiative-8-2007.html. Page 18 of 19
Metro DC Health Information Exchange (MeDHIX) AHRQ 1 UC1 HSO16130-01
Detailed information on current activities and future plans for CRISP is available at the Maryland Health Care Commission web site, http://mhcc.maryland.gov/electronichealth/hie.html. MeDHIX/AHRQ Facilitated Resources to Expand and Enhance Safety Net EHRs and HIE • Montgomery Cares – a Montgomery County, MD, program to expand the safety net clinics to provide high quality care to more uninsured. The ability to acquire, use, and share health data electronically was integral to program expansion and assessment • Kaiser Permanente grant to enhance the medication management function of the CHLCare shared EHR to meet unusual needs of safety net clinics • Care First Blue Cross Blue Shield grant to add disease management and planned care extensions to CHLCare and MeDHIX • Funding to integrate behavioral and oral health care into safety net clinics • Komen grant for breast cancer outreach regional expansion • Expanded health care for the homeless funding • County support for diabetes standards of care assessment project • Meyer Foundation support MeDHIX Related Regional Activities and Participation • Maryland Governor’s Health Information Technology Task Force to Study Electronic Medical Records. • DC RHIO (formerly National Capital Area RHIO). Advisory Board • Regional Primary Care Coalition. • Montgomery County Health Information Exchange Project (MCHIE) report and recommendations for a statewide HIE. • “Emergency Department-Primary Care” (ED-PC Connect) reduction of avoidable ED use funded under a Maryland Dept. of Health and Mental Hygiene grant
8.0 Publications and Presentations Montgomery County Health Information Exchange Collaborative, “Strategies for a Person -Centric, Inclusive Maryland Health Information Exchange” http://mhcc.maryland.gov/electronichealth/MCHIE_Final_Report.pdf “Metro DC Health Information Exchange (MeDHIX) Characteristics, Challenges, Lessons Learned” AHRQ 2008 Annual Conference; Thomas L. Lewis and Leta Kajut, Center for Community Based Health Informatics “Partnering To Assist Montgomery County Maryland's Uninsured into Becoming the Healthiest Community in America”, OpenHRE Conference; Lewis, TL and Kajut, L, Dec. 12, 2006 www.openhre.org/local/UG06/PCC.pdf “Health Information Technology, Health Information Exchange, and Community Perspectives”. The Rockville Institute and Universities of Shady Grove; Contemporary Issues Seminar Series, Lewis, TL, Watson, MR, May 5, 2009, https://www.rockvilleinstitute.org/seminar/spring2009hit.asp?q=lewis
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Microsoft Amalga HIS Demo System Q1 FY10 Accounts Payable Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the Accounts Payable process offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which Inventory, Departments Materials Management, Purchasing and Accounts Payable staffs are involved in creating purchase orders, receiving the orders from vendor and paying the vendor. At various stages, several built-in reports are also used by the demo personas.
Roles and Personas Role Request Clerk Department Manager Purchase Clerk Purchase Manager Purchasing Receive Clerk Department Receive Clerk Accounts Payable Clerk Accounts Payable Manager
Name RequestClerk One DepartmentManager One PurchaseClerk One PurchaseManager One ReceiveClerk One ReceiveClerk Two APClerk One APManager One
User Name RequestClerk1 DepartmentMgr1 PurchaseClerk1 PurchaseMgr1 ReceiveClerk1 ReceiveClerk2 APClerk1 APMgr1
Last verified version 5.4 SP6
Table of Contents 1 2 3 4 5 6 7 8 9
Demo Scenario ....................................................................................................................................... 3 Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC .................................................................................................... 3 2.1 Request Clerk looks at automatic Purchase Requests and creates manual Purchase Request .......... 4 Department Manager approves the Purchase Request ....................................................................... 10 Purchasing Clerk processes the request and creates a Purchase Order ............................................ 13 Purchasing Manager approves the Purchase Order Request ............................................................. 18 Purchasing Clerk orders the items from the vendor ............................................................................. 20 Purchasing Receiving Clerk receives the items ................................................................................... 22 [Optional] She distributes the items received ....................................................................................... 25
© 2009 Microsoft Corporation. All rights reserved.
10 11 12 13 14
[Optional] Department Receiving Clerk receives the distributed items ................................................ 27 Accounts Payable Clerk creates invoices ............................................................................................ 29 Accounts Payable Clerk creates payments for the invoices to be paid in the current term ................. 31 Accounts Payable Manager approves the payments ........................................................................... 35 Accounts Payable Clerk executes payments and runs Monthly Payment by Vendor Report .............. 37
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario
Inventory levels of a few items at Contoso Main Pharmacy store went below minimum levels. The system is setup to automatically place Reorder (Purchase) Requests. As there was a local flu epidemic warning issued, the Requesting Clerk at the store creates a manual purchasing request to overstock the Ciprofloxacin medicine to meet the upcoming needs. She also looks at the On Order Report, Over Maximum and Below Minimum Reports. Department Manager approves the purchase request. The Department Manager looks at the Approved Requests Exceeding Total Approval Limits Report and Expense Reports. The Purchasing Clerk at Contoso Medical Center Purchasing department receives the purchasing request. She processes the request by selecting the right vendor and creating a Purchase Order. She looks at the Vendor Item Prices Report. After her Purchasing Manager approves the request, she orders the items from the vendor. Vendor ships the items and Purchasing Receiving Clerk at Contoso receives and accepts the items. A Purchase Receipt is automatically created. She confirms or adjusts the charges on the receipt and enters vendor's invoice information. After the items are received, they can be distributed automatically or manually. She then runs the Distribution Report for the month. Department Receiving Clerk at the pharmacy store receives and confirms the distributed items. Accounts Payable clerk at Contoso Medical Center creates an Accounts Payable invoice for the purchase receipt transaction. The invoice, purchase receipt and purchase order are automatically linked and the clerk confirms them with Transaction Browser. She enters information such as payment type and credit term. She then posts the transaction to Sub-Ledger. The invoice will be paid in the upcoming credit term. She then runs the Top Vendor Report for the month. For the current credit term, there are a few invoices ready to be paid - she creates Accounts Payable payments for the respective vendors and submits the payments for approval. Her Accounts Payable Manager approves the payments. Depending on the type of the payments, the Accounts Payable clerk executes the payments in different ways and posts the transactions to Sub-Ledger. The transactions are then ready to be posted to the General Ledger. Finally she runs the Monthly Payment by Vendor/Account Report.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC.
Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC
In this section, we start Virtual PC Talking Points Start the Microsoft Virtual PC
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Click Steps Open Microsoft Virtual PC and start the Amalga HIS virtual machine
Screenshots
Launch Amalga HIS application on the laptop to connect to the virtual machine
Note: Use administrator and pass@word1 to troubleshoot the virtual machine
3 Request Clerk looks at automatic Purchase Requests and creates manual Purchase Request Inventory levels of a few items at Contoso Main Pharmacy store went below minimum levels. The system is setup to automatically place Reorder (Purchase) Requests. As there was a local flu epidemic warning issued, the Requesting Clerk at the store creates a manual purchasing request to overstock the Ciprofloxacin medicine to meet the upcoming needs. She also looks at the On Order Report, Over Maximum Exceeding Total Approval Limits Report and Below Minimum Reports. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type RequestClerk1 In Password field, type pass@word1 Click Click Select Location
Expand Contoso Medical Center Select Main Building
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Screenshots
Click on the Inventory application
Click on Inventory > Replenishment > Outstanding Reorder Request
Under Store, select Pharmacy Main Store
Click Search
Explain about various tabs on the Find Requested Items form
Click on the Outstanding tab
The Outstanding tab gives the ability to search for outstanding requests based on requested date and number of overdue days The Received/Distributed tab gives the ability to search for requests that were received or distributed between given dates
Click on the Received/Distributed tab
The Item/Comment tab gives the ability to search for requests that were related to a given item
Click on the Item/Comment tab
The Find Request Form tab gives the ability to search for requests based on several search criteria such as request type, request status, requested date range and requested for store etc.
Click on the Find Request Form tab
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Sort the requests by Requested On Date in descending order
Sect the most recent request
Click View > Request…
Explain about various tabs on the Purchase Request Details window
Show the Purchase Request Details
The Purchase Information tab gives the information about the purchase –e.g. order number, status, vendor etc.
Click on the Purchase Information tab
The Employee(s) with Approval Rights tab gives the list of employees who can approve the purchase requests
Click on the Employee(s) with Approval Rights tab
The Responsible Purchasing Staff tab gives the list of purchasing staff responsible for the purchase request being seen
Click on the Responsible Purchasing Staff tab
The History tab gives the historical information about the purchase request
Click on the History tab
The Request Details tab gives the information about the purchase – e.g. item, requested quantity and other item details
Click on the Request Details tab
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By staying on the Purchase Request Detail window, one can navigate back and forth to the next or the previous purchase request
Click Next to move to the next purchase request
Next and Previous buttons allow the functionality to navigate back and forth
Click Previous to move to the previous purchase request
Click Close
Click Close
Click on Inventory > Replenishment > Create Reorder Request
Under Requesting store:, make sure Pharmacy Main Store is selected
Click Add...
On the Selected Items to Add, select I want to use the Item Search screen and select the items myself
Click OK
In Search for:, type Ciprobay
Click Search
Select Ciprobay 250 mg tab
Click OK
For the item added, under Requested column, change the quantity to 10,000
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Under Required On date, choose two weeks from today
Click Create
Click Yes
At the bottom, click on Requests you have created today
Click Close
Click on Inventory > Reports > Below Minimum Report
Under Stores, select Pharmacy Main Store
Click Show
Click Close
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Click on Inventory > Reports > On Order Report
Under Stores, select Pharmacy Main Store
Click Show
Click Close
Click on Inventory > Reports > Over Maximum Report
Under Stores, select Pharmacy Main Store
Click Show
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Click Close
4 Department Manager approves the Purchase Request
Department Manager approves the purchase request. The Department Manager looks at the Approved Request Report and Expense Reports. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type DepartmentMgr1 In Password field, type pass@word1 Click
Click on the Departmental Materials Management application
Click on Departmental Materials Management > Request > Find Requested Items
Under Purchasing Site, select Pharmacy Purchasing Bangkok
Click OK
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Screenshots
Under Request Status, select Pending Approval
Click Search
Sort by Item Name
Explain about other tabs at the top
Show Ciprobay 250 mg tab and its status of Pending Approval
Click Close
Click on Departmental Materials Management > Request > Approve Purchase Requests
Under Dept, select 1000 Balance Sheet
Select the purchase request for Ciprobay 250 mg tab
Next to Purchase Info, show all the tabs – Approve, Request Price, Reject and Void
Click on the Approve tab, click Approve
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Click Close
Click on Departmental Materials Management > Reports > DMM Interactive Reports
Select Approved Requests
Exceeding Total Approval Limits
Click View
Click Show
Click Close
Select Expense Report
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Click View
If prompted, click Pharmacy Purchasing Bangkok, click OK
Change the From date to 1/1/2006
Click Show
Select any result, click View > Distribution Detail
Click Close
Click Close
Click Close
5 Purchasing Clerk processes the request and creates a Purchase Order
The Purchasing Clerk at Contoso Medical Center Purchasing department receives the purchasing request. She processes the request by selecting the right vendor and creating a Purchase Order. She looks at the Vendor Item Prices Report. Talking Points
Page 13 of 41
Click Steps
Screenshots
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type PurchaseClerk1 In Password field, type pass@word1 Click
Click on the Purchasing application
Click on Purchasing > Order > Process Purchase Requests
Under Purchasing Site, select Pharmacy Purchasing Bangkok
Click OK
Explain about various tabs on the Process Purchase Requests form
Click on the Process Vendor Item price Request tab
The Process Vendor Item Price Request tab comprises of three panels: Price Request grid: This panel
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contains a list of items that have been sent to the purchase site for price quotation.
Item Price Request Details panel: This panel displays request details for the item selected on the Price Request Panel.
Set Purchase Info panel: This panel allows user to change vendor or item on the request and input a price quotation which is then sent back to the approval personnel’s request approval work list. The Process to Purchase Order tab consolidates all approved requested items, regardless of the department or store requesting for the item.
Click on the Process To Purchase Order tab
Select the purchase request for Ciprobay 250 mg tab
Click Functions > Change Vendor
Select the row for vendor Salas & Co Plc
Click Open
Next to Vendor, click on …
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In the Search Vendors window, Under Item, type 103280, click on Search
As there are no other vendors providing the items, select the chosen vendor, click OK
Click Close
Click OK
Click Create PO…
In the Purchase Order window, enter Discount% as 5
Click Save
Click on Documents(0)
Click to Add Document > Scan
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Select Document Type as Contract
Click OK
Add To Browser gives Transaction Browser dialog using which one can browse through all related transactions
Click Add To Browser
By expanding the Purchase Order, one can browse and look at the Purchase Request for which the Purchase Order was created
Expand Purchase Order
The details of the Purchase Request can be looked right from the Transaction Browser
Click on Purchase Request
Let us look at the Purchase Request details
Click Open
Once looked at, one can close the Purchase Request window
Click Close
Click Close
Show the Status as Pending Approval
Click Close
Click Close
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The newly created Purchase Order can be searched using Search for Purchase Orders screen
Click on Purchasing > Order > Search for Purchase Orders
There are other search criteria available e.g. status, transaction type, vendor etc.
Click Search
We just created the purchase order, and don’t need to look at it.
Click Close
Click on Purchasing > Reports > Purchasing Interactive Reports
The Vendor Item Prices report lists all vendor to item mappings with their last unit cost (LUC) based on the last ordered date range.
Select Vendor Item Prices
Click View
There are several criteria one can enter on the report e.g. currency, vendor, item etc.
Under Vendor, type 39, press Enter
Click Show
Click Close
Click Close
6 Purchasing Manager approves the Purchase Order Request The Purchasing Manager approves the Purchase Order Request. Talking Points
Page 18 of 41
Click Steps
Screenshots
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type PurchaseMgr1 In Password field, type pass@word1 Click
Click on the Purchasing application
Click on Purchasing > Order > Approve Purchase Orders
Under Purchasing Site, select Pharmacy Purchasing Bangkok
Click OK
Click Show
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Select the Purchase Order for Ciprobay 250 mg tab
Click Open…
Click Close
Click Approve
Click Close
7 Purchasing Clerk orders the items from the vendor Purchasing Clerk orders the items from the vendor. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type PurchaseClerk1 In Password field, type pass@word1 Click
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Screenshots
Click on the Purchasing application
Click on Purchasing > Order > Search for Purchase Orders
Under Purchasing Site, select Pharmacy Purchasing Bangkok
Click OK
Click Search
Select the Purchase Order for Ciprobay 250 mg tab
Show the Status as Approved
Click Order…
Click OK
Show the Status as Ordered
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Click Close
8 Purchasing Receiving Clerk receives the items
Vendor ships the items and Purchasing Receiving Clerk at Contoso receives and accepts the items. A Purchase Receipt is automatically created. She confirms or adjusts the charges on the receipt and enters vendor's invoice information. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type ReceiveClerk1 In Password field, type pass@word1 Click
Click on the Purchasing application
Click on Purchasing > Receive > Receive Items from Vendors
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Screenshots
Under Purchasing Site, select Pharmacy Purchasing Bangkok
Click OK
Next to Purchase Order No:, click …
Click Search
Select the Purchase Order for Vendor Code 39
Click OK
Each Pack contains 10 – see the Conversion Factor
Under Received Qty, type 1000
Under Accepted Qty, type 1000
In the Invoice no:, type SAL1234
Click Save
Add To Browser gives Transaction Browser dialog using which one can browse through all related transactions
Click Add To Browser
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By expanding the Purchase Receive, one can browse and look at all the related transactions
Expand Purchase Receive
The details of the Purchase Request can be looked right from the Transaction Browser
Click on Purchase Request
Let us look at the Purchase Request details
Click Open
Once looked at, one can close the Purchase Request window
Click Close
The details of the Purchase Order can be looked right from the Transaction Browser
Click on Purchase Order
Let us look at the Purchase Order details
Click Open
Once looked at, one can close the Purchase Order window
Click Close
Click Close
Click Print Item Labels…
Click Print…
Select the printer by changing the location
Click OK
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Click Close
At the bottom, unselect Automatic Distribution
Click Post
If prompted, click OK
Click Close
9 [Optional] She distributes the items received
After the items are received, they can be distributed automatically or manually. The Purchasing Receiving Clerk distributes the items and then runs the Distribution Report for the month. Talking Points
Click Steps
Continue using ReceiveClerk1 session
Click on Purchasing > Receive > Purchase Distribution
Next to Receive Transaction No:, click …
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Screenshots
Click Search
Select Purchase Receipt for Vendor Code 39
Click OK
Click Load Items
Click Save
Click OK
Click Functions > Print Distribution Report…
Click OK
Click Close
The newly created Purchase Distribution can be searched using Search for Purchase Distributions screen
Click on Purchasing > Receive > Search for Purchase Distributions
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There are other search criteria available e.g. status, transaction type, department etc.
Click Search
We just created the purchase distribution, and don’t need to look at it.
Click Close
Click on Purchasing > Reports > Purchasing Interactive Reports
Select Distribution Report
Click View
Change To date to End of current month
Click Show
Click Close
Click Close
10 [Optional] Department Receiving Clerk receives the distributed items Department Receiving Clerk at the pharmacy store receives and confirms the distributed items.
Page 27 of 41
Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type ReceiveClerk2 In Password field, type pass@word1 Click
Click on the Departmental Materials Management
Click on Departmental Materials Management > Receive > Department Receiving
Under Department, type 1000 and press Enter
Click Show
Select the Distribution for Ciprobay 250 mg tab
Select the Selected column checkbox
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Screenshots
Click Receive
Click Yes
Click Close
11 Accounts Payable Clerk creates invoices
Accounts Payable clerk at Contoso Medical Center creates an Accounts Payable invoice for the purchase receipt transaction. The invoice, purchase receipt and purchase order are automatically linked and the clerk confirms them with Transaction Browser. She enters information such as payment type and credit term. She then posts the transaction to Sub-Ledger. The invoice will be paid in the upcoming credit term. She then runs the Top Vendor Report for the month. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type APClerk1 In Password field, type pass@word1 Click Click on the Accounts Payable application
Page 29 of 41
Screenshots
Click on Accounts Payable > Invoice > Create Invoice from Purchasing
If prompted, select Contoso Medical Center, click OK
Click Search
Select the row for Vendor Code 39 Select the Selected checkbox
Click Create Invoice
Click on the Payment Terms tab
Under Credit term, select Net 15 days
Under payment type, select Cheque
Click Save
Click Add To Browser
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Expand Purchase Receive
Click on Purchase Request
Click Open
Click Close
Click Close
12 Accounts Payable Clerk creates payments for the invoices to be paid in the current term
For the current credit term, there are a few invoices ready to be paid – she creates Accounts Payable payments for the respective vendors and submits the payments for approval. Talking Points
Click Steps
Continue using APClerk1 session
Click on the Accounts Payable application
Click on Accounts Payable > Payment > AP Payment
If prompted, select Contoso Medical Center, click OK
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Screenshots
In Vendor, type 39
Click Add…
Make sure to select Payment type as Cheque
Click Search
Select the invoices with Vendor Invoice No inv001, select the Selected checkbox
Select the invoices with Vendor Invoice No 4546546, select the Selected checkbox
Click OK
Show the Submit For Approval checkbox
Click Save
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Click Add To Browser
Expand Payment-PMT-… tree node
Click on all the subsequent nodes, and tell that they can all be opened and they are all linked
Click Close
Click Close
Click on Accounts Payable > Payment > AP Payment
In Vendor, type 39
Change Payment type to Citibank
Change Payment Subtype to Citibank Export
Click Add…
Click Search
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Select the invoices with Vendor Invoice No invoice34343, select the Selected checkbox
Click OK
Show the Submit For Approval checkbox
Click Save
Click Close
Click on Accounts Payable > Payment > Create Multiple AP Payments
Click Add…
Under Vendor, type 39
Change Payment type to Citibank
Talk about how one can select Invoices based on Due Date
Click Search
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Select the invoices with Vendor Invoice No invoice, select the Selected checkbox
Click OK
Explain that one can repeat such process to add multiple vendors and invoices
Click Close
Ideally, a clerk would create payments for all the outstanding invoices that are due today or in current payment period We already created a couple of payments, let us not create one Click No
13 Accounts Payable Manager approves the payments Her Accounts Payable Manager approves the payments. Talking Points Start Microsoft Amalga HIS
Page 35 of 41
Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Screenshots
In User name field type APMgr1
In Password field, type pass@word1 Click
Click on the Accounts Payable application
Click on Accounts Payable > Payment > Approve AP Payments
If prompted, select Contoso Medical Center, click OK
Click Show
Select the first payment for Salas & Co Plc
The Accounts Payable manager can view the Invoice for the payment right from the Approve screen here
Click Invoice…
She reviews the invoice and closes it
Click Close
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She is now ready to approve the payment
Click Approve
Select the second payment for Salas & Co Plc
She can view the Invoice for the payment right from the Approve screen here
Click Invoice…
She reviews the invoice for the second payment and closes it
Click Close
She is now ready to approve the second payment
Click Approve
Click Close
14 Accounts Payable Clerk executes payments and runs Monthly Payment by Vendor Report
Depending on the type of the payments, the Accounts Payable clerk executes the payments in different ways and posts the transactions to Sub-Ledger. The transactions are then ready to be posted to the General Ledger. Finally she runs the Monthly Payment by Vendor/Account Report. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type APClerk1 In Password field, type pass@word1 Click Click on the Accounts Payable application
Page 37 of 41
Screenshots
Click on Accounts Payable > Cheque printing > Print Cheques
If prompted, select Contoso Medical Center, click OK
Select Payment Subtype to A/C PAYEE ONLY
Click Search
Select the row for Salas & Co Plc
Click Print
If there is no default printer set up, change the location of the printer to Main Building Select a printer Click Set As Default
Click OK
If prompted, click OK
Click Close
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Click on Accounts Payable > Payment > Execute AP Payments
Change Payment type to Citibank
Change Payment Subtype to Citibank Export
Click Search
Click Execute…
Next to Name of export file, click …
Type in Salas & Co Citibank Export.xml
Click Save
Click Export
Click OK
Click Close
Page 39 of 41
Click Close
Click on Accounts Payable > Reports > AP Interactive Reports
Select Monthly Payment by Vendor / Account and Cost Centre Code
Click View
Under Period, select current period e.g. For August 2009, it would be 2009PRD8
Click Show
Click Close
Click Close
Close the Amalga Application
This concludes the Accounts Payable demonstration. Page 40 of 41
The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
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Microsoft Amalga HIS Demo System Q1 FY10 Accounts Receivable Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the Accounts Receivable process offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which Patient Finance and Accounts Receivable staffs are involved in processing the charges of a patient, issuing invoices to patient and his insurance company and receiving payments from them. At various stages, several built-in reports are also used by the demo personas.
Roles and Personas Role Patient1 Financial Claims Clerk Accounts Receivable Clerk Remittance Clerk
Name Joe Addington Sylvie Narp ClaimsClerk One ARClerk One RemittanceClerk One
User Name Financial ClaimsClerk1 ARClerk1 RemittanceClerk1
Last verified version 5.4 SP6
Table of Contents 1 2
Demo Scenario ....................................................................................................................................... 3 Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC and Microsoft Amalga HIS......................................................... 3 2.1 Stop current shift and Start a new shift ............................................................................... 3 2.2 3 Patient Finance Clerk processes charges for Joe Addington and generates invoice ............................ 5 4 She then accepts the payments from patient ....................................................................................... 10 5 Shift ends for the day ............................................................................................................................ 12 6 Patient Finance Clerk then makes a bank deposit ............................................................................... 13 7 Claims Clerk confirms insurance coverage and generates invoice...................................................... 14 8 Accounts Receivable Clerk creates Credit and Debit Memos .............................................................. 20 9 Remittance Clerk receives payment from the insurance company ...................................................... 26 10 Remittance Clerk deposits the payment and runs Paid Invoice Report ............................................... 32
© 2009 Microsoft Corporation. All rights reserved.
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario
Joe Addington, an Inpatient patient at Contoso Medical Center, is ready to be discharged. Patient Finance staff member/Cashier adds any remaining charges and confirms the policies. She then processes the charges by applying the policy to the right splits. Claims are automatically generated and invoiced. Invoices are created to the patient and his insurance company and they are posted to SubLedger. Patient pays the amount due by him. Payment is accepted and mapped to the invoice. The shift ends for the day. After end of the shift, she makes the bank deposits. Claims Clerk handles the payments received. He confirms the insurance coverage with Joe’s insurance company. He then prepares the customer statement including all invoices during the month to Joe’s insurance company. He also runs the Print Statements report. The insurance company communicates back that it cannot fully pay one of the line items of the invoice and requests Contoso to correct the invoice with a new amount. Accounts Receivable clerk uses “Balance Roll Over” feature to credit the insurance and debit the patient. This will automatically create Credit memo and Debit memos. A new invoice is sent to the insurance company. The patient is now associated with an unpaid debit memo. An Unpaid Invoice indicator will show up on Joe’s patient header next time he visits. Later, the insurance company sends payments for the new invoice. Remittance Clerk accepts the remittance, adds the payments and maps them to the invoice. He then deposits the payment and posts the transaction to the Sub-Ledger. He then runs the Paid Invoice Report.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC. In section 2.2, we stop the current shift and start a new shift for the demonstration.
Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC and Microsoft Amalga HIS
In this section, we start Virtual PC Talking Points
Click Steps
Start the Microsoft Virtual PC
Open Microsoft Virtual PC
Launch Amalga HIS application on the laptop to connect to the virtual machine
Screenshots
Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2
Stop current shift and Start a new shift
In this section, we stop the current shift and start a new shift Talking Points
Page 3 of 36
Click Steps
Screenshots
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type financial In Password field, type pass@word1 Click
Click on the Patient Finance application
Click on Patient Finance > Cashier > Shift
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Select Contoso Medical Center
Click OK
Click End Shift
Click Yes
Click Start Shift
Click Close
3 Patient Finance Clerk processes charges for Joe Addington and generates invoice
Joe Addington, an Inpatient patient at Contoso Medical Center, is ready to be discharged. Patient Finance staff member/Cashier adds any remaining charges and confirms the policies. She then processes the charges by applying the policy to the right splits. Claims are automatically generated and Page 5 of 36
invoiced. Invoices are created to the patient and his insurance company and they are posted to SubLedger. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type financial In Password field, type pass@word1 Click
Click on the Patient Finance application
Page 6 of 36
Screenshots
Click on Patient Finance > Cashier > Bed Charges
In the Patient search box, type Joe Addington, press Enter
Click Search
Click Process…
Click OK
Click Close
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Click on Patient Finance > Cashier > Patient Billing
In the Patient search box, type Joe Addington, press Enter
Select the open visit, click Open
Click Add Charge…
Click Add Package…
In Search for:, type Comprehensive
Click Search
Select Comprehensive Checkup Program – Male
Click OK
Click Add Package…
In Search for:, type Full
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Select Full Wellness Evaluation (VTL, BH)
Click OK
Click Save
Click Close
Click on the Process Charges tab
Click Policies (1)…
Select Fabrikam policy
Click Add>
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Click OK
Click Apply Policy
Click Complete Split
Click Make Invoice
On the Bill Options, unselect all the checkboxes
Click OK
4 She then accepts the payments from patient
Patient pays the amount due by him. Payment is accepted and mapped to the invoice. Talking Points
Click Steps
Continue Financial session
Make sure you are on the Payments tab
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Screenshots
Select the invoice for Joe Addington under Payer column
Click Pay…
Click Add
Under Payment Type, select Cash
Under Amount, type the entire Remaining amount
Click OK
Click Print…
Click Preview…
Close Report Preview
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Click OK
Click Close
5 Shift ends for the day The shift ends for the day. Talking Points
Click Steps
Continue Financial session
Click on Patient Finance > Cashier > Shift
Under THB row, under End Amount, type the amount equal to payment made by the patient plus 2000
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Screenshots
Click End Shift
If prompted, click Yes
Click Close
6 Patient Finance Clerk then makes a bank deposit After end of the shift, she makes the bank deposits. Talking Points
Click Steps
Continue Financial session
Click on Applications > Accounts Receivable
Click on Accounts Receivable > Bank Deposit > Cashier Bank Deposit
Click on Add Shift…
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Screenshots
Click Search
Select shift started today
Click OK
Click Post
Click Details
Select the payment manually made by Joe Addington
Click Browse Remittance
Explain that one could select all the nodes and click Open
Expand Remittance - … node
The invoice, payments and bank deposit are all linked together
Click Close
Click Close
Click Close
7 Claims Clerk confirms insurance coverage and generates invoice
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Claims clerk handles the payments received. He confirms the insurance coverage with Joe’s insurance company. He then prepares customer statement including all invoices during the month to Joe’s insurance company. He also runs the Print Statements report. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type ClaimsClerk1 In Password field, type pass@word1 Click
Click on Applications > Accounts Receivable
Click on Accounts Receivable > Invoice > Search AR Invoice
Select Contoso Medical Center
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Screenshots
Click OK
Click Search
Select the Unpaid Invoice with Claim Status Invoiced
Click Open
Click Details
Click Next
Click Previous
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Click Close
Show the customer name Fain Ltd
Click Functions > View Claim…
Show the policy name Fabrikam On the Claim tab, show the limit amounts
See the information on the subscription tab
Click on the Policy Subscription tab
Click View > Policy….
Explain about various tabs on the Policy screen.
Click on the tab Rules
Click Close
On the Claim window, click on the Claim Notes (0) tab
Click Add Note…
In the Description, type Policy looks good for this claim, ready to submit.
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Click OK
Click on the Claim tab
Now Claims clerk is ready to prepare the invoice
Change the status from Invoiced to Preparing
Click Save
Let us assume, Claims clerk has prepared the invoice
Change the status from Preparing to Prepared
Click Save
Now, let us assume, Claims clerk has sent the invoice
Change the status from Prepared to Sent
Click Save
Click Close
If prompted, click Yes
Click Add To Browser
Explain that one can open all the linked objects and close them
Expand Invoice AR… node
Click Close
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Click Print
Click Close
Click Close
Click on Accounts Receivable > Reports > AR Interactive Reports
Select Print Statements
Click View
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On the Statement Type, make sure Customer Statement is selected
Under Invoices To, select end of this month Note: Default month is previous month. Under Outstanding To, select end of this month
Note: Default month is previous month.
Click Search
Select the Select checkbox for Fain Ltd
To view the statement details, click View…
Click View…
Click Close
To view how the printout would look like, you can see the preview
Click Preview
Click Close
Claims clerk then prints the statement
Click Print
Click Close
Click Close
Click Close
8 Accounts Receivable Clerk creates Credit and Debit Memos
The insurance company communicates back that it cannot fully pay one of the line items of the invoice and requests Contoso to correct the invoice with a new amount. Receivable clerk uses “Balance Roll Over” feature to credit the insurance and debit the patient. This will automatically create Credit memo and Debit memos. A new invoice is sent to the insurance company. The patient is now associated with an unpaid debit memo. An Unpaid Invoice indicator will show up on Joe’s patient header next time he visits. Talking Points
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Click Steps
Screenshots
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type ARClerk1 In Password field, type pass@word1 Click
Click on Applications > Accounts Receivable
Click on Accounts Receivable > Invoice > Search AR Invoice
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Select Contoso Medical Center
Click OK
Click Search
Select the Unpaid Invoice with Claim Status Sent
Click Open
Click Function > View Claim…
On the Claim window, click on the Claim Notes (1) tab
Click Add Note…
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In the Description, type Insurance Company gives a reason for not paying one of the line items. Credit Memo will be issued.
Click OK
Click on the Claim tab
Click Close
Click Close
Click Close
Click on Accounts Receivable > Invoice > Balance Roll Over
Next to Transaction no, click …
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Click Search
Select the invoice with the Claim status Sent
Click OK
Under the Credit Amount, enter the amount 1000
Show other details of the Credit Memo
Under Comment, type
Show the patient and other details of the Debit Memo
Click on the Roll Over Balance To tab
Click Post
Make sure you are on the Credit Transactions tab
Click Add To Browser
Expand Credit Memo AR -… tree node
Explain that the node items can be opened and that they are all linked
Expand and click on all the subsequent nodes
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Insurance Company gives a reason for not paying one of the line items. Credit Memo will be issued.
Expand Debit Memo AR -… tree node
Explain that the node items can be opened and that they are all linked
Expand and click on all the subsequent nodes
Click Close
Click Close
Click on Accounts Receivable > Invoice > Search AR Invoice
Click Search
Select the Unpaid Invoice for Customer Fain Ltd (seen at the bottom of the screen)
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Click Add To Browser
Expand Invoice AR -… tree node
Explain that the node items can be opened and that they are all linked
Expand and click on all the subsequent nodes
Click Close
Click Close
9 Remittance Clerk receives payment from the insurance company Later, the insurance company sends payments for the new invoice. Remittance Clerk accepts the remittance, adds the payments and maps them to the invoice. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type RemittanceClerk1 In Password field, type pass@word1 Click Click on Applications > Accounts Receivable
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Screenshots
Click on Accounts Receivable > Remittance > Remittance
Select Contoso Medical Center
Click OK
Next to Customer, click …
In the Name, type Fain Ltd
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Click Search
Select the entry with Unpaid Invoices checkbox selected
Click OK
Click Instalments > Add…
Click Search
Select the unpaid invoice
Click OK
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Click Payments > Create
Under Payment Type, select Cheque
Under Payment SubType, select A/C PAYEE ONLY
Under Reference Number, type Fain-123456
Under Amount, type an amount 1000 less than Owing Amount
As there is a difference between paid amount and owing amount, Remittance Clerk checks to see if there are any credit memos associated with the invoice
Click Instalments > Open Invoice…
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Click Add To Browser
Expand Invoice AR -… tree node
Show the amount of 1000
Select Credit Memo AR - …tree node
Click Close
Click Close
Click Instalments > Add…
Click Search
Select the Credit Memo for the amount of 1000
Click OK
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Click Post
Click Close
Click on Accounts Receivable > Remittance > Search Remittance
Click Search
Select the top most row for the remittance just created
Add To Browser gives Transaction Browser dialog using which one can browse through all related transactions
Click Add To Browser
By expanding the remittance node, one can see all the related transactions associated with the remittance
Expand Remittance… node
Click Open
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Click Close
Click Close
Click Close
10 Remittance Clerk deposits the payment and runs Paid Invoice Report
Remittance Clerk then deposits the payment and posts the transaction to the Sub-Ledger. He then runs the Paid Invoice Report. Talking Points
Click Steps
Start Microsoft Amalga HIS
Continue RemittanceClerk1 session
Click on Accounts Receivable > Bank Deposit > Bank Deposit
Click Add
Click Search
Select the cheque
Click OK
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Screenshots
Under Control Count, type 1
Under Control Amount, type the entire amount
Click Post
Click Functions > Add To Browser
Expand Bank Deposit -… tree node
Explain that the node items can be opened and that they are all linked
Click on all the subsequent nodes
Click Close
Click Close
Click on Accounts Receivable > Invoice > Search AR Invoice
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Click Search
Show that the Invoice is Closed
After selecting the invoice, click Open
Click Functions > View Claim…
Show the Claim Status of Closed
Click Close
Click Close
Select the Credit Memo
Show that the Credit Memo owing amount is zero
Select the Debit Memo
Explain that the amount owed by the patient will show up as Unpaid Invoices in the patient header
Show that the Credit Memo owing amount is 1000
The patient will pay the bill during his next visit or the hospital can send an invoice to the patient’s address and Accounts Receivable will receive the payment later Click Close
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Click on Accounts Receivable > Reports > AR Interactive Reports
Select Paid Invoices Report
The Paid Invoices Report shows the invoices paid by an individual payer for a defined time period.
Click View
Next to Payor, click …
In the Name, type Fain Ltd, click Search
Select the top row
Click OK
Show the invoices paid by Fain Ltd for the selected period
Click Search
Click Close
Click Close
Close Amalga application
This concludes the Accounts Receivable demonstration.
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The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
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Microsoft Amalga HIS Demo System Q1 FY10 General Ledger Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the General Ledger process offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which accounting staff is involved in working together to close an accounting period.
Roles and Personas Role Accounting Clerk Accounts Payable Clerk Accounts Payable Manager
Name Accounting Clerk One APClerk One APMgr One
User Name AccountingClerk1 APClerk1 APMgr1
Last verified version 5.4 SP6
Table of Contents 1 2
Demo Scenario ....................................................................................................................................... 2 Demo Setup ............................................................................................................................................ 2 Start Microsoft Virtual PC .................................................................................................... 2 2.1 3 Accounting Clerk executes the Fixed Assets Depreciation Run ............................................................ 2 4 She then posts the outstanding transactions to the General Ledger ..................................................... 4 5 She then closes the AR, AP, FA, Payroll and Purchasing Ledgers ....................................................... 7 6 She closes the General Ledger of the accounting period. ..................................................................... 9 7 Accounting Clerk reopens the accounting period ................................................................................. 11 8 Accounts Payable Clerk creates AP payment ...................................................................................... 12 9 Accounts Payable Manager approves the payment ............................................................................. 14 10 Accounts Payable Clerk executes the payment and posts the transaction ......................................... 16 11 Accounting Clerk posts transaction to GL and closes the period ......................................................... 19 12 She then checks the financial reports for the period ............................................................................ 23 For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario
Accounting Clerk at Contoso Medical Center is ready to close the current accounting period. She first executes the Fixed Assets Depreciation Run for the period. She then posts the depreciation transactions as well as any other outstanding transactions of the period to the General Ledger. She then closes the Accounts Receivable, Accounts Payable, Fixed Assets, Payroll and Purchasing System ledgers for the accounting period. Finally, she closes the General Ledger of the accounting period. Later in the day, Accounts Payable clerk at Contoso informs the Accounting Clerk that one of the Accounts Payable invoices is not created. She requests her to re-open the period. The Accounting Clerk re-opens the Accounts Payable ledger and General Ledger for the period. Accounts Payable clerk creates the Accounts Payable payment. Her manager approves the payment. She then executes the payment and posts the transaction to the Sub Ledger. Accounting Clerk then posts the Accounts Payable transaction to the General Ledger and closes Accounts Payables ledger and then closes the General Ledger. Accounting Clerk then checks all the basic financial reports for the period – Trial Balance, Balance Sheet, Profit and Loss Statement.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC. Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC
In this section, we start Virtual PC. Talking Points Start the Microsoft Virtual PC
Click Steps
Screenshots
Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
3 Accounting Clerk executes the Fixed Assets Depreciation Run
Accounting Clerk at Contoso Medical Center is ready to close the current accounting period. She first executes the Fixed Assets Depreciation Run for the period.
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Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type AccountingClerk1 In Password field, type pass@word1 Click
Click on the General Ledger application
Click on General Ledger > Accounting Period > Period Status Overview
Select Contoso Medical Center, click OK
Under Accounting Year, select 2007
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Screenshots
As a demonstration of the functionality, we are trying to close Period 3 of 2007
Click Close
Click on Applications > Fixed Assets
Click on Fixed Assets > Depreciation > Depreciation Run
Under Accounting Period, make sure 2007 year and 3 month are selected
Click Load Details
Click Save
Click Run
Click Close
4 She then posts the outstanding transactions to the General Ledger She then posts the depreciation transactions as well as any other outstanding transactions of the period to the General Ledger.
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Talking Points
Click Steps
Continue using AccountingClerk1 session
Click on Applications > General Ledger
Click on General Ledger > General > Post To GL
Under Posting Rule, select Fixed Assets Depreciations
Change the From Effective date to 3/1/2007
Click Search
Ideally, accounting staff would complete processing all the posting rules.
Click Post
As part of demonstration, we show how we just look at a couple of posting rules. If there are any transactions, we will post them.
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Screenshots
Click Yes
Under Posting Rule, select Accounts Payable Invoice
Click Search
Click OK
Click Search Next
Click OK
Repeat the process for a couple of Posting Rules
Click Close
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5 She then closes the AR, AP, FA, Payroll and Purchasing Ledgers She then closes the Accounts Receivable, Accounts Payable, Fixed Assets, Payroll and Purchasing System ledgers for the accounting period. Talking Points
Click Steps
Continue using AccountingClerk1 session
Click on General Ledger > Accounting Period > Close/Open Period
Under Ledger, select Account Payable
Under Year, select 2007
Under Ledger, select 2007PRD3
Click Close Period…
Under Comment, type Closing Accounts Payable period
Click OK
Under Ledger, select Accounts Receivable
Click Close Period…
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Screenshots
Under Comment, type
Closing Accounts Receivable period
Click OK
Click Run
Click Close
Under Ledger, select Fixed Asset
Click Close Period…
Under Comment, type Closing Fixed Asset period
Click OK
Under Ledger, select Payroll
Click Close Period…
Under Comment, type Closing Payroll period Click OK
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Under Ledger, select Purchasing System
Click Close Period…
Under Comment, type Closing Purchasing System period
Click OK
Click Close
Click on General Ledger > Accounting Period > Period Status Overview
Under Accounting Year, select 2007
Click Close
6 She closes the General Ledger of the accounting period. Accounting Clerk then closes the General Ledger of the accounting period. Talking Points
Click Steps
Continue using AccountClerk1’s session
Click on General Ledger > Accounting Period > Close/Open Period
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Screenshots
Under Ledger, select General Ledger
Under Year, select 2007
Under Ledger, select 2007PRD3
Click Close Period…
Under Comment, type Closing General Ledger period
Click OK
Click Run
Click Close
Click Close
Click on General Ledger > Accounting Period > Period Status Overview
Under Accounting Year, select 2007
Click Close
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7 Accounting Clerk reopens the accounting period Later in the day, Accounts Payable clerk at Contoso informs the Accounting Clerk that one of the Accounts Payable invoices is not created. She requests her to re-open the period. The Accounting Clerk re-opens the Accounts Payable ledger and General Ledger for the period. Talking Points
Click Steps
Continue using AccountClerk1’s session
Click on General Ledger > Accounting Period > Close/Open Period
Under Ledger, select General Ledger
Under Year, select 2007
Under Ledger, select 2007PRD3
Click Reopen Period…
Under Comment, type APClerk1 contacted and wants me to reopen the period
Click OK
Under Ledger, select Accounts Payable
Under Year, make sure 2007 is selected
Under Ledger, make sure
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Screenshots
2007PRD3 is selected
Click Reopen Period…
Under Comment, type APClerk1 contacted and wants me to reopen the period
Click OK
Click Close
Click on General Ledger > Accounting Period > Period Status Overview
Under Accounting Year, select 2007
Click Close
Close Microsoft Amalga HIS
8 Accounts Payable Clerk creates AP payment Accounts Payable clerk creates the Accounts Payable payment. Talking Points
Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
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Screenshots
In User name field type APClerk1
In Password field, type pass@word1 Click
Click on the Accounts Payable application
Click on Accounts Payable > Payment > AP Payment
If prompted, select Contoso Medical Center, click OK
In Vendor, type 39 and press Enter
For the purpose of demonstration, let us change the payment date to 3/28/2007
Change the payment date to 3/28/2007
Change Payment type to Citibank
Change Payment Subtype to Citibank Export
Click Add…
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Click Search
Select the Selected checkboxes for both installments with Vendor Invoice No – ‘INV-SALAS-6578’
Click OK
Click Save
Click Close
Close Microsoft Amalga HIS
9 Accounts Payable Manager approves the payment Accounts Payable manager approves the payment created. Talking Points
Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
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Screenshots
In User name field type APMgr1
In Password field, type pass@word1 Click
Click on the Accounts Payable application
Click on Accounts Payable > Payment > Approve AP Payments
Select Contoso Medical Center
Click OK
Click Show
Select payment with the payment date 3/28/2007
Click Approve
Click Close
Close Microsoft Amalga HIS
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10 Accounts Payable Clerk executes the payment and posts the transaction Accounts Payable clerk executes the payment and posts the transaction to the Sub Ledger. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type APClerk1 In Password field, type pass@word1 Click
Click on the Accounts Payable application
Click on Accounts Payable > Payment > Execute AP Payments
Select Contoso Medical Center
Click OK
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Screenshots
Under Payment type, select Citibank
Under Payment Subtype, select Citibank Export
Under From payment date, select 3/1/2007
Under Until payment date, select 3/31/2007
Click Search
Select Payment for Salas & Co Plc
Click Execute…
Next to Name or export file, click …
Under File name, type Salas & Co Plc.xml
Click Save
Click Export
Click OK
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Click Close
Click Close
Click on Accounts Payable > Payment > Search for Payments
Under Payment Date, select 3/1/2007
Under Payment Date To, select 3/30/2007
Click Search
Show the payment’s Status as Posted To Sub-Ledger
Select the payment
Click Open…
Click on the History tab
Click Close
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Click Close
Close Microsoft Amalga HIS
11 Accounting Clerk posts transaction to GL and closes the period Accounting Clerk then posts the Accounts Payable transaction to the General Ledger and closes Accounts Payables ledger and then closes the General Ledger. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type AccountingClerk1 In Password field, type pass@word1 Click Click on the General Ledger application
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Screenshots
Click on General Ledger > General > Post To GL
Under Posting Rule, select Accounts Payable Payment
Change the From Effective date to 3/1/2007
Click Search
Click Post
Click Yes
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Click Close
Click on Applications > Accounts Payable
Click on Accounts Payable > Payment > Search for Payments
Under Payment Date, select 3/1/2007
Under Payment Date To, select 3/31/2007
Click Search
Show the payment’s Status as Posted To GL
Select the payment
Click Close
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Click on Applications > General Ledger
Click on General Ledger > Accounting Period > Close/Open Period
Under Ledger, select Account Payable
Under Year, select 2007
Under Ledger, select 2007PRD3
Click Close Period…
Under Comment, type AP Payment transaction done by APClerk1 is posted and reclosing the period
Click OK
Under Ledger, select General Ledger
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Click Close Period…
Under Comment, type AP Payment transaction done by APClerk1 is posted and reclosing the period
Click OK
Click Run
Click Close
Click Close
Click on General Ledger > Accounting Period > Period Status Overview
Under Accounting Year, select 2007
Click Close
12 She then checks the financial reports for the period
Accounting Clerk then checks all the basic financial reports for the period – Trial Balance, Balance Sheet, Profit and Loss Statement. Talking Points
Click Steps Continue using AccountClerk1’s session
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Screenshots
Click on General Ledger > Reports > GL Interactive Reports
Select Trial Balance Report
Click View
Under Start Period, select 2007PRD3
Under End Period, select 2007PRD3
Trial Balance report produces a standard trial balance report used in accounting activities such as account and reporting reconciliations for a selected range of fiscal years.
Click Show
Show the trial balance report for the selected period and close.
Click Close
Select Balance Sheet Reports
Click View
Under End Period, select 2007PRD3
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The Balance Sheet Report generates a standard balance sheet report for the selected chart of accounts and fiscal year.
Click Show
Show the balance sheet report for the selected period and close.
Click Close
Select Profit and Loss Reports
Click View
Under Start Period, select 2007PRD3
Under End Period, select 2007PRD3
The Profit and Loss Report displays the revenue and expenses for the company or individual Cost Centre for a userdefined fiscal period. You can view the details of individual movements of an account.
Click Show
Additionally, you can view the Budget and UOS values, and compare it to the actual. Show the Profit and Loss report for the selected period and close.
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Click Close
Click Close
Close Microsoft Amalga HIS
This concludes the General Ledger demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
Page 26 of 26
Microsoft HealthVault Imaging Demo Scenario HealthVault Imaging Partner Workflow Microsoft Corporation Published MO/YR Author John Strauss
1 Summary HealthVault Imaging will show how patients’ can manage access to their image studies via HealthVault to improve communication of medical imaging with the potential of eliminating the cost and challenges of exporting and importing via CD-ROM. Through partnering, image studies stored within HealthVault can be visualized by medical professionals through a familiar viewer. This demonstration will show studies stored in HealthVault are visualized with the lifeImage services. Applicable Region
United States
2 Target Business Users / Roles
Radiologists, Referring Physicians, Patient
Contents 1 2 3 4 5
Summary ................................................................................................................................................ 1 Applicable Region ................................................................................................................................... 1 Target Business Users / Roles ............................................................................................................... 1 Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Set Up .......................................................................................... Error! Bookmark not defined. View Data Requirements ................................................................................................................. 8 Info Module ...................................................................................................................................... 9 Input Module .................................................................................................................................. 10 Dashboards .................................................................................................................................... 11 Reports .......................................................................................................................................... 11 QEdit .......................................................................................................................................... 11 Other Functionality ......................................................................................................................... 12
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
1
3 Value, Scenario, Story, Roles, Processes Example:
Amalga Value:
Not applicable
Demo Scenario:
In this demonstration we use HealthVault and a third party viewer (lifeIMAGE) to demonstrate the communication workflow from an imaging provider to the patient and subsequently to his/her primary care physician.
Questions to tailor demonstration to audience long-term enterprise goals:
1. How do you currently transmit images from radiology providers to the referring physician? 2. If via CD, how much is spent producing CD-ROMs for communication of medical images? 3. Do you currently or are you planning to support PHRs? 4. What services does radiology currently provide to the referring physician to enhance referral business? 5. Does radiology currently provide services (other than imaging) directly to the referring physician’s patient?
Demo Introduction / Story:
This demo shows the workflow for a connected feed between entities and HealthVault in order to support the PHR and share patient data with all parties.
Role(s):
Referring Physician (primary care) Radiology Receptionist Radiologist Patient
Processes:
HealthVault lifeIMAGE
HSG Customers who have implemented similar scenario:
University of Chicago/lifeIMAGE
2
2 DEMO SETUP The actual demo starts at section 3. This section should be completed before beginning the actual presentation/demo. In section 2.1, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration.
2.1 Log in to Microsoft Amalga In this section, we launch our browser Talking Points
Click Steps
Click on the IE icon
Screenshots
3
3 Begin Demo Talking Points
Click Steps
Screenshots
The patient has just completed an imaging study and is being given a CD containing his study as well as a previous exam that had been conducted at this facility last year. The receptionist at the imaging facility inquires if the patient has a PHR? He does not and she informs him about HV and shows him the sign-up procedure.
Navigate to healthvault.com
Click on Create a Free Account
The patient already has a Windows Live account and signs into this account
Need patient name and password –suggest we use Alexandar Bogue from RSNA database Click Sign In
The receptionist inputs patient demographic information from the patients’ records
Complete registration page.
She shows him where to upload the images from the provided CD
Click on the Health Information tab
Registration page
Health Information page
4
She also shows him how to input other health information for himself
Click on Allergy plus sign After screen displayed click CANCEL
The receptionist shows the patient how to enter information for his family members
Click on Family History
The receptionist shows the patient how to share HV inforamtion with people or places he designates
Click on Sharing tab and click Clear All and then selected Allergies
The patient returns home, logs onto his. He then signs into his HV account and uploads his images from the CD.
Show Health Information screen and click on Upload a File
5
Patient inserts the CD into his computer’s drive
The patient browses to his CD drive and the image files
He copies the file names from the CD and pastes them into the description field
Click on Browse Locate CD and then image files Copy file names Paste file names in description field Click Save
Patient clicks SAVE. Patient also uploads prior study Once uploaded a screen appears offering to allow physicians to access the file using lifeIMAGE viewer
Click the lifeIMAGE logo Enable sharing through lifeIMAGE
Medical Images page showing lifeIMAGE logo
Patient is prompted by query “With whom do you wish to share your imaging studies?”
Patient is prompted to enter his physician’s email address
lifeIMAGE page?
The patients’ primary care physician receives an email alert from lifeIMAGE that one of his patients has posted images for his review. The physician logs onto the lifeIMAGE web site, logs in as a physician.
The physician accesses his patient’s imaging study and the prior study.
The physician reviews the report he has received via fax from the imaging provider.
The physician views the images
Patient enters his physician’s email address and clicks SAVE
Physician clicks on link embedded in email which takes him to a physician log-in screen
Sharing page
Physician log in
From lifeIMAGE After logging in, he is directed to patient’s page containing imaging studies
Click on an image study. lifeIMAGE viewer launches
HV page containing patient image thumbnails
lifeIMAGE viewer with study
6
and images are displayed
The physician and the patient review the results the following day and a treatment course is decided
Data Dictionary
7
View Data Requirements
Please enter the scenario-specific View data requirements Example Name of Data Element
Have data yes/no
Need data
Data source
UIS Database
UIS table
UIS data element name
8
Info Module Example Please enter scenario-specific Info Module requirements Module Name
Data Exists Y or N
Table Names
Mock Up Exists
Related Module
9
Input Module Example Please enter scenario-specific Input module requirements Module Name
Data Exists Y or N
Table Names
Mock Up Exists
Related Module
10
Dashboards Example
Please enter scenario-specific Dashboard requirements Dashboard Name
Chart Name
Summary
Reports Please enter scenario-specific Reporting requirements Name of Data Element
Have data yes/no
Need data
Data source
UIS Database
UIS table
UIS data element name
QEdit Example Please enter scenario-specific QEdit requirements View Name
Data Element (Column)
QEdit Enabled
11
Other Functionality Please enter scenario-specific functionality requirements not listed in above tables Name
Description
12
Microsoft Amalga HIS Demo System Q1 FY10 HR and Rostering Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the Human Resources and Rostering process offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which multiple HR, Clinical and Administrative users are involved.
Roles and Personas Role Human Resouces Ward Administrator Nurse Manager Nurse
Name HumanResources One WardAdmin One Emma Liao Nancy Paul
User Name hr1 wardadmin1 nurse1 nurse3
Last verified version 5.4 SP6
Table of Contents 1 2 3
Demo Scenario ....................................................................................................................................... 2 Demo Setup ............................................................................................................................................ 2 Start Microsoft Virtual PC .................................................................................................... 2 2.1 Demo Scenario ....................................................................................................................................... 2 (Optional) HR Adds a New Employment Position............................................................... 2 3.1 HR Staff adds new employee to HR system ....................................................................... 6 3.2 HR Staff Updates Payroll Data for New Employee ........................................................... 11 3.3 Ward Administrator plans Roster ...................................................................................... 12 3.4 Nurse Manager Manages and initiates Roster ................................................................. 16 3.5 Nurse Clocks in late for shift ............................................................................................. 22 3.6 Nurse Manager Connects Clock In event ......................................................................... 23 3.7 Later in the day, the new employees checks her personal information ............................ 26 3.8 New Employee calls in sick after a couple of days ........................................................... 28 3.9 Nurse Manager checks Rostering reports ........................................................................ 30 3.10
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to
[email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario
Contoso Medical Center’s management decides to further improve patient care in Intensive Care Unit by improving the number of nurses attending in each shift. Human Resources Generalist hires a new nurse, Nancy Paul, and sets up her employee account in Amalga Hospital Information System by using the New Employee Wizard. She also adds her payroll information. Meanwhile the system administrators take care of setting up Windows NT account so that Nancy can login to Amalga HIS system. Using Amalga HIS Rostering application, a Ward administrator can plan rostering information of a given department’s one or more roster areas. WardAdmin1, Contoso’s Ward administrator, who plans rostering for Intensive Care Unit 2, updates the roster area’s shift template to add shift information for the new nurse. Emma Liao, the Nurse Manager for Intensive Care Unit, then assigns the new nurse to the roster. Nancy Paul comes late to the hospital on her first day and her account is already set up. She clocks in her time and provides patient care in Intensive Care Unit. Nurse Manager checks her late clock in information and connects it to the current shift. Later in the day, Nancy checks her employee and payroll information using Employee Self Service module. A couple of days later, Nancy calls in sick. Nurse Manager updates roster with Nancy’s sick information and assigns another nurse to cover for her on that day. She then goes on to check some of the rostering reports provided by Amalga HIS.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections. In section 2.1, we start Virtual PC.
Note: Remember that some changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC
In this section, we start Virtual PC. Talking Points Start the Microsoft Virtual PC
Click Steps
Screenshots
Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
3 Demo Scenario 3.1
(Optional) HR Adds a New Employment Position
Contoso Medical Center’s management decides to further improve patient care in Intensive Care Unit by improving the number of nurses attending in each shift. In this section, Human Resources Generalist Page 2 of 31
creates a new RN position in Intensive Care Unit 2 in Amalga HIS. In the Demo VM, there are a plenty of vacant positions, but it would be beneficial to show this workflow. So, this is just an optional step. Talking Points
Click Steps
Start Microsoft Amalga HIS
Start the Amalga HIS application by double-clicking on the HIS application on the desktop
Set the location of the VPC
Click Select Location Expand Main Building > Eight Floor > Ward 8 North Select Nurse Station 8C Click on OK
Login in to HIS as HR1
In User name field type hr1 In Password field, type pass@word1 Click
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Screenshots
Click on the Human Resources application
Click on Human Resources > General > Positions
Under Place of work, select All Click on Search
Displays all positions in the tree view
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Under Find, select All or part of the node name
Type Intensive Care Unit 2 Click Find
Under Intensive Care Unit 2, select 14 RN full time (2 position vacant) position
New position gets added to the selected node in the tree
Click on New position…
New position screen with some default values is displayed
Next to Place of Work, click on …
In the Text Filter, enter ICU Select Fifth Floor > Ward ICU 2 > Nurse Station ICU 2 Click OK
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Leave all other values as it is worth talking about the exhaustive information that can be defaulted to and changed if required
Accept other defaults
New position gets added to the selected node and also displays the vacant position as an extra row in the tree
Click Close
3.2
Click OK
HR Staff adds new employee to HR system
Human Resources Generalist hires a new nurse, Nancy Paul, and sets up her employee account in Amalga Hospital Information System by using the New Employee Wizard. Talking Points
Click Steps
Continue using hr1 session
Click on Human Resources > General > Employees
Click on New->New Employee Wizard…
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Screenshots
Talk about details can be read from card such as national id etc if was integrated and connected to card reader. Worth mentioning Malaysia id card is already integrated.
Enter name as Nancy Paul Under Enter the new person’s hospital number…select passport In the text box, type A11010 Click Next
Worth mentioning if read from card details would already be there
Click Full Name Local… First: Nancy Last: Paul Click OK Under Sex, select Female Under Date of birth, change year to 1978 Click Next
Here employee no. can ether be created by system or can be entered manually, hospital can choose to follow either
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Select I want to the system to generate Employee number. Click Next
Employment details are recorded in this screen
Under Reason, select Additional Staff Under Position Status, select Permanent Next to Position No, click on … Next to Department, click on …
All positions for the dept are listed including the new position that was created earlier.
In the search box type 6012 Click Find Double-click on 6012 – Intensive Care Unit 2 Scroll to the top and double-click on the position 1354 – Senior Nurse Click OK
Under Employee Status, select Active
Accept other defaults Click Next
Here fill birth and nationality
Under Country of nationality, select India Under Country of residence, select United Arab Emirates Click Next
Here demographic details are
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Click Address to Business
filled
Select Mailing Address Select Billing address Click Business… Type the address: Country: United States Address: Contoso Hospital One Chocolate St. Region: WA Postcode: 98052 City: Redmond
Here fill Official documents
Click OK
Email Business –
[email protected]
Phone: +1 425 555 1234
Click Next
Under Passport, type A1101 Under Visa, type E999 Click Next
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This completes the creation of new employee
Click Finish
Note down the new employee id number
Employee screen is opened
Click on Take Photo or Load Photo > From Camera or From File… After taking/uploading the picture, close the Photo window
Click Print Id Card
Select Staff Click OK
Attach scanned documents such as educational certificates, previous employment records, licenses, passport copies etc
Click Documents (0) Click on Quick Scan or Add Document Browse to or scan a document Add a Document Type = Social Security Card Click OK Click Save
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Add clinical role as it eventually allows or restricts access to patient management modules
Click on Clinical Staff Roles tab
Select Nurse
Click Save
3.3
HR Staff Updates Payroll Data for New Employee
Human Resources Generalist then adds the new employee’s payroll information. Meanwhile the system administrators take care of setting up Windows NT account so that Nancy can login to Amalga HIS system. Talking Points
Click Steps Continue using hr1 session
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Screenshots
Select the Payroll Master tab
Unselect Deduct social security Under Currency, select USD – US Dollars
Select the Pay Rates tab
Under SAL-Salary o Under Amount column, type 3000 o Under Period column, keep Month Under ALL-Allowance o Under Amount column, type 1000 o Under Period column, keep Month Under O12-Overtime x1(current rate) o Under Amount column, type 40 o Under Period column, keep Hour Click Save Click Close
3.4
Ward Administrator plans Roster
Using Amalga HIS Rostering application, a Ward administrator can plan rostering information of a given department’s one or more roster areas. WardAdmin1, Contoso’s Ward administrator, who plans rostering for Intensive Care Unit 2, updates the roster area’s shift template to add shift information for the new nurse.
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Talking Points
Click Steps Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type wardadmin1 In Password field, type pass@word1 Click
Click on the Rostering application
Click on Rostering > General > Plan Roster
Select Contoso Medical Center, click OK
Under Department, select 6012 – Intensive Care Unit 2
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Screenshots
Click Show
Under Template Shifts tab, click Add Shift
A new shift is added at the top of the table
Select the top row, click Edit…
Under Roster Role:, select RN Team Member Under Shift template:, select N8Eve (15:00- 23:000)’ Click Close
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Check graphs- head count and roster role
Click on the Head Count Summary tab
Click on the Roster Role Summary tab
Set up a night shift Premium for the Team Leaders
Click on the Template Shifts tab Under the Template Shifts, select any RN Team Leader Role row
On the right-side, select the Shift Premium tab
Click Add…
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Under Premium column, select Shift Diff/ Shift
Under Quantity column, type 2
Apply template to current Roster period
At the top, select the Assign Templates to Roster Period tab
Click Auto Assign
Click on the Roster Role Summary tab
Click on the Head Count Summary tab
Click Close
3.5
Nurse Manager Manages and initiates Roster
Emma Liao, the Nurse Manager for Intensive Care Unit, then assigns the new nurse to the roster. Talking Points
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Click Steps
Screenshots
Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type nurse1 In Password field, type pass@word1 Click
Click on the Rostering application
Click on Rostering > Department Administration > Roster Group
Select Contoso Medical Center, click OK
Under Department, select 6012 Intensive Care Unit 2
Click Show
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Under Roster Group, make sure RN Evening Shift group is selected
On the right side, select Nurse Three Click
On the Add/Remove Roster Group Employee window, accept the defaults, click OK
We can also search using Select from All
In the middle of the screen, click Select from All…
Under Name or number:, type Nancy Click Search
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Select Nancy Paul, click OK
On the Add/Remove Roster Group Employee window, accept the defaults, click OK
Click Close
Click on Rostering > General > Manage Roster
Under Department, select 6012 Intensive Care Unit 2
Under Roster area, select ICU-2
Under Roster group:, select RN Evening Shift
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Right-Click on new nurse Nancy Paul, click Edit Personal Pattern…
On Personal Roster Pattern, click Add Work Shift
The user here can change the start day of the week. But, we will still keep Monday as the starting day.
Click Edit…
Here we apply the new Roster Shift Template we set up earlier in the demo or manually change the start and end times.
Under Roster Role:, select RN Team Member
Click Close
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Under Start time, type 15:00 Under End time, type 23:00
Continue to add shifts, this time using the Add Work Shift Clone button
Click Add Work Shift Clone Click Add Work Shift Clone Click Add Work Shift Clone Click Add Work Shift Clone
When Friday comes up in the series, click Add Day Off instead. Repeat for Saturday.
Click Add Day Off
Select the Public holiday off checkbox
Click Close
Now we apply the personal shift pattern to the new employee record
Right-click the employee Nancy Paul , and click Apply Personal Pattern
Talk about Apply All Personal Patterns
Click OK
Select Adrienne Dame, rightclick and select Apply Personal Pattern
Click Add Day Off
Click OK
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Click on the Template Summary tab
Click Close
3.6
Nurse Clocks in late for shift
Nancy Paul comes late to the hospital on her first day and her account is already set up. She clocks in her time by about 5 minutes late and provides patient care in Intensive Care Unit. For the purpose of demonstration, let us use nurse3 session. Talking Points
Click Steps Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type nurse3 In Password field, type pass@word1 Click
Click on the Time Attendance Clock Event Logger application
Open the time clock application with the camera connected
Click on Time Attendance Clock Event Logger > General > Clock Event Logger
Note that application errors will occur without a camera connected
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Screenshots
In the employee number field, type the number noted above
Click Blue Arrow button
Close Time and Attendance Clock
We now will check on the clock event and view details
Click on Time Attendance Clock Event Logger > General > Process Clock In/Out
View the photo taken at the time of clock event
Double click on the new clock event for the new employee Click Close
Next we go back to Manage Roster to reconcile the early/late clock event
3.7
Click Close
Nurse Manager Connects Clock In event
Nurse Manager checks new employee’s late clock in information on the first day and connects it to the current shift. Talking Points
Click Steps
Next we go back to Manage Roster to reconcile the early/late clock event
Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type nurse1 In Password field, type pass@word1 Click Click on the Rostering application
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Screenshots
Click on Rostering > General > Manage Roster
Under Department, select 6012 Intensive Care Unit 2 Under Roster area, select ICU-2
Under Roster group:, select RN Evening Shift
Select the Roster Attendance tab
Select the new employee Nancy Paul on the left hand side
This is to just show manual connecting
If the time of demonstration is close to Nancy’s work shift, the clock in will be automatically connected to her shift. If Connect to is not enabled, click Disconnect
By clicking in Connect To, Nurse Manager can manually assign the Clock event to a particular Shift start/end The system can be set up to do this automatically of course- this workflow would pertain to someone who was exceptionally early or late
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Click Connect to
Select today’s date
Click Set As Clock In Close the window
Click Close
Finish Clock Demo by showing Attendance Review by the Charge Nurse/Nurse Manager
Click on Rostering > General > Roster
Under Department, select 6012 Intensive Care Unit 2 Under Roster area, select ICU-2 Under Roster group:, select RN Evening Shift
Click Show
Select the new employee Nancy Paul
At the bottom, click on the Attendance tab
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Click Close
3.8
Later in the day, the new employees checks her personal information
Later in the day, Nancy checks her employee and payroll information using Employee Self Service module. Talking Points
Click Steps Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type nurse3 In Password field, type pass@word1 Click
Click on the Rostering application
Click on Rostering > General > Employee Self Service
Select Address, Phone, Email, Banking and Languages
In the password, type pass@word1 Press Enter Click Open Service
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Screenshots
See the Demographics
Under Languages, click Add
Under Language column, select Urdu
Under Phones, next to Home, type the number – 1 425 555 1235 Click OK
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Select Personal Details Report
Click Open Service
Click Close
Click Close
3.9
New Employee calls in sick after a couple of days
A couple of days later, Nancy calls in sick. Nurse Manager updates roster with Nancy’s sick information and assigns another nurse to cover for her on that day. Talking Points
Click Steps Start the Amalga HIS application by double-clicking on the HIS application on the desktop
In User name field type nurse1 In Password field, type pass@word1 Click Click on the Rostering application
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Screenshots
Click on Rostering > General > Manage Roster
Under Department, select 6012 Intensive Care Unit 2 Under Roster area, select ICU-2
Under Roster group:, select RN Evening Shift
Click on the Roster By Date
Select the new employee Nancy Paul
Right-click on tomorrow’s date/ next working date, select Edit > Convert To Leave…
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Under Leave type, select Sick with BH M/C
Click OK
Click on the Roster By Template tab
Click Blue right arrow to change to tomorrow’s date/next working date
Barbar is the replacement for Nancy
Right-click on Barbar Lott, select Apply Personal Pattern
Click OK
Click Close
3.10 Nurse Manager checks Rostering reports Nurse Manager then goes on to check some of the rostering reports provided by Amalga HIS. Talking Points
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Click Steps
Screenshots
Remain in Nurse Manager role. One nurse calls in sick, fill shift with a nurse that has the day off.
Continue using nurse1 session
Click on Rostering > Reports > Roster Period Summary
Under Department, select 6012 Intensive Care Unit 2
Click Show
Click on Rostering > Reports > Track Roster Attendance
Under Department, select 6012 Intensive Care Unit 2
Under Roster group:, select RN Evening Shift
Click Close
This concludes HR/Rostering demonstration
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Microsoft Amalga HIS Demo System Q1FY10 Inpatient Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the Inpatient functionality offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which providers, registration, pharmacist, and cashier are involved in providing patient care to an inpatient patent. The scenario showcases admission process, surgery scheduling, computerized physician order entry, clinical documentation, pharmacy workflows, electronic medication administration recording, and finally the discharge workflows.
Roles and Personas Role Patient Registration OR/Ward Admin/Registration Doctor Nurse Pharmacist Cashier
Name Ahmad Bilal Elena Velez Amezaga Wendy Richardson Matt Hink - Orthopedics Emma Liao Tom Higginbotham Sylvie Narp
User Name registration registration2 doctor7 nurse1 pharmacist1 financial
Last verified version 5.4 SP6
Table of Contents 1. Demo Scenario ....................................................................................................................................... 3 2. Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC .................................................................................................... 3 2.1 Create Text Files ................................................................................................................. 4 2.2 Schedule Surgery................................................................................................................ 5 2.3 Start Shift, Run Routine Fill Processing .............................................................................. 6 2.4 3. Begin Demo .......................................................................................................................................... 12 Ahmad Bilal arrives at the hospital and Registration admits the patient for his scheduled 3.1 surgery 12 Registration sends Internal Mail alert to OR Admin and Doctor ....................................... 13 3.2 Schedule surgery and attach surgeon’s e-preference card .............................................. 14 3.3 Surgery scheduled with equipment needed, surgeon’s e-preference card looked at, and 3.4 new resources added ..................................................................................................................... 19 © 2009 Microsoft Corporation. All rights reserved.
3.5 Ahmad is moved to the surgery room, patient received ................................................... 21 Ahmad is back in the room after the surgery; Nurse records vitals every 4 hours ........... 21 3.6 Doctor examines Ahmad and prescribes medication. ...................................................... 22 3.7 Pharmacist reviews, fills and checks medications. Medications are distributed to Ahmad’s 3.8 room 24 Nurse monitors Medication administration schedule and administers medications for 3.9 Ahmad 26 Ahmad sees his EMR and Charge Summary in his room ................................................ 28 3.10 Doctor and Nurse plan for Ahmad’s discharge ................................................................. 28 3.11 Doctor completes his Discharge Tasks – Placing Discharge Order, Writing Discharge 3.12 Summary and prescribing Discharge medications ........................................................................ 31 Nurse completes the Discharge Tasks ............................................................................. 34 3.13 Ahmad is discharged......................................................................................................... 37 3.14 Ward Admin checks the bed clean status scorecard ........................................................ 38 3.15 Patient Pays his Bills ......................................................................................................... 39 3.16 For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2009 Microsoft Corporation. All rights reserved.
1. Demo Scenario Ahmad Bilal, a patient suffering from stomachache, is scheduled for a surgery. He arrives at the hospital and Registration admits the patient into a room on the 8th floor ward. As the patient is expected to have a short stay at the hospital, he is admitted with a Short Stay Discharge Workflow designed for such a stay. Registration sends an Internal Mail alert to OR Admin and Dr. Matt Hink, the Doctor who is scheduled to perform the surgery. The Operating Theatre admin schedules the surgery and attaches surgeon’s e-preference card. She also schedules all the necessary equipment needed for the surgery. By looking at the surgeon’s e-preference card, she also adds any other resources needed for the surgery. Ahmad is moved from his room to the surgery room. After the surgery is performed, he is back in the room. Emma Liao, a nurse attending the shift, continues to record vitals every 4 hours to monitor Ahamd’s condition. Right before the end of the shift, the doctor examines Ahmad and prescribes some medications. The Inpatient pharmacist reviews, fills and checks the medications ordered. The medications are then distributed to Ahmad’s room. The nurse attending the shift monitors the Medication Administration Schedule for the Ward and administers the medications for Ahmad using Electronic Medication Administration Record. While taking rest in his room, Ahmad sees his Electronic Medical Records and Charge Summary from his room itself. After a couple of days, he recovers from the surgery and is ready to be discharged. The Doctor and Nurse plan for Ahmad’s discharge. Using the Short Stay Discharge Workflow, the Doctor completes his Discharge Tasks – Placing Discharge Order, Writing Discharge Summary and prescribing Discharge medications. The Nurse, Pharmacist and Patient Finance then complete their Discharge Tasks. Ahmad gets discharged and pays his portion of the bill. The Ward Admin checks the bed clean status scorecard to monitor the bed status on the ward.
2. Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC. In section 2.2, we create a couple of text files used in the demo. In section 2.3, we schedule the surgery for the patient in the demo and In section 2.4, we start shift and run routine fill processing.
Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1 Start Microsoft Virtual PC In this section, we start Virtual PC Talking Points
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Click Steps
Screenshots
Start the Microsoft Virtual PC
Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2 Create Text Files In this section, we create text files. Talking Points
Click Steps
Open Windows Explorer
Click on My Documents
Right-click on the right side explorer window and select New > Text Document
Change the name of the text file to Dr Matt Hink’s ePreference card.txt
Double-click on the file to open it
Type Doctor Hink likes his patient to be ready with all pre-op procedures done and likes to reconfirm before the actual procedure.
Click File > Save
Close the text document
Right-click on the right side explorer window and select New > Text Document
Change the name of the text file to Discharge Notes for Ahmad Bilal.txt
Double-click on the file to open it
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Screenshots
Type Ahmad is ready to be discharged. Make sure he takes his discharge medications home.
Click File > Save
Close the text document
Close Windows Explorer window
2.3 Schedule Surgery In this section, we schedule surgery for the patient used in the demo. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type registration In Password field, type pass@word1 Click
Click on the Appointments application
Click on Appointments > General > Enterprise Scheduling
In the Enterprise Scheduling Window, click in the Employee field
Type Matt and press Enter
In the Calendar Tab, select a time for today
Right click the highlighted
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Screenshots
time slot
Click Add Appointment…
In the Patient Appointment Window, type Ahmad Bilal and press Enter
Set Reason Field to Other
Comments: Surgery
Set Appointment type Field to Routine
Set Appointment Method Field to patient request
Click OK
Click X to close
2.4 Start Shift, Run Routine Fill Processing In this section, we start the cashier shift and run routine fill processing. Talking Points
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Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Screenshots
In User name field type financial In Password field, type pass@word1 Click
Click on the Patient Finance application
Click Patient Finance > Cashier > Shift
Select Contoso Medical Center, click OK
If Shift if not started, click Start Shift
Click Close
Close Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
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Click Select Location Expand Contoso Medical Center Expand Main Building Expand Eighth Floor Select Ward 8 South Click OK
In User name field type pharmacist1 In Password field, type pass@word1 Click
Click on the Pharmacy application
Click on Pharmacy > Supply > Routine Fill Processing
Select the following: th Pharmacy: IPD 4 floor
Section: Distribution Ward: Ward 8 South
Click on More > Bring Up To Date NOTE: This could take up 30 minutes to an hour depending upon system resources!
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Click OK
After the Pharmacy is up to date, click Process
Click OK
Click Close
Click Close
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Click on Pharmacy > Supply > Pharmacy Queue Manager
Select the following: Pharmacy: IPD 4nd floor Section: Distribution Sort by: Priority and duration Stage: All
Click Refresh
Select all the entries by selecting the first row, holding shift key and selecting the last row
Right-click and select Delete Selected Entries
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Click Yes
Click Close
Close Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
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Click Select Location
Expand Main Building > Eight Floor > Ward 8 North
Select Nurse Station 8C
Click OK
Close the Amalga application
3. Begin Demo
3.1 Ahmad Bilal arrives at the hospital and Registration admits the patient for his scheduled surgery Ahmad Bilal, a patient suffering from stomachache, is scheduled for a surgery. He arrives at the hospital and Registration admits the patient into a room on the 8th floor ward. As the patient is expected to have a short stay at the hospital, he is admitted with a Short Stay Discharge Workflow designed for such a stay. Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type registration In Password field, type pass@word1 Click
Click on the Registration application
Click on Registration > Appointments > Patient Appointments
In the patient search box type Ahmad Bilal
Click Search
Registration notices the appointment scheduled for the surgery; she also sees that the surgery will be performed by Dr. Matt Hink
Click Close
Click on Registration > Admission > Inpatient Admission
In the patient search box type Ahmad Bilal
On the Open inpatient visit window, select Create new visit, visit type: IPD Click OK
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Screenshots
Click on the Inpatient tab
All of these options are configurable by the facility. In this case we will set to following options.
Select the following: Discharge Workflow : Short Stay Discharge Workflow Ambulatory status: Walking Arrival Mode: Self Comment: Surgery Primary service: Consult Doctor Priority: Standard Source: Physician Referral Visit reason: Other
We will add Dr. Hink as his as the Primary and Admitting Physician
Under Caregivers, Click Add > Primary Doctor > Find Search in the Name or number for Matt and select Matt Hink Click Yes
Click Select Bed…
Under Ward, select Ward 8 South
We are now going to look for a vacant bed that is in the Ward 8 South for our patient
Click Search
Choose a bed on the eighth floor, let us say 815 Click OK
Click Close
Click Save
3.2 Registration sends Internal Mail alert to OR Admin and Doctor Registration sends an Internal Mail alert to OR Admin and Dr. Matt Hink, the Doctor who is scheduled to perform the surgery. Talking Points
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Click Steps Continue using the previous session
Screenshots
Click on Applications > Ward
Click on Ward > General > Internal Mail
Click on New
Next to To, click …
In the Destination, type Registration Two, click Search
Click Add
In the Destination, type Matt Hink, click Search
Click Add
Click OK
In the Subject: type – Surgery Appointment patient Admitted
In the Body: type – Surgery Appointment patient Ahmad Bilal admitted.
Click Send
Click Close
Close Microsoft Amalga HIS
3.3 Schedule surgery and attach surgeon’s e-preference card The Operating Theatre admin schedules the surgery and attaches surgeon’s e-preference card. Talking Points In this section, we are using Radiology application to show Operating Theatre functionality. We will demonstrate how a procedure or a surgery can be scheduled along with the materials and resources required for the procedure or surgery.
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Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Screenshots
In User name field type radiologist1 In Password field, type pass@word1 Click
Click Radiology
Open Radiology > Main > Workspace
On Image Service Requests, New…
In the Patient Appointment Window, type Ahmad Bilal and press Enter Referral date – today
Referring physician – Matt Hink
Radiologist – Ankur Chavda (Dr.)
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Reason for request – Reason R1
Reporting Site: Redmond
Unselect Confirm Request
Under Procedures and Resources, Find: Laparoscopic
Select and add Laparoscopic Cholecystectomy, click Add>>
If prompted, click OK
Click on Scheduling tab
Change the start date for all the Surgery steps to today Change the start time of the first step from 8:00 AM to demonstration time (to match appointment time)
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The procedure is made up of three steps which have the duration of 20, 60, and 20 minutes. If you were to set the start time for the first procedure to 17:00 then the second step would be 17:20, and the third step would be 18:20.
Make absolutely sure all the resources are scheduled correctly, or you will not be able to confirm the request later
in the demo.
Click OK
If prompted, click Yes
Select the Image Service Request created above
Right-click > Show Attached Documents
If prompted, click Close Add Document > Add From File… Browse to and select My documents > Dr Matt Hink’s e-Preference card.txt
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Select the Document type – Others
Click OK
Click Close
3.4 Surgery scheduled with equipment needed, surgeon’s e-preference card looked at, and new resources added She also schedules all the necessary equipment needed for the surgery. By looking at the surgeon’s e-preference card, she also adds any other resources needed for the surgery. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type registration2 In Password field, type pass@word1 Click
Click on the Radiology application
Click on Main > Workspace
Next to Service, click … Click None, select Surgery Click OK
Click Refresh
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Screenshots
Right-click on the Image Service Request for Ahmad Bilal, click on Show Attached Documents
Click on the Others document on the left hand side Show Dr Matt’s preferences
Click OK
Select the Image Service Request for Ahmad Bilal, click Edit…
Click on the Scheduling tab
Scroll down the top frame and right-click on Task Step Surgery, and select Add Resources…
In the Keyword: field, type Toshiba, click Search
Select Toshiba – Laparoscopic sterile instrument kit/tray
Click OK
Click OK
Select the Image Service Request for Ahmad Bilal, click Confirm
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3.5 Ahmad is moved to the surgery room, patient received Ahmad is moved from his room to the surgery room. Patient is received and surgery is performed. Talking Points Patient is transferred from his Inpatient room to Surgery room.
Click Steps
Screenshots
Continue previous registration2 session
Amalga’s Portering application can be used to request portering
Click on Upcoming Procedures
Click on Refresh
Right-click on the first entry, select Receive Patient…
In the waiting area, select Registration Radiology Clinic
Click OK
Click on Waiting Patients
Click on Refresh
Right-click on the first entry, select Process Patient
Surgery is now performed on the patient.
Click Close
Close Microsoft Amalga HIS
3.6 Ahmad is back in the room after the surgery; Nurse records vitals every 4 hours After the surgery is performed, he is back in the room. Emma Liao, a nurse attending the shift, continues to record vitals every 4 hours to monitor Ahamd’s condition. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type nurse1 In Password field, type
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Screenshots
pass@word1 Click
Click on the Ward application
Click on Ward > General > Patient Chart
In the patient search box, type
Click Yes
Click OK
Click on Clinical Forms
Under Active Form, select Vital Signs
Type the vitals:
Ahmad Bilal
Temperature: 37.7 Pulse/min: 100 Respirations/min: 12 Blood Pressure: 120/90
ah
Click Save
Click Verify
On the Verification window, clear the Associated Print Form field
Click OK
Close the Clinical Forms window
Click Close
Close Microsoft Amalga HIS
3.7 Doctor examines Ahmad and prescribes medication.
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Right before the end of the shift, the doctor examines Ahmad and prescribes some medications. Talking Points
Click Steps
If a tablet PC is available during the demo, you can do this section on a tablet PC too
On the Tablet PC, double-click Microsoft Amalga HIS Icon
In User name field, type doctor7 In Password field, type pass@word1 Click
Click on the Ward application
Click on Ward > General >
Patient Chart
In the patient search box, type Ahmad Bilal
Click on the Flow sheet tab
Expand Care Results > Physical Examination and select the check box next to Vital Signs
On the right-hand side, select all the select checkboxes
See the vitals below in the chart
Click on the Medications tab
Click Prescribe… in the bottom toolbar
Under the Orderable Items panel, select the My Favorites tab
Select CIPROFLOXACIN 250 MG TAB (CIFLOXIN)
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Screenshots
In the Orderable Item Detail: CIPROBAXY 250 MG TAB (CIFLOXIN) panel, double-click on the dose - 2 tablets (500 mg) orally twice daily for 2 weeks
Click Modify in the bottom toolbar
Change Start drop-down to As Soon As Possible
Click Confirm
Talk about Immediate/Initial Fill and Routine fills in IP Pharmacy.
Click Review Orders
Medications are filled, checked and distributed towards every day.
Click Submit
Click Close
Click Close
Close Microsoft Amalga HIS
3.8 Pharmacist reviews, fills and checks medications. Medications are distributed to Ahmad’s room The Inpatient pharmacist reviews, fills and checks the medications ordered. The medications are then distributed to Ahmad’s room. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type pharmacist1 In Password field, type pass@word1 Click
Click on the Pharmacy application
Click on Pharmacy > Supply > Pharmacy Queue Manager
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Screenshots
Talk about integration with Swisslog Pharmacy Robot
Select the following: nd
Pharmacy: IPD 4
floor
Section: select nothing Sort by: Priority and duration Stage: click on … > click All and click OK
Click Refresh
Under the Patient Queue (1) panel, select the entry for Ahmad Bilal
Click Review
Under the Medication Order panel, make sure you see the Review Decision and Review Confirmation sections Note: If you don’t see the two sections, click the up arrows until you see them
Under Review Decision, select Verify
Under Reason, select Reviewed patient medication profile: therapy is appropriate
Under the Review Confirmation section, click Reviewed button
If prompted, click OK
Click Close
Under Section, select Distribution
Click Refresh
Under the Patient Queue (1) panel, select the entry for the
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patient Ahmad Bilal Click Fill
If prompted, click OK
For all the items, one by one, select, scroll down on the right hand side and click Filled
Click Print All Labels Click OK
Click Close
Click Refresh
Under the Patient Queue (1) panel, select the entry for Ahmad Bilal Click Check
Under the Medication Order panel, scroll down and click Checked
For all the items, one by one, select, scroll down on the right hand side and click Checked
Click Close
Click Refresh
Click Close
Close Microsoft Amalga HIS
3.9 Nurse monitors Medication administration schedule and administers medications for Ahmad The nurse attending the shift monitors the Medication Administration Schedule for the Ward and administers the medications for Ahmad using Electronic Medication Administration Record. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type nurse1 In Password field, type pass@word1
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Screenshots
Click
Click on the Ward application
Click on Ward > General > Ward Manager Under Ward, expand and select Ward 8 South Click Search
Select the patient Ahmad Bilal and click on MAR in the bottom toolbar
This ward is configured for Bar Coded Medication Administration (BCMA).
On BCMA window, click Override
Note: In order to user bar codes, you must have already printed our Employee ID card for Nurse1 and patient ID card for Ahmad to scan the bar code
Select Barcode Missing Click OK
Override is ok if no bar code readers are present during the demo. On BCMA window, click Override
Select Barcode Missing Click OK
If not visible, scroll to the right to see the next administration time
Double-click on the Due administration time
If barcode label for the medication is available, we can scan it.
On BCMA window, click Override Select Barcode Missing Click OK If enabled, select Administer radio button
Click Record Click OK
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Double-click on the next administration time
If barcode label for the medication is available, we can scan it.
On BCMA window, click Override Select Barcode Missing Click OK
Discuss other tabs available in this screen
Show Too early to administer message
Click Close
Click Close
3.10
Ahmad sees his EMR and Charge Summary in his room
While taking rest in his room, Ahmad sees his Electronic Medical Records and Charge Summary from his room itself. Talking Points
Click Steps
Continue nurse1 session
This is where a nurse/doctor can show patient’s EMR/bills in his room.
Click on Ward > General >
In the patient search box, type for Ahmad Bilal
Click on the Medications tab
Under the Review tab, nurse/doctor can also see/show the patients the orders placed before and results arrived.
Click on the Rx Review tab
Patient Chart
He can also look at other reports, X-Rays and other historical results.
Click Charges in the bottom toolbar
Click Charge Summary
Click Close
3.11
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Doctor and Nurse plan for Ahmad’s discharge
Screenshots
After a couple of days, he recovers from the surgery and is ready to be discharged. The Doctor and Nurse plan for Ahmad’s discharge. Talking Points
Click Steps
Continue nurse1 session
Click on Ward > General > Ward Manager Under Ward, expand and select Ward 8 South Click Search
Select the patient Ahmad Bilal
Click on Discharge Status…in the bottom toolbar
Under Status:, select Planned
Under Expected Discharge Date:, select today and after a couple of hours
Click OK
As the nurse is discharging Ahmad the doctor asks the nurse to print out a Discharge Summary note.
Select the patient Ahmad Bilal Select Print Forms…
Click OK
Enter Matt Hink into the Physician: text box
Drill down into IPD MR > Physician Form Group and select the Discharge Summary Page 1.1
Select the Preview button to review this is the correct form Click Close
The nurse will hand this form to the doctor in order for him/her to make notes around the patients discharge.
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Select Print in the upper right corner
Screenshots
Click Close
Click Close
Nurse will now look at the Discharge Workbench to see all the tasks that are to be done for the patient as he is now planned to be discharged.
Click on Ward > General >
If a profile is not selected, select Discharge Workbench Profile - Nurse
Enter Ahmad Bilal for the Patient name
Click Refresh
Click on View Tasks at the bottom
Show all the Active and Not Active discharge workflow tasks
Click Close
Nurse will now scan in the doctors notes
Click Ward > Documents > Add Document to Patient File
Click Add Document > From File…
Discharge Workbench
Browse to and select Discharge Notes for Ahmad Bilal.txt file under My documents Click Open
Select the Verify button from the top of the right side
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toolbar
Enter Ahmad and hit the enter key
Select the current visit and click OK
Select the Hospital Form radio button and then click on the build button
Enter Discharge for the Form name and click Refresh
Select the Form No. 206 from the list (Discharge Summary Page 1.1) Click OK
Under Physician, type Matt Hink, and press Enter
Click OK
Click OK
Close the window
Close Microsoft Amalga HIS
3.12 Doctor completes his Discharge Tasks – Placing Discharge Order, Writing Discharge Summary and prescribing Discharge medications Using the Short Stay Discharge Workflow, the Doctor completes his Discharge Tasks – Placing Discharge Order, Writing Discharge Summary and prescribing Discharge medications. Talking Points
Click Steps On the Windows Desktop, double-click Microsoft Amalga
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Screenshots
HIS Icon In User name field, type doctor7
In Password field, type pass@word1 Click
Click on the Ward application
Click on Ward > General >
Discharge Workbench
Under Patient, type Ahmad Bilal and press Enter
Click Refresh
Show the Not Active tasks
Click on View Tasks
Next to Discharge Order, click Start
In the patient header, scroll down to see Update Status
Click on Update Status
Change the Status to Confirmed
Click OK
Show the Not Active tasks turning into Active
Next to Discharge Order, click Set Complete
Next to Write Discharge Summary, click Start
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Next to Prescribe Discharge Medications, click Start
Click on Ward > General >
Patient Chart
In the patient search box, type for Ahmad Bilal
Click on the Report tab
Double-click on the Discharge Summary
In the report, under Patient’s condition upon discharge, select Improved
Under Type of discharge, select With approval
Click Save & Verify
Click OK
Click on the Medications tab
Click on Prescribe…
Doctor can also discontinue any medications – anytime during the patient’s stay or before discharge.
Under Orders panel, click on the Discharge Prescription tab
Under Orderable Items panel, select Search tab
In the Filter filed, type Ciprofloxacin
Select CIPROBAY 250 MG TAB (CIFLOXIN)
In the Orderable Item Detail: CIPROBAXY 250 MG TAB (CIFLOXIN) panel, double-click on the dose - 2 tablets (500 mg) orally once daily for 2 weeks
Click Review Orders
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Click Submit
Click Close
Click Close
Next to Write Discharge Summary, click Set Complete
Next to Prescribe Discharge Medications, click Set Complete
Click Close
Close Microsoft Amalga HIS
3.13
Nurse completes the Discharge Tasks
The Nurse, Pharmacist and Patient Finance then complete their Discharge Tasks. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type nurse1 In Password field, type pass@word1 Click
Click on the Ward application
Click on Ward > General >
Discharge Workbench
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Screenshots
Under Patient, type Ahmad Bilal and press Enter
Click Refresh
Click on View Tasks
Next to Patient Education,
click Start
Next to Follow up
Appointments, click Start
Click on the Visits tab
Click on Patient Appointments in the bottom toolbar
Click on Add…
Click in the Employee field,
Choose a desired time – two weeks from the demonstration day.
Set Reason Field to Check up
type Matt Hink and press Enter
Set Appointment type Field to Follow-up Set Appointment Method Field to patient request
Click OK
Click Close
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Click on Ward > General >
Patient Chart
In the patient search box, type for Ahmad Bilal
Click on the Patient Education tab
Expand Exit Care Templates > Surgery > Abdominal Pain > Abdominal Pain (English)
Under first drop down, next to Water, select 04 hours
Under second drop down, next to Water, select 99 F (32.2 C)
Click Verify and Print
Click OK
Click Close
Click on View Tasks
Next to Patient Education,
click Set Complete
Next to Follow up
Appointments, click Set Complete
Click on the Visits tab
For the purpose of demonstration, let us assume that pharmacist prepared the discharge medications, and portering requests were made.
Click on Change Workflow… in the bottom toolbar
Talk about Financial discharge workflows. For the purpose of demonstration, let us make pharmacist and administrative staff discharge tasks optional
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Unselect the checkboxes under the Applicable column next to
o Dispense Take home medications o Portering Requests o Clean the room
Click OK
Click Close
3.14
Ahmad is discharged
Ahmad gets discharged. Talking Points
Click Steps
Continue using nurse1 session
Click on Ward > General > Ward Manager
Under Ward, expand and select Ward 8 South Click Search
Select the patient Ahmad Bilal
Click on Discharge
Select the following: o Discharged reason: With approval o Discharged outcome: Improved o Discharged To Location: Home o Discharged by: Dr. Matt Hink
Under Coding by: select Matt Hink
Next to Code, click …
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Screenshots
Select the checkbox next to ICD9CM Search for stomach
Select the first entry
Click OK
Click OK
Click Yes
Click Process Charges…
Click Process…
Click OK
Click Close
Click OK
Click Close
Close Microsoft Amalga HIS
3.15
Ward Admin checks the bed clean status scorecard
The Ward Admin checks the bed clean status scorecard to monitor the bed status on the ward. Talking Points
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Click Steps
Screenshots
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type registration2 In Password field, type pass@word1 Click
Click on the Ward application
Click on Ward > General >
Visit Scorecard
Select Ward at the top
Under Ward, select Ward 8 South
Click Refresh
Click Show Legend
Click Hide Legend
Click Close
Close Microsoft Amalga HIS
3.16
Patient Pays his Bills
Ahmad pays his portion of the bill and leaves the hospital. Talking Points
The patient has now been discharged and has been handed his bill containing all the charges related to his hospital visit (both ED and IPD)
Click Steps On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type financial
In Password field, type pass@word1 Click Click on Patient Finance application
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Screenshots
Click on Patient Finance > Cashier > Patient Billing Select Contoso Medical Center and click OK
Enter Bilal in the Search field and press Enter key
The Visit Browser window opens
Select the first item in the Closed Visits list Click on Open button The Cashier window opens
Click on Process Charges tab
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Click on Make Invoice button
If prompted click on Yes button regarding pending services
Select the Remove from patient work queue option Make sure that the Block patient phone calls is selected Click on OK
Patient invoice has now been generated for the InPatient visit
Make sure you are on the Payments tab
Patient will now pay what was invoiced
Click Pay…
In the Amount column, enter full amount, equal to Owing Amount
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In the Print Receipts field, enter 1
Click on OK
If you do not have a default printer defined, a dialog box will pop-up stating that.
If prompted, click OK
The Cashier window now shows that a payment has been made
Show the payment made
Since the visit was closed already when the patient was discharged by the Nurse, there is no need for the cashier to close the visit
Click Close
Click Close
Close the Microsoft Amalga application
This concludes the demo. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
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Microsoft Amalga HIS Demo System Q1 FY10 Outpatient Demo Script Microsoft Corporation Published: September 2009
Summary This demo script will walk you through the Outpatient functionality, as managed by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which a pregnant woman attends a scheduled ante natal checkup. The scenario showcases enterprise scheduling process, work queues, computerized physician order entry, pharmacy workflows, and some of the patient finance workflows.
Roles and Personas Role Patient1 Patient2 Registration docto1 doctor2 Phlebotomist Pharmacist Cashier
Name Shannon Dascher Susana Aguirre Elena Velez Amezaga Rie Sasaki Jacek Maśliński Phlebotomist One Tom Higginbotham Sylvie Narp
User Name registration doctor1 doctor2 Phlebotomist1 pharmacist1 financial
Last verified version
5.4 SP6
Table of Contents 1 2 3
Demo Scenario ....................................................................................................................................... 3 Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC .................................................................................................... 3 2.1 Create Shannon Dascher’s Future Lab Order .................................................................... 3 2.2 Begin the Demo ...................................................................................................................................... 7 Shannon Dascher Previously Called to Schedule Appointment ......................................... 7 3.1 Susana Aguirre Arrives for Walk-in Appointment ............................................................... 8 3.2 Shannon Dascher Arrives for Doctor’s Appointment ........................................................ 10 3.3 Shannon Dascher Visits the Phlebotomist ........................................................................ 14 3.4 Shannon Dascher Returns to Women’s Center Registration ........................................... 15 3.5 3.5.1 Doctor Rie Sasaki reviews Shannon’s Electronic Medical Records ................................. 17 3.5.2 Doctor Prescribes Medication ........................................................................................... 19 3.5.3 Doctor Signs-out Shannon Dascher ................................................................................. 21 Shannon Dascher Schedules a Future Doctor’s Appointment ......................................... 22 3.6
© 2009 Microsoft Corporation. All rights reserved.
3.7
Shannon Dascher Pays Cashier for Patient Visit ............................................................. 24
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario Shannon Dascher is a pregnant 23 year old woman who is visiting the Contoso Medical Center Outpatient Department (OPD) Women’s Center for her second ante natal visit. She is in reasonably good health with the exception of hypertension, which has been diagnosed and is being monitored by her physician Dr. Rie Sasaki. Shannon already called in to make an appointment. When Shannon Dascher arrives for her appointment, the patient in front of her, Susana Aguirre, had already been in fetal-distress. Leveraging the enterprise scheduling feature, the receptionist determines which OBGYN doctors are available for Susana’s walk-in perhaps-emergency appointment. Susana is checked-in and safely escorted to an examination room. The receptionist then checks-in Shannon Dascher for her previously scheduled appointment. Shannon had a future lab order placed by her doctor and she proceeds to the laboratory collection center. Phlebotomist collects the blood for the CBC order. Shannon is then added to the doctor’s queue. Dr. Sasaki examines Shannon, looks at the previous lab tests done and prescribes some medication and signs out for the visit. Shannon then schedules her next follow-up appointment for the future, pays the current visit payment and pick-up her prescription at the pharmacy to go home.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start Virtual PC. In section 2.2, we create Shannon Dascher’s future lab order. Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written. 2.1 Start Microsoft Virtual PC In this section, we start Virtual PC Talking Points Start the Microsoft Virtual PC
Click Steps
Screenshots
Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2 Create Shannon Dascher’s Future Lab Order Doctor Jacek Masilinski, one of Shannon Dascher’s OB/GYN caregivers, schedules a Future Lab Order, a Complete Blood Count (CBC) Lab Test, for the Shannon Dascher.
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Click Steps
Talking Points Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Microsoft Amalga HIS is cost center driven, so the workstation must be set to a specific cost center location.
Click Select Location Expand Contoso Medical Center Expand Main Building Expand Second Floor Expand Womens Center Click Nurse Station / Registration Ob/Gyn Womens Centre Click OK
Login to Microsoft Amalga Hospital Information System.
In User Name Field type doctor2 In Password Field, type pass@word1 Click
Open the Clinic Application
Click on the Clinic Application
Open Patient Chart.
Click Clinic > General > Patient Chart
Open Patient Chart Window for Shannon Dascher.
In the patient search box, type shannon d Press Enter Key
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Screenshots
If necessary, assign an active caregiver, Doctor Jacek Maśliński, to Shannon Dascher.
Click Yes Button
Under the Role type, select Consulting Physician Click OK
In the Patient Chart Window, under the Computerized Patient Order Entry (CPOE) Tab, Doctor Jacek Masilinskji adds a future lab test for Shannon Dascher.
Click on the CPOE tab
Note that the search automatically starts as you begin typing. Microsoft Amalga HIS searches and displays, the Complete Blood Count (CBC) test.
In the Browser Panel (lower left corner), in the Find field, type CBC
In the Detail: CBC panel (lower right corner), click on the Location tab
In the Acquire order at subpanel (lower right corner), select Other Click …
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In the Select Area Window, Expand Contoso Medical Center Expand Main Building Expand Second Floor Expand Womens Center Click Nurse Station / Registration Ob/Gyn Womens Centre Click OK
Click Add
Click Submit
Unselect Close after print
Click Close
Click Close
Confirm the future CBC work order was added for Shannon Dascher.
In the Orders Information Panel (upper right corner), click on the Orders tab
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Click Close
Close the Microsoft Amalga application
3 Begin the Demo 3.1
Shannon Dascher Previously Called to Schedule Appointment
Shannon Dascher is a pregnant 23 year old woman who is visiting the Contoso Medical Center Outpatient Department (OPD) Women’s Center for her second ante natal visit. She is in reasonably good health with the exception of hypertension, which has been diagnosed and is being monitored by her physician Dr. Rie Sasaki. A week ago, Shannon already called in to make an appointment. Talking Points
Click Steps
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Login to Microsoft Amalga Hospital Information System (HIS).
In User Name Field type registration In Password Field, type pass@word1 Click
Open the Appointments application.
Click on the Appointments application
Open Enterprise Scheduling.
Click on Appointments > General > Enterprise Scheduling
Open the Enterprise Scheduling Window for Doctor Rie Sasaki.
Under Employee, type Rie and press Enter
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Screenshots
In the Calendar Tab, select a desired time slot
Note: This time slot should be the approximate time of the demo. Her appointment should be for “now.”
Right click the highlighted time slot, select Add Appointment…
In the patient search box, type Shannon D, press Enter
Set Reason Field to Ante natal care Set Appointment type to Routine Set Appointment Method to patient request Click on More Details
Set Requesting location Field to Womens Center
Click OK
Show the newly created appointment
Close the Patient Appointment Window
3.2
Susana Aguirre Arrives for Walk-in Appointment
When Shannon Dascher arrives for her appointment, the patient in front of her, Susana Aguirre, had already been in fetal-distress. Leveraging the enterprise scheduling feature, the receptionist determines which OBGYN doctors are available for Susana’s walk-in perhaps-emergency appointment. Susana is checked-in and safely escorted to an examination room. Talking Points
Click Steps
Continue using Registration session
Click on Applications > Registration
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Screenshots
Click on Registration > Registration > OPD Visit Registration
You will demonstrate, the patient search feature and people picker.
In the patient search box, type susana and press Enter
Select Susana Aguirre row
Click OK
You are now creating a new outpatient visit.
Click OK
Click on the Outpatient tab
You can provide some details about this walk-in visit.
Set the Source: to Unknown
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Set the Visit reason to Ante natal care : Fetal distress
In the Services Panel (lower right corner), click Add…
In the Request/Allocate caregiver Window, set the Specialty to OB/GYN (Women)
Click Find
Microsoft Amalga HIS automatically finds the appropriate doctor for the chosen specialty. You many click the Find Button again to see if another doctor is available.
Accept the first doctor – Jacek Maslinski
Unselect Print form after request/allocate Checkbox
Click OK
Click Save
Click Close
3.3 Shannon Dascher Arrives for Doctor’s Appointment Shannon Dascher checks-in with the registration receptionist who confirms Shannon’s appointment, verifies Shannon’s patient information and notifies her that the doctor ordered a CBC lab test. The receptionist directs her to the Phlebotomist to have blood drawn and reminds her to return to the registration desk for her doctor examination. Talking Points
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Click Steps Continue using Registration
Screenshots
session Patient Shannon Dascher arrives for scheduled appointment with Doctor Rie Sasaki.
Click on Registration > Registration > OPD Visit Registration
We will just type in Shannon to demonstrate the people picker features.
In the patient search box, type Shannon D and press Enter
Select the current appointment for Shannon Dascher.
In the Open outpatient visit Window, select the Select Checkbox Click OK
View Dr. Rie Sasaki’s schedule.
In the Request/Allocate caregiver Window, click View Schedule
Notice that Shannon Dascher’s appointment is in Doctor Rie Sasaski’s Calendar.
After viewing the calendar, close the Enterprise Scheduling Window
Unselect Print form after request/allocate
Click OK
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Review Shannon Dascher’s Patient information
Click on the Patient Attributes tab
Review Shannon Dascher’s Patient Attributes information
Click on the Contacts tab
Click on the Outpatient tab Under Source: select Unknown
Review Shannon Dascher’s Contacts information.
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Click on the Financial tab
Review Shannon Dascher’s Financial information.
Click on the Future Orders tab
Note that Shannon Dascher has a future order. Selecting the Future Order, will verify the order and associate it with this visit.
Select the first column Future Order checkbox
Click Save
Click Close
Click on Registration > Reports > Print Forms
In the patient search box, type Shannon D and press Enter
Click OK
Click Add
Under the Form panel, click Search
Under Search, type Queue
Click Search
For form 6, select the Select checkbox
Click Preview
Close the Preview Form window
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Click Save
Click Print
Click Close
Click Close
Close the Amalga HIS application
3.4 Shannon Dascher Visits the Phlebotomist The receptionist directs Shannon Dascher to the Phlebotomist who will draw her blood for the CBC lab test. Talking Points
Click Steps
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User Name Field type phlebotomist1 In Password Field, type pass@word1 Click
Open the Clinic application.
Click on the Clinic application
Collect the blood specimen.
Click on Clinic > Orders > Specimen Collection
You can also find the patient by partial last name.
In the patient search box, type Shannon D and press Enter
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Screenshots
Microsoft Amalga HIS automatically assigns the Verified Order in the Specimens to Collect Panel.
Select the Collect Checkbox
The Phlebotomist can print a label to indentify Shannon’s speicmen’s collection.
Review the CBC blood test Process Types.
Click Allocation…
Click OK
Click Save
Click Close
If prompted, click Yes
The Verified Order was moved from the Specimens to Collect section to the Collected Specimens section.
Click Close
Close the Microsoft Amalga HIS application
3.5 Shannon Dascher Returns to Women’s Center Registration Shannon completed her blood draw for her CBC Lab Test and returns to the Women’s Center Registration Desk for her appointment. Talking Points
Click Steps
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User Name Field type registration In Password Field, type pass@word1 Click
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Screenshots
Click on the Clinic application
Demonstrate the Patient Queue.
Click on Clinic > General > Patient Queue
Note: You may receive an error in this step. Close the error window and continue.
In the Patient Work Queue Window, confirm the Work Queue is set to Womans Center Click on Refresh
You will notice that Shannon Dascher is displayed in the Women’s Center Patient Work Queue.
Select the row for Shannon Dascher
Shannon’s queue status is set to Ready to Call after she checks with the receptionist.
Click Ready to Call
When the examination room is available, Shannon is called. The system will automatically call Shannon by her visit number over the intercom. In addition, Shannon’s visit number is display on a split screen TV monitor.
Click Call
When Shannon is directed to the examination room, her queue status is set to Now Serving.
Click Now Serving
Notice the Call Event for Shannon Dasher is Now Serving.
Click Close
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Close the Microsoft Amalga application
3.5.1
Doctor Rie Sasaki reviews Shannon’s Electronic Medical Records
Dr. Sasaki examines Shannon, looks at the previous lab tests done. Talking Points
Click Steps
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User Name Field type doctor1 In Password Field, type pass@word1 Click
Before and during Shannon’s examination, the doctor will review her Electronic Medical Record (EMR).
Click on the Clinic application
Click on Clinic > General > Patient Chart
If Shannon Dascher has her printed OPD Registration Form, the nurse or doctor can scan her barcode to view the Patient Chart.
In the patient search box, type Shannon D and press Enter
On the patient header, click on Caregivers link
Click New Role…
Under Role type:, select Consulting Physician
Click OK
Click Close
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Screenshots
Review the extensive Patient Chart Overview information.
Click on the CPOE tab
Review the CBC Order History.
In the Order Information Panel, click the Orders tab Select the CBC Order Row for the recent specimen collection Click History
The Phlebotomist collected the specimen for the CBC blood test, but the lab technician has not yet processed the test and therefore the lab results are not available for review.
Click Close
The doctor reviews the lab results for a previous test.
Click the Review tab
Review a previous lab result.
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Click the By Category tab
Expand Lab Result, and select the second lab
Show the lab report on the right-hand side
3.5.2 Doctor Prescribes Medication Doctor Rie Sasaki diagnoses Shannon Dascher’s medical condition and prescribes a medication to treat her symptoms. Talking Points
Click Steps
Continue using doctor1 session
After examining the patient, the doctor prescribes medication to treat the diagnosis.
Click on the Medications tab
Click Prescribe…
In the Prescription [New - ] Window, in the Orderable Items panel, click My Formulary tab
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Screenshots
Microsoft Amalga HIS references its internal medication database to determine inter-drug interactions and interactions with patient mediation allergies and diagnosed medical conditions.
In the Orderable Items panel, under antibiotics, mouse over in AUGEMENTIN 156MG/5 ML row
The system displays that the patient has an allergic reaction to Augmentin. The system displays that the patient is pregnant and Achromycin is not recommended.
In the Orderable Items panel, under antibiotics, mouse over
The system displays a pregnancy precaution with the use of Ciprobay.
In the Orderable Items panel, under antibiotics, mouse over in CIPROBAY 250MG TABLET row
Under Antibiotics, select the CIPROBAY 250MG tablet row
The system determined the common dosage for Ciprobay and you will order this dosage.
In the Orderable item Detail Panel (upper right hand corner), double-click the blue highlighted row (Take 2 tablets (500 mg) orally every 12 hours until discontinued)
The Orders Panel displays the common dosage ciprobay selected.
Under Supply period length, type 14
Under the drop-down next to Supply period length, select Days
Click Confirm
In the Order Session Panel, click Review orders
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in ACHROMYCIN 250 MG CAPSULE row
The Prescription [New - ] Window displays the medication(s) prescribed.
Review the orders
Amalga HIS assigned the rd prescription to the OPD 3 Floor Pharmacy. You may select External supply field to have the prescription filled at an external pharmacy.
Talk about where the orders are being routed to.
You will now submit the medication prescription to the Contoso Pharmacy.
Click Submit
Microsoft Amalga HIS displays the recently prescribed medication in the CPOE Medication Profile Tab
Review different tabs
3.5.3
Doctor Signs-out Shannon Dascher
Dr. Sasaki is done with Shannon’s examination and signs out for the visit.
Continue using doctor1 session
The doctor will now record the patient visit diagnosis and remove the patient from the doctor’s work queue.
Click on the Signout tab
In the Code Field, click …
The doctor can select a diagnosis code from the doctor’s list of common codes. If the code is not present, the doctor will utilize the diagnosis code search feature. In this example you will select from a list of common specialty codes.
In the Code Browser Window, select Common Codes (Specialty)
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In the Common Codes (Specialty), click …
select Allied Health Personnel
Click OK
Notice that Other general examinations description is in the Selected Code Panel.
Select the Other general examinations row
Click OK
The doctor can record several diagnoses. The doctor selects the primary diagnosis.
In the Patient Chart Window, in the Patient Coding Panel, make sure the Primary checkbox is selected
In the Actions Panel, select Completed
Click Save
Click Close
Close the Amalga HIS applciation
3.6 Shannon Dascher Schedules a Future Doctor’s Appointment Shannon Dascher goes to the Appointment Desk to schedule a follow-up appointment with Doctor Rie Sasaki. Talking Points
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Click Steps
Screenshots
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User Name Field type registration In Password Field, type pass@word1 Click
Shannon Dascher arrives at the Appointment Desk to schedule a future doctor visit.
Click on the Appointments application
Click on Appointments > General > Patient Appointments
If Shannon Dascher has her printed OPD Registration Form, the nurse or doctor can scan her barcode to schedule an appointment.
In the patient search box, type Shannon D and press Enter
Click Add…
In the Patient Appointment Window, set the Event time: Start date Field to a future date
Set Event time: Start time to 10 AM Set Event time: End time to 11 AM Set Reason Field to Ante natal care Set Appointment type to Follow-up
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Set Appointment method to patient request Click More Details Set Requesting Location to Womens Center
Under Employee, type Rie Sasaki, press Enter
Save the future scheduled appointment.
Click OK
Click Close
Close the Microsoft Amalga HIS application
3.7 Shannon Dascher Pays Cashier for Patient Visit The receptionist directs Shannon Dascher to the Cashier to pay for her lab test and doctor’s visit. Talking Points
Click Steps
Launch Microsoft Amalga HIS application
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User Name Field type financial In Password Field, type pass@word1 Click
Click on the Patient Finance application
Click on Patient Finance > Cashier > Patient Billing
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Screenshots
If the Select Company Window is displayed, chose Contoso Medical Center.
Select Contoso Medical Center
If Shannon Dascher has her printed OPD Registration Form, the nurse or doctor can scan her barcode to pay for her OPD visit.
In the patient search box, type Shannon D and press Enter Press Enter key
The patient’s open visit(s) is displayed.
Click Open
Click on the Process Charges tab
Click on Make Invoice
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Click OK
Select Close visit
Select Remove from patient work queue Click OK
Make sure you are on the Payments tab
Click Pay…
Change the amount to full amount, equal to the Owing amount Click OK
Review the Cashier Window.
Click Close
Click Close
Close the Amalga HIS application
This concludes the Outpatient demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
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Microsoft Amalga HIS Demo System Q3 FY09 Patient Finance Demo Script Microsoft Corporation Published: March 2009
Summary This demo script will walk you through the Patient Finance functionality offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which an OPD patient and an IPD patient are visiting Contoso Medical Center. As the patients receive their care, several charges are applied to their visits. At the end of the visits, the cashier creates invoices for them. Claims staff completes the workflows in preparing, sending and following up on the claims related to the visits. Patient Finance workflows are showcased through the actions performed by several personas.
Roles and Personas Role Patient1 Patient2 Registration Financial Doctor Financial2
Name Mel Hollar Bruce Smith Elena Velez Amezaga Sylvie Narp Rie Sasaki Financial Two
User Name
registration financial doctor1 financial2
Last verified version 5.4 SP6
Table of Contents 1 2 3 4 5 6 7 8 9
Demo Scenario ....................................................................................................................................... 3 Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC .................................................................................................... 3 2.1 Set VM Location .................................................................................................................. 3 2.2 Financial creates a new policy and attaches the policy to Patient1 ....................................................... 4 Financial creates a new claim for Patient1 for the upcoming visit.......................................................... 9 Charges are estimated and new claim is authorized............................................................................ 10 Patient1 arrives for the OPD surgery, Registration checks in .............................................................. 14 Financial associates the claim with the visit ......................................................................................... 16 Patient1 is done with the surgery, and charges applied ....................................................................... 18 Finance creates invoices while Patient1 pays a portion of the bill responsible .................................... 20
© 2009 Microsoft Corporation. All rights reserved.
10 Patient2, who was admitted earlier, is requested to deposit additional amount. When ready to be discharged, his Bed charges are processed ............................................................................................... 22 11 Finance adds any remaining charges, creates invoices and patient pays a portion of the bill ............ 24 12 Financial2 works on the claims to prepare and send ........................................................................... 26 13 Financial2 also addresses other claims in different stages .................................................................. 31 For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario
Mel Hollar (Patient1) is referred to Contoso clinic for an Outpatient surgery. As there are some changes in his policy, he has faxed in the policy and referral information to the clinic. Finance staff creates the new policy, which currently does not exist in the system. Several rules, prices, and exclusions are included in the policy. Claims staff is requested to create a new claim for the patient. After the claim has been created, charges are estimated and the claim is authorized. Patient1 arrives for the OPD visit on the day of the surgery. New admission is created and the existing claim is associated with the visit. Charges are applied during the visit and at the end of the visit the cashier creates an invoice by which the status of the claim is automatically changed to “Invoiced”. The system also handles Patient1’s second policy of a 5% employee discount for the guarantor fees. Patient pays after discount charges responsible by himself. Meanwhile, Bruce Smith (Patient2), who was already admitted to the hospital, had deposited an amount at the time of admission. Several charges were added to the patient during his stay at the hospital. As his current charges went over the deposited amount, he is requested to deposit additional amount. At the time of discharge, the patient’s bed charges are processed. Charges are automatically split based on the policy rules and exclusions. Patient’s partial payment after the deposits are counted in is paid off. For the rest of the amount, a claim is automatically created with “Invoiced” state. Claims staff works on both the claims. The claims are moved through several statuses – preparing, prepared, and finally sent. Claims staff moves on to address two other claims that had the statuses “Requires follow-up”.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections. In section 2.1, we start Virtual PC. In section 2.2, the VM’s location is set for the requirements of the scenario.
Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC
In this section, we start Virtual PC Talking Points Start the Microsoft Virtual PC
Click Steps Open Microsoft Virtual PC and start the Amalga HIS virtual machine Launch Amalga HIS application on the laptop to connect to the virtual machine Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2
Set VM Location
In this section, VM’s location is set.
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Screenshots
Talking Points
Click Steps
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Set the location of the VPC
Click Select Location
Screenshots
Expand Contoso Medical Center Expand Main Building Expand Second Floor Expand OPD 2nd Floor Click OK Close the Microsoft Amalga HIS
3 Financial creates a new policy and attaches the policy to Patient1
Mel Hollar (Patient1) is referred to Contoso clinic for an Outpatient surgery. As there are some changes in his policy, he has faxed in the policy and referral information to the clinic. Sylvie Narp, Finance employee, creates the new policy, which currently does not exist in the system. Several rules, prices, exclusions are included in the policy. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type financial In Password field, type pass@word1 Click
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Screenshots
Click on Patient Finance
Click on Patient Finance > Policy > Policy
Enter or select the following: Name: Contoso Financial Class : Insurance Policy type: Insurance Third Party … > Organisation … Name : Fain Ltd Click Search Click OK > OK Click Save
Click on the Rules tab
Click Edit Rules
Click Use Template
Select Standard 85-15 Click OK Click OK
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Click on the Overview tab
Click on the Exclusions tab
Next to Packages, click on …
Click on Add…
In the search for, type wellness evaluation, click Search
Click OK
Click OK
Click on the Limits tab
Click Add
Under Limit Type column, select OPD visit total
Under Value column, type 2000, followed by Tab
Click Add
Under Limit Type column, select IPD visit total
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Under Value column, type 10000, followed by Tab
Click on Save
Click on the Overview tab
Click on the Change Log tab
Click Close
Click on the Forms tab
Click on the Claim Info tab
Click on the Members tab
Click Add…
Next to Member, click …
In the Search for:, type Mel
Click Search
Select the patient Mel Hollar
Click OK
Click OK
Click Save
Click on the Members tab to see if the member added is saved
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Click on the Identification tab
Click on Add…
Under ID Type:, select Policy Document
Click Scan/Add From File
Select the scanned output or a text file with test content
Click OK
Click on the Documents tab
Click on Edit…
Click on Add Document > Add From File…
Select a text file with test content
Under Document Type:, select Customer
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Click OK
Click Close
4 Financial creates a new claim for Patient1 for the upcoming visit
Claims staff is requested to create a new claim for Patient1 for the upcoming visit. Sylvie Narp, Financial, creates the new claim. Talking Points
Click Steps
Continue using the Financial session
Click on Patient Finance > Process Claim > Claim
If Select Company window is prompted, select Contoso Medical Center and click OK
Click New Claim
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Screenshots
In the Patient Search box, select Mel Hollar patient and then press Enter
Change IPD to OPD
Click on the Policy Subscription tab
Next to Name, click …
Type Contoso in the Policy name field, click Search Select Contoso > OK
Click Save
Under Financial Class, select Insurance
Click on the Patient Notes tab
Click on the Claim Notes tab
Click on the Letters tab
Click on the Visit Info and Policy Comments tab
Click on the History tab
Click on the Documents tab
Click on the Charge Estimates tab
5 Charges are estimated and new claim is authorized
After the claim has been created, charges are estimated and the claim is authorized. Talking Points
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Click Steps
Screenshots
Continue using the Financial session
Make sure you are on the Charge Estimates tab, click Create
Change Visit type group to OPD
Click Add > Items from Estimate Template
Under Surgery, select Appendix
Click OK
Click on the Policies tab
Click on the Process Charges tab
Click Create
On the Estimates tab, click Add >
Click Save
Click Close
Click View > Detailed Estimate
You are on the Charge Estimates tab
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Click Save
Click Close
Click on Patient Finance > Process Claim > Preauthorization Work Bench
Click on the Preauthorising tab
Select the entry for Mel Hollar
Click Open Claim
Click on the Claim Notes
Click Add Note…
In the Description, type – Contacted Fain Ltd with the charge estimate and confirmed the guarantee for the charges
Click OK
Finance staff wants to add the guarantee letter
Click on the Documents tab
Click Edit…
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Click on Quick Scan/Add Document > Add From File…
Selected the scanned Guarantee Letter or from a text file with test content
Click OK
Click on the Claim tab
Change the status of the claim from Pre-Authorising to Authorized/Pending
Click Save
Click Close
If prompted, click Yes,
While working on this claim, financial staff looks at other claims that have 90% or more authorization amount usage or exceeded
Click on the Authorisation Exceed tab
Click on the Authorisation Amount Usage > 90% tab
Click Close
Close Microsoft Amalga HIS
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6 Patient1 arrives for the OPD surgery, Registration checks in Patient1 arrives for the OPD visit on the day of the OPD surgery. New admission is created. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type registration In Password field, type pass@word1 Click
Click on Registration
Click on Registration > Registration > OPD Visit Registration
In the Patient Search box, type and select Mel Hollar > Enter
On the Open Outpatient visit window, select Create new visit, click OK
Click on the Outpatient tab
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Screenshots
Type or select the following:
Ambulatory status: Walking Arrival Mode: Self Comment: Surgery Primary service: Consult Doctor Priority: Standard Source: Clinic Referral Visit reason: Abdominal Discomfort
Under Services, click Add…
Select Override auto allocation
Under Caregiver, type Rie Sasaki > press Tab
Under Patient queue, select Day Surgery
Unselect Print form after request/allocate checkbox
Click OK
Click Save
Click on the Financial tab
Select Override policy financial class
Under Financial Class, select Insurance
Under Patient, select Contoso, click Add>
Select Employee Discount, click Add>
Click Save
Click Close
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Close Microsoft Amalga HIS
7 Financial associates the claim with the visit Sylvie associates the existing claim with the newly created visit. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type financial In Password field, type pass@word1 Click Click on the Patient Finance icon
Click on Patient Finance > Process Claim > Claims Work Bench
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Screenshots
If you get the Select Company window, select Contoso Medical Center and click OK
Change the Claim Status group to Pending
On the left, at the top, select Summary
Select Grid view
Under Authorized/Pending status, select Contoso claim
Click Open
Next to Visit Number, click …
Select the open visit, click OK
Click Save
Click Close
If prompted, click Yes
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Click Close
8 Patient1 is done with the surgery, and charges applied Charges are applied during the OPD visit. Talking Points
Click Steps
Continue using the financial session
Click on Patient Finance > Cashier > Patient Billing
In the Patient Search box, type and select Mel Hollar > Enter
Select the Open visit, click Open
Click Add Charge…
Click Add Service…
Search for Appendix Select Appendix C/S Click OK
Click Add Service…
Search for Surgery Select Day Surgery Bed – 1st -2 hours Click OK
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Screenshots
Click Add Service…
Search for Anesthesia Select Anesthesia General 1 St Hour (Minimum) Click OK
Click Add Service…
Search for Doctor Select General Doctor Fee Click OK Select Rie Sasaki Click OK
Double-click in the Price column and edit the last row for Doctor’s fee to have a price of 500
Click Review
Click Close
Click Save
Click Close
Click Close
Click Close
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9 Finance creates invoices while Patient1 pays a portion of the bill responsible
At the end of the visit, cashier creates an invoice by which the status of the claim is automatically changed to “Invoiced”. The system also handles Patient1’s second policy of a 5% employee discount for the guarantor fees. Patient pays after discount charges responsible by himself. Talking Points
Click Steps
Continue using the financial session
Click on Patient Finance > Cashier > Patient Billing
In the Patient Search box, type and select Mel Hollar > Enter
Select the Open visit, click Open
Click on the Process Charges tab
Notice the Claim Code number
Select the top Insurance policy row
Click on Apply Policy
Show how the limits and split percents are applied
Select the Guarantor policy row
Click on Complete Split
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Screenshots
Show how two insurances are handled perfectly well
By selecting the Guarantor row, show the discount %s and after discount amount
The Patient is responsible for the partial split
Under Discount reason, select Employee Discount
Click on Make Invoice
Click Yes
Select Close Visit and Remove from patient work queue checkboxes
Click on the Payments tab
Select the second row for which payer is Mel Hollar
Click on Pay…
Change the amount from 0 to 1198 (equal to Remaining Amount)
Click OK
Click Close Click Close
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10 Patient2, who was admitted earlier, is requested to deposit additional amount. When ready to be discharged, his Bed charges are processed
Meanwhile, Bruce Smith (Patient2), who was already admitted to the hospital, had deposited an amount at the time of admitting. Several charges were added to the patient during his stay at the hospital. As his current charges went over the deposited amount, he is requested to deposit additional amount. At the time of discharge, the patient’s bed charges are processed. Talking Points
Click Steps
Continue using the financial session
Click on Patient Finance > Cashier > Visit Aging
Under Visit type, select IPD (fourth one from the bottom, not the bottom most), click Refresh
Select the patient Bruce Smith Note: If you don’t see the patient, make sure you select the right entry under Visit type above.
Show the Total Charges, and Outstanding Deposit
Click Close
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Screenshots
Patient is requested to deposit additional amount.
Click on Patient Finance > Cashier > Deposit and Refund
A deposit is being made on behalf of him
Select the patient Bruce Smith > Enter
Click on Add
Change the Amount column to 5000 > Tab
Click Save
Click on the Deposit History tab
Click Close
Let us assume that the patient is now ready to be discharged
Click on Patient Finance > Cashier > Bed Charges
In the Patient Search box, type Bruce Smith > Enter
Click Search
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Click on Process…
Click OK
Click Close
11 Finance adds any remaining charges, creates invoices and patient pays a portion of the bill
After all the charges are added, the invoices are created. Charges are automatically split based on the policy rules and exclusions. Patient’s partial payment after the deposits are counted in is paid off. For the rest of the amount, a claim is automatically created with “Invoiced” state. Talking Points
Click Steps
Continue using the financial session
Click on Patient Finance > Cashier > Patient Billing
In the Patient Search box, type Bruce Smith > Enter
Select the Open visit, click Open
Show all the charges applied to the patient while he was in the hospital
Talk that if there are any more charges that need to be added before the patient is discharged, they can be added here.
Click Add Charge…
Click Close
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Screenshots
Click on the Process Charges tab
Show that no policies were added to the visit at the time of creation of the admission
Click on Policies(1)…
Select Fabrikam claim, and click Add > Click OK
Click Apply Policy
Click Complete Split
The Patient is responsible for the remaining split
Click on Make Invoice
Click Create Invoice
Unselect all the checkboxes Click OK
Click on the Payments tab
Select the bottom row for which payer is Bruce Smith
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Click on Pay…
Click on Deposits…
Click on OK
Show the deposit made earlier
Click Add
Change the third row Payment Type to Cash
Change the amount in third row from 0 to 390 (equal to Remaining Amount)
Click OK
Click Close
Click Close
12 Financial2 works on the claims to prepare and send
Claims staff works on both the claims. The claims are moved through several statuses – preparing, prepared, and finally sent. Talking Points
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Click Steps
Screenshots
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type financial2 In Password field, type pass@word1 Click
Click on Patient Finance
Click on Patient Finance > Process Claim > Claims Work Bench
If prompted, select Contoso Medical Center, click OK
Change the Claim Status group to Any
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On the left, at the top, select Summary
Select Grid view
Under Invoiced status, select Summary – Invoiced
Adjust the View top value from 10 to 30 Show that the claims With Policy Names Contoso and Fabrikam are in there with Invoiced status
Select the claim for Contoso
Click Open
Show the amount, balance, visit number and Invoice number etc.
Click on Open > Open Invoice
Click OK
Show several fields on the General tab
Click on Details
Click Next four times to show all the line items of the invoice
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Click Close
Click on the Payment Options tab
Click on the Additional tab
Click on the Visit Information tab
Click on the Package Information tab
Click on the Item Group Summary tab Click on the History tab Click on the GL Transaction tab Click Close
Change the status of the claim from Invoiced status to Preparing Click Save
Change the status of the claim from Preparing status to Prepared
Click Save
Change the status of the claim from Prepared status to Sent
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Click Save
Click Close
Click Yes
Select claim for Fabrikam
Click Open
Show the amount, balance, visit number and Invoice number etc. Change the status of the claim from Invoiced status to Preparing
Click Save
Change the status of the claim from Preparing status to Prepared
Click Save
Change the status of the claim from Prepared status to Sent
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Click Save
Click on the History tab Click Close
Click Yes
13 Financial2 also addresses other claims in different stages
Claims staff moves on to address two other claims that had the statuses “Requires follow-up”. Talking Points
Click Steps
Continue using the financial2 instance of Microsoft Amalga HIS
Change the Claim Status group to Requires Follow Up
On the left, at the top, select Summary - Requires Follow Up – Not Sent
Select the invoice with policy 68 for amount 557
Click Open
Click on Claim Notes (0)
Click on Add Note…
Under Description, type Spoke with Agnes at Fain Insurance and she stated that they would play the amount within 14 days. No check number yet Click OK
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Screenshots
Click on the Claim tab
Change the status to Sent
Click Save
Click Close
Click Yes
Click Close
Click Patient Finance > Process Claim > Search Claim
Talk about a great feature to search claims with so many available filters
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Select the Claim Status checkbox on the left hand side filters
On the Display Values on the right hand side, scroll down and select Requires Follow Up – Manual Date
Click Search
Select the invoice
Click Open
Click on Claim Notes (0)
Click on Add Note…
Under Description, type Spoke with Linda at Baines Insurance and she stated that the submitted charges are not covered. Further follow up necessary
Click OK
Click on the Claim tab
Change the status from Requires Follow Up – Manual Date to Requires Follow Up – Rejected
Click Save
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Click Close
Click Yes
Click Close
This concludes the Patient Finance demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
Page 34 of 34
Microsoft Amalga HIS Demo System Q3 FY09 Radiology Demo Script Microsoft Corporation Published: March 2009
Summary This demo script will walk you through the Radiology functionality offered by the Microsoft Amalga HIS system. The demonstration is designed around a real world scenario, in which a patient is taken to Contoso hospital with a suspected brain injury following a Road Traffic Accident. Whilst the Radiologist is reporting on the CT images of the patient, he is requested to perform an urgent MRI study for a second patient. Workflows are showcased through radiology procedures performed on these two patients.
Roles and Personas Role Patient1 Patient2 Registration Doctor Radiographer1 Radiologist1
Name Michelle Wright Whoever Elena Velez Amezaga Rie Sasaki Radiographer One Radiologist One
User Name
registration doctor1 radiographer1 radiologist1
Last verified version 5.4 SP4
Table of Contents 1 2
Demo Scenario ....................................................................................................................................... 3 Demo Setup ............................................................................................................................................ 3 Start Microsoft Virtual PC .................................................................................................... 3 2.1 Doctor places a CT scan order on Patient1, Michelle Wright ............................................. 3 2.2 3 Receptionist receives Patient1 to the waiting area................................................................................. 5 4 Radiographer1 checks the order and starts the Image capture for Patient1 ......................................... 9 5 Radiographer1 completes the image capture, adds acquisition notes and a red flag ......................... 12 6 Radiographer1 completes the post processing, dose tracking, materials used and confirms the image acquisition for Patient1 ................................................................................................................................ 15 7 Radiologist1 opens and studies Patient1’s images .............................................................................. 17 8 Radiologist1 suspends Patient1’s session, attends another request of Patient2 ................................. 31 9 Radiologist1 reports on Patient2’s images ........................................................................................... 32 © 2009 Microsoft Corporation. All rights reserved.
10 Radiologist1 returns to suspended session and completes the diagnosis of Patient1’s images ......... 35 For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Scenario Michelle Wright is involved in a minor Road Traffic Accident (RTA). After a couple of days of rest at home, she started complaining of frequent headaches and is taken to Contoso Hospital. She is admitted to the Outpatient Department and the attending doctor orders a Brain and Base of skull CT scan procedure as a brain injury is suspected. Elena Velez Amezaga, a receptionist in the Radiology department, sees the confirmed image service request for Michelle Wright (Patient1) and she checks in the patient and receives her into the waiting area. Radiographer1 starts the image acquisition and notices Patient1 is in distress; she suspends the image capture. As the patient becomes better she restarts and completes the capture. Radiographer1 performs post processing, dose tracking, materials used, adds a red flag and acquisition notes and confirms the CT scan acquisition for Patient1. Radiologist1 studies the images captured and prepares the reports. While studying the CT images for Patient1, the Radiologist is notified to perform an urgent MRI image study for Steven Smith (Patient2). He suspends his study for Patient1 and starts studying Patient2’s images. He then completes the study for Patient2, prepares a report and switches back to the suspended session for Patient1. Finally, he completes the study for Patient1 and prepares a report.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections. In section 2.1, we start Virtual PC. In section 2.2, Dr. Sasaki places a CT scan order for patient Michelle Wright for her brain.
Note: Remember that the changes you make to the VM need to be discarded for you to re-run the demo script as written.
2.1
Start Microsoft Virtual PC
In this section, we start Virtual PC Talking Points
Click Steps
Start the Microsoft Virtual PC
Open Microsoft Virtual PC and start the Amalga HIS virtual machine
Launch Amalga HIS application on the laptop to connect to the virtual machine
Screenshots
Note: Use administrator and pass@word1 to troubleshoot the virtual machine
2.2
Doctor places a CT scan order on Patient1, Michelle Wright
In this section, Dr. Sasaki places a CT scan order for patient Michelle Wright for her brain. Talking Points
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Click Steps
Screenshots
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
Set the location of the VPC
Click Select Location Expand Contoso Medical Center Expand Main Building Expand Second Floor Expand Medical Clinic Click OK
Login to Microsoft Amalga HIS as Doctor1
In User name field, type doctor1 In Password field, type pass@word1 Click
Click on the Clinic application
Create CPOE order for Patient Michelle Wright.
Click on Clinic > Orders > Create CPOE Order Hide the clinic list after you have selected Create CPOE order
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In the patient search box, type Michelle Wright or shortcut 0329 and press Enter
Under the Browser panel, select the Radiology tab In the Find: field, type Brain and base
Select Brain and Base of skull (CT)
On the General tab under detail, change the priority to STAT. Note: Under Indications, do not select any – this will cause the image service request to be unconfirmed as it needs reason for request field
Click Add
Under the Active Orders panel, select the new order, click Submit
Unselect Close after print Click Close
Click Close
Close Microsoft Amalga HIS
3 Receptionist receives Patient1 to the waiting area Elena Velez Amezaga, a receptionist at Radiology labs, sees the confirmed image service request for Patient1 (Michelle) and she checks in the patient and receives her in to the waiting area.
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Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field, type registration In Password field, type pass@word1 Click
Click on the Radiology application
Click on Radiology > Main > Workspace Hide the Radiology list after you have selected Workspace
Click Refresh to see the latest Imaging Service Requests
Show the Confirmed status for the order for Michelle Wright
Under Procedure steps, select the row. Right-click and select Open
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Screenshots
Select the Scheduled check box
Click on the Scheduling tab One can change the starting time for the procedure
Show that the CT scanner room 1 is automatically scheduled and talk about the ability to set up procedure plans ahead with various steps and resources in each step
Click OK
Talk about Ad-hoc Service Requests.
Click New…
The one we are seeing here was created automatically when a CPOE order was placed by a provider. However, one can also create an ad-hoc image service request from here. Talk about scheduling here. Talk about how one can schedule resources (providers, medical devices, equipment etc.) for the image can service requests.
In the patient search box, enter Shannon Dascher and press Enter Under Procedures and Resourses, search for and select Brain and Base of skull CT, click Add >> Click on the Scheduling tab, show the resources automatically scheduled for the image service request Click on the Request tab Talk about all other fields on the tab Click Cancel
Schedule tab allows someone to see the schedule of a given resource of type room, equipment, or employee
Click on the Schedule tab on the left Next to Find resource, click … Search for CT scanner, and select CT scanner room 1 Click OK Show the procedure that was
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just scheduled
Talk about the concept of Timestamping.
Click on the Upcoming Procedures tab on the left
Talk about how upcoming procedures and waiting patients tab are optional but need to be done if effective tracking is needed.
Click Refresh
Note the STAT priority for Michelle’s order
Right-click on Michelle Wright patient, select Receive Patient…
Under the Waiting area:, select CT Waiting Area
Click OK
Click on the Waiting Patients tab on the left
Click Refresh
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Right click select Process patient
Click Close
Close Microsoft Amalga HIS
4 Radiographer1 checks the order and starts the Image capture for Patient1 Radiographer1 is serving the CT scan lab. He checks in the patient and looks at some previous images taken of her some time ago. He then starts the CT scan image acquisition, but suspends the image capture due to the patient being in distress. Talking Points
Click Steps
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type radiographer1 In Password field, type pass@word1 Click Click on the Radiology application
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Screenshots
Click on Radiology > Main > Workspace
Hide the Radiology list after you have selected Workspace
Talk about the procedure filters explain why they are there then close them…looks too busy otherwise
Click on the Tech List tab
Talk about the Stored Display buttons (worklists specific to modality)
Adjust the From Date to 12/1/2006
Click on Hide << to hide the procedure filters
Click Refresh Show the Stored Display buttons and select the CT Room 1 button Click on the Patient column header to sort the list by patient name
Talk about a single solution Radiographer now has become part of the patients healthcare being able to view EMR, great for interventional. Talk about how the Radiographer can look at previous image service requests, acquisition notes / images directly without leaving th application.
Right-click on the entry Michelle Wright for Brain and Base of skull (CT) procedure, select Patient View > Overview Click on the Requests tab on the left Click on the Imaging tab Click on the Emr tab Close Mrs. Michelle Wright tab If exist, under previous acquisitions, you can select a previous acquisition and right click to select Quick View Click Hide << Under Status, select Confiemd checkbox Select the patient Thomas Taylor – for BRAIN procedure with RP ID BUM000010000001 Select the previous acquisition at the bottom, and right-click > Quick View Close the Study Viewer window Adjust the From Date to
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Yesterday Click Refresh
Talk about attached documents. If there are any documents attached to the service request, either at the time the order was placed or any documents attached by the receptionist, this is how one can see the attached documents. The radiographer herself can attach documents using this window. For the purpose of demonstration, let us not attach any documents.
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Right-click on the entry for Michelle Wright, select option Show Attached Documents Talk about how one can attach documents from here. Click OK
The image capture is started. The patient goes through some distress while the CT scan acquisition has been made. Talk about allergies here.
Once the patient had enough time to gain composure, radiographer1 starts the image capture again.
Right-click on the entry for Michelle Wright, select Start… Right-click on the entry for Michelle Wright, select Suspend
Right-click on the entry for Michelle Wright, select Start…
5 Radiographer1 completes the image capture, adds acquisition notes and a red flag Radiographer1 then completes the image capture for Michelle Wright, adds acquisition notes and a red flag Talking Points
Click Steps
Continue using the radiographer1 instance of Microsoft Amalga HIS
Image acquisition is completed.
Right-click on the entry for Michelle Wright, select Complete
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Screenshots
Talk about Acquisition Notes.
Right-click on the entry for Michelle Wright, select Edit Acquisition Notes…
Radiographer enters the notes.
In the Report Editor window, on the right-hand side, expand Templates
We could create different templates, and for the purpose of demonstration let us see how an X-Ray template would look like.
Double-click on General X-Ray Show the template Talk about different buttons. On the image top left corner, click Edit
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Select the Select Color tool on the left (the bottom one) and select Red color
Select the Draw Ellipsis tool (third tool from the top)
In the Image Annotator screen, draw a circle around rightshoulder to indicate trauma area.
Click OK
Click on the Insert picture into document button Click Cancel
Let us go back to the Blank Report.
Double-click on Blank Report
Talk about Quick Texts. We can collate a list of frequently used terms and save them as Quick Texts to use them later.
Type the following: and/or use Quick Text (/distress)
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Patient was in distress, had to suspend image acquisition to give patient time to gain composure.
An icon will appear to indicate that the acquisition has Acquisition Notes.
Click OK
Radiographer can flag an acquisition for attention.
Right-click on the entry for Michelle Wright, select Flag for Attention > Red Flag
Explain red dot is used for abnormality in conjunction with the acquisition note to identify an abnormality to A & E for example
6 Radiographer1 completes the post processing, dose tracking, materials used and confirms the image acquisition for Patient1 Radiographer1 then completes the post processing, dose tracking, materials used and confirms the image acquisition. Talking Points
Click Steps
Continue using the radiographer1 instance of Microsoft Amalga HIS
Radiographer1 then completes the post processing, dose tracking, and material management.
Right-click on the entry for Michelle Wright, select Edit…
He gives the patient Ultravist 370 mgI/50ml injection
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You can also double click the entry after the complete to bring up the post processing screen
Screenshots
On the Post Processing screen, on the Procedure tab, under Comments, you can add a comment
Click on the Dose Tracking tab
Explain that defaults can be used and then modified, if that is easier.
Modify the Dose Information, Comments and Exposures as necessary
Talk about how one can add materials, medicines, medical supplies used during the image acquisition for billing purposes.
Click on the Materials Management tab
Click Add…
Next to Item, click …
Under search for, type Ultravist,
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click Search
Select Ultravist 370 50 mL
Click OK
Select XRAY
Click OK
Click OK
Radiographer is done with the post processing and so confirms the image acquisition.
Right-click on the entry for Michelle Wright, select Confirm
Click Close Exit Amalga HIS Application
7 Radiologist1 opens and studies Patient1’s images Radiologist1 studies the CT images captured for Michelle Wright and is ready to create a report. Talking Points
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Click Steps
Screenshots
Start Microsoft Amalga HIS
On the Windows Desktop, double-click Microsoft Amalga HIS Icon
In User name field type radiologist1 In Password field, type pass@word1 Click
Click on the Radiology application
Click on Radiology > Main > Workspace Hide the Radiology list after you have selected Workspace
Click on the Reporting tab
Talk about Procedure Filters. Once can hide them too.
Click Hide <<
Next to Show studies from:, change the from date to 9/9/2007 Click Refresh Click on the Patient column header to sort the list by patient name
Talk about organized system displays. By selecting a display, one can only see the defined types of image studies according to the filters/procedure types chosen.
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Show the Stored Display buttons and select the CT Reporting button
Here CT scan button will bring CT scan image studies only.
In the list of studies, select the study of Michelle Wright for BRAIN and Base of skull (CT) procedure – this is the one with RP ID BMC0900025601
Radiologist can see the icon to know that there were some Acquisition Notes
Under Image studies, right-click on the study, select View Acquisition Notes Click Close
Using the Administration tab, one can manually import the images and assign them to the patients. For the purpose of demonstration, let us use already uploaded and assigned image studies. Talk about how the Radiologists can look at previous image service requests, images directly without leaving from the application.
Select the study of Michelle Wright for BRAIN procedure – this is the one with RP ID BUM000129000001
Right-click on the entry for Michelle Wright, select Patient View > Overview Click Yes Under Role type, select Radiologist Click OK Click on the Requests tab on the left Click on the Imaging tab Click on the Emr tab Expand and show the CPOE order placed by the doctor Close Mrs. Michelle Wright window using the small black X next to the green arrow
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Using the Administration tab, one can manually import the images and assign them to the patients. For the purpose of demonstration, let us use already uploaded and assigned image studies.
Make sure to select the study of Michelle Wright for BRAIN procedure – this is the one with RP ID – BUM000129000001
Right-click and click Open… or double click
Show that the preferred Display protocol for Radilogist1 is 4x4
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Drag the first image at the bottom to the top left window
For the purposes of demonstration, let us change the layout to 1x1
Click on the Pointer > Layout
Select 1x1 layout (the top one)
Scroll the vertical scroll bar on the right to see all the images
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Scroll back to the middle
Click on the Show Images button at the bottom
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Right-click on the image and select Zoom
By holding the left mouse button down, move the mouse up and down to zoom-in and zoom-out, left click pans the image
Click on the Reset button on the top
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Right-click on the image and select Magnifying Window
Move the mouse around to move the magnify box Hold down the left mouse button and move up, down, left and right for windowing level modes.
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Right-click inside the magnifying window and select Close
Right-click on the image and select Window Level > Invert
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Right-click on the image and select Window Level > Invert
After reset mention there are shortcuts you can use, like CTRL + R to bring up report editor, various., H to flip an image horizontally
Click on Reset button on the top
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Click H to flip an image horizontally Click H again
Click on Display Cine Toolbox button
Click on Play button
Click Close on the Cine Toolbox
Scroll to the middle image
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Right-click on the image and select Image Filters
Under Filters, select Sharpen
Click +
Click Close on the Filters Toolbox
Talk about tabbing
Click New on the virtual toolbar to create a new tab
This is a unique feature that no one else provides.
Drag an image from the bottom into the main window
Click Remove to remove the tab
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Click on Add Study for Comparison
Click on Close
Right-click on the image and select 3D Visualization > 3D Segmentation
Demonstration the 3D Visualization tools and close
Click on the Pointer > Layout
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Select 4x4 layout
Select Show Images button at the bottom
Right-click on the image and select Link Series
Then select each image you want to be linked Once done all the changes you make will be applied to all the
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linked images
8 Radiologist1 suspends Patient1’s session, attends another request of Patient2 While studying the CT images for Michelle, Radiologist1 is notified to perform an MRI image study for Steven Smith. He suspends his study for Michelle and starts studying Steven’s MRI images. Talking Points
Click Steps
Continue using the radiologist1 instance of Microsoft Amalga HIS
Radiologist1 is paged or notified manually by the radiographer about an urgent MRI study that needs to be performed.
Right-click on the image and select Suspend
Radiologist1 suspends his study.
Talk about the Stored Displays. By selecting a display, one can only see the defined types of image studies according to the
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Click on the MRI Reporting Stored Display button
Screenshots
filters/procedure types chosen. Here MRI button will bring MRI image studies only.
In the list of studies, select the row for patient Steven Smith for the procedure L-S SPINE – the one for the patient with RP ID BUM00009900001
Double-click on the study to open
For the purpose of demonstration, let us assume that the Radiologist has analyzed the MRI images for Steven Smith
9 Radiologist1 reports on Patient2’s images After studying the images for Steven Smith, Radiologist1 creates and saves a report. Talking Points
Click Steps
Continue using the radiologist1 instance of Microsoft Amalga HIS
Click on the Dictate button
Click on the Record button
Close the Dictate window
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Screenshots
Press CTRL +R to open the report editor
Select the Show all templates checkbox
Scroll down and select MRI LS SPINE
Click Create Report
Under the Impression section, type /ldp and press Enter to fill in the Quick Text The disc arrowed is bulging & pressing on the spinal nerve. Lumbar disc prolapse
To demonstrate how easy it is to create a quick text for the future, select a part of the text typed above, drag it into Quick Text > General (private) tree node
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Right-click on the quick text that got created, select Properties
Edit the Macro field to /test
Click Close
In the report, use the newly created Quick Text
Under Quick Text, right-click on /test node and select Delete
Click Yes
Under the Report Indicator:, select Normal
Click Save
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Click Close
Click on Close button to close the study
For the purpose of demonstration, let us leave the study with In Progress status
Click OK
10 Radiologist1 returns to suspended session and completes the diagnosis of Patient1’s images After completing the study for Steven’s high priority request, Radiologist1 switches back to the suspended session for Michelle. Finally, he completes the study for Michelle and prepares a report. Talking Points
Click Steps
Continue using the radiologist1 instance of Microsoft Amalga HIS
Click on Sessions drop down and select Michelle Wright to return to Patient1
Click on Write or view reports for the current Study button
Select the Show all templates checkbox
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Screenshots
Scroll down and select CT BRAIN
Click Create Report
Under the CT BRAIN section, type the following No abnormalities seen
Talk about Submit. Once submitted, the report task status is changed to Complete. In general, a radiologist would click on Submit as soon as he is done with preparing the report. For the purpose of demonstration let us not click Submit so that we can reuse the image in the future again.
Click Save You can optionally click Submit > OK Note: Do not commit the changes to the VM if you clicked Submit
If you did not click Submit, click Close
Click the Close button to close the study For the purpose of demonstration, let us leave the study with In Progress status Click OK
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Click Close
This concludes the Radiology demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
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Amalga UIS Demo Scenario Amalga UIS – Accountable Care Chronic Disease Strategies Microsoft Corporation Published: Version History: 1/9/11 Created by S. Malme
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Accountable Care Chronic Disease Strategies
Amalga Value:
As Healthcare providers define and implement their approach to effective delivery against an Accountable Care strategy, it is common for an organization to develop a new and comprehensive approach to the management of patients with chronic disease. In the HFMA’s compendium of Accountable Care, Moore & Coddington highlight 7 steps to accountability in their article, “accountable care, the journey begins”. Step 6, “Identify patient-related strategies for improvement” clearly points to the importance of care coordination, medical homes and chronic care strategies as part of an overall accountable care strategy. In this demonstration scenario, we will demonstrate how a healthcare enterprise can identify and assess panels of chronic disease patients. In addition, we will show how these patients can be managed, with the objective of maximizing quality and optimizing cost, to achieve improved health outcomes.
•
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
Demo Introduction / Story:
• •
What are the key changes to clinical and business processes that you have prioritized as part of your accountable care strategy? How will you automate the identification and management of chronic disease patients to drive improvements in quality and cost? How will your team engage and enable chronic patients to manage their own health as part of your chronic disease management programs?
In this scenario, we highlight one potential approach to improve on the proactive care of a chronic disease patient population. Given the importance of effective chronic disease management to an organization working toward an accountable care business model, we will focus our scenario on the key activities required to engage and manage a panel of patients, including: (1) identification of patients who require an increased level of care management (2) segmentation of patients to focus care management on those who represent greatest risk / cost (3) selection of patients based on condition and “gaps” in care (4) workflows and systems to support care management of the selected patients (5) devices and applications to support patient self-management
2
Role(s):
Healthcare Executive leading ACO Transformation Primary Care Physician leading care delivery across an integrated network Case Manager
Processes:
Population Analysis and Risk Assessment Case Management for High Risk Chronic Patients Patient Empowerment to manage their own health & wellness
HSG Customers who have implemented similar scenario:
New York Presbyterian Mayo Clinic Cleveland Clinic
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\ Password: HSGP@ssw0rd
2 Accountable Care Chronic Disease Strategies – Hyperlipidemia Talking Points
As part of any ACO strategy, execution against a well defined patient strategy is a critical success factor. This Seven Step model, defined by Moore and Coddingtion in their article entitled “accountable care, the journey begins”, defines 7 major and interrelated decisions to be made during the formation of an ACO.
Click Steps
Screenshots
PPT: Amalga UIS – Accountable Care Chronic Disease Strategies
3
In this demonstration, we will show how Amalga UIS can be used as part of an IT infrastructure to support the effective development and management of patient panels in an ACO environment. To support continuous improvement in the management and delivery of care for our chronic patients, we will adopt the following process for patient identification and prioritization, physician attribution, health management, care delivery optimization and enablement of Best Practices.
PPT: Amalga UIS – Accountable Care Chronic Disease Strategies
In our management of a specific panel of Hyperlipidemia patients, we use Amalga UIS to integrate data from across the care continuum; including data from our PCP network, our patients, hospitals and other clinics or specialty providers.
PPT: Amalga UIS – Accountable Care Chronic Disease Strategies
This integrated view of our patient population is available in near real-time to providers across an accountable care network. As we aggregate data from across our health network, we use this chronic care dashboard to visualize our hyperlipidemia patient population; segmenting patients based on health risk.
Amalgademos Dashboard: Chronic Patient Panels Patient Panel: Dyslipidemia
4
To better understand the logic applied to segment and risk stratify our hyperlipidemia patients, we can click on the RISK hyperlink. Here we see the algorithms used to segment our hyperlipidemia patients into high, medium and low risk groups.
Click on the RISK link on the hyperlipidemia dashboard
Looking at the results of our hyperlipidemia population analysis, we see that more than 97% of our patients range from low to intermediate in their risk and we have just over 2% of patients who are at high risk.
Click back to again view the Hyperlipidemia dashboard
To manage these high risk patients, we’ll use Amalga to quickly select and manage their hyperlipidemia. In Amalga, we see our panel of hyperlipidemia patients (in our demonstration we see all patients seen from January through March of 2005). This list of more than 17,000 patients is quickly filtered down to our target population of hyperlipidemia patients with high risk by applying a filter on the RISK column. With the RISK filter applied, we see a population of approximately 400 patients.
Select View Manager Group: MKT – Panel Hyperlipidemia,
With a well defined panel of hyperlipidemia patients, we use Amalga to join this patient panel with the associated clinical data. With this integrated view of our hyperlipidemia patients, we use Amalga as a worklist for our Case Managers to ensure that these high risk patients are prescribed a statin.
Select View Manager Group: MKT – Panel Hyperlipidemia,
User View: Hyperlipidemia – Cholesterol Goal Apply filter for High Risk patients
User View: Hyperlipidemia – Cholesterol Goal Apply filter for High Risk patients
5
To automate the workflow and ongoing communication typically required to manage our Hyperlipidemia and other chronic disease patients, we can also export our high risk patients into Microsoft CRM. Using CRM automated workflows, we can improve both the productivity and efficacy of our case management efforts. To populate Microsoft CRM with our patient data, we can install a fully automated interface. We can also perform a simple export/import using Microsoft Excel.
In Microsoft CRM, our Case Management team has direct access to all the patient demographic and contact information. In addition, we’ve also customized our case management view to include the patients medication list and most recent LDL test results.
Using view: Hyperlipidemia – Patients wo Statin, select: System >> Export to Excel Show data exported to Excel worksheet Launch Microsoft CRM Select Patients & Staff from the left-side navigation pane Select Import Data Select the file: “Patient-data.xls” Complete the Import Data wizard
Show the “Patients” view within the category “Patients & Staff”. Display the “Active Contacts” for a complete list of the imported patients.
With the patient data now available in CRM, we can use the workflow and communications management capabilities of CRM to automate and track all patient interactions. To demonstrate one approach to Case Management automation, we SELECT ALL patients in our Active Contacts view and will use the Quick Campaign wizard to define the communications required for these patients.
SELECT ALL patient in the Active Contacts view by selecting the ALL patient checkbox Click on Quick Campaign in the command line
6
In the Quick Campaign wizard, we are prompted to name the campaign. We reply with: “Hyper lipidemia Patients wo Statin”
Click through Quick Campaign Wizard
As we define our campaign, the system asks us to select the communication(s) required to engage the patient. For the purposes of this example, we will simply ask our Case Managers to give our Hyperlipidemia patients a phone call. We can assign the patients either to ourselves or to other Microsoft CRM Users.
Select Activity Type: Phone Call
Name Campaign “Hyperlipidemia Patients wo Statin”
Select Assign to another user or team: Select “Steven Malme” Click Next to continue with campaign creation
When complete, we can continue with campaign creation by clicking Next. For each patient phone call, we are able to specify the detailed activities and instruction for our case management team.
Provide description of the activity expected with each of our Hyperlipidemia patients
7
When we click “Next”, we get a summary of the simple campaign that we’ve created for our Hyperlipidemia patients .
Click Next and provide a summary of the quick campaign that we’ve created.
To use this campaign to track and manage the interaction with our hyperlipidemia patients, we click on “Outreach” and “Quick Campaigns” on the left-side navigation pane.
Click “Outreach” on the left-side navigation pane
When we click on the campaign “Hyperlipidemia Patients wo Statin”, we see the queue of calls that has been created for our Case Manager.
Click on campaign: “Hyperlipidemia Patients wo Statin”
Using this queue, our Case Managers can systematically contact and document this required intervention.
In this scenario, we’ve demonstrated how you can use Amalga and Microsoft CRM to help automate the process of patient identification, segmentation and engagement required to more effectively manage chronic disease.
Click “Quick Campaigns” on the left-side navigation pane
Provide overview of the phone call queue created to support the Case Management contact and management of this campaign.
Switch back to PPT: Amalga UIS – Accountable Care Chronic Disease Strategies
8
Using these solutions we have streamlined our chronic disease management function via: Automation of our chronic disease patient panels Delivery of a longitudinal view for all patients Coordinated and documented patient engagement Automated communication of activities across our care delivery team, and Workflows to support best practices
Display final slide in PPT: Amalga UIS – Accountable Care Chronic Disease Strategies
9
Amalga UIS Demo Scenario Amalga UIS – Accountable Care Transformation Microsoft Corporation Published: Version History: 1/9/11 Created by S. Malme
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Accountable Care Financial Operations Amalga UIS as the primary data management platform to support finanical analysis of a population of patients for whom an organization is accountable (the “at risk” organization)
Amalga Value:
Amalga UIS as a process improvement engine to continually transform the providers, processes and practices that deliver care for a patient population.
•
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
• •
How do you integrate and analyze data from your extended care delivery network (ambulatory, acute and tertiary providers)? How do you aggregate this same data, from across the care continuum, with data provided by your payers? How have you segmented and defined the target populations that you will manage?
Organizations that go “at risk” for a population of patients, whether they be insurance companies and/or providers who aspire to become accountable care organizations, require precise insight into the conditions, care and costs associated with their patients.
Demo Introduction / Story:
In this demonstration, we highlight the capabilities of Amalga UIS to serve as the primary data source and analytics engine to support the accountable care transformation. Specifically, we will highlight • the process by which we can segment and risk stratify a patient population, • analysis of charge, payment and cost data to capture the total cost and revenue opportunity within our network, • analysis to drive physician alignment and support the design and implementation of best practices, • integrated systems and processes to actively engage patients and support care delivery across the continuum.
• •
Role(s):
•
Healthcare Executives “taking risk” for a patient population Population Business Manager accountable for an entire panel of patients CMO / Physician Leadership who need to manage both quality and cost of care
Processes:
Segmentation and Analysis of patient populations Segmentation and Analysis of providers (serving a population) Identfication of Best Practices (supported by both cost & quality) Identification of Outliers and design of new care management interventions
HSG Customers who have implemented similar scenario:
Caritas Christi Novant
2
2
DEMO SETUP
2.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\ Password: HSGP@ssw0rd
3 Accountable Care Financial Operations Talking Points
Based on our discussions with healthcare executives across the country, the challenge of “bending the cost curve” is directly reflected in projected revenues for healthcare providers. While strategies and implementation may vary, transformation in healthcare services is simply required to ensure long term viability.
Click Steps
Screenshots
Show PPT slide from Amalga UIS – Accountable Care Transformation
Accountable care transformation requires effective planning and change management across many different vectors. In this slide, we highlight one model to categorize and manage this transformation, as documented by Moore and Coddington in the HFMA ACO Compendium. In this demonstration, we will work through a handful of scenarios that support the “Design, development, enhancement and modification of care support elements”.
3
As part of our accountable care transformation, we will highlight the use of Amalga UIS in combination with other Microsoft analytics tools to •
• • •
•
Show PPT slide from Amalga UIS – Accountable Care Transformation
Assess and Manage high risk patients and patient flow across our delivery network; Measure and manage provider alignment; Optimize costs; Transform our care delivery model from adverse event intervention to wellness management; and Engage patients and families in the active management of their health
To effectively manage our panel of cardiovascular patients, we first need to understand the incidence of cardiac disease across our patient population. Our Cardiovascular Patient Population chart provides a comprehensive view of cardiovascular patients across our entire healthcare network; including acute, ambulatory, tertiary and referring providers. In addition, we can also aggregate data from payers to gain insight into services delivered beyond our network. We are limited in our view only by the data that is available.
Select Chronic Patient Panels from the list of available dashboards on amalgademos Select the Heart Disease category from the list of available patient panels Select Cardiovascular Population Panel
4
To better understand risk and potential costs associated with our cardiovascular patients, we will drill down into specific diagnosis and assign risk (risk for LOS, complications and morbidity as an example). In our risk stratification example, we provide analysis of both our CHF and AMI patient populations. Risk is calculated via an integrated data feed that allows Amalga to interact with Premier’s risk stratification services.
Select the View Manager category: MKT – Cardiovascular Select the User View: MKT – AMI CHF Benchmark + Risk Select the User View: MKT – AMI Benchmark + Risk Select the User View: MKT – CHF Benchmark + Risk
__________________________ Note: In the selected user views, highlight the total population and the estimated risk for morbidity, complications and LOS. In the CHF view, look at “Stats” on the Comp Risk column and highlight the 23% of patients who are at high risk of complications
To drill down on our population of cardiovascular patients to understand both volume and revenue, we select the sharepoint dashboard Cardiovascular RCM by Diagnosis. In this chart, we see the distribution of cardiovascular patients by both diagnosis and total charges.
Click on the drop-down list of selected charts / graphs and select: Cardiovascular RCM by Diagnosis
To further assess revenues for our cardiovascular population, we can select a specific diagnosis and drill into charges and payments for each individual physician. In this case, we see the revenues associated with our CHF population.
Click on the drop-down list of selected charts / graphs and select: Cardiovascular RCM by Diagnosis
Scroll down to show the chart of patients by diagnosis and by total charges.
Scroll down to show the chart displaying details Dx Codes Click on 428 to see the detailed view of charges and payments for CHF by Physician
5
While our cardiovascular dashboards provide a high-level summary of network operations, the “devil” of accountable care transformation clearly lies in the details. To provide both flexible and comprehensive access to the required data, we change our view from Sharepoint to Amalga UIS. In the Cardiovascular RCM Summary view we see a complete listing for all cardiac patients for the 1st quarter of 2006. Using this summary, we can quickly gain insight into the metrics and measures underlying our cardiovascular line of service. As an example, we will apply a filter on diagnosis to select all patients diagnosed with congestive heart failure. With this population of patients, we can quickly determine Maximum LOS, Average & Total Charges and Physician Productivity. Using the metrics captured in our quick analysis, we segment our CHF population into two different populations: (1) those who had a LOS < the Mean LOS and (2) those who had a LOS >= the Mean LOS Comparing our Short vs. Long LOS patients and the average charges per patient, we see a clear difference in our Long LOS patients. Based on the available literature, we know that both cost and quality of care can be significantly improved in a closely managed CHF environment.
Select the View Manager category: MKT – Cardiovascular Select the User View: Cardiovascular RCM Summary Apply Filter on Diagnosis Codes with the Filter: (1) Diagnosis Codes (2) Contains Text (3) 428 Request Stats on the columns: (1) (2) (3) (4)
LOS Average Charge Total Charges Attend MD volumes
Select the View Manager category: MKT – Cardiovascular Select the User View: Cardiovascular RCM Summary Click on Clone to create the view: CHF – Short LOS Repeat this same series of steps to create the view: CHF – Long LOS
6
To work through the detailed analysis required to define and manage CHF patients against a best practice clinical guideline, we combine our clinical data with the billing data from our hospital; or we may create a view that includes charges for all CHF patients across the entire care continuum.
Select the View Manager category: MKT – Cardiovascular
Our Cardiovascular RCM Detail view includes a single line item for every single charge incurred by a cardiac patient. By applying a filter for Dx Code 428, we can quickly review the most common charges incurred for our CHF patient population.
(3) 428
Continuing with our CHF analysis, we can use Amalga + Sharepoint to measure and manage our use of drugs for CHF patients.
In Sharepoint, on the Heart Disease Patient Panel,
As part of our Cardiovascular Dashboard, we have created a high-level view of drugs prescribed for our cardiac patients, showing both utilization and cost.
Select the User View: Cardiovascular RCM Detail Apply the Filter: (1) Diagnosis Codes (2) Contains Text
Request Stats on the Charge Desc column
Select CAD Drug Usage to show utilization (unit volume) Select CAD Drug Charges to show total charges for drugs prescribed to our CAD patients
7
To effectively manage best practices for our CHF patient population, we use Amalga to capture CHF patient data from across our provider network. In Amalga, we’ve created the view, Cardiovascular RCM by Drug Charges to give us this realtime view into drug utilization for all cardiac patients.
Select the View Manager category: MKT – Cardiovascular Select the User View: Cardiovascular RCM by Drug Charges
In this particular view, you can see that we’ve limited our analysis to all cardiac patients seen during the 1st quarter of 2006. To view our CHF patients, we again apply a filter for Diagnosis Code of 428. Looking across this patient population, we use Stats to identify potential opportunities for physician alignment to drive improvements in both cost and quality. While most hospitals have already optimized their formulary to ensure optimal quality using the most cost effective drugs, the same cannot be said for the extended care delivery networks that are typical of an accountable care organization. Some simple examples that we see in our analysis of drug usage for our CHF patients include: (1) Use of atorvastatin vs. lovastatin. Based on available literature, you may elect to use lovastatin for patients whose goal for cholestoral reduction is < 35% - 40%. While you may recommend atorvastatin for patients whose goal exceeds 40%.
Apply the Filter: (1) Dx Codes (2) Contains Text (3) 428 Request Stats for the column Charge Description Apply the Filter: (1) Charge Description (2) Contains Text (3) ATROVASTATIN| LOVASTATIN Apply the Filter: (1) Charge Description (2) Contains Text (3) ESOMEPRAZOLE| FAMOTIDINE
8
(2) Use of esameprazole (Prilosec) vs famotidine (Nexium). Due to cost, you may select esameprazole as your recommended proton pump inhibitor vs. the more expensive famotidine.
Another significant factor to consider in the redesign of care delivery are the referral and follow-up patterns of both providers and patients.
In Sharepoint, on the Heart Disease Patient Panel, Select Cardiovascular PCP Follow-up
In this chart, we see a graphical view of the follow-up visit patterns for patients across all facilities in our care delivery network.
To review and analyze the underlying data, we can use Amalga and our Cardiovascular PCP Follow-up view. Here we see the date, time, provider and location for each PCP visit and the very next visit for that patient. This “breadth” of this view is limited only by the available data, so if you have access to ADT data from across all clinics and hospitals in your care delivery network, you can effectively map provider and patient follow-up patterns “in network”. Adding claims data to your ADT data, you can extend your view to all providers and facilities delivering care to your accountable population.
Select the View Manager category: MKT – Cardiovascular Select the User View: Cardiovascular PCP Follow-up
9
In this demonstration, we’ve touched on a number of SharePoint dashboards and Amalga views that may be used to inform and accelerate (1) the segmentation and risk stratification of a patient population, (2) the analysis of care delivery processes and the design of best practices and (3) the analysis of both provider referrals and patient flow across our healthcare network.
Select PPT: Amalga UIS – Accountable Care Transformation Show Provider Transformation slide
To highlight some of the customer experiences that support the use of Amalga UIS and Sharepoint as a platform for Provider Transformation, we highlight the experiences of El Camino, SJHS and Golden Living. You may also use these tools to support and accelerate performance of your healthcare delivery network. Some examples of customers who are using Microsoft technologies to drive network transformation include: Mayo Clinic, New York Presbyterian and Cleveland Clinic. In this demonstration, we’ve shared a number of examples to highlight the value of Amalga + other Microsoft technologies to support and accelerate the transformation that comes as part of any accountable care initiative.
Select PPT: Amalga UIS – Accountable Care Transformation Show Network Transformation slide
Select PPT: Amalga UIS – Accountable Care Transformation Show Amalga slide
With instant and flexible access to data from across the healthcare continuum, we believe that Amalga may serve as an effective platform to drive the process change and improvement required of top-performing healthcare delivery networks.
10
Microsoft Amalga UIS Demo System Q1 FY09 Amalga Quality Measures Module Scenario Microsoft Corporation Published: March 2009
Summary Performance measures are tools that help determine how well hospitals perform patient care. The momentum around collection and reporting performance measurement data is ramping up at a very rapid pace. Public reporting and pay-for-performance (P4P) will continue to evolve and become market drivers for increased transparency and improved quality outcomes. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) use hospital quality measures under the Hospital Quality Initiative. State agencies and other proprietary entities have developed their own performance measures as well. Today CMS is driving the largest P4P initiative for all hospitals that receive Medicare reimbursements. Hospitals that do not report core measures will receive a 2% reduction to their Medicare payment reimbursements. For some hospitals, a 2% reduction can amount to several million dollars. Lack of automation tools, shortage of staff, as well as inadequate internal processes present major difficulties for hospitals that are required to meet monthly core measure compliance reports. Hospitals are hard pressed to develop an effective process to capture the data accurately and in a timely fashion, and many hospitals encounter problems due to duplication of activities. Hospitals recognize the need for better, cost effective alternatives for managing enterprise quality reporting initiatives. In building the module, Microsoft approached today’s regulatory quality measures from an entirely different vantage point. Instead of retrospective data reviews across multiple information systems, we leveraged the speed at which the Amalga can receive rapid data feeds in real time (in seconds) to drive concurrent core measure calculations. Our scoring mechanism identifies patients based on real time clinical data feeds that trigger core measure inclusion and exclusion rules for 81 core measures. Second, rigid data schema for documenting and abstracting core measure data across multiple systems leave little time to proactively ensure patient’s are receiving care based on clinical guidelines. The module is a single application for calculating core measure compliance. The application is agile and flexible to leverage existing information systems for collecting core measure data and provides hospitals with a variety of ways to capture discrete data elements whether electronic or manual. Role: Physician, Quality Analyst, CMO, VP Quality, CNO, Case Managers, Front Line Nurses, Abstractors Personas: See roles.
© 2008 Microsoft Corporation. All rights reserved.
Table of Contents 1. Value, Scenario, Story, Roles, Processes .............................................................................................. 3 1 Demo Setup ............................................................................................................................................ 4 Start Demo Laptop and log in ............................................................................................. 4 1.1 Log in to Microsoft Amalga ................................................................................................. 4 1.2 2 Acute MI and Heart Failure Core Measure Scenario ............................................................................. 7 For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected]
© 2008 Microsoft Corporation. All rights reserved.
1. Value, Scenario, Story, Roles, Processes Amalga Value:
Demo Scenario: Questions to tailor demonstration to audience pain / requirements?
• • • •
Real Time Compliance Proactive Intervention Seamless Integrated Data Market Adaptability
Hospital Quality Measures Module • • • •
Is your hospital able to conduct concurrent review of core measure compliance during the patient stay or is it generally during the retrospective abstraction and review process? How does your hospital decide which patients are core measure patients during the hospital stay? How do you know if all your patients received aspirin within 24 hours of arrival? Are you able to drill down to discover where compliance gaps occur across CMS and TJC core measures?
Demo Introduction / Story:
The growing number of hospital quality measures regulated by the Centers for Medicare and Medicaid Services (CMS) is placing increasing burden on hospital resources. Healthcare providers are often unable to track in real time core measure data to ensure compliance of CMS quality measures prior to a patient discharged from the hospital. In this demonstration we show how the Amalga Quality Measures Module gathers in real time fragmented core measure data into a single application for concurrent quality compliance reviews of Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia (PN), Surgical Care Improvement Project (SCIP), Pregnancy (PR), Children’s Asthma (CAC), Readmission Measures (HF, AMI, PN) and Outpatient measures. Learn how real time patient identification and scoring capabilities ensure providers identify the right core measure patients to complete time sensitive quality measures. Change retrospective compliance reviews into prospective quality improvement interventions.
Role(s):
Chief Quality Officer,Chief Medical Officer, Chief Nursing Officer, Service Line Managers/ Department Heads, Attending Physicians, Case Managers, Front Line Nurses, Performance, Improvement Team Members, Quality Reporting Abstractors
Processes:
Healthcare processes include: • Monitoring patients in the ED and throughout the inpatient stay. • Discharge process. • Core measure abstraction process. • Data aggregation.
HSG Customers who have implemented similar scenario:
None
© 2008 Microsoft Corporation. All rights reserved.
1 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration.
1.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Screenshots
Start Demo Laptop Log in using demo machine credentials
1.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Open Amalgademos.com Use your DEMO credentials to Enter into the site
Click Steps
From Internet Browser Open www.Amalgademos.com
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Navigate to ProductionDemos page
Open Amalga Console from the site.
Connect to the Remote App
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
© 2008 Microsoft Corporation. All rights reserved.
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
2 Acute MI and Heart Failure Core Measure Scenario In this section, we demonstrate the power of Amalga to use real-time data to identify core measure patients and calculate compliance. Talking Points
I’m going to show you how Amalga gathers fragmented core measure data elements into a single application for real time compliance reviews and concurrent calculations of hospital quality measures.
Tracking CMS quality measures are labor intensive and noncompliance can result in financial loss to the hospital.
Most of the time hospitals don’t know if a patient falls in a core measure population until discharged with an ICD-9 code, leaving little chance to impact quality compliance while the patient is still in the hospital.
Questions such as: 1.How many pneumonia patients received an antibiotic within 4 hours? 2. Did we complete all discharge instructions and smoking counseling for our heart failure patients? are often difficult to answer.
Recognizing these challenges, Microsoft created a module that identifies in real time a patient’s probability of falling in a core measure population. At the same time, the module is concurrently calculating whether
© 2008 Microsoft Corporation. All rights reserved.
Click Steps
Click the Apps menu option Select Core Measures
Screenshots
the hospital passed or failed patient specific core measures.
`I’m going to show you two core measure examples. The first is an Acute Myocardial Infarction (AMI-1) measure.
The AMI-1 view reflects the data elements necessary to calculate whether a patient received aspirin within 24 hours before or after arrival.
© 2008 Microsoft Corporation. All rights reserved.
If the view does not default to AMI 1, click the View Manager Select the AMI-1 view Click Apply
The view you see can easily be modified to reflect specific data columns that align to the user’s workflow needs.
In this example Amalga calculates the minutes remaining in this column for all patients that have come through the ED. You can sort these patients by ascending order to see which patients have the fewest minutes remaining and take action by sending an alert or creating an automated work list.
The scoring column next to the minutes column informs you of the probability that the patient will fall in the AMI core measure category. The score is based on certain clinical values such as chief complaint and lab results, which I will explain in a moment.
In this view I can also see which patients do not have a contraindication (i.e. allergy) or meet one of CMS’ exclusion criteria such as a clinical trial patient or age less than 18.
Overall, I’m able to track all the patients that have passed or failed this measure. This significantly helps nurses, physicians and the quality team focus their time on quality improvement instead of creating manual lists or conducting retrospective reviews.
© 2008 Microsoft Corporation. All rights reserved.
Click the Minutes Remaining column to sort in ascending order
There are several ways to insert data in the module. This application leverages the Amalga data platform that can capture hundreds of real time data feeds from other systems. It’s important to note the user does not need to enter data in Amalga if already doing it in another system.
I can manually insert data through dropdowns that correlate to a specific measure. The values in the dropdown reflect exactly what CMS requires for reporting purposes.
Another way to insert data is through a quick edit on any of the values in the grid. In places where the process is predominantly manual, Amalga allows the user to create electronic forms embedded in the workflow to capture the data and documentation requirements needed to complete the core measure.
© 2008 Microsoft Corporation. All rights reserved.
Click on Input tab. Click on Discharge Status dropdown Close the Input view
Right click on a patient’s complaint and click QEdit. Click out of QEdit.
In the second example I will show you how a hospital scores patient probability for a Heart Failure measure. (Pull-up PowerPoint Slide)
Each hospital is able to customize their own scoring criteria based on their clinical workflow process, IT systems and availability of data. Each value is given a weighted score. Higher the score, higher the likelihood the patient falls in a particular category.
© 2008 Microsoft Corporation. All rights reserved.
Click the View Manager Select the HF 4 view Click Apply
In this example, the hospital selected 3 values to help identify patient probability: compliant, ejection fracture, and BNP.
Click on shortcut and launch the “PowerPoint –Quality (AMI/HF)” slides
Since Amalga is able to capture unstructured text, the chief complaint can represent multiple values such as chest pain, chest squeeze, SOB, and others. The hospital also selected an ejection fracture value from the Echocardiogram (ECG) to measure how much blood the heart is pumping. Third, the BNP blood test checks the level of BNP in the blood. Higher the BNP, greater indication of heart failure. A typical scenario includes a patient arriving at the ED complaining of chest pain. The admissions clerk enters chest pain in the documentation system. Amalga automatically gives the patient a score of 50 points. Within 15 minutes the patient is put on an echocardiogram to measure the ejection fracture. 30 min later the ordered lab result shows a BNP greater than 100 and increases the score again to 200. Within 45 minutes we know this patient is likely a heart failure patient.
© 2008 Microsoft Corporation. All rights reserved.
Click back to the Amalga HF-4 view.
If the BNP was less than 100 the score would decrease. These scores are arbitrary and can be adjusted at anytime More importantly, scoring values focus clinicians on the right core measure patients to ensure compliance for time sensitive measures. No other system can do this as efficiently as Amalga. For hospitals that see several hundred new patients a day, tracking compliance can get very difficult, especially when it include CMS exclusion criteria. (Pull up PowerPoint slides)
Right click for a Quick Edit on Alexander Bogue’s BNP value. Note: He should be 5th record down Change the value to 90. Change it back to 120.
Click on shortcut and launch the “PowerPoint –Quality (AMI/HF)” slides
This is an example of the complex CMS specification guidelines associated with core measure reporting. The module calculates these guidelines as data feeds enter Amalga.
For example, the Heart Failure measure HF-4 for smoking counseling excludes patients that indicate no history of smoking. If I learn the patient has a history of smoking I can change the status to (Yes). The module now tells me the patient falls in a heart failure population and I haven’t completed smoking counseling.
© 2008 Microsoft Corporation. All rights reserved.
Click back to the Amalga HF-4 view. Right click on a patient with a history of no Adult smoking history. Change it to YES.
I can filter on patients by score, medication, age, past/fail, or any of the core measure data elements.
In this case I want to view all patients that have a history of smoking to ensure they are discharged with smoking counseling.
The ability to organize core measure data in the Amalga dashboard allows me to track daily, weekly or monthly performance scores for each core measure. I can create reports and have them automatically e-mailed to recipients. Also, the module allows me track compliance by physicians, hospital unit and other key variables. Here I can monitor the most common chief complaints for heart failure patients. All this information is available in real time while the patient is in the hospital.
Amalga provides a single application for users to view all clinical, financial, administrative, lab, imaging, and quality data across the enterprise. This is critical for those involved in abstracting
© 2008 Microsoft Corporation. All rights reserved.
Click on FILTER. Add Adult Smoking History and set it equal to Y. Click OK twice. Remove filter before closing the view.
Click on the Shortcut dropdown Click “Perfomance Point – Heart Failure”. Close out of the dashboard.
and reporting quality data in order to better understand the case mix of the patient. This reduces the need to pull additional clinical data from disparate systems in the hospital.
© 2008 Microsoft Corporation. All rights reserved.
Amalga UIS Demo Scenario Amalga UIS – Analytics Microsoft Corporation Published: Version History: 2/18/11 Created by M. Bortnick
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Data Standardization Bringing together an organization’s data assets into a centralized system is only the first step towards making it usable by the instituion’s employees beyond their existing workflows. In many cases the there are challenges that can readily be addressed just by looking at the original correlated data that has been stored in Amalga. Analysis is made further meaningful by using additional calculated data such as risk stratification data from an external vendor.
Amalga Value:
In this scenario, we will demonstrate how a Service Line Manager, Financial Analyst or other Administrator may use their Amalga data asset to evaluate how well their physicians are managing AMI and CHF population at their facilities. This evaluation brings together clinical, financial and risk stratification data into a single view within the Amalga client using the Advanced View Editor, or Data Catalog. While this is useful, additional visualization of the data helps uncover the context for where resources/processes are performing well and where there is potential for improvement. We use the PowerPivot Add-in for MS Excel to connect to Amalga, create the dashboard, and publish up to SharePoint 2010 (Enterprise Edition) to share with the team. • •
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
Demo Introduction / Story:
• • •
How do you analyze your process and resource performance for patient populations (e.g by diagnosis)? Do you have have access to clinical data in case you need to evaluate the individual patient or encounter context? Would having this data during the analysis help? How easy it to bring the data together? Describe your current process. How easy is it to create analytics and visualizations on this data? How easy is it to change the analysis if new data becomes available or if a new visualization is needed?
In this scenario, we highlight the following: (1) Advanced View Editor, Data Catalog. This feature provides users with a shopping cart type of experience for picking the fields of data from institution familiar entities and sources of data. (2) Amalga Data Access Provider (DAP). This feature provides a direct database-like connection over HTTP to our application server for other applications like MS Excel, SharePoint, SAS, or SPSS. Amalga security is maintained for all of these connections. (3) PowerPivot. A free MS Excel add-in that empowers users to analyze millions of rows of data and create analytical visualizations to share with other directly or via SharePoint 2010 Enterprise Edition. (4) SharePoint 2010 Enterprise Edition. A team portal environment that shares published PowerPivot dashboards in a preconfigured gallery.
2
Role(s):
Service Line Manager Financial Analyst Other Hospital Administrator
Processes:
Service Line Performance Evaluation Resource and Process Optimization
HSG Customers who have implemented similar scenario:
Working with a few current customers to develop plans
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS Production Amalga Professional Client
Click Steps
Screenshots
Select “Production Demos” under the “Demonstrations” menu selection
From the “Applications” menu in the top right, select “US – Sample Hospital”
In the “Production” section, choose “Amalga UIS R2SP2 ”
Userid: demo\<username> Password: HSGP@ssw0rd
2 Analytics Talking Points
In this scenario we’ll look at the challenge of evaluating how well an institution’s providers and processes are handling the AMI (Acute myocardial infarction, ICD9 410.x) and CHF (Congestive heart failure 428.x) population. We will look at the the key indicators of average LOS (length of stay), average charges, and average payments received by complication risk.
Click Steps
Screenshots
PPT: Amalga UIS – Analytics
The process that we will go through provides a low cost method to realize real value. Iterations can be made with
3
business stakeholders to modify the analysis to get to an agreed upon format. In addition to diagnosing well and under performing areas, this approach can be used as an ongoing process control tool. The scenario starts in the Amalga Professional Client.
Here we can see a list of patients with AMI (410.x) and CHF (428.x) diagnosis (in the PrimaryDx column).
We also see:
• • • • • •
Complication Risk Stratification (CompRisk Strat) Morbidity Risk Stratification (MorbRisk Strat) Mortality Risk Stratification (MortRisk Strat) Length of Stay (LOS) Sum of charges made to payer (TotalCharges) Sum of payments received (TotalPayments)
Select the “US – Sample Hospital” application From the View Manager “MKT – Panel Heart Disease” select the “Benchmark+Risk – AMI CHF” view. The charge and payment data are not included in this view by default. You can add the TotalCharges and TotalPayments columns and change the start of the datascope to 1999. Filter by “ComRisk Strat” for a value of “HIGH”. Try to determine charges and payments for the high and low LOS physicians.
Filtering on HIGH complication risk, we can get a sense of the average LOS, charges, and payments by physician and for the entire group. However, using PowerPivot on this same data will make it easier to visualize the analysis. Once built, the analysis will also update with newer data as it is added in the future. .
4
(Optional if you want to show authoring workflow)
We’ll open PowerPivot and connect to the same Amalga data view using our credentials
Select “Production Demos” under the “Demonstrations” menu selection From the “Production Applications” group, select the “PowerPivot 2010” icon.
This is beyond the scope of what we should show at HIMSS. Contact M. Bortnick if showing this is required. Amalga shares the same views of data to other applications so that customers can maximize the reuse of their data assets. Amalga security is maintained in these scenarios removing the need for individuals to maintain personal databases such as MS Access. They can instead use the trusted Data Catalog to access entities organized in user meaningful structures.
Select “Main Menu” under the “Directory” menu selection From the “Dashboard” group, select the “PowerPivot Gallery” tile. Select the “AMI and CHF – LOS Cost by Physician” file. Open in Excel with Editing Select HIGH from the CompRisk Strat slicer in the left hand vertical section.
(optional – use as appropriate) Amalga parsers optimize the data sharing experiences. While Amalga stores data as it was sent into the system, this does not mean that it is properly correlated (e.g. by patient) or structured in a way to optimize the user or application experience. Amalga parsers perform this work.
5
At this point an Analyst has connected to the same Amalga data view, pulled a copy of the data into PowerPivot, and created a dashboard to analyze the same information.
Here we can see the Top 20 providers with the largest LOS. If we filter for only HIGH Complication Risk in the slicer, we can see that: •
•
The avg LOS is 19.6 days for the Top 20 providers with a writeoff amount of $27.6K (Charge – Payment) While the avg LOS for providers who see the most cases is 13.8 days with a writeoff of $22.7K.
This suggests that one group of providers may be treating patients in a lower cost way at the same quality – with the assumption that the patients were not readmitted at a later date. This result may warrant further research in Amalga to understand the medical histories for the patients and/or more thorough statistical research to understand if this is a statistically significant correlation. To recap, Users put together views of data using the Amalga Professional Client and the Data Catalog. While the client provides an easy way to look at a grid of data, deeper analysis is sometimes needed to see correlations and meaningful trends.
PPT: Amalga UIS – Analytics
PowerPivot was used to put together Analytics that showed that one group of providers had lower AMI/CHF patient LOS at a lower writeoff. PowerPivot
6
connected to Amalga using the Data Access Provider functionality. Other applications such as MS Excel or 3rd Party apps such as SAS and SPSS can connect to Amalga in a similar manner.
7
Microsoft Amalga Demo System Q1 FY09 Bed Management (Pager Simulation) Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the Bed Management features offered by Microsoft Amalga. Role:
Floor Nurse Nursing Supervisor Bed Control Administration
Table of Contents 1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log into Microsoft Amalga .................................................................................................. 3 2.2 Identify Patients Based on Treatment Status and Time Since Admission ............................................. 5 Closing Comments ................................................................................................................................. 9
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
The key take away of the Amalga Bed Management Demo Pager is to show the power of the real-time data flow into Amalga and how this information becomes actionable.
Demo Scenario:
This scenario highlights the 23-hour observation patient and how, through realtime alerts clinical workflow can be driven to ensure that this patient is either admitted or discharged prior to the 23-hour mark
Questions to tailor demonstration to audience pain / requirements?
1. How do you handle your 23-hour observation patients? 2. Do you have any issues with these patients passing the 23-hour mark without action being taken? 3. What workflow challenges are you currently faced with that real-time alerts could better enable you to these flows? 4. Do your clinicians receive real-time alerts to help manage workflow? 5. How do you ancillary staff handle real-time alerts to better manage workflow?
Demo Introduction / Story:
The 23-hour observation patient is one scenario which hospitals struggle with daily. The challenge is to ensure that the appropriate decision regarding the care of this patient takes place prior to the 23-hour mark. If this patient goes over the 23-hour mark without full admission or discharge orders, the hospital will lose reimbursement. Additionally, this could potentially occupy a bed that may be used for another patient. During this scenario, the nurse will be alerted via pager when that this patient is a 23-hour observation via an automated message go to their pager/cell stating At this point, the nurse could take action by calling the attending physician regarding received discharge orders or full admission orders. At the 18-hour mark, the house supervisor is alerted that this patient’s 23-hour observation status will expire in five hours. The last alert would be sent to the VP of patient care alerting them that the patient has one hour before this status expires. Once discharge instructions are written (manually or electronically) the nurse is alerted that the patient's paperwork is in order and the patient can be discharged. The Length of stay analysis could be viewed per provider with same DRG/same unit based on DRG. We could then expand the search to other DRG's again comparing both unit and physicians once again
Role(s):
In this scenario, this impacts the workflow of the floor nurse, nursing supervisor (bed control) and administration. Though working with other realtime alerts, this could potentially impact every employee at the institution.
Processes:
Patient-centered real-time alerts; how transactions are passed to in real / nearreal time.
HSG Customers who have implemented similar scenario:
Unknown
Page 2 of 9
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Log in using provided demo machine credentials
Screenshots
Click
2.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Page 3 of 9
Screen Shots
Open Amalga Console from the site.
Connect to the Remote App
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
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3 Identify Patients Based on Treatment Status and Time Since Admission In this section, we demonstrate how to identify patients for research. Talking Points
Click Steps
Launch View Manager to select a different view. Typically this defaults to “01Visuals” user view, but this is not guaranteed.
Launch View Manager (“01Visuals”)
Click on “Clinical Baseview Demo Pager” user view, then press the “Apply” button.
Scroll Grid View left to right and right to left (if applicable depending upon monitor resolution; may need to expand columns to display horizontal scroll bar)
Open the Pager
Click on the Shortcuts button Select the Pager option
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Screenshots
Pager displays in its wait state showing Battery100%
The two fields of interest here are “TimeSinceAdmission” and “TreatmentStatus” Time Since Admission will trigger the pager to display a message depending on the timeframe of when the tool is executed.
Entering 4 here indicates 4 hours since admission. This is a numerical-only free text type of QEdit. If required by your organization, the number of hours since admission Qedit may be configured to minutes instead of hours.
Notice the message on the pager: To: Nurse Patient Name MRN number Alert: 4 hours since admission This communication only occurs when the “TreatmentStatus” is
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Quick Edit the Time Since Admission Right click TimeSinceAdmission box to launch Quick Edit (QEdit) Choose “QEdit Edit”
Input 4into the Quick Edit field Click OK
Incomplete
Quick Edit the TreatmentStatus to Complete This particular Quick Edit is a one-click type Quick Edit which is preferred when choices are limited in a Quick Edit situation Depending on your particular workflow, “Complete” could indicate that the discharge paperwork is complete and entered in the system, thus the patient is ready for discharge, or some other parameter as dictated by your organization Clear the pager application
QuickEdit the TimeSinceAdmission on the record with TreatmentStatus changed to “Complete”
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Right click TreatmentStatus to launch Quick Editor Choose Complete
Clear the Pager by clicking the Clear button The Pager re-displays Battery 100%
Quick Edit the Time Since Admission Right click TimeSinceAdmission box to launch Quick Edit (QEdit) Choose “QEdit Edit”
Input 18 into the Quick Edit field Click OK
Note that the pager does not provide a message because the treatment has been completed. Message reads: “Battery 100%” -- which is the default message on the pager. Quick Edit the TreatmentStatus to Incomplete on the record Quick Edited to Complete earlier in the demonstration so the record can be used throughout the remainder of the scenario.
Right click to launch Quick Editor Choose Incomplete
Note the message on the pager has been escalated to the Floor Nurse. Message Reads: To: Floor Nurse Patient Name MRN number Alert: 17 Hour Observation: 18 Hours
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Quick Edit the Time Since Admission Right click TimeSinceAdmission box to launch Quick Edit (QEdit) Choose “QEdit Edit”
Input 23 into the Quick Edit field Click OK
Note the message on the pager has been escalated to the Administrator. Message Reads: To: Administrator Patient Name MRN number Alert: 23 Hour Observation: 23 hours Clean Up
Clear Pager Close Pager application Clear Quick Edits
4 Closing Comments Talking Points
Through the Amalga alerting mechanism, and real-time patient disposition information,I was better able to manage real-time bed control for 23 hour observation patients thus appropriately resourcing beds needed for admitted patients
Click Steps
Screenshots
This concludes the Bed Managementdemonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
Page 9 of 9
Microsoft Amalga Demo System Q1 FY09 Clinical/Patient Drill Down Microsoft Corporation Published: February 2009
Summary This demo script will walk you through many of the features offered by Microsoft Amalga.
Table of Contents
1 2 3 4 5
6 7 8 9 10 11 12 13 14 15 16 17 18 19
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log into Microsoft Amalga .................................................................................................. 3 2.2 Introduction to the Amalga Grid .............................................................................................................. 5 Zoom-In/Zoom-Out ................................................................................................................................. 5 Using Views ............................................................................................................................................ 6 In this section, we will briefly discuss using Views. ......................................................................... 6 Grid Cells ................................................................................................................................................ 7 Labs ........................................................................................................................................................ 8 Info Screen ........................................................................................................................................... 10 Images .................................................................................................................................................. 11 CT Scans .............................................................................................................................................. 14 Radiology readings ............................................................................................................................... 15 Medications........................................................................................................................................... 16 EKGs .................................................................................................................................................... 16 Scanned Documents ............................................................................................................................ 18 Past Medical History (PMH) ................................................................................................................. 19 Dictations .............................................................................................................................................. 20 Demographics....................................................................................................................................... 20 Orders ................................................................................................................................................... 21 Angiogram and Echocardiogram Videos .............................................................................................. 22
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Demo Scenario:
Questions to tailor demonstration to audience pain / requirements?
Amalga UIS Clinical Intro
1. How do your physicians and clinicians get access to an integrated view of the health data for a patient? How do you access the data available across your healthcare enterprise? Across your community? Across the State? 2. How does your organization leverage and reuse existing healthcare data to improve clinical processes, manage costs andimprove patient outcomes?
Demo Introduction / Story:
In this demonstration, we provide an overview of Amalga UIS 2009. Amalga represents a new class of systems designed to integrate information from across the continuum of care and make that data available, to both improve care for individual patients and drive continuous process improvements across the healthcare spectrum. In this introduction, we provide an overview of the Amalga system and a glimpse of the healthcare data captured for an individual patient. This example focuses on the integrated, robust view of information that can be made available to your clinical team. In the same way, Amalga can also be used to look across the healthcare enterprise to identify process defects, identify potential improvements and automate clinical and business processes.
Role(s):
Clinical / Medical Staff Hospital Administration Financial Managers
Processes:
Point of Care
HSG Customers who have implemented similar scenario:
MedStar St. Joseph’s WHIE
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup
This section is used to prepare for the presentation. These steps should be complete before beginning the demo. The actual demo begins in step 3.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in using the provided laptop credentials
Press Ctrl-Alt-Delete
Screenshots
Enter the provided laptop login information Click
2.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
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In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
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3 Introduction to the Amalga Grid In this section, we provide an introduction to the Amalga Grid functionality. Talking Points
Click Steps
This is the Amalga Grid. It uses a spreadsheet format that is very familiar and easy to use, and yet can display a lot of data on one screen. It does all of the things that you'd expect a grid to be able to do. You can click on a column heading to sort.
Click on Name to sort in ascending order
You can click again on a column heading to sort in reverse order.
Click on Name to sort in descending order
This process works on any column.
Screenshots
Click on the Demo Notes so that it sorts in ascending order
4 Zoom-In/Zoom-Out In this section, we demonstrate Zoom-In/Zoom-Out. Talking Points
Click Steps
Here we see a list of patients. If you want to see the prior history of visits for a patient, you can use the ‘Zoom-In’ button to do that.
Select the row of BOGUE, ALEXANDER
You can configure the ZoomIn to see the prior history matching patients by any demographic or combination of demographics.
Click on Zoom-In> MRN
On this button you can match patients using the hospital’s Medical Record Number, or by SSN. It can also be configured to match patients using Amalga’s enterprise-
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Screenshots
wide patient ID. Here, you can see all the visits for this patient, in this case, 126. (Note: This number may change, so read it from the screen).
Hover over to the row count Total: 126in the upper right corner
You can explore any of these
Click onZoom-Out
visits, or you can click ZoomOut to go back to the original view.
5 Using Views
In this section, we will briefly discuss using Views. Talking Points
A View can be chosen to display certain columns, arranged in a certain order within the grid, sorted in a certain order or filtered on different fields.
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Click Steps
Click on the View Manager, which should be displaying as 01 - Visuals to show a list of Views that can be selected.
Screen Shots
These customized views may be created by a user for their own personal use or may be provided by any of the roles the user belongs to. Changing these views here change the default settings for this view.
Select 08 - Clinical View or another user view from the list Click Apply The screen will change to selected View, which will show certain columns, arranged in a certain order and filtered on different fields and conditions.
Repeat the steps above to return to the 01 – Visuals view
6 Grid Cells In this section, we demonstrate Grid Cells. Talking Points
Click Steps
Note that for any of these patients, you can immediately see whether or not there is data for that patient. These cells show the date of the most recent result.
Point to theLabs and XRay columns
So, for Ms. Papenfuss,there will be Lab results, XRay results, and Radiology Readings.
Select the row of PAPENFUSS, SHELLEY(second line)
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Point to the Grid cells under theLabs and XRay columns
Screenshots
It isn’t necessary to look for CT results, because the cell is blank and we know there are no CT scans for this patient.
Scroll to the right and show the blank Grid cell under theCT column
This is one of many ways that you can take huge volumes of information and make it available to the clinician in an organized way that doesn’t overwhelm them.
7 Labs In this section, we demonstrate Labs. Talking Points
A patient’s data can be easily accessed from the data grid. Let’s double-click on Alexander Bogue’s patient record.
Click Steps
Select the row of BOGUE, ALEXANDER(first line) Double-click on the row for BOGUE, ALEXANDER Select Labs Make sure Selected Visit is selected
Here are all of the labs for this patient. Here are all of the Hematology lab results.
Click on the Heme(5) tab
Here are all of the Coag results.
Click on the Coag(2) tab
Note that you can see in parentheses how many results can be found on each tab. That is one of the many ways that we save clinicians time and organize the vast amount of data.
Click on the Immunology(0)
There’s no reason to click on the ‘Immunology’ tab, because we know ahead of time that there are no results there.
Click on the All(50) tab
Here you can see all of the patient’s labs on a single tab. Notice that the Glucose is
Double click on the top lab result (Bedside Glucose)
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Screenshots
abnormally high. Is that a new finding? Double click on any lab and instantly see the lifetime history of that lab. We see that this patient has a very long history of high glucose levels – this is not a new finding. With one click on the graph button, you can graph these results over time. You can easily see that this diabetic patient virtually never has a controlled glucose level. You can see the normal range, and this patient is almost always way above the high end of normal.
You can hover over any point to get more information about that reading You can also space out the readings equally to get a better view of the data
Scroll down Click on Graph…
Show the two horizontal lines toward the bottom of the graph (circled in red here)
Hover over a point or two to show the pop up information Click Space points equally in the lower left corner
We can see at a glance that this patient is almost never at a good glucose level Close the Graphs window Close the Lab Details window Leave the Info Window open
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8 Info Screen In this section, we demonstrate Info Screen. Talking Points
Note that we don’t have to double-click on the cells to see all of the patient’s information.
Click Steps
Point to various sections on the left hand side.
Once this Info screen is launched, you can just click all the items on the left hand side to see all the info about the patient.
For instance, you can click on the Images to see all of the patient’s x-rays and CT scans.
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Click Images
Screenshots
9 Images In this section, we demonstrate Images. Talking Points
Click Steps
Here, you can see thumbnail
Even though the thumbnails are obviously not diagnostic quality, you can still get important information from them. In this person’s case, we know that they had a finger amputated
When the thumbnails come up, scroll down the images view to 4/12/06 and show the hand x-ray with the finger amputation
If you want to see the x-rays before and after the finger amputation, you can easily see that with the thumbnails. In the x-ray from 8/25/05 the patient had not yet had an amputation, but as we saw on4/12/06, you can see that the middle finger has been amputated.
Select 8/25/05 from the list on the right to show the x-ray thumbnails
We can look at a specific image in great detail by double clicking it to launch the Image Viewer Let’s look at a chest x-ray for this patient
Scroll up to the top and select the chest x-ray from 4/14/06 Double click on the image to launch the Image Viewer Note: This may take a moment to load
images of every medical imaging procedure the patient has ever had.
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Screenshots
Here is the x-ray. You can click and drag on any area to change the contrast (left-toright) and brightness (up-anddown)
In the Image Viewer window, click and drag the mouse left and right, then up and down to demonstrate contrast and brightness
The Image Viewer offers a variety of tools for looking at and analyzing images
Click the arrow next to Zoom Select Region
Using the Region Zoom, we can see a close-up of the central line placed in this patient
Drag a box over the centralline on the x-ray
While Zoomed-In, you canmove around (“pan”) to see the different parts of the chest x-ray.
Click Pan Drag the image around to pan to different areas
And you can click ‘Reset Settings’ to get back to the original view.
Click on Reset Settings button on the right
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You can Window/Level to get a better look at the otherwise hidden parts of the x-ray.
Select the Window Level – Region button
Now you can see the lung markings.
Click and drag a square on the pure white in the lowest middle part of the x-ray. Point out the back bones that are now visible
Using a combination of zooming and the Window Level, we can see things not readily visible in the image In the abdomen are the vertebral bones, but we can’t see them. With a click and drag, we can.
Use Region Zoom to bring up the lowest abdomen/spinal section of the image Use the Window/Level button and click and drag to show the vertebrae that were not originally visible Click on the Reset Settings button once finished
If the patient wants a copy of the x-ray or if you want to use the x-ray for a presentation, you can export it to a file by clicking on the Export button.
Click on the Export button, show the Export dialog
With one click on the Report button, you can see the Radiologist’s reading. This seems like a pretty normal xray. Let’s see if the radiologist agrees.
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On the Export... window, click on Cancel
Click on the Reportbutton
The radiologist agrees that this is a normal x-ray.
Scroll down to show the final report on the x-ray showing no abnormalities Close theRadiology Reading window
10 CT Scans We can look at CT scans in much the same way
Close the Image Viewer Locate a CT Scan in the list (designed by CT in the Modality column) Double click the CT image to open the CT
We can use any of the features seen on the x-ray such as panning or changing brightness levels. We can also click through the various levels of the CT Scan We can also scroll rapidly through them to get a moving image of how things look
Click the down arrow a couple times
Close the Image Viewer when finished with CT scans
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Click and hold the down arrow for 1 second to show the animation of the CT scan
11 Radiology readings In this section, we demonstrate Radiology readings. Talking Points
Click Steps
With one click, you can see all radiology readings the patient has ever had.
Click on the Radiology Readings link on the left side of the Info Screen
We can view all the radiology readings at once
Click on *All*in the left menu
And we can view them for just this visit we selected, or every one of the patient’s visits on record
Click All Visits located in the bottom left. You may need to re-select *All*
We can see all the readings done for this patient including 20 X-rays, 4 MRIs, a few ultrasounds.
Click through a couple tabs
We also know there’s no need to click on Mammograms or Nuclear Medicine, as there is no number being reported
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Screenshots
12 Medications In this section, we demonstrate Medications. Talking Points
Click Steps
With one click, wecan see the Meds that have been given to this patient.
Click on the Medication link on the left side of the Info Screen
Screenshots
13 EKGs In this section, we demonstrate EKGs. Talking Points
We can also quickly see every EKG the patient has ever had.
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Click Steps
Click on the ECG link on the left side of the Info Screen
Screenshots
Here you can see the thumbnails of every EKG. You can double-click on an EKG to see it up close.
Double-click on the first EKG
You can click and drag to Zoom-In on a beat or two, and then pan around.
Click and drag a box to Zoom-In on several beats
You can even do electronic callipering to see how fast the heart is beating.
Pan around with the pan window in the lower right
Select the Measureradio button Selectthe Count Per Minute radio button Drag a line between the tops of the two beats, and see the length
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See how the heart rate correlates with the EKG Machine’s automatic reading of the heart rate shown in the upper right. Click ‘Fit In Window’ to get back to the original view.
Click Fit In Window button on the lower right Close EKGViewer window
14 Scanned Documents In this section, we demonstrate Scanned Documents. Talking Points
Click Steps
If the information lives only on paper, you can scan in that paper and make it instantly accessible to every clinician.
Click on the Scanned Documents link on the left side of the Info Screen
Here you can see thumbnails for every scanned piece of paper on this patient.
Click on All above Visit Date
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Screenshots
You can navigate the documents by Visit Date or Document Type. You can double-click a thumbnail to see any document.
Expand the Document Type and Visit Date lists if they are not already Click through several subcategories to show the organization Return to the Alllisting Double-click on the first thumbnail in the upper left corner (Clinical 1 from 6/22/2006).
Here is the document. You can click and drag to Zoom-in to better see the information
Click and drag to demonstrate zooming
Close the Document Imaging window
Note: You have to click once on the document to activate it, then do the click and drag.
15 Past Medical History (PMH) In this section, we demonstrate Past Medication History (PMH). Talking Points
With one click, you can see the patient’s past medical history.
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Click Steps
Click on the Past Medical History link on the left side of the Info Screen
Screenshots
Scroll down and see the past medical history
16 Dictations In this section, we demonstrate Dictations. Talking Points
With one click, you can see every dictation the patient has ever had.
Click Steps
Screenshots
Click on the Dictations link on the left side of the Info Screen
Note that you can instantly see on the tabs that there will be multiple Cardiology and Cardiac Surgery results.
17 Demographics In this section, we demonstrate Demographics. Talking Points
With one click, you can see all of the patient’s demographic and insurance information.
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Click Steps
Click on the Demographicslink on the left side of the Info Screen
Screenshots
We can view demographic information about the patient.
Show the demographics tab
Tabs can be created to show insurance information, visit info, or any other important information that needs to be summarized
18 Orders In this section, we demonstrate Orders. Talking Points
With one click, you can see every Order the patient has had.
Click Steps
Click on the Orders link on the left side of the Info Screen
Gloss through a couple of the tabs to show all the Orders for the patient
Close the Info window and return to the grid when finished
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Screenshots
19 Angiogram and Echocardiogram Videos We can also look at videos for various procedures a patient has undergone. Let’s look at another patient. As before, we go into their Information window to the Images module Here we can see an X-ray, echocardiogram, and an angiogram
Double click on Shelley Papenfuss
Click Images
Let’s look at her angiogram
Double click on the angiogram on 12/17/2005
Here we can see a single still image from the angiogram, but some video has been recorded as well.
Double click on the 3rd image (3/16) to play the video
Click the Play arrow if it does not automatically play
Notice how poorly her heart is beating due to poor blood flow. Having all this information at every bedside saved each cardiologist over an hour every day because they no longer had to walk over to the file room and find each of the angiogram discs.
Close the Image Viewer when finished
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You can also see echocardiogram videos.
Double click on the echocardiogram from 12/19/2005
Here we can see the heart beating and the valves flapping
Close the Image Viewer and Info window when finished with the video
Log out of Amalga
This concludes the Clinical Patient Drill Downdemonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
Page 23 of 23
Microsoft Amalga Demo System Ensure Follow-up on Critical / Abnormal Results Microsoft Corporation Published: February 2009
Summary This demo shows how Amalga can track and display critical or abnormal values for patients, allowing physicians to take appropriate actions. Role:
Personas:
Table of Contents 1 2 3 4 5 6
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log into Microsoft Amalga .................................................................................................. 3 2.2 View Abnormal Pap Smears................................................................................................................... 4 Follow-up on Critical/Abnormal Test Results ......................................................................................... 7 Blood Culture Treatment and Analysis ................................................................................................... 8 Critical Platelet Levels .......................................................................................................................... 11
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2009 Microsoft Corporation. All rights reserved.
Value, Scenario, Story, Roles, Processes Amalga Value:
Highlight the value of Amalga in managing / treating patients with critical or abnormal test results.
Demo Scenario:
Amalga UIS - Critical Abnormal Results
Questions to tailor demonstration to audience pain / requirements?
1. How do you monitor and manage patients who have critical or abnormal conditions? 2. How do you automate and manage communication of abnormal results with your patients? 3. When an infectious disease is identified in your hospital, how do you manage treatment of the patient and limit further infection? 4. How do you ensure appropriate follow-up and treatment of high-risk patients?
Demo Introduction / Story:
In this scenario, we highlight a number of scenarios in which Amalga can be used to identify critical and high risk patients and then manage the communication and processes required to optimize care for these patients. Specifically, we will show • How Amalga can identify patients with abnormal PAP Smear results and automate our communication and follow-up with these patients • How Amalga can be used to manage best practice treatment for patients with HIT • How Amalga provides the immediate information necessary to manage and contain a MRSA infection for both the diagnosed patient and other patients who have the potential for infection
Role(s):
Chief Medical Officer Infection Control Manager Healthcare Executives & Administration Management
Processes:
Infection Control Patient Communication
HSG Customers who have implemented similar scenario:
St. Joseph MedStar
© 2009 Microsoft Corporation. All rights reserved.
1 Demo Setup
The actual demo starts at section 3. The steps in this section should be completed before beginning the scenario.
1.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Press Ctrl-Alt-Delete
Screenshots
Enter provided laptop login credentials Click
1.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2009 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
2 View Abnormal Pap Smears Talking Points
Click Steps
An OBGYN clinic was 6months behind on their pap smear results – they recognized this was a problem since that meant they were 6 months behind in notifying women that they might have cancer so that they could seek treatment.
Click the User View manager Select Abnormal Pap Smears from the list of available user views Click Apply
© 2009 Microsoft Corporation. All rights reserved.
Screenshots
The clinic utilized Amalga to do a better job in caring for patients with abnormal pap smears.
Amalga receives feeds for all test results. Here is a view in Amalga that displays all pap smears with abnormal results.
Every morning, a nurse pulls up a view of patients who have not been notified of their abnormal pap smears.
Click the User View manager Select Abnormal Pap Smears – Need Letter 1 Click Apply
The OB/Gyn clinic helped design a custom screen that they use to prepare the letters.
Select Laverne Bolivar Click Input Select OBGYN – PAPSmear from the left menu
© 2009 Microsoft Corporation. All rights reserved.
On this screen, the nurse enters overview information regarding the patient’s Pap smear result such as the date the test was done.
On the next tab, the nurse configures the content of the letter to be sent to the patient.
Click Letter1
Some of Ms. Bolivar’s information is automatically pulled from Amalga to populate the form, such as the Medical Record Number. Other information is entered by the nurse using simple checkboxes and entry boxes.
Close the Input window after discussing the talking point.
The nurse also monitors another view that automatically shows all patients who received the first letter 30 days ago or more, but have not yet scheduled a follow-up appointment.
Open the User View Manager
A grid displays showing patients who need to have a second letter sent to them
Select Abnormal Pap Smears – Need Letter 2 Click Apply
© 2009 Microsoft Corporation. All rights reserved.
To send a second letter, the nurse clicks the Input button and selects the Letter2 tab
Select Laverne Bolivar Click Input Select OBGYN – PAPSmear Select the Letter2 tab
In order to send a second letter, only a date needs to be specified, as all the relevant information from the first letter can be reused for the second letter.
Close the Input window after discussing the talking point.
3 Follow-up on Critical/Abnormal Test Results Many hospitals are interested in putting together rapid response teams to intervene when the patient is doing poorly before it is too late. The challenge is in identifying these patients. This view serves as a worklist for the rapid response team. Any patients with certain severely abnormal tests that suggest a potential lifethreatening problem automatically show up on this list. For example, we can see that every patient on this list has a least one severely abnormal result for at least one of these tests.
Open the View Manager Select the 10 - Severe Illness Lab Indicators view Click Apply
Point out the flags C for critical, H for high, and L for low
© 2009 Microsoft Corporation. All rights reserved.
In addition to looking at a list of selected abnormal tests, we can create a view that shows every single critical lab value.
This view shows all critically abnormal lab values.
Open the View Manager Select the All Criticals = One row per lab view Click Apply
4 Blood Culture Treatment and Analysis We can look at a view of every positive blood culture by room and unit. This view can serve as a work list to the infection control team, the doctor, and/or the nurse manager to ensure that every patient with a positive blood culture is on antibiotics, and more importantly, the right antibiotics. This helps ensure that patients get the best possible care. MRSA is a superbug – a highly resistant germ. Patients infected with MRSA require special attention to ensure that the infection is properly treated and that it does not spread elsewhere in the hospital. In Amalga we can easily see every patient with a positive blood culture for MRSA.
Open the View Manager Select the Blood Culture By Room/Unit/Svc view Click Apply
Click Filter Select BC Organism from the list of available columns Click Add Filter
© 2009 Microsoft Corporation. All rights reserved.
We create a filter to find all germs with a name that starts with MRSA.
Enter EQUALS TO in the Operator field Enter MRSA in the values field Click OK on the filter pop-up Click OK to apply the new filter
The view now displays only those MRSA-positive blood cultures.
What other patients in the hospital are being treated by the doctors treating the MRSA patients? Those patients need to be treated as if they might have MRSA if they show signs of an infection. We might also need to use special handling precautions on those patients if we are to avoid spreading MRSA elsewhere throughout the hospital. Let’s “grab” this list of doctors treating MRSA patients from this view.
Right-Click the column heading for Attnd MD Name
Now let’s look at all the patients in the hospital today.
Click Copy Distinct Values to Clipboard
Open the View Manager Select the Clinical View (inhouse) view Click Apply
© 2009 Microsoft Corporation. All rights reserved.
Now we can filter the view to see only those patients being cared for by a doctor treating a MRSA patient.
Click Filter on the Amalga menu
Select AdmittingMDName from the list of filters Click Add Filter
We can paste in the list of doctors treating MRSA patients that we grabbed from the previous view.
Select CONTAINS from the Operator drop-down menu Right-click the Values box and select Paste Click OK to finish creating the filter Click OK to apply the filter
Now we can see a list of all patients treated by those physicians who were exposed to MRSA patients Appropriate actions may be taken to contain possible spread of the disease and provide appropriate treatment if these patients show signs of infection.
© 2009 Microsoft Corporation. All rights reserved.
5 Critical Platelet Levels When a person is on Heparin, a blood thinner, the platelet count can drop. Platelets are needed for the blood to clot. The combination of a blood thinner plus poor clotting from low platelets can cause life threatening hemorrhage This is called heparin-induced thrombocytopenia, or HIT. The mortality of HIT is as high as 90% if the condition goes unrecognized for several days. Unfortunately that can happen more frequently than it should in a typical health care system.
Open the View Manager Select the HIT Patients view Click Apply
In Amalga we have created a view that serves as a work list that can be monitored by the charge nurse or doctor to identify patients who might have HIT. These are patients on Heparin or another blood thinner who also have ether a rapid drop in platelet count or a critically low platelet count.
As you can see, this view is based on a series of filters on several fields. Without involving IT, endusers can iteratively modifythe parameters as needed. If, for example, the grid is showing too many people who don’t actually have HIT, or missing people who do have HIT, the user can open the filters, change any criteria, and see the result instantly without ever contacting the IT department.
Click Filter Select C_HIT_LAST_PLATELET_ COUNTLESS THAN 80 from the “Filters” list (list on the right) Click Edit Filter Click Cancelto exit the individual filter edit Click Cancel to exit the filter window
© 2009 Microsoft Corporation. All rights reserved.
Log out of Amalga when finished with the demo
Click Logout at the top right
© 2009 Microsoft Corporation. All rights reserved.
Amalga UIS Demo Scenario Amalga UIS – Data Standardization Microsoft Corporation Published: Version History: 2/18/11 Created by M. Bortnick
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Data Standardization Bringing together an organization’s data assets into a centralized system is on ly the first step towards making it usable by the organization. Much of the data is either uncoded or coded to different vocabularies. Amalga can be used to not only store the original data but to also store normalized or transformed versions of the same data. Either version can then be used by users and applications.
Amalga Value:
The typical customer need for this functionality centers around the meaningful use interoperability. Many customer system use different vocabularies (also called Terminology Sets) than what is used in CCD documents. For example, for medications FirstDataBank or Multum is typically used by clinical systems for coding whereas RxNorm is used in CCD. Further complicating the issue, NDC is used by pharmacy systems as that vocabulary is focused more on dispensing of stocked drugs. In this scenario, we will demonstrate how Amalga uses the HLI Terminology Services (LE or Language Engine is the product name) to provide coded values and normalized descriptions for the incoming medications message feed into the Amalga parser. Note that this is a highly technical demo.
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
Demo Introduction / Story:
• • • • •
What is your organization’s terminology strategy? How will your organization integrate incoming CCD data into workflow? Are all of your systems prepared to ingest this data? What happens if you receive uncoded data? Coded data in the wrong vocabulary? How do you get a full view across your acute and ambulatory systems?
In this scenario, we highlight the following: (1) Amalga Script Engine. We will open a package and look at a parser’s message script. (2) Parsing layer flexibility to interact with web services. We will call out to the Cloud Hosted service, howeve r this could be a locally hosted version as well.
2
Role(s):
IT Pro – Integration Analyst
Processes:
Data Standardization Data Ingestion
HSG Customers who have implemented similar scenario:
Working with a few current customers to develop plans
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS Sandbox environment’s Script Explorer
Click Steps
Screenshots
Select “Production Demos” under the “Demonstrations” menu selection In the “HSG Sandbox” selections, choose the “HSG SBox DB Server” Userid: demo\<username> Password: HSGP@ssw0rd Open up the Script Explorer from the Start menu
2 Organization Hierarchy Driven Data Management Talking Points
Amalga brings together data from systems that would otherwise be isolated to create a comprehensive data asset. In addition to storing the orginal data, Amalga makes it easy to correlate the data to concepts such as patient identity and to standard vocabularies with the core purpose of making it easy to adapt to changing institution needs.
Click Steps
Screenshots
PPT: Amalga UIS – Data Standardization
3
One such area is normalizing coded and uncoded data. Problems, procedures, labs, medications, and other key healthcare data may exist as freetext or coded values in a particular vocabulary. For example, medications are typically coded in FirstDataBank or Multum vocabularies in clinical systems. However other sources may be coded in RxNorm (CCD) or NDC (pharmacy systems). In many cases it is useful to see the data in a single vocabulary. In this demonstration, we will show how the Amalga Script Engine infrastructure in combination with HLI’s LE Product can be used to solve this problem. Let’s take a closer look at what is going on in this example.
PPT: Amalga UIS – Data Standardization
Medications data flows into Amalga making its way to the Script Engine. This data is typically HL7 data but could be XML or any other format. The Script Engine contains compiled C# scipts that process the message for storage into Amalga. The original data is always stored into Amalga. However, in this example we also want to store the HLI provided standardized codes and descriptions. The parser scripts will call out to the HLI LE web services interface that provided the codes and descriptions for the message content. The script will then store this alongside the original data. Note that the returned values could be multiple vocabularies.
4
Of course, not all data will have matches to the vocabularies. These exceptions are managed through the HLI LExScope and LEAP products. Admins can see what message terms did not produce a match and then make expert judgements about what the correct matches should be.
PPT: Amalga UIS – Data Standardization
This will then be immediately applied to all messages going forward. Amalga allows the replay, or reprocessing of the already received messages, so that past messages can be updated with the new matches.
Let’s get to the demo. I’m logged into the Script Explorer tool. This is where an IT Professional – Integration Analyst would configure the scripts that will process incoming messages to Amalga. In this case, an existing medications feed package already exists and is configured to interface with the HLI Cloud Hosted Web Service.
Select “Production Demos” under the “Demonstrations” menu selection In the “HSG Sandbox” selections, choose the “HSG SBox DB Server” Userid: demo\<username> Password: HSGP@ssw0rd Open up the Script Explorer from the Start menu Select “Packages” Select the “HCA_RDE” row. Select the “Launch Visual Studio” menu item in the Tasks list on the left-side panel.
5
In the table script you see the configuration that will pass the message value for a medication to the HLI LE Web Services.
The table script uses a helper object to call out to the HLI LE Web Services.
Open “HLIMedLookupTableScript.c s” Select the ProcessLocalHLI
Open “HLILookup.cs”
Here you can see both a Cloud Hosted and Local option. We’ll choose the Cloud Hosted option. Running the script we can see the output from the HLI LE Web Service. In this case, we are storing all the results that were returned.
Run debugger by hitting the play icon in the toolbar. When the message selector appears select the first message only. This contains the “Raceinephrine” medication for processing. Step through the code with F10 if you want to show the actual call.
6
Amalga UIS Demo Scenario Amalga UIS – Data Upload Wizard Microsoft Corporation Published: Version History: 2/15/11 Created by E. Moody
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Data Upload Wizard The Upload Wizard is an Amalga PowerToy that allows an end-user or departmental manager to bring in their own data without requiring the assistance of an IT pro, or allows an IT pro to bring in a new data table with minimal effort. User data may be imported in the form of an Excel spreadsheet, a delimited text file, or web sources such as RSS feeds. Data can be imported on a onetime basis or can be scheduled for automatic retrieval on an ongoing basis. Data loaded through the upload wizard may be joined to any other existing data within an Amalga system to significantly enhance the power and flexibility of the system as a whole.
Amalga Value:
The Wizard has three modes available for bringing data into Amalga: (1) From Excel, (2) Scheduled Upload, and (3) Web Extract. “From Excel” mode is appropriate for importing a one-time file or a rarely updated file, such as a temporary data file, an annual reference file, or a permanent translation table. “Scheduled Upload” mode is useful for automatically importing files from an FTP site that are updated on a daily, weekly, or monthly basis. “Web Extract” mode creates a scheduled process that retrieves a web page at defined intervals and passes the captured page to a C# script which can pre-parse the page to extract data. To use “Web Extract” mode, a preprocessing script is required. This demonstration focuses on “From Excel” mode. We will illustrate how the Upload Wizard can be used to import a simple translation table into Amalga. In addition, we will show how this table can be joined to an existing baseview using the Advanced View Builder. •
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
• •
Do you ever have private datasets and need to join them quickly to other institutional datasets for operational purposes, research, or other institutional activity? Do you have reference files or translation tables that you wish could be used to help analyze and understand other data in your system? Do you ever create spreadsheets for your team and wish they could be in the same system you use for everything else?
The Upload Wizard is an Amalga PowerToy that allows an end-user to bring in their own data without requiring the assistance of an IT pro.
Demo Introduction / Story:
For example, hospital departments use a variety of different codes to systematize their daily operations. Hospital employees either memorize these codes or use an external reference to derive the meaning of the codes. The Upload Wizard allows a departmental manager to import look-up tables directly into Amalga so that employees can see meaningful descriptions alongside the confusing codes. In this demo, we will upload a look-up table for discharge disposition codes and will join it to a clinical view.
2
Role(s):
IT Pro Clinician Departmental Manager Financial Officer Researcher
Processes:
Data Upload Combining Baseviews
HSG Customers who have implemented similar scenario:
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we login to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\ Password: HSGP@ssw0rd Navigate to the “Upload Wizard Visuals” view located in the “MKT – Upload Wizard” Group
2 Upload Wizard – Discharge Disposition Talking Points
Click Steps
Screenshots
3
The Upload Wizard is an Amalga PowerToy that allows an enduser or departmental manager to bring in their own data without requiring the assistance of an IT pro.
PPT: Upload Wizard
Data may come from an Excel spreadsheet, a delimited file, or a web source.
The Wizard has three tool tabs: (1) From Excel allows you to import files manually, (2) Scheduled Upload allows you to import files automatically from an FTP site on a daily, weekly, or monthly basis, and (3) Web Extract mode allows you to import extracted data from a web page. This mode requires a preprocessing script.
PPT: Upload Wizard
The Help button tells the user how to prepare their Excel spreadsheet for import. This demonstration will illustrate how to upload look-up tables into Amalga using the Upload Wizard.
PPT: Upload Wizard
4
Hospital departments use a variety of codes to track their daily operations.
PPT: Upload Wizard
External sources containing reference tables are necessary to make sense of the codes.
PPT: Upload Wizard
Every hospital keeps track of the discharge disposition of their patients using some type of notation. In the Amalga snapshot, this hospital uses codes like D7N, ATX, ATE, ATW, and AMA.
PPT: Upload Wizard
In this example, the reference table for the hospital discharge disposition codes has been loaded into an Excel spreadsheet.
PPT: Upload Wizard
5
The Upload Wizard will automatically import the data and transform the Excel reference table into an Amalga View.
PPT: Upload Wizard
The new reference data can be combined into your existing clinical view using the Advanced View Builder to join on any common variable.
PPT: Upload Wizard
We will show you how this works in Amalga.
PPT: Upload Wizard
Go to Amalga Click Admin Click Upload Wizard
Now that we are in the dialog, we can select our file for import.
In the “From Excel” tab, Click “Select Excel File to Upload.”
6
The tool displays one row for each dataset in your Excel spreadsheet and allows you to select which datasets you would like to import. Table names are automatically derived from the Excel spreadsheet and are editable. In this case, the hospital chooses to use a “UW_username” prefix for uploaded files and loads them into a special database called ezUpload. This makes it easy for the DBA to manage the incoming data. By clicking “Create Views,” a new view is automatically created.
Click “Create Views.” Click OK
A pop-up letting you know the view was imported appears.
We can go to the View Manager to find the new view.
Navigate to the View Manager Show them the newly imported view under your login (DEMO\username) Still in the View Manager, go to the “Upload Wizard Discharge Table” view in the “MKT – Upload Wizard” group. NOTE: You can also open your newly generated view, resize the columns, and click Edit to remove the row guid. Going to the already prepped view saves you a step.
7
Using the Advanced View Editor, we can combine our newly created view with the “Upload Wizard Visuals” view.
Open the View Manager Click “New” Click”Advanced View” In the left pane, highlight “UW_elmoody_DEMO_VISUAL S” Click “Add Field” In the left pane, find “UW_elmoody_DISCHARGE_DI SPO” Click to expand. Highlight “DispoTranslation” Click “Add Field” In the right pane, under “Select Baseview,” click down arrow to select “UW_elmoody_DEMO_VISUAL S” The right and left pane should display “DischargedDispo” Click OK. **Please note that before the view can be combined using the Advanced View Editor, a row identifier has to be added to the view in Amalga Manager. For this reason, this operation will not work with the view YOU just imported unless you go to Amalga Manager and add the row identifier to the DischargedPosition” column first. Click “Save” Name your view
8
Your new view contains the translated disposition codes.
Navigate to the View Manager to show them that the newly “Amalgafied” view is there, under your login. Go to the MKT – Upload Wizard group and Click on the “Upload Wizard Visuals with Table” to show them the new view.
We have shown how a look-up table can be rapidly loaded into Amalga and used to help translate unreadable codes into meaningful, human readable information.
PPT: Upload Wizard
The Upload Wizard can equally well be used to bring in larger datasets to augment existing Amalga data for a variety of purposes including research, clinical care, and operational improvement. You can end the demo at this point, review the additional use cases outlined in the PPT, or review how to prepare an Excel spreadsheet.
Click help in the dialog to get Instructions on how to prep an Excel spreadsheet.
9
Microsoft Amalga Demo System Denials Management Microsoft Corporation Published: February 2010
Summary This demonstration highlights the high level analytics and detailed insight that can be delivered via an integrated Microsoft Health Solution. In this demonstration, we highlight the graphical analysis and charting capabilities of Microsoft SharePoint. To support the detailed charge, payment and denial analysis required to effectively secure payment and change the underlying process or documentation issues associated with claim dentails, we also demonstrate the use of Amalga UIS in combination with SharePoint. With Amalga UIS, we can easily navigate across the systems and processes that support insurance validation, service authorization, clinical documentation and claims submission to determine how or why we have been denied payment. By systematically reviewing the underlying reason for denial, we hope to not only secure payment for past services, but to also implement new processes to ensure future payment and reduce administrative rework.
Table of Contents 1 2
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 1.1 Log in to Microsoft Amalga ................................................................................................. 3 Executive Summary of Claim Denials .................................................................................................... 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
Value, Scenario, Story, Roles, Processes
Demo Scenario Questions to tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
Denials Analysis & Management 1. What financial and operational goals have you established to drive improvements in reimbursement? 2. What process and workflow changes have you installed to optimize reimbursement? Do these systems support ongoing, real-time analysis of your charges, payments and denials to ensure that you maximize revenue? 3. How do you enable and automate workflows in your organization? 4. Which 3 payers typically rank atop your denials list and how do you effectively manage your systems and data to maximize reimbursement by these (and all other) payers? 5. How to you optimize reimbursement for your services? Contoso Health System has done a reasonably good job of managing denials and effectively capturing revenue with an average quarterly denials rate of 2% or less for the past 4 quarters. However, we know that denials continue to represent a clear opportunity for both increased revenue and staff productivity. In this brief demonstration, we will highlight the work done by Contoso’s CFO to identify an additional $300K+ in revenue for Contoso Health System.
Role(s):
Financial Managers Hospital Leadership & Administration Clinical Team
Processes:
Financial Clearance / Management Admissions Scheduling Billing and Revenue Cycle Management
HSG Customers who have implemented similar scenario:
MedStar
© 2008 Microsoft Corporation. All rights reserved.
1.1 Log in to Microsoft Amalga Demos In this section, we log in to Microsoft Amalga Demos Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
Connect to the Remote App
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
2
Executive Summary of Claim Denials Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to Dashboards page
Click on Demo Central Dropdown Select “Dashboard” from the dropdown
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
Although Claim Denials have
been managed down to a reasonably low level at Contoso Hospital, we are constantly looking for ways to reduce denials, improve reimbursement and ensure effective use of both our clinical and financial staff.
Select the Dashboard: Denials Analysis
As part of our regular process for
managing denials, we electronically aggregate all of our billing and reimbursement data in Amalga UIS and we use Amalga to support the analysis of our financial performance
Contoso Health System has been
relatively consistent in the level of denials, with about 2% of total charges being denied. While our performance has been consistent, we would still like to reduce the frequency of denials due to the impact on both financial performance and staff efficiency
Navigate to Payer Denials Denial by Payer Chart is displayed
Referring to the chart, we can
see that there are 3 primary areas where additional analysis may be of value. Almost 50% of our denials come from Medicare, another 35% are spread across private payers and 15% can be attributed to self-pay patients.
Let’s looks at the details
Right Click on Medicare bar in
Here we see that the majority of
Select “Switch to MEDICARE”
underlying our Medicare denials our Medicare denials, nearly 1,000 claims, were declined as non-covered services. In addition there are an additional 450 claims that were declined due to issues with authorization and/or coding.
Denial by Payer Chart
to focus our graphical analysis on Medicare Denials
Select Drill Down To >> Denial Reason >> Category
© 2008 Microsoft Corporation. All rights reserved.
To better understand the line of
service where we see the majority of our Medicare denials, we drill down to the service line view provided by our sharepoint dashboard
With the availability of this
discrete data, we change our view of this data from a hard to read graph to a simple chart showing denials by service
Right click on the Non-Covered bar
Select Drill Down To >> Service >> Service
Right click anywhere in the Chart Area
Select Report Type >> Grid
Outside the Emergency Room,
we see that there are a significant number of denials in our Invasive Cardiology Services (CAI) Medical Oncology (SBS) and General Surgery (TFO)
To understand the details
underlying these denials, our top line dashboard and analytics have been quite helpful in focusing our action. However, we now require another level of information and analysis to identify the root cause and systematically reduce denials.
To replicate the list of denials by Line of Services outside the Emergency Room, we can quickly apply a set of filters in Amalga UIS.
To view the denials for the past quarter, we click on View Manager and select the view “Denials by Quarter”.
To show a detailed listing of
denied claims by Line of Service, right click on the total # of denials for CAI, SBS or TFO
Select Show Details and a new detail window is displayed
Switch to Amalga UIS Select Apps and select US Amalga Financials
Click on View Manager Select the View:
Denials by Quarter
© 2008 Microsoft Corporation. All rights reserved.
Click
Filter
Select Primary Insurance from Columns and click Add Filter Type Medicare in the Values box Click OK
Select Denial Description from Columns and click Add Filter Type NON-COVERED SERVICES in the Values box Click OK
Select Svc from Columns and click
Add Filter
Change the Operator dropdown to Contains text
Type CAI|SBS|TFO in the Values box
Click OK Click OK
Finally, click on the Svc column header to sort the results by Line of Service
Now that we’ve got a clear view of the denials, we want to work our way back through to the charges and clinical documentation to better understand the root cause.
Right click on the Account column header
Select Copy Distinct Values to Clipboard
To review the charges that have
been denied, we click on the Account column and select Copy Distinct Values. This saves a list of all the unique Account codes where we’ve received a denial.
© 2008 Microsoft Corporation. All rights reserved.
To review the detailed charges
that have been denied, we open the Charge Detail view and apply a filter to show only those charges that correspond to the specific accounts there were denied payment
To prioritize our denials analysis
work, we will work our way through each of the 3 top Lines of Service, starting with Invasive Cardiology.
After applying both the filter on
Account and selecting Invasive Cardiology, we simply view the Stats for the Charge Description field.
Click on the Filter button Select Account and Add Filter Select the Operator of “Contains”
Paste the Distinct Values
(copied from the Denials view) into the Values field
Right click on a CAI line item in the Svc Column
Select Filter on Contents Click on OK to apply the CAI filter
Right click on Charge Description column
Select Stats Click on Count to sort in descending order
Clicking on the Count column, we sort the resulting Charge Descriptions in descending order and, as a result, we establish a very clear priority for reviewing our CAI denials with a focus on reimbursement for Recovery Rooms, Esomeprazole and Infusion Supplies
Looking at Esomeprazole, we have a clear incentive for driving improvements in our denials with a total of $42K in total charges denied for the use of this drug.
Given the specific requirements for Medicare reimbursement of Esomeprazole (conditions and ICD-9 coding), we can now work back through the individual claims and address the clinical and administrative changes required to optimize reimbursement.
We repeat this process for the
top denial codes in both Medical Oncology and General Surgery
© 2008 Microsoft Corporation. All rights reserved.
Example: Top Cai Denials
Example: Top Sbs Denials
Example: Top Tfo Denials
Looking at our Denials data from a different perspective, we view our Denials by Category. Since we have already launched a vteam to work through NONCOVERED SERVICES, we are now ready to tackle the next big priority: Denials resulting from inappropriate authorization.
To view the underlying reasons
for Authorization denial, we click on the Authorizations column and Drill Down To Hospital Services
Surprisingly, we see that our
Navigate to the Dashboard tab on Demo Central
Select the Denials Analysis dashboard
Select Category Denials Right Click on the
Authorization bar
Select Drill Down To >> Service >> Service
View the Chart
Internal Medicine department has the largest number of denials due to lack of Authorization
To understand the details
underlying this performance, let’s dive into the data and views provided by Amalga UIS to inform our decision on denials in Internal Medicine
We limit our view by applying a
filter on the Svc column, limiting our view to Internal Medicine
Navigate to Amalga UIS Click on View Manager Select Denials by Quarter Right Click on the first instance of Int in the Svc column
Select Filter on Contents Click OK Click OK to apply the filter
To prioritize our work, we will
look at the Stats associated with the Primary Insurance company for each of our Denials We sort this list to show Payers in descending order and see that 40% of our authorization challenges are related to 3 payers: Kaiser, Blue Cross and MAMSI
Right Click on Primary
Insurance column header
Select Stats Sort Stats in descending order based on Count
Click Close
© 2008 Microsoft Corporation. All rights reserved.
With 20% of our Authorizations
related to Kaiser, we will apply a filter to the Denials view to show Kaiser claims
When we review the Denial
Description, we see that the vast majority of denials are caused by poor Coordination of Benefits
Right click on one of the Kaiser patients in the Primary Insurance column
Select Filter on Contents Click OK Click OK to apply the Filter Right click on Denial
Description column header
Select Stats Click Close To assess the impact of Kaiser
denials, we Copy Distinct Values to Clipboard for the Account Numbers associated with these Denials
Now we select the Charge Detail view and apply a filter to show only those accounts that have been denied for due to lack of authorization from Kaiser
We can see that there are 275
claims that have been denied for this reason and by requesting Stats for the Charge Amount, we can see that the total denied charges are $321K
Right click on Account Select Copy Distinct Values to Clipboard
Navigate to the Charge Detail view
Click Filter Select Account from Columns and click
Add Filter
Select Operator dropdown Contains text
Paste copied values in the Values box
Click OK Click OK to Apply the Filter Show Stats for the Charge
Amount column to highlight the $321K in Charges
Click Close Given the number of records to
be processed, we sort the data to highlight the Charges in descending order
To work our way through these
patients and systematically identify the issues associated with Coordination of Benefits, we will use the Financial Info dialog to review the Charges, Payments, Denials and Write-offs for each individual patient
Click twice on the Charge
Amount column to sort charges in descending order
Select the first patient Click the
Info button
Select Financials to show the
Charges, Payments, Denials and Write-offs detail tabs
© 2008 Microsoft Corporation. All rights reserved.
In summary, this demonstration highlights the unique capability of Amalga to integrate data from across clinical and financial systems. By bringing this data together, we are able to effectively analyze our existing processes to identify process improvements. In this specific example, we highlight integration with Microsoft Sharepoint and the associated graphical analysis capabilities. In addition, we show how Amalga UIS can be used to drive the decisions and process changes required to improve revenue capture and avoid leakage due to failed or inconsistent processes. The opportunity highlighted in this simple demonstration represents an increment $360K in revenues for Contoso hospital. Imagine what would be possible if we invested another 5 minutes.
This concludes the Denials Analysis demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q1 FY09 End User Empowerment Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the End User Empowerment features offered by Microsoft Amalga. Role: Personas: See Roles.
Table of Contents 1 2 3 4 5 6 7 8 9
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Amalga Workflow .................................................................................................................................... 3 Pre-Amalga ......................................................................................................................... 3 2.1 With Amalga ........................................................................................................................ 3 2.2 Demo Setup ............................................................................................................................................ 4 Start Demo Laptop and log in ............................................................................................. 4 3.1 Log into Microsoft Amalga .................................................................................................. 4 3.2 User Views.............................................................................................................................................. 6 Filtering the Data Grid .......................................................................................................................... 12 Data Scope ........................................................................................................................................... 16 Data Grids............................................................................................................................................. 17 Cohort Functionality .............................................................................................................................. 19 Cleanup Created Views in Preparation for Next Walk-Through ........................................................... 21
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2009 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Shows the ease with which end users can configure their own environment and query data in sophisticated ways without knowing query languages or programming or being dependent on IT to run reports or perform data extracts.
Demo Scenario:
This demo shows some of the various ways that a knowledge worker is empowered to access data and configure their own environment.
Questions to tailor demonstration to audience pain / requirements?
1. Do you already have a data aggregation strategy such as a data warehouse? If so, are all of your knowledge workers empowered without having to learn complex tools to get the information they need or do they have to go to IT for help?
Demo Introduction / Story:
Show the introductory build slides first and talk about how without Amalga, knowledge workers are constantly being asked from above to fix problems (often problems that have been retrospectively measured with BI tools), but to do the analyses they need to fix the problem they either have to be power users of complex BI tools or they have to go to IT to get reports and data. This results in a backlog for the IT analysts. The second slide shows how empowered users can query the data themselves with Amalga and only go to IT for very special needs.
Role(s):
Typical knowledge worker
Processes: HSG Customers who have implemented similar scenario:
Page 2 of 21
All
2 Amalga Workflow 2.1
Pre-Amalga
2.2
With Amalga
Page 3 of 21
3 Demo Setup
The actual demo starts at section 4. Talk about the following pre-demo sections and what happens in those sections. In section 3.1, we start the demo laptop and log in to start the demonstration. In section 3.2 we log into Amalga to start the demonstration.
3.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Enter the provided demo machine login credentials
Screenshots
Click
3.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
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In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
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4 User Views In this section we demonstrate how to navigate and configure user views. Talking Points
Amalga offers the ability for users to create, copy and edit their own views allowing for a powerful way to organize and display information This view we’re looking at here shows a lot of information about a few specific patients. But what if we want to cut down on the amount of information we’re seeing? By using the View Manager, we can edit views to our liking. However, this view may be used by many people, as it’s under another account Note the 01 - Visuals view is under g_sales Since we’re not logged in as g_sales, we can’t edit this view, as that might cause problems for other users who can see the 01 - Visuals view. Therefore we’re going to want to create our own personal copy of this view, customized to our own liking. Using the clone functionality, we can pull down a copy from g_sales into our own User
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Click Steps
Open the View Manager Make sure 01 – Visuals is selected Click Clone
Screenshots
Library An edit window appears, allowing us to make some customizations to what fields we see, the date range, filters, and more. We can give it a new name. Now we can pick and choose what columns we see. On the right are the columns that are currently in the view. The left shows columns that are available to be added.
Now let me take a minute to talk more about what we’re seeing here. User views in Amalga are based off of baseviews. A baseview is essentially the way in which Amalga pulls back data from a database. A view created in SQL is available to be used in Amalga. This means that any columns found in the database can easily be accessed in Amalga with the
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Enter a name for the new view. This script uses Demo Visuals as the name, but any name will suffice
aid of SQL Here, we can see the Demo Visuals view is created off of a baseview called Clinical Baseview Demo The baseview can pull back any and all information that might be needed for the user views that will be built upon it. Baseviews can have permissions set on them to only allow certain users to view them and create user views off them. Additionally, column names may be customized so they appear uniform throughout all the user views created off them. The fields you see here are not necessarily named the same in the database. More user-friendly names may be set up in the baseview. I can still edit the column names of my own views if I like, but this provides a common base for everyone to work off of.
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Now, getting back to our user view, we want to limit this view to only a few certain columns. We’re not interested in any lab details, scans, tests, etc. We can simply remove those fields Let’s also add in another column – location unit. This column tells us what unit the patient is in, for that hospital.
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Select the newly created view and click Edit Select, then click Remove Field for the following: Labs XRay Rad CT MRI Angio NM Note: Even if you select them all at once, you must click Remove Field once for each field
Select LocationUnit from the Left column
Click Add Field
Additionally, let’s say we want to be able to easily see which hospital the patient is in, without having to scroll to over to the right By selecting Institution and clicking the up arrows, we can rearrange the order of any of these fields
We can also change the way this view is going to sort when you open it. By clicking the Sort tab, we see all the columns in our view. Notice that most of these columns were not in our chosen view. They were available to us, but we didn’t add them. This is because we still have access to all the columns provided by the baseview, even if we choose not to show them. If we wanted, we could sort on any of these columns, regardless of whether or not we can see them on the view. In this case, let’s remove our current sort, and add one on the patient’s name. If we wanted to, we could
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Select Institution Click the Up Arrow until it’s between LOS and Attd MD
Click the Sort tab in the View editor Select Demo Notes and click Remove Field Select Name from the Available column and click Add Field Click Sort Order a couple times to demonstrate switching the order
switch any sort between ascending or descending order. We could also add multiple sorts, and prioritize them using the Up and Down arrows, if necessary Now we’re done with our preliminary view setup Once we click OK, we can see that the new Demo Visuals view has been added to our own library, apart from g_sales If we wanted to make this new view our default every time we load Amalga, we could check this box at the bottom. Now we apply the view
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Click the OK button to save the view Show the checkbox at the bottom, but do not leave it clicked Click Apply
5 Filtering the Data Grid
In this section, we illustrate the ability to apply filters to the data grid.
The new view is now displayed. We can see the name we’ve given the view at the top. We can also see the Institution field we brought up, the sort on the patient’s name, and the fact that the lab fields are no longer here.
Point out the View name, the moved institution field, the sort on the patient’s name, and the fact that all the lab and test columns are gone
There are a number of features available to us once we’re looking at a view One of the most powerful tools Amalga offers is the ability to filter views based on any of the columns we have available Filters can be applied to the default view, or on the fly to the current grid. If we wanted, we could go into the user view editor like before and add a filter. This filter would be applied every time the view is loaded.
Open the View Manager
Select Demo Visuals
Click Edit
Click the Filter tab
Click Cancel to exit the Edit screen
Click Cancel to return to the view
Click Filter
If we don’t want the filters to be applied every time we open this view, we can instead place filters on just the available view Using the Filter button, we see the same functionality as the Filter tab before Let’s say we want to show only
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those patients who are in HHH3, one of the institutions in our hospital facility. We can add a filter on the Institution column that shows only rows where the value is HHH3 Here we can see all the filters available to us. Notice we can filter on any of the columns in the baseview. They don’t even have to be part of the view. We can select the Institution field and add a filter that narrows our view to only those patients seen at HHH3 There are many options available for filtering. If we’re filtering on numerical fields, we can use operators like LESS THAN or GREATER THAN, BETWEEN, and EQUALS TO For textual columns, we have options including CONTAINS, BEGINS WITH, ENDS WITH, and more For the Institution, we’re going to add a filter that contains “HHH3” We can see that the view has now refreshed to only show those patients who visited the hospital designated HHH3
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Select Institution
Click Add Filter
Select Contains
Enter HHH3 in the Value field
Click OK
Multiple filters can also be applied to one view to really give you control over what data you’re viewing. Returning to the filter screen, our Institution filter is still there. Now we’re going to modify our filter so it shows patients who were in both hospitals HHH2 and HHH3. There are two ways we can do this. Notice the Clause Number on the Edit screen. By default, Amalga groups all the filter statements together as a single clause, which means they essentially act as a single filter. However, by changing this clause number to 2, we can make it a separate statement. Done this way, Amalga will combine the view to show rows from both clauses. So for this example, we could create two clauses, one in which the Institution value contains HHH3, and another where it contains HHH2. This would return all rows for both institutions We’re going to have to recreate this VisualFlag filter as well. This filter was in place on the original view we started working with. We want to leave it in place, as it’s keeping this view from returning many hundreds of records.
Once the view refreshes, we can now see that the Institution column has entries for both HHH2 and
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Click the Filter button
Select Institution from the LEFT column
Click Add Filter
Change the Clause to 2
Select Contains
Enter HHH2 into the value field
Click OK
Select VisualFlag from the LEFT column
Click Add Filter
Change the Clause to 2
Select EQUALS
Enter y into the value
Click OK
Click OK
HHH3 This is only a sample of the controls provided by Amalga’s filters. For example, complex AND/OR statements can be written which show data with very specific values allowing you to narrow down huge stores of data to a few manageable rows. Also, the IN statement allows you to paste in a list of values pulled from elsewhere in Amalga, allowing you to search for values contained in a large list.
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6 Data Scope Talking Points
Grids can also be filtered based on date ranges In the baseview, any database field which contains a date may be used as the basis for the time scope on a grid. In this particular view, the Admit Date Time is the chosen field As you can see now, we’re currently looking at data between the years 1999 and 2006 Looking at the Admit Date Time column, we can see our values range between 2004 and 2006. Let’s change our scope to 2005. Now our data is limited to only patients who were admitted in 2005 and who fall under the filters we applied earlier Date scopes can be applied on the fly like we saw here, or they may be applied on the User View edit screen Doing so there would change the default scope whenever the view is loaded. The way we’ve done it here only applies to this one session.
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Click Steps
Click the Date Scope button
Select Range of Dates
Change the year to 2005 on both the To and From values
Click OK
Screenshots
7 Data Grids In this section we illustrate the functionality of the data grid. There are other helpful tools available to us on the datagrid to better organize information or provide data on what you’re seeing. Columns can be rearranged and resized on the fly. Our Institution column appears to be a little bit too small. Using the same conventions found in other software, we can resize columns by simply dragging the edge out further. You can also auto-resize with a simple double-click.
Expand the Institution column by dragging the right edge out slightly
Double click the column to auto-resize
We can also rearrange the columns by dragging them to where we need them.
Click and drag the LocationUnit column to the left
Sorts can also be applied on-the-fly by simply clicking a column heading. We can sort on Length of Stay by
Click LOS to sort in ascending order. Click again to sort in descending
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clicking on the column. Clicking again sorts in descending order
Finally, we can get stats on a column to help us get useful information out of the data we’re seeing. Let’s say we want to get some information on how long our patients we’re looking at have been staying in the hospital. We can right click the column heading and select stats. Here we can see a breakdown of the values in the column, and other helpful information like averages, mean, median, etc
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Right-click LOS
Click Stats
8 Cohort Functionality Talking Points
Finally we’re going to talk about cohorts. A cohort is essentially a very powerful way of organizing large amounts of data. Created by Amalga admins, cohorts allow a user to quickly filter multiple values very quickly. The LocationUnit field we added earlier contains the location in the hospital of all our patients. What if we wanted to find everyone who is in the Intensive Care Unit? For this hospital, their Intensive Care unit is designated as Unit 4. Knowing this, we can add a cohort to look at all wings of the ICU. First, let’s get rid of the existing filters we’ve added.
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Click Steps
Click Filter
Remove all filters except the original VisualFlag filter
Screenshots
Now we apply the cohort using the button located near the View Manager We select all the cohorts that start with 4 by clicking and dragging. Once we’ve selected them all, we click OK and the view will refresh showing all the LocationUnits beginning with 4. Cohorts like these can be easily set up for any field by an admin who in turns adds them to baseviews for the users to work with.
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Click the Cohort button
Scroll down to the 4’s section and highlight (shiftclick) every entry that begins with 4
Click Add
Click OK
9. Cleanup Created Views in Preparation for Next Walk-Through Talking Points
After the demo is complete, open the View Manager and delete the Demo Visuals view that was created
Click Steps
Screenshots
Open the View Manager Select 01 Visuals and click Apply Open the View Manager Select Demo Visuals Click Delete View
This concludes the End User Empowerment demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, e-mail address, logo, person, place, or event is intended or should be inferred.
© 2008 Microsoft Corporation. All rights reserved.
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Microsoft Amalga Demo System Q3 FY09 Financial Process Automation Microsoft Corporation Published: February 2009
Summary This presentation will demo a workflow to ensure that patients are pre-authorized and notified of their services, physician and clinical resources are effectively scheduled and the hospital maximizes reimbursement for services.
Table of Contents 1 2
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Start Demo Laptop and log in ............................................................................................. 3 1.1 Log in to Microsoft Amalga ................................................................................................. 3 1.2 Missing or Incorrect Authorization for Services ...................................................................................... 5
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
Value, Scenario, Story, Roles, Processes
Demo Scenario:
Financial Process Automation The ability to integrate clinical and financial data to drive real-time process improvement is one of the key benefits that Amalga enables. In this demonstration we highlight a simple Amalga-enabled workflow to ensure that patients are pre-authorized and notified of their services, physician and clinical resources are effectively scheduled and the hospital optimizes reimbursement for services.
Questions to tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
1. What financial and operational goals have you established to drive improvements in reimbursement? 2. What process and workflow changes have you installed to optimize utilization of clinical resources? 3. How do you enable and automate workflows in your organization? 4. How do you manage and automate authorization from your primary payers? 5. How to you optimize reimbursement for your services? With profitability for most major healthcare organizations running in the low single digits, it’s critical that your organization maximizes reimbursement for the medical services that you deliver. In addition, given the significant costs associated with clinical staff and hospital assets, it’s equally important that you manage the utilization of these assets by delivering services for which you will be fairly compensated. In this demo, we will show you how to use Amalga to help automate a financial clearance process to optimize reimbursement for services and ensure effective utilization of our clinical staff.
Role(s):
Financial Managers Hospital Administration Clinical Team
Processes:
Financial Clearance / Management ADT Scheduling Billing and Revenue Cycle Management
HSG Customers who have implemented similar scenario:
MedStar
© 2008 Microsoft Corporation. All rights reserved.
1.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Log in using the provided Amalga credentials
Screenshots
Click
1.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
2
Missing or Incorrect Authorization for Services Talking Points
To manage the financial data and processes in Amalga we are going to use the Amalga Financial Application.
Click Steps
Click Apps in the top right
corner of the Amalga client
Select Amalga Financials
To ensure effective
Select 01 -OP Denialsin the
In this view, we see all services
Right-click on the Denial
reimbursement for our medical services, we’ve created a specific view in Amalga to highlight all Out-Patient Denials
and patients for which we have been denied payment. Using the Stats feature, we can gather a bit of additional insight into the reasons for denial.
Reviewing the reasons for denial,
View Managerif it is not already applied
Description column header
Select Stats Click Close when finished discussing
we see that a number of the reasons tie back to our patient pre-administration process, including: Insurance Verficiation, 5% Missing Billing Info, 5% No Pre-Cert / Auth, 8%
Using Amalga to drive financial
process improvements, Washington Hospital Center, saw these same trends in their patient admissions process. To better understand the issue and also automate their financial pre-admit processes, they used Amalga to inform and automate the entire process.
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
When we look across the
reasons for denials, one of the issues that is clearly called out is the impact of pre-certification and authorization on potential reimbursement.
Filter on No Pre-Cert/Authby
right clicking a cell with that value and selecting Filter on Contents Verify the filter says “Denial Description Equals To NO PRECERT/AUTH” then click OK twice to apply the filter
Open the View Manager Select OP Denials – No Auth Click Apply To upgrade our pre-admission
process, there are a couple of issues that we must address. First, to ensure that we focus our pre-cert and authorization process improvements on the right payers, we look at the distribution of denials across our top payers and see that there is a clear need to focus on patients covered by three payers: Aetna, Amerigroup and Capital Care.
Right click on Primary Insurance
Click on Stats Click Close when finished discussing
The impact of our failed authorization process is clear by simply looking at our performance against this process. By failing to gain proper authorization, we are not only foregoing payment for service but we are also negatively impacting clinical utilization. To address this problem, we can actually use Amalga to design, implement and automate our financial authorization process.
We can automate the
authorization process by setting up a structured work queue.
In this example, we’ve setup a
number of Financial Clearance Views. These views represent the queue of incoming patients that require financial clearance.
Open the View Manager Select Financial Clearance – Unsch – Black, M
Click Apply
In this example, we have created a view for our pre-authorization specialist, Michelle Black. We can see the incoming patients and what financial clearance they require.
Notes: 4 filters were added to the default view to show only those records where the
© 2008 Microsoft Corporation. All rights reserved.
FinanciallyCleared column is set to ‘N’
By using this view to automate
our financial clearance process, wecan greatly reduce the time it takes to both authorize and inform patients.
For each patient in Michelle
Black’s queue, we select the patient and then display the detailed patient information (demographics, insurance information and the dictations and orders for the patient) required to effective complete the pre-admit process.
Select a patient name Click the Info button Select and display the
Demographics, Dictations and Orders
Add complete click steps
Through the use of quick edits,
Needs updated image
Michelle Black can edit the Financially Cleared column, switching patients to authorized, once everything is taken care of.
When we have contacted the
payer and informed the patient of any pre-admit requirements, we can complete the Financial Clearance process by simply setting the Financially Cleared Flag to “Y”, removing this patient from the view.
Right click on the Financially
Cleared column for the selected patient
Select “Y” to denote that the patient has completed the Financial Clearance process
Note the patient will disappear
from the list, as the filter is only showing Non-financially cleared patients
In summary, this demonstration highlights the unique capability of Amalga to integrate data from across both your clinical and financial systems. By bringing this data together, we are able to effectively analyze our existing processes to identify process improvements. In this specific example, we highlight the work that has been done at Washington Hospital Center to identify upgrades in their pre-admission process to eliminate nearly 20% of their denials. To enable this process improvement, we used Amalga to integrate the data, identify the problem and automate the ongoing patient pre-admit authorization process.
This concludes the Financial Process Automationdemonstration. © 2008 Microsoft Corporation. All rights reserved.
The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Page 1 of 18
Microsoft Amalga Demo System Q1 FY09 General Research Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the General Researchfeatures offered byMicrosoft Amalga. Role: Clinical research investigator, Chief Scientific Officer, Director of Research Informatics, staff research scientist, lab technician.
Personas:See Roles.
Table of Contents 1 2 3 4 5 6 7
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 4 Start Demo Laptop and log in ............................................................................................. 4 2.1 Log into Microsoft Amalga .................................................................................................. 4 2.2 Identify New Subjects for Biomarker Trial Protocol ................................................................................ 5 Subject Monitoring & Retention ............................................................................................................ 11 Assay & Research Data Tracking......................................................................................................... 13 Closing Comments ............................................................................................................................... 17 Cleanup Created Views in Preparation for Next Walk-Through ........................................................... 18
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2009 Microsoft Corporation. All rights reserved.
Page 2 of 18
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Reduction of research operation cycle times leading to reduced costs and increased research velocity towards outcomes
Demo Scenario:
Lung cancer biomarker clinical trial protocol with a focus on subject (i.e., patient) identification, retention, and easy access to research data. 1. Does your institution conduct research? 2. What sort of research activities does your organization conduct? Basic research, translational research, clinical trials, etc.? 3. Are you building a research ‘knowledge base’ that is aggregating research data and information? 4. Do the investigators at your site find it challenging to access, manage, and use research data? I.e., does your research data sit in different silos?
Questions to tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
Translational medicine research is a continuum of complex activities requiring multiple disciplines, investigators and an integrated view of patients and research activities. Clinical trials are one of the many activities in the research continuum. More than 2.3 million people participate in approximately 80,000 clinical trials annually. Unfortunately, the increasing complexity of clinical trial protocols is making it more difficult to recruit and retain clinical trial subjects. Enrollment rates for trial subjects meeting eligibility criteria dropped from 75% in 1999 to 59% in 2006 1. According to the Center for Information and Study on Clinical Research, if the percentage of cancer patients increased to 10% (vs. current 5%), studies could be completed in a year vs. the current 3 to 5 year time horizon. To illustrate how Amalga can impact the research cycle times, we will explore a lung cancer biomarker trial protocol that will help physicians predict a patient’s lung cancer prognosis. We will look at how we can use Amalga to identify new subjects for a biomarker trial protocol, automate the identification and retention of trial subjects, and track the status and availability of primary research data.
1
Tufts Center for the Study of Drug Development
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Page 3 of 18
Role(s):
Clinical research investigator, Chief Scientific Officer, Director of Research Informatics, staff research scientist, lab technician.
Processes:
Patient consent, trial subject identification, supporting institutional review board (IRB) policies, assay requests, biospecimen processing, subject monitoring and retention.
HSG Customers who have implemented similar scenario:
Moffitt, University of Washington, Seattle Children’s Hospital
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2 Demo Setup
The actual demo starts at section 4. Talk about the following pre-demo sections and what happens in those sections. In section 3.1, we start the demo laptop and log in to start the demonstration. In section 3.2 we log into Amalga to start the demonstration.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in as iadmin
Enter the provided Amalga login credentialsClick
2.2
Screenshots
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
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In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Screen Shots
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Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
3 Identify New Subjects for Biomarker TrialProtocol In this section, we demonstrate how to identify patients for research. Talking Points
At our academic medical center, patients are consented for their participation in a clinical trial protocol. If they participate, patient information is deidentified and stored in “Research Subject Base
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Click Steps
Screenshots
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View” and made available to investigators with appropriate privileges. Let us take a look at the Research Base View. Launch View Manager to select a different view. Typically this defaults to “01Visuals” user view, but this is not guaranteed.
Launch View Manager (“01Visuals”) Click on “Research Subject” user view, then press the “Apply” button.
The Research Subject base view provides me a fast and easy way to identify research subjects that qualify for my biomarker trial protocol. By default this view displays the fields that I use most often to identify possible trial subjects.
Scroll Grid View left to right and right to left
To quickly identify and track the right research subject with the right trial protocol, I can always modify this view or create a new custom view.
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Open View Manager
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Select Research Subject. Click Clone.
For example, if my trial protocol eligibility criteria required imaging information, I could add fields for CT and MRI scans.
Scroll through fields Select a CTDATE or MRIDate fields. Click Add Field.
For this biomarker trial protocol, I will create a custom view.
Name ‘cloned view’ “Lung Biomarker II”. Click OK. From the View Manager, select and apply “Lung Biomarker II” view.
We currently have about ~50K possible research subjects in our Research Subject base view. But for my lung cancer biomarker trial protocol, I need to find research subjects that meet the specific trial protocol eligibility criteria.
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Highlight total patient count in upper right hand corner of grid view.
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My subjects are required to be older than 18 years old, can be either male or female, and need to be diagnosed with cancer within the last six months.
Using the filter function I can quickly start identifying my trial subjects.
Open Filter
I will filter on Age and a range of diagnosis codes for cancer.
Choose “Age” from the Available list
Click “Add Filter” from middle buttons
Change Operator to “GREATER THAN” and input “18” as the Values field
Click “OK”
Choose “Diagnosis_Codes” from the Available list
Click “Add Filter” from middle buttons
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Change Operator to “BETWEEN”, then input “139” into the first Values field and “240” into the second Values field
Click “OK” to exit Filter Editor
Click “OK” again to confirm and exit Filter screen
Now, I have quickly narrowed my possible cohort of trial subjects from about 50K to less than1000 that could participate in a cancer biomarker trial protocol.
Show updated total count in upper right hand corner.
To meet all the eligibility criteria of our trial protocol, we need to refine our current cohort further. We need to find those subjects that are diagnosed with lower lobe lung cancer within the past six months.
We can use a key word filter to refine the specificity of our current selection.
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Right click first cell in Diagnosis_Description. Click “Filter on Contents”.
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Create a Filter on Diagnosis_Description that Contains “Low Lobe”.
Click “OK” to exit Filter Editor
Click “OK” again to confirm and exit Filter screen
To meet the time of diagnosis criteria we can adjust the Data Scope.
Confirm that the Data Scope Date Range is 12/01/2005 to 06/30/2006
Within a few simple steps, I identified small set of potential subjects to include in my biomarker trial protocol. To save me time identifying future subjects matching the criteria I just set up, I can save this view with the applied filters.
Open view manager
Click Save Settings to retain filter changes
Click Apply to return to the Grid View
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4 Subject Monitoring & Retention In this section, we demonstrate how to view necessary data to retain subjects. Talking Points
Click Steps
I can further reduce my cycle time for identifying research subjects by setting up an alert for the trial protocol criteria that I set up earlier.
Click on Info.
Click Alert Configuration You may be prompted to enter a default email address. If so, click No Click New
Highlight the features of the Alert Dialog box
Enter Alert Name “Lung BioMarker Trial II”
Select the Custom Notification radio button Enter custom message: “New subjects meeting trial eligibility”
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Screenshots
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Click Cancel
Click Close
I could have also set up an
Optional – extended retention scenario.
Skip these next steps if short on time.
In our current example, we only considered some of the research activities related to an intervention clinical trial protocol.
With the appropriate institutional review board policies in place (IRB), I could also consider using Amalga and its Health Vault connection to monitor subjects in an observational trial protocol. For example, I could monitor the glucose levels in response to exercise for a group of diabetic out patient subjects.
Launch View Manager (currently “Lung BioMarker II”)
Click on “01-Visuals” user view, then press the “Apply” button.
Select Alexander Bogue
Select Info
Select “HealthVault”
alert if a subject dropped out from a trial too.
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Highlight how Microsoft has delivered on our “Connecting Care” strategy component by integrating Amalga directly with HealthVault.
Blood Glucose Tab
Click Close to return to the Amalga Grid View
5 Assay & Research Data Tracking Talking Points
Click Steps
Our Research Services Core Lab provides a variety of assay services. These services generate many different types of research data that are stored in many different systems like laboratory information systems (LIMS) for tracking the location of biosamples, instrumentation and data collection software for gene expression profiling, and local reporting systems for tissue pathology data. For research subjects I identified earlier, I can issue a request to the Research Services Core Lab to assay the tissue samples collected from my research subjects.
Page 13 of 18
Launch View Manager (currently “01-Visuals”)
Screenshots
Page 14 of 18
Click on “Lung Biomarker II” user view. Then press the “Apply” button.
Show the number of subjects identified in upper right hand corner.Your results may vary from screen shot
Click the “Input” button
Choose “Assay Request” module
Note you are still working with the de-identified patient.
Note also that Amalga is receiving a transaction and is therefore not a READ ONLY system.
Page 14 of 18
Click “X” to close.
Page 15 of 18
I need an integrated view of my research data specific to my lung cancer trial protocol. Now, let us find out status of my pathology and gene expression assays for all my subjects in my lung biomarker trial protocol.
Launch View Manager (currently “Lung Biomarker II”) Click on “Research_Svc_Core” user view, then press the “Apply” button.
For this clinical trial protocol, I set up custom view to track the assay status and results for all my trial biosamples processed by the Shared Research Services Group. I can quickly scan and see that the assays for the four recent trial subjects are still processing for tissue pathology and gene expression profiling. These four patients were selected for the biomarker study based on specific criteria: age, time of diagnosis and tissue type.
Scroll Grid view left to right and highlight tissue processing status fields Clinical_Path_I and Clinical_Path_II (showing “processing”).
Page 15 of 18
Note: you may want to click on the column header to sort and show “processing” at the tope of the column.
Page 16 of 18
I can export the contents of
the grid view into Excel and quickly link to an FTP site to download the raw gene expression data and prepare this data for down-stream analysis in my gene expression analysis package of choice.
Page 16 of 18
Click on System and click on Excel, switch to Excel worksheet, highlight pointer on FTP site.
Note: this may take some time to generate the Excel document.
Page 17 of 18
6 Closing Comments Talking Points
The connected framework of Amalga allowed me to identify and monitorresearch subjects eligible for my lung cancer trial protocol. I also reduced my cycle time communicating and monitoring the availability of my assay results. Overall, using Amalga I introducedefficiencies into my research operations that contribute to starting and completing the research trial on time, to lowering the total cost of a trialprotocol and increase the speed to actionable outcomes.
Page 17 of 18
Click Steps
Screenshots
Page 18 of 18
7 Cleanup Created Views in Preparation for Next Walk-Through Talking Points
Click Steps
Delete “Lung Biomarker II” user view in preparation for next execution of this script.
Launch View Manager
Select “Lung Biomarker II” user view
Click Delete
Confirm delete of user view
Screenshots
Click OK
Exit View Manager
This concludes the General Researchdemonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
Page 18 of 18
Microsoft Amalga Demo System Q1 FY09 Hospital Acquired Conditions Scenario Microsoft Corporation Published: February 2009
Summary This demo script will showcase the ability to use Amalga to show patients have conditions prior to arrival at the hospital. Role:
Physician, Administrator, Quality Analyst
Personas:
Table of Contents 1 2 3
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log in to Microsoft Amalga ................................................................................................. 3 2.2 HAC Scenario ......................................................................................................................................... 6
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Demo Scenario:
Hospital Acquired Conditions The …
Questions to tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
1. What financial and operational goals have you established to drive improvements in reimbursement? 2. What process and workflow changes have you installed to optimize utilization of clinical resources? 3. How do you enable and automate workflows in your organization? 4. How do you manage and automate authorization from your primary payers? 5. How to you optimize reimbursement for your services? With profitability for most major healthcare organizations running in the low single digits (2% - 5%), it’s critical that your organization maximizes reimbursement for the medical services that you deliver. In addition, given the significant costs associated with clinical staff and hospital assets, it’s equally important that you manage the utilization of these assets by delivering services for which you will be fairly compensated. In this demo, we will show you how to use Amalga to help automate a financial clearance process to maximize reimbursement for services and optimize utilization of our clinical staff.
Role(s):
Financial Managers Hospital Administration Clinical Team
Processes:
Financial Clearance / Management ADT Scheduling Billing and Revenue Cycle Management
HSG Customers who have implemented similar scenario:
MedStar
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Log in to the demo machine using provided credentials
Screenshots
Click
2.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Open Amalgademos.com Use your DEMO credentials to Enter into the site
Click Steps
From Internet Browser Open www.Amalgademos.com
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Navigate to ProductionDemos page
Open Amalga Console from the site.
Connect to the Remote App
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
© 2008 Microsoft Corporation. All rights reserved.
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 HAC Scenario In this section, we demonstrate … Talking Points
Click Steps
Amalga provides the ability to create views that show different information based on the role of the specific user at that time. User views are derived from base views and can be created and modified in seconds.
Click the View Manager
As of October 2008, CMS
Click on the View button
announced it would no longer pay for certain Hospital Acquired Conditions. The treatment of certain blood conditions caused by inadequate inpatient glycemic control is one example. Specifically, CMS will not reimburse hospitals if a diabetes patient’s blood glucose level results in Diabetic Ketoacidosis, which costs around $42,974 per hospital stay. I will show you one of several ways nurses, physicians and
and select HAC Clinical View. It will look very similar to the 01 - Visuals view. Verify Alexander Bogue is near the top of the list.
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
quality staff can use Amalga to monitor and track hospital acquired conditions.
Mr. Alexander Bogue is a
Click on Alexander Bogue.
patient admitted to the hospital complaining of chest pain with a history of hypertension and type 2 diabetes. If I click on Mr. Bogue I see his medical history. Note that I can see, in parentheses, how many results can be found on each tab. That is one of the many ways that we save clinicians time and organize the vast amount of data.
Click the Info button Click the Labs module.
© 2008 Microsoft Corporation. All rights reserved.
Here are all of the labs for
Click on the Heme tab.
Mr. Bogue. Here are all of the Hematology lab results.
© 2008 Microsoft Corporation. All rights reserved.
Here are all of the Chem
Click on the Chem tab.
results.
© 2008 Microsoft Corporation. All rights reserved.
Here I can see all of the
patient’s labs on a single tab. Notice that the Glucose is abnormally high. I can double click on any lab and instantly see the lifetime history of that lab.
Double click on the top lab
result (Bedside Glucose). Scroll down.
© 2008 Microsoft Corporation. All rights reserved.
Instantly we see that this
Click on graph button.
patient has a very long history of high glucoses, which informs me to pay close attention to his blood glucose levels. With one click on the graph button we can graph these results over time. We can easily see that this diabetic patient virtually never has a controlled glucose level. You can see the normal range, and this patient is almost always way above the high end of normal.
Point out the two horizontal lines toward the bottom of the graph. Close the graph, the lifetime history of glucoses, and the Labs Module.
© 2008 Microsoft Corporation. All rights reserved.
The real power of Amalga
comes not just from being able to drill down deeply on a per-patient basis, but also being able to look across a cohort of patients in the hospital and their case mix data. We can analyze the data right here from the Amalga Grid.
Open the View Manager and Apply the HAC High Risk Diabetes view. Click Apply
© 2008 Microsoft Corporation. All rights reserved.
For this particular HAC, we
can monitor the number of patients in the hospital that have diabetes.
In just a click we can see
Right Click on the cell
patients for a particular doctor or group of doctors, on a particular service or group of services, or on a particular unit or group of units. To ensure appropriate monitoring of glucose treatments I am able to set up automatic alerts to the nursing staff or physician if a patient’s blood glucose levels are not within range.
beneath the Unit column header that includes the value 2C. Select Filter on Contents. Ensure you are filtering LocationUnit EQUALS TO 2C Select OK, OK.
© 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Let’s remove the filter to zoom back out.
Click Filter button Select the LocationUnit EQUALS TO ‘2C’ row Click Remove Filter button Click OK
© 2008 Microsoft Corporation. All rights reserved.
Patient non-compliance with diet and medications instructions is an important reason for changes in clinical status. After the patient is discharged, hospitals do not know if the patient will comply with the 6 discharge instructions. The ability to sync-up HealthVault data in Amalga provides clinicians or nurses with the ability to track daily glucometer readings, blood pressure or patient
Click Find Enter Bogue in the Last name field Enter Alex in the First name field Click OK Double Click on one of the Alexander Bogue rows to open the labs viewer
Click on HealthVault module along the left column.
© 2008 Microsoft Corporation. All rights reserved.
Taking appropriate action
while the patient is in the home environment can reduce unnecessary 30-day readmissions. Also, in the event the patient ends up back in the ED complaining of chest pain, the hospital is immediately able to view in Amalga the patient’s medical history and view glucometer, weight, and blood pressure data captured in a clinic or medical home environment over a period of days, weeks or months. This improves diagnosis and care treatment and reduces the need to readmit the patient. It also improves CMS Present on Admission documentation requirements in the ED for hospital acquired conditions. Lastly, better documentation of patient conditions in the ED under new Medicare Severity DRGs (MS-DRGs) increases reimbursement rates.
Click on blood glucose. Click on medications and view the list of meds. Please note: the data you see might vary from the screen shots.
© 2008 Microsoft Corporation. All rights reserved.
Log out of Amalga
Close the Info Viewer Click UnFind Click the Logout button at the top-right of the Amalga client
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga UIS Demo System ImagingScenario Microsoft Corporation Published: March 2009
Summary Images are an important part of a patient’s medical record. While users have become accustomed to access to most of a patient’s textual clinical information, access to images been limited and fragmented. The Amalga UIS Medical Imaging module unifies images f siloed imaging departments across an enterprise and between entities to provide a single images along with non-image data both within and outside the institution. In these demonstrations, we will show how Amalga UIS Medical Imaging module provides a comm viewer for clinical users to have fast access to images from multiple departments such as Radiology, Cardiology and other DICOM enabled groups across the enterprise. Also, we highlight some key features that allow users to quickly understand a patient’s imaging his context of the rest of the patient’s medical record.
© 2008 Microsoft Corporation. All rights reserved.
Table of Contents 1 2 3
Value, Scenario, Story, Roles, Processes ................................................................................ Demo Setup ............................................................................................................................. 2.1 Start Demo Laptop and log in................................................................................ 2.2 Log in to Microsoft Amalga .................................................................................... Imaging Scenario .....................................................................................................................
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Demo Scenario: Questions to tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
Unified View and Access to a Patient’s Images 1. Do you have access to radiology, cardiology and other departmental images throughout your enterprise? 2. Do you work in an IDN? If so, do you have access to all the patient images across the IDN in one view?
Images are an important part of a patient’s medical record. While users have become accustomed to access to most of a patient’s textual clinical information, access to images has been limited and fragmented. The Amalga UIS Medical Imaging module unifies images from siloed imaging departments across an enterprise and between entities to provide a single view of images along with non-image data both within and outside the institution. In these demonstrations, we will show how Amalga UIS Medical Imaging module provides a common viewer for clinical users to have fast access to images from multiple departments such as Radiology, Cardiology and other DICOM enabled groups across the enterprise. Also, we will highlight some key features that allow users to quickly understand a patient’s imaging history in context of the rest of the patient’s medical record.
Role(s):
Clinical Team
Processes:
Patient Care
HSG Customers who have implemented similar scenario:
MedStar
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. In section 2.1, we start the demo laptop and log in to start the demonstration. In section 2.2, we log into Amalga to start the demonstration
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to the demo machine
Enter the provided demo machine credentials
Screenshots
Click
2.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Open Amalgademos.com Use your DEMO credentials to Enter into the site
Click Steps
From Internet Browser Open www.Amalgademos.com
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Navigate to ProductionDemos page
Open Amalga Console from the site.
Connect to the Remote App
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
© 2008 Microsoft Corporation. All rights reserved.
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Imaging Scenario Talking Points
Patient Patty Danford
Click Steps
Ensure that the 01 – Visuals
view is displayed. arrives in ER complaining Select Danford, Patty of chest pain. The ER physician orders an x-ray of the chest Exam is completed and images are sent to Amalga
Physician uses Amalga to view the patient medical information
button at Click top to open Info Window Or – double click on row
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
Through Amalga, the physician has access to all of the patient’s information such as labs, medications, past medical history, scanned documents, images, etc. This holistic view can include the data within one facility/hospital as well as across the IDN or multi-site facility/hospital The Image Viewer includes a color coded graphical representation of Patty Danford’s imaging history. This provides a quick and easy way to understand the patient’s past studies at a glance. In addition, we can filter the timeline to limit the information to the relevant data.
Click on left of component launcher
Click timeline Click
If prospect answers setup question that he/she does not have access to all the patient images across the IDN, then say the following: In this case, Patty had X-rays taken at both Hospital 1 and 2. Each hospital has its own separate PACS. Amalga can bring images from different © 2008 Microsoft Corporation. All rights reserved.
on
hospitals together in one unified view.
In this case, the physician wants to focus on the current encounter and look at the patient’s x-rays.
Select CR Chest Study from 8/11/2005 09:24
The Image Viewer uses server side processing to facilitate faster delivery and minimize network utilization to provide clinicians with access throughout the enterprise. The server only sends what is needed to provide optimal quality for the monitor. Once the image is loaded, the user can manually manipulate the window’sbrightness/contrast level to change the appearance to focus on certain structures.
Click Hold and Drag up or down across image to change the window’sbrightness/contrast level. Move around the image to get the image appearance to change.
Click Or double click on row
© 2008 Microsoft Corporation. All rights reserved.
In addition to the manual adjustment, the user has the ability to adjust the window level by selecting a region of interest and the system will automatically optimize the display based on the selection.
Click the drop down for to select
Click and Drag multipleboxes of area of interest to auto window level. Image will adjust window level accordingly across entire image to optimize
Comment [jk1]: I can’t get multiple selections. Tried shift-, ctrl, alt-click and combinations.
Adjusting the window level is fast and easy and users can quickly return the display to the default by pressing reset.
Click button to restore image to default position and window level
© 2008 Microsoft Corporation. All rights reserved.
At the top of the screen, Amalga has a pictorial index of the patient imaging history. The Physician notices the patient has a prior study. The Physician wants to compare the current x-ray with the previous x-ray.
Click the drop down for
The Physician can quickly drag and drop the previous study directly from the timeline to view the image side by side.
Click and Drag 1st image
to select
on the timeline to right viewport area Note: The timeline is at the top of the image viewer.
On the left side of the screen is the study navigator panel. It lists the series and images for each particular study. In order to help provide clear context of whichseries are loaded into the viewer, series that are displayed have a little icon on the bottom right to indicating where the image is displayed. In this case, the older study is loaded in the right part of the screen.
© 2008 Microsoft Corporation. All rights reserved.
The Physician has loaded the prior x-ray and wants to check the radiologist’s report. The Physician can quickly select one of the images and click the Report button to display the report for that study. The prior report indicates a normal study.
Comment [jk2]: Again, I cannot find how to do this.
Click on the right image Click Close Report Viewer
To help make the comparison process more efficient, the image viewer has a linking ability.
Click
Now that the images are linked, as the Physician changes the window level on the newer x-ray (on left), the older x-ray (on right) is automatically updated.
Click and Drag boxes of area of interestto auto window level. Image will adjust window level accordingly across entire image to optimize
© 2008 Microsoft Corporation. All rights reserved.
This linking ability also applies to the zoom …
Using scroll wheel, zoom in about 100%
and panning.
Click and drag green box in Zoom preview window until lung is in viewer or use the Region Zoom option
Now that we’ve focused in on a particular region of the image, the Physician can quickly focus in on one of the images and return back to the comparison mode by a simple double click.
Double click on right image viewer to expand that image Double click on image to return to 1x2 view
© 2008 Microsoft Corporation. All rights reserved.
Now that the physician has finished with his/her comparison…
he/she may wish to look at some of the patient’s other studies. By modifying the filter to show all the studies, the pictorial image timeline show all of Patty Danford’s images.
The image viewer layout can be expanded up to 2x2.
Click button to restore image to default position and window level
Click Click Click
Click the drop down for
to select
© 2008 Microsoft Corporation. All rights reserved.
The Image Viewer can display most common DICOM image types including Cardiology motion images If prospect answers setup question that he/she does not have access to radiology and cardiology images in one viewer, thenhighlight the following:
Click and Drag 3rd image
on the timeline to bottom left viewport area
With Amalga you can have one viewer for your Radiology and Cardiology images. Mention MedStar Cardiology Case study. Having all the images along with all the other medical information in one place saved clinicians 1.5 hours daily. Click and Drag last image
on the timeline to bottom right viewport area
© 2008 Microsoft Corporation. All rights reserved.
The first image in the series was just a screenshot. We can view other images of thatseries by clicking the onscreen buttons. This helps minimize mouse fatigue so uses don’t have to move the mouse around the screen as much to do simple actions.
Move mouse over a image
and wait for to appear Move mouse to bottom right viewport and click on up
button once when it appears to advanced to next image
The Physician can easily adjust the playback speed as needed.
Click
The Physician decides to focus on the Angiography and can close the other studies from the navigation panel
Close first 3 studies in the series navigation panel clicking on the x for those studies
to increase or decrease playback speed
© 2008 Microsoft Corporation. All rights reserved.
The cardiac cath shows left circumflex artery occlusion and was treated with a stent.
Click and drag Image 7/18
into the bottom right viewport area Now the Physician can see the blood flow both pre and post stent placement at the same time.
Click and drag Image 16/18
into the bottom left viewport area That patient developed neurological symptoms after the stent procedure and receives a CT of the head. The Physician also decides to look at the current and prior CT Head studies.
Click and Drag 1st image
on the timeline to top right viewport area
© 2008 Microsoft Corporation. All rights reserved.
Click and Drag 5th image
on the timeline to top left viewport area
One of the challenges with CT studies in some systems is the inability to quickly view the same series at different window levels. Using the image viewer, we can easily load the same series in separate viewports…
Click and drag second image for 08/10/2005
into the top left and bottom left viewport area Click and drag first image for 01/07/2005
into the bottom right viewport area
© 2008 Microsoft Corporation. All rights reserved.
and apply see the same series with two different window levels. One to highlight brain structures and the other to highlight bone structures.
Click on bottom left viewport Click the drop down for to select
Click on bottom right viewport Click the drop down for to select
Now we can link all the images so actions apply to all the images
Click
© 2008 Microsoft Corporation. All rights reserved.
We can zoom in slightly to maximize our image
Using scroll wheel, zoom in about 128%
Now as we scroll, all the images are scrolled. This makes it easier for the Physician to look at the images. At image 13 of the 8/10/2005 image, the head CT shows subarachnoid hemorrhage possibly due to too much anticoagulation medication during the stent procedure.
Move mouse over a image
The Image Viewer also has basic tools such as measurements and annotations. We can quickly measure the findings with a few steps.
to and wait for appear Click (or click and hold) up to advance through series until top left image shows image 13/28 Click
and select the dropdown for Distance The cursor will change to a crosshairs and enable action as a ruler
© 2008 Microsoft Corporation. All rights reserved.
Measure lesion by clicking once to start the line, moving mouse to end point, and clicking again to end line. Repeat for second measurement.
The Amalga UIS Medical Imaging Module allows clinicians to unify images from multiple departments, within and across multiple institutions, and access them in one place with related clinical information. Clinicians can visualize images from multiple DICOM modalities. The Module uses server side processing to facilitate faster delivery and minimize network utilization to provide clinicians with access throughout the enterprise.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q3 FY09 Incident Reporting and Investigation Microsoft Corporation Published: February 2009
Summary
This demonstration walks users through the creative use of Views in order to focus in on a specific situations for analysis, in this case, for purposes of Incident Reporting and Investigation.
Role: Personas:
Table of Contents 1 2 3 4 5 6 7 8
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ................................................................................................................. 3 Log in to Microsoft Amalga ..................................................................................................................... 3 Setting the Initial View ............................................................................................................................ 5 Using the INPUT Button ......................................................................................................................... 5 Quality Case Analysis ............................................................................................................................. 5 Quality Case Analysis ............................................................................................................................. 8
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Demo Scenario:
Questions to tailor demonstration to audience pain / requirements?
Incident Reporting and Investigation
1.
Demo Introduction / Story:
Role(s):
Processes:
HSG Customers who have implemented similar scenario:
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup
In section 2, we start the demo laptop and log in to start the demonstration. In section 3, we log into Amalga to start the demonstration. The actual demo starts at section 4.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials
Screen Shots
Click
2.2
Log in to Microsoft Amalga
In this section, we log in to Microsoft Amalga Talking Points Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Setting the Initial View Talking Points
Screen Shots
Select the Quality
Click Steps Management Cases View . Click Apply
This is a view of all Quality Management cases – cases in which someone in the enterprise raised a concern about the quality of care provided to a patient.
The View displays all Quality Management cases.
4 Using the INPUT Button Talking Points
By selecting a patient and clicking the input button, we can see the details of any one of these cases. We can also enter new comments or new information.
Click Steps
Screen Shots
Main Filter shows all Quality Management cases.
Select a patient and click INPUT button to expand on the record.
Click COI to bring up the Case of Interest module
Close the Input window
WITHOUT saving – click the X or Cancel to exit
5 Quality Case Analysis Talking Points
© 2008 Microsoft Corporation. All rights reserved.
Click Steps
Screen Shots
In addition to manually entering quality concerns through Amalga, we can query the data that already exists in Amalga to identify potential lapses in the quality of care. By saving that query, we can automatically identify those patients again in the future. Let’s find all patients who returned for care less than 3 days after being discharged from the hospital. Those represent patients who might have been discharged prematurely.
Click Filter
Remove any currently existing filters (CaseOfInterestType)
Add a filter on INFO_LV between 0 and 3.
Add a filter on INFO_LV_DISPO where it BEGINS with disc
Click OK
Here we see all patients who visited the emergency department, were discharged, and returned to the hospital within 3 days.
We can right-click on the admitting MD column to see which doctors are most associated with these types of bounce backs. We can target our feedback and educational programs to decrease the frequency of premature discharge.
Right-click on the LastVisit MD column heading Select Stats and click the count column twice to sort in descending. Click Close when finished with the screen
© 2008 Microsoft Corporation. All rights reserved.
Perhaps we want to check if there is a spike in premature discharges during Christmas when doctors and patients are eager to get home to their families. We can easily graph this data using the Amalga Dashboard to look for such trends.
Click Dashboard
Select Quality Management
Contrary to what we might have thought, this graph shows that there is not a spike in premature patient discharges around the holidays. There was a minor drop in November, but no major fluctuations to be concerned with.
Select the Patient Bounceback chart
Click Edit Chart
Click Close or X when finished discussing the graph and return to the grid view
We can further filter our data to show patients who returned to the hospital within 3 days and were so sick they had to go to the Intensive Care Unit (ICU) Adding one more filter will show us these patients who are of obvious concern as to the level of care provided.
Click Filter
Add a filter on ICU where it is NOT BLANK
We can even dive deep into any one of these patients to get a better understanding of the clinical situation – why they might have been discharged prematurely, and the patient’s clinical course during the return visit.
Switch to the 01 – Visuals view and execute the desired portions of the Clinical Intro script.
© 2008 Microsoft Corporation. All rights reserved.
6 Quality Case Analysis Talking Points
Click Steps
Open the View Manager
Select the One Row Per Narcotic Antitode
Click Apply
Now we grab a copy of all these patients given antidotes.
Right-click on the Visit ID column header
Select Copy Distinct Values to Clipboard
Opening up a new view we’ve created, we see a list of all instances in which a patient was given narcotics during the month of January. Did any of these patients also require a narcotic antidote?
Open the View Manager
Select One Row Per Narcotic
Click Apply
Click Filter
Select GEID and click Add Filter
Select BEGINS WITH
Right-click the Values field and click Paste
Click OK
We can also utilize Amalga to rapidly identify other quality concerns, such as patients who may have been prescribed too high a dose of narcotics. We can go to the View Manager and select a view that shows one row per narcotic antidote given.
Knowing we have all those antidote entries stored, we can add a filter to show only those patients given antidotes.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
So now we see a list of all patients in January given narcotics which were then given antidotes. These may be cases of concern in which a patient was potentially given too high a dose of narcotics.
Click Logout
This concludes the Incident Reporting and Investigation demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q3 FY09 Infection Control Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the Infection Controlfeatures offered by Microsoft Amalga. Role:
Personas:
Table of Contents 1 2
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Viewing Isolation & Culture Results........................................................................................................ 3
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Ability to support interventions and workflows across the healthcare organization that help minimize occurrences of infections and optimize their management
Demo Scenario:
Infection control
Questions to tailor demonstration to audience pain / requirements?
• How do they perform infection control surveillance, management and reporting activities? • Do they need help understanding infection control issues in their environment?
Demo Introduction / Story:
Infection control is a critical function in every healthcare organization. Activities include monitoring for new infections and identifying infection patterns, exploring ways to reduce infections, monitoring for compliance with infection control practices and reporting infection control practices to external organizations. Amalga can be used to facilitate many of these steps and facilitate communication of tasks and activities across the healthcare environment
Role(s):
Infection Control officer and staff, CMO, nurses, physicians
Processes:
Documenting placement of indwelling devices in patients Assigning patients to isolation status discovering patterns of new infections
HSG Customers who have implemented similar scenario:
Examples of HSG customers who have done something similar -- WHC
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup
In section 2, we start the demo laptop and log in to start the demonstration. In section 3, we log into Amalga to start the demonstration. The actual demo starts at section 4.
2.1 Start Demo Laptop and log in In this section, we start the demo laptop and log in to start the demonstration. Talking Points Click Steps Screen Shots
Start Demo Laptop
Start Demo Laptop
Log in to laptop
Enter provided laptop login credentials Click
2.2
Log in to Amalga
Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Viewing Isolation & Culture Results In this section, we demonstrate how to view culture results and establish a patient’s isolation status Talking Points
In the view called labResultssingle line, we have one result perlaboratory panel, filtered on microbiology studies
Click Steps
Open View Manager Click Lab Results – Single Line
Microbiology reports have multiple lines of text per report. In this view, all of the lines of text are merged together into a single cell, facilitating free-text searches of the reports. The multiple lines are concatenated together into this lab results string column.
Hover over LABRESULTSTRING values
This hover text shows all the lines of text available for a report. Several userviews have been set up that look at the same baseview in different ways. They can show specific organisms causing infection, specific locations where infections occur, specific specimens that have been cultured (such as blood) and specific patterns of antibiotic susceptibility This view currently shows all microbiology results, but we can filter the lab results based on ones which contain a positive blood culture. We can also look at how many of these cultures are happening in different units of the hospital. I can perform stats on the location column and find out the fact that 5 East is the place where most of these cultures are coming
Right-Clicka LABRESULTSTRING cell (not column heading) Click Filter on Contents Change Operator dropdown to Contains Enter POSITIVE BLOOD CULTURE in the Values field Click OK - OK
Right-Click the Ward column-heading Click Stats Click Count twice to sort in descending order
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
from An Infection Control officer can use this information to try to understand why infections are more common on one ward vs. another. There may be issues with staff training in the use of barrier protections, hand washing or managing infected waste materials. When an Infection Control officer discovers an infection is occurring in a patient, they can flag the patient to be put on a specific infection control / isolation protocol This status indicator is displayed as part of the standard Amalga view to all clinical staff. From the isolation status view, the nurses look to see which patients are on isolation status. The Isolation Status is entered via an Amalga dialog. In the isolation indicator entry dialog you can say that this isolation status is being started because this patient has a particular organism that has been found. The isolation status column is also shown in the lab results baseview, enabling the Infection Control officer to know whether newly discovered infections require a change in a patient’s isolation status. (after steps are complete) – We can see a new entry has been added, with MRSA in the Contact restriction Using the cohort function, the standard clinical baseview can be filtered to show patients on any individual ward. Since the isolation status is part of the standard
Select a patient record Click Input Click Isolation Indicator Entry Click Manage SelectContact for the Isolation Indicator Select MRSA for the reason Check the Start and End Date boxes Click Apply & Close Click Save Close the window Open View Manager Select Isolation_View Update highlighted verbiage to match Amalga UIS instance verbiage
Cohorts are working now, but the code for the isolation ward is unknown, thus can’t be filtered on at the moment
© 2008 Microsoft Corporation. All rights reserved.
clinical baseview, it is easy to see which patients on the ward are on an isolation status.
Add click steps here
In this way, the isolation status column serves as a communications link between the infection control team and the nursing staff for understanding who is on what kind of isolation status. A separate Infection Control activity involves proper management of devices inserted into patients in order to keep these devices from causing infection. An Amalga dialog and baseview facilitate this effort The Device Tracker dialog allows documenting all devices inserted into patients, as well as the dressing changes that are done to the devices. It also displays any potential infections occurring in patients, allowing investigation of potential causality of devices to infections.
Open View Manager Select 01 - Visuals Select Kate Richarson Click Input ClickDevice Tracker Entry
© 2008 Microsoft Corporation. All rights reserved.
Usage: indicate the device that you are putting into a patient (IV, catheter, feeding tube, etc.), where it gets put in, technique used to put it in, when it was put in, where it was done, when the next dressing change is due on this line.
Click Manage
Fill in the following information: Device: NasoGastric Single Lumen Site: External Jugular Vein Side: Posterior Method: Exchanged Over Guidewire Date: [Yesterday] Note: Only enter Date Inserted, not date removed Fill in the remaining information with any relevant data
The Device Tracker also allows printing of a procedure report which is placed in the medical record to document device insertion.
Click Apply & Close Click Save
Select a Device Mention the possibility to Printhere.
Once they document the lines, they use this to print a form which goes on the chart for documenting the procedure. The print dialog lists the forms available for printing, and is basically a procedure report that has all the information already printed on it so the doctor can sign it and then it goes in the chart.
There are a couple other views here. You can double clickcurrent devices to edit these.
Double-click on a device in the grid to show that the device can be updated.
© 2008 Microsoft Corporation. All rights reserved.
Add images here
On the second tab you can see Non-Current Devices.
The third tab shows the history of all devices that have been placed in the patient. Those that have been removed are show in strikeout text.
There willbe a base view that will show all the devices that are in place in all patients. You can get a view across the hospital or on particular ward for which patients have which devices in or you can get a view of which users are putting a devices in if you want to see all the devices that a particular user has put in.
Click Cancel button to exit this screen without saving. Click the Complete Device History tab Close the Input dialog window
Insert click steps
The views also are able to show positive culture results in relations to devices. Adding in the device tracker information will show the positive cultures in a patient and doing some kind of time relation. There will also be a view that shows which devices are overdue for dressing changes
© 2008 Microsoft Corporation. All rights reserved.
Insert Images
There is a column for BC indicating a positive blood culture. If there was a positive BC noted after the line was placed a “Yes” would showup, so you can see whether there is some potential association between the line being in place and the patient having a positive blood culture.
Open View Manager Select Blood Culture by Room/Unit/SVC Click Input Click Device Tracker Entry Need data entered here for a specific pt to hightlightin demo
Infections that occur while the patient is in the hospital are a significant problem, and are often difficult to treat. They are more likely due to drug resistant organisms and are a significant source of added cost, morbidity and mortality. They are often preventable with proper management of indwelling devices. Since they can often be prevented, insurance payers such as Medicareare now declining to reimburse hospitals for the care of such hospital acquired infections. As such, hospitals have a strong incentive to prevent their occurrence, and tools like the Amalga Device Tracker and associated views are very valuable toward this end.
This concludes the Infection Control demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Amalga UIS Demo Scenario Amalga UIS – Meaningful Use Microsoft Corporation Published: Version History: 2/13/11 Created by S. Malme
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Meaningful Use
Amalga Value:
Amalga demonstrated as the primary platform for management and reporting of Meaningful Use attainment. Expanding on the value delivered by Amalga as your enterprise health intelligence platform, we demonstrate how you can use Amalga as the central data store, reporting and management solution to help you attain meaningful use; across disparate EMRs, distrubted facilities and providers who lead or lag on the Meaingful Use adoption curve. •
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
• •
How do you integrate and analyze data across your entire healthcare enterprise, including both acute and ambulatory EMRs, to ensure that your providers attain and maintain meaningful use? How do you manage, in real-time, the collection and reporting of meaningful use metrics? As you continue to expand your healthcare network, how do you ensure rapid and flexible reporting on EMR usage and meaningful use of HIT?
Organizations that are eligible to benefit from Meaningful Use incentives; and may also be penalized for lack of meaningful use compliance, are faced with the challenge of driving consistent adoption of EMRs and supporting HIT systems.
Demo Introduction / Story:
Role(s):
In this demonstration, we highlight the capabilities of Amalga to serve as the primary data source and analytics engine to support Meaningful Use attainment. Specifically, we will highlight • The process by which we capture detailed EMR usage data, across disparate EMRs, • The reporting and analysis capabilities delivered via Amalga and Sharepoint • The persistent use of Amalga as a reporting and management engine to ensure that your organization attains and maintains Meaningful Use of Health Information Technology
• • •
Healthcare Executives responsible for driving Meaningful Use Providers who are challenged with attaining and maintaining meaningful use of HIT External agencies who need / require reporting of MU data
Processes:
Real-time capture and analysis of MU calculated measures Manual entry and management of remaining MU criteria Reporting and analysis of MU attainment
HSG Customers who have implemented similar scenario:
None at this time
2
2
DEMO SETUP
2.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\ Password: HSGP@ssw0rd
3 Amalga Management of Meaningful Use Talking Points
We are pursuing modular certification for Stage One Meaningful Use criteria for Amalga and HealthVault Community Connect.
Click Steps
Screenshots
Show PPT slide from Amalga UIS – Meaningful Use
Building on our strategy of delivering an enterprise health intelligence platform, Microsoft continues to work with the ONC and our Customers to define and deliver Meaningful Value. We believe that this value is best realized by focusing our efforts on sharing data with patients and families, other providers and external reporting agencies. To support phase 1 of Meaningful Use, we will certify both Amalga and HealthVault Community Connect. Beyond basic certification, our Amalga customers may consider using Amalga as a platform for Meaningful Use reporting and management. In this demonstration, we will highlight how a customer may use Amalga to capture data from a crosssection of EMRs and provide a
3
consolidated view (both in summary and detail) to effectively attain “meaningful use”.
As a preview to this demonstration, we can see how Amalga, used in combination with a Sharepoint Meaningful Use dashboard, can be used to provide an executive, provider and meaningful use manager view. In the Meaningful Use Panel, we see a simple view of MU attainment at a facility level. To drill-down on this view and manage attainment at an individual physician level, we switch to our Physician Attainment chart. In the third view, we see how the underlying data for both of these charts can be directly accessed, viewed and managed using Amalga.
Show PPT slide from
To ensure that our healthcare enterprise attains and maintains Meaningful Use of Health Information Technology, we use Amalga and Sharepoint as an integrated MU management solution.
Access amalgademos (www.amalgademos.com)
Amalga UIS – Meaningful Use
Select Dashboard: Meaningful Use on the main Silverlight control panel Select the by Facility view
In this chart, you see an executive view of Meaningful Use attainment highlighting all MU Measures that can be automatically calculated. By simply integrating and analyzing the data from the EMRs deployed across your healthcare enterprise, we can see a near real-time view of your meaningful use attainment. This is true even when individual physicians may be using more than 1 EMR when switching between facilities.
4
To effectively manage Meaningful Use attainment, we really need to drill-down beyond a facility summary and identify specific HIT adoption hurdles.
Select Dashboard: Meaningful Use on the main Silverlight control panel Select the by Physician view
To attain meaningful use, we really need to drill-down into the behaviors and adoption of HIT at an individual physician level. To support adoption and attainment, we refer to this sharepoint chart built atop the detailed provider data that is collected in Amalga. In this particular view, we see the current status of physician Brent Amado. As you can see, Brent is doing a good job of maintaining a current problem list and using electronic lab results in his practice. In addition, Brent is making good progress on maintaining an active medications lists for all his patients. However, Brent also has some heavy lifting to attain meaningful use and we can see that there are a few criteria where he needs help from his supporting care delivery team. Specifically, we can see that Brent needs to capture and document additional data as part of his care delivery process; specifically smoking status, demographis and vitals. This same view, by physician, can be easily displayed by simply selecting a physician from the drop-down list. To analyze the performance of our health system against the meaningful use criteria, we have noticed some challenge in our providers using existing systems to manage active medications and active medication allergies.
Switch to Amalga. Select View Manager category MKT – Meaningful Use Select the User View MU Reporting
To analyze and manage this issue with supporting data to drive physician behavior, we look
5
to Amalga. In this view we see the detailed reporting of physician attainment, by measure, for more than 400 physicians (for our 2 selected measures). To effectively manage attainment of meaningful use, we will need to address adoption all the way down to an individual physician.
Apply filter on PhysicianName
Using this same view, we apply a filter to the PhysicianName field to select and view the meaningful use and tracking of medications and medication allergies for a single physician.
Removing this filter (for an individual physician) and adding a filter on attainment to identify all physicians who have already achieved >60% usage across all measures is yet another way to manage the adoption of HIT; in this case, on a group basis.
Remove filter on PhysicianName Apply Filter on Attainment % > 60%
Whether we choose to manage adoption on an individual physician basis or across a group of providers based on common usage patterns, Amalga and Sharepoint give us the fiexibility to choose our approach to MU attainment.
6
In this demonstration, we’ve touched on a number of SharePoint dashboards and Amalga views that may be used to (1) highlight the current performance of our organization against the requirements of meaningful use (2) identify, manage and report on MU compliance and (3) support adhoc analysis of our MU strategy and execution.
Select PPT: Amalga UIS – Meaningful Use
While Amalga and Sharepoint may only be one piece of your Meaningful Use platform, these solutions provide flexible and near real-time access to the HIT adoption data required to attain and maintain meaningful use.
7
~1~
Microsoft Amalga Demo System Q3 FY09 Medication Reconciliation Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the Med Recfeatures offered by Microsoft Amalga. Role:
Patient using HealthVault, Admitting Nurse
Personas:
[email protected],
Amalga user
Table of Contents 1 2 3 4 5 6 7 8 9
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 4 Start Demo Laptop and log in ............................................................................................. 4 2.1 Log into Microsoft Amalga .................................................................................................. 4 2.2 Log in to Microsoft HealthVault............................................................................................................... 6 Patient enters medication information into HealthVault ......................................................................... 7 Viewing medication information from the Amalga HealthVault module.................................................. 9 Medication Reconciliation at time of admission.................................................................................... 11 Discharge Instructions .......................................................................................................................... 13 Uploading Information to HealthVault ................................................................................................... 16 Viewing updated medication information in HealthVault ...................................................................... 16
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
~2~
Value, Scenario, Story, Roles, Processes
Amalga Value:
Primary Value of Amalga demonstrated via this scenario – Data collection, data sharing with Health Vault, Summarization of data, Communication across the enterprise
Demo Scenario:
Name of Demo Scenario – Medication Reconciliation
Questions to
Questions that you recommend to qualify your audience or clarify the issues that they want to see addressed in the demonstration
tailor demonstration to audience pain / requirements?
-- How are you currently performing medication reconciliation, and how well is the process working? -- Do you have difficulty getting a complete home medication list for patients? -- Do you have difficulty providing complete medication profiles to patients?
Demo Introduction / Story:
Your Introductory story - suggest that you include interesting industry facts or information the audience may find compelling or relevant - - Medication Reconciliation is a required process, one that is often difficult for healthcare organizations to perform well and efficiently. The demo shows how the combination of Amalga and HealthVault can be used to provide staff with a reliable and readily available list of the medications a patient takes at home, to use this information at the time of hospital discharge to reconcile inpatient medications with home medications, and to communicate back to patients information about the medications they should take after leaving the hospital
Role(s):
Which Healthcare roles / jobs are touched by this scenario? (CMO, Physician, CEO, etc.) - physicians, nurses, CMO, patients
© 2008 Microsoft Corporation. All rights reserved.
Processes:
~3~
Which common healthcare processes are included in the demonstration? -- documentation -- summarization -- communication with patients
HSG Customers who have implemented similar scenario:
Examples of HSG customers who have done something similar WHC
© 2008 Microsoft Corporation. All rights reserved.
~4~
Demo Setup
2
The actual demo starts at section 4. Talk about the following pre-demo sections and what happens in those sections. In section 3.1, we start the demo laptop and log in to start the demonstration. In section 3.2 we log into Amalga to start the demonstration.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in as iadmin
Press Ctrl-Alt-Delete
Screenshots
Select iadmin In the Password field, type pass@word1 Click
2.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
~5~
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3
~6~
Log in to Microsoft HealthVault Talking Points
The patient logs in to their personal Microsoft HealthVault account
Click Steps
Enter the following link into Internet Explorer: https://account.healthvaultppe.com Enter the following information: E-mail:
[email protected] Password: amalga@15
Dianna Navarra’s HealthVault account is displayed.
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
4
~7~
Patient enters medication information into HealthVault
Dianna Navarraneeds to add a new medication she is taking to her current HealthVault records
Navigate to the Medication screen Here, the user will see their current list of medications, as of the last time they interacted with Health Vault. This list is entirely patient-managed. Dianna wants to document a new medication that has been started by a private physician, someone who does not automatically send data to Health Vault It is possible for information about private prescriptions filled at commercial pharmacies to be automatically fed into Health Vault. The user would need to integrate this information with their Health Vault record. Dianna Navarraenters all the appropriate information regarding her prescription
Click the Health info tab
Click Medication Click +Add on the Medication grid
Enter the following information, note semicolons denote the next text box/drop down for the line: Name: Inderal, 40 mg oral tablet Strength: 1; tablet; 1 tablet Dosage: 40; milligram; 40 milligrams How often: 2; daily; 2 daily How taken: by mouth Remaining optional fields may be left blank Click Save
© 2008 Microsoft Corporation. All rights reserved.
The Medication grid is refreshed, showing the newly added Medication
© 2008 Microsoft Corporation. All rights reserved.
~8~
5
~9~
Viewing medication information from the Amalga HealthVault module
Medical personnel wish to view the medical information Dianna Navarra has entered via HealthVault This section requires that a collaborative link exist between the Amalga user and the HealthVault user. This has already been setup for this demonstration A HealthVault user has full control over what aspects of their information is available to the Amalga user
In Microsoft Amalga, open the Sample Hospital application. The 01 – Visuals view should be displayed. If not, open it using the View Manager. Select Dianna Navarrafrom the grid and click Info (image 1) Once the info window displays, click HealthVault(image 2)
© 2008 Microsoft Corporation. All rights reserved.
Dianna Navarra’s HealthVault information is displayed, however an update must be run to retrieve the most up-todate information
~ 10 ~
Click Update Patient… (image 1) Check Retrieve medication and allergy data from my HealthVault account(image 2) Click Update Patient (note, this may take a few seconds after the button click) Please note: if the new medication does not display, proceed to the next step.
Close the information windows and return to the 01 – Visuals view
Click the X at the top right of the information window to close the module and return to the 01 – Visuals view Please note: deleting the medication from HealthVault then performing the Update Patient Scenarios steps does not appear to remove the medication from Amalga
`
© 2008 Microsoft Corporation. All rights reserved.
6
~ 11 ~
Medication Reconciliation at time of admission
Open the Medication Reconciliation module in theinput dialog for Dianna Navarra
You can now view the list of meds that the patient was taking upon admission to the hospital.
This module is used by the Amalga user to document what they believe to be the set of medications the patient takes at home at the present time. In this module, they will have access to the patient's HealthVault medication list, a list of past medications that Amalga has been aware of that the patient has been taking at home, and some general list of medications from which the user may choose. The top panel shows the medications that the Amalga user has confirmed as being on active home medication for the patient at the time of the current visit. This list of confirmed medications is specific to each clinical visit. To add a new medication or the medication recently added on HealthVault, click the Add Newbutton located at the top
With Dianna Navarraselected in the 01-Visuals view, click the Input button (image 1) Click the Medication Reconciliation module from the list
The displayed default tab is Admit Med Profile
Click the Add New button in the top right corner
© 2008 Microsoft Corporation. All rights reserved.
~ 12 ~
right. Once the medication chooser dialog box is open you may select from a list of medications. Once a selection is chosen, the top portion of the dialog box displays the specific variations of the medication available (if there are variations). The selection is automatically populated on the Selected Items tab at the bottom of the screen. You then simply check the medication(s) to add and click Save& Close.
You must save the change.
Select Acne-Clear from the browser list. Select and check the 2nd selection (benzoyl peroxide topical gel 10%)
Check the benzoyl peroxide topical gel populated automatically in the Selected Items tab at the bottom of the screen Click Save& Close
Click Save at the bottom right of the screen to save the change Click OK on the Form Saved dialogue box
The added medication is populated alphabetically in the Home Medications list.
Once all the medications are updated, save and close the dialog, then close the info window to return to the 01 – Visuals view
Click the X at the top right of the info window to return to the 01 – Visualsview Note: the Print function is not yet working, thus that functionality could not be scripted
© 2008 Microsoft Corporation. All rights reserved.
7
Discharge Instructions
We will now switch to the time of hospital discharge. We need to determine which medications the patient will take at home after discharge, and reconcile this list with the patient's previous home medications and the current active inpatient medications. Reopen the Input window for Dianna Navarraand navigate to the Medication Reconciliation module. The admitting medications profile is displayed on the Admit Meds Tab in section 6 above. The Discharge Meds tab will provide information regarding any inpatient medications as well as previously prescribed medications There are several fieldswhich display meds. One of the fields will group the medications to be continued. Another will display medications to stop. Another just shows medications to be started after discharge. The user may want to first select the medications for the patient to continue taking after discharge. If a particular med is an active inpatient med as well as a prior home med, the version the patient is to continue at home should be selected and added to the Medications to be Continued list. The fields available will show the current active inpatient medications, along with the previously documented home medications.
~ 13 ~
Select Dianna Navarrafrom the 01 – Visuals view Click Input Click Medication Reconciliation
Click the Discharge Meds tab
Click Add Newunder Medications to be Continued
The Chooser dialog box will display Select (check): 1.esomoprazole delayed release capsule 20 mg 2.propranolol (Inderal) 3.Calcium carbonatesimethicone tablet (Gas-X)
© 2008 Microsoft Corporation. All rights reserved.
The 3 meds will populate under
Selected Items in the lower field on the screen
The meds just added populate in the Medications to be Continued section and must be saved to remain effective.
The user now interacts with the middle field to document which prior home meds should be stopped (i.e. not resumed when the patient goes home).
A list of medications not yet allocated is presented.
~ 14 ~
Click Select All checkbox Click Save& Close
Click OK when the confirmation dialog box appears
Click the Add Newbutton on the right side in the Medications to be Stopped section
Select (check)all: amoxicillin capsule, esomeprazole, ranitidine, sodium chloride Click Select All Click Save& Close Click OK
The medications are added to the list to stop the patient from taking them Now the user interacts with the bottom grid to document the new medications that should be started at home after discharge.
© 2008 Microsoft Corporation. All rights reserved.
~ 15 ~
The user would thenchoose which medication(s) the patient should take after discharge.
Click Add New under the heading Medications to be Started After Discharge
The user may want to browse by drug name or search. We will browse by drug name.
Browse by Drug Nameon Medications tab/left column Selectaspirin Select (check) the following in Prescriptions field (upper right): Aspirin tablet buffered 500 mg, orally every 6 hours Select (check) under selected items in lower field Click Save& Closeto exit out of the medications after discharge dialogue box Click OK Click Save to save all changes to meds, and OK to acknowledge saved changes
All the medication information is presented and ready to be printed. The print function allows for multiple options for printing, including only new prescriptions, all prescriptions, any changes in physicians, and more.
Note: The print function is not working, so this feature could not be scripted for this demo
Click the X to return to the 01 – Visuals view
© 2008 Microsoft Corporation. All rights reserved.
8
~ 16 ~
Uploading Information to HealthVault
The information updated in Amalga can be uploaded so it may be viewed in HealthVault. In order to do this, a Discharge Summary must be sent via the HealthVault module in the Info panel Note the “Send a discharge summary to my HelathVault account” with the time and date sent (Under connected to Microsoft HealthVault at the top)
Select Dianna Navarrain the 01 – Visuals views Click Info Click HealthVault Click Update Patient…
Select (check) “Send a discharge summary to my HealthVault account” Click Update Patient Move curser over “Send a
discharge summary to my HealthVault account” text to show confirmation
9
Viewing updated medication information in HealthVault
Dianna Navarra may now log in to HealthVault and view her medication information that has recently been updated by her physician
If you are not logged in as Dianna Navarra, visit:
https://account.healthvaultppe.com Email: [email protected] Password: amalga@15
First, Dianna must accept the changes sent by HealthVault
Click Health Information Click Continuity of Care Record (CCR)
A Continuity of Care Record has been sent to her HealthVault account. Here, she can determine what parts of that record she wants to integrate into her account.
Click the Add Items link on the most recent CCR record at the top of the list Click Choose items to add
© 2008 Microsoft Corporation. All rights reserved.
~ 17 ~
Here, Dianna can choose what medications she wants reflected in her HealthVault account. In this case, she wants to see all the medications her doctor has prescribed for her, so we’re going to add them all.
Verify the CCR contains the
Having added the new medications, Dianna returns to her medication information within HealthVault to see they have been added.
Click Health information
medications altered earlier in the script
Click Save to Record
Click Medication
The medication information appears in HealthVault showing the recently added medications
The demo is now complete, but it must be set up to run again in the future
While still logged in as Dianna
(NOTE: list needs to be updated since meds have changed)
Navarra, delete all medications from her list with the exception of Zantac and Lipitor Switch back to Amalga, select Dianna Navarra, and click Info Click the HealthVault module and delete any medications, leaving any references to Zantac or Lipitor Close the Info dialog and enter the Input dialog. Click the Admit Med Profile dialog. Removed all drugs from all sections with the exception of Zantac and Lipitor Sign out of Amalga and HealthVault Please note: deleting the medication from HealthVault then performing the Update
© 2008 Microsoft Corporation. All rights reserved.
~ 18 ~
Patient Scenarios steps does not appear to remove the medication from Amalga
This concludes the Medical Reconciliationdemonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q1 FY09 New Unit Microsoft Corporation Published: February 2009
Summary This demo script will walk you through the New Unit features offered by Amalga. It is designed to provide information on opening and supporting a new hospital unit. Role:
Personas:
Table of Contents 1 2 3 4
Value, scenario, story, roles, processes ................................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log into Microsoft Amalga .................................................................................................. 3 2.2 Introduction ............................................................................................................................................. 5 Creating a New Unit ............................................................................................................................... 7
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected]
© 2008 Microsoft Corporation. All rights reserved.
1 Value, scenario, story, roles, processes Amalga Value:
Demo Scenario:
This demo presents views designed to provide information on determining whether the patients, staff, and facilities exist to support the creation of a new hospital unit. Using cardiovascular disease as an example, this presentation shows how you can determine how many current and recent patients are admitted with cardiovascular issues and what kind of staff would be necessary to support a unit. Finally we determine if the financial backing exists to support the unit. The ability to determine this information can prove to be invaluable in ensuring all the proper support is in place to facilitate a new hospital unit. It assists in adaptability as well as controlling expenses.
Questions to tailor demonstration to audience long-term enterprise goals:
1.
Demo Introduction / Story:
Role(s):
Processes:
HSG Customers who have implemented similar scenario:
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup 2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Log in using provided demo machine credentials.
Screenshots
Click
2.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Introduction Talking Points Our hospital is overcrowded.
There are patients in the Emergency Room waiting to get into the hospital, and other outpatients waiting for admission. How can we identify the patients who are likely candidates for discharge? In the left column we can see the patient’s length of stay in days.
We can click the filter button
and set the filter to find all the patients who have been in the hospital more than 30 days. Certainly some of these would be good potential candidates for discharge to a long-term skilled nursing facility. [Filter to get patients in hospital more than 30 days].
Click Steps
If not already on 02:Clinical View (inhouse), then open the View Manager Type 02 in the Search box Select 02 – Clinical View (inhouse) under MKTData Aggregation – EDW Click Apply Click Filter Select LOS Click Add Filter Select Greater than or equal to from the Operator Drop down Enter 30 into the value Click OK to add the filter Click OK to apply the filter to the view
We can sort by length of stay
by clicking on the column heading, and reverse sort by clicking again. The patient with the longest stay has been here for 8 months (244 days)! By right-clicking on the LOS column and selecting “Stats” we can instantly see the mean and median length of stay.
By right-clicking on the LOS column and selecting “Stats” we can instantly see the mean and median length of stay.
If not already, click the LOS column heading twice to sort in descending order
Right-click the LOS column heading SelectStats Click Close when finished with this explanation
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
There are a lot of patients waiting for ICU beds. Using the cohort button, we’re able to select all of the ICU patients. In this example, the ICU units begin with the code ‘4’ (fourth floor). We’ll select all the ones beginning with 4 which will show us all ICU patients who have been in the hospital for more than 30 days. [Look at the count and say] There are [x] patients who have been in the ICU for more than 30 days. Perhaps some of these patients can be moved to a step down unit to make room for the sick patients in the ER. I can even compare this to prior
time periods. By selecting the datascope button [select February 1 2006 – February 28 2006 under range of dates] I can see a snapshot of the number of ICU patients in that month with a length of stay greater than 30 days (compare the number in the upper right corner to the one we just saw – note more or less or about the same).
Of course, we can’t just move
the patient without knowing the details of their clinical situation. Using Amalga we can look at all the information about any patient to make a real determination about the appropriateness of a possible location move. [Now do clinical intro]
Click the Cohorts button: Multi-select all Units that begin with 4from the Unit list (Click 40, then scroll down to 4NW, hold the shift key and click 4NW). Note: A glitch may add several unwanted entries, scroll back through the Selected list and ensure only those beginning with 4 have been added Click Apply
Click the Data Scope drop down (the arrow that pops up when you hover over the date range at the top left) Select Range of dates… Enter February 01, 2006andFebruary28, 2006 into the date range Click OK Using the 01 – Visuals view, run portions of the Clinical Introscript showing a patient who has had an angiogram
© 2008 Microsoft Corporation. All rights reserved.
The patient we looked at had
cardiovascular disease.
Perhaps we can improve
hospital throughput by opening a dedicated short-stay cardiovascular unit. Let’s look at all patients with cardiovascular disease.
4 Creating a New Unit Here is a view of all patients with cardiovascular complaints. We treat about 355 cardiovascular patients in a one week period. In this view we took the freetext complaint -- whatever the registration clerk happened to type in – and mapped it to a standardized term.
Open View Manager Type 04 in the Search box Select 04 - UMLS Mapped CV Complaints Click Apply
Our parsers call a third party natural language processing tool todo the mapping. For example,‘CVD’ was converted to ‘cardiovascular disorders. The question is then asked, do we have enough patient support to open a short-stay cardiovascular unit? This view limits us to only those records containing the term “cardiovascular” in the parent category. We want to know if we can support a short-stay cardiovascular unit, so we apply a filter that limits this view to only patients who were in the hospital for less than 3 days. Checking the total at the top right, we see we can support a short-stay cardiovascular unit with the given patient volumes
Click Filter Select LOS Click Add Filter Change the Operator to LESS THAN Change the value to 3 Click OK
© 2008 Microsoft Corporation. All rights reserved.
Click OK
Who am I going to staff the short stay unit with? What kind of doctors do I need and in what ratio?
When I right-click Stats on the Hospital Service column, I see that over 1/3 of the patients are treated by cardiologists, about 13%by internists and 9% by thoracic surgeons. Now we know how the shortstay unit needs to be staffed. The next question I might have is; what is the payer mix that I can expect? By right-clicking Stats on the insurance column I can see the payer mix that I’m going to get in my cardiovascular unit. This helps me determine the financial viability of the unit. Taking it a step further, I want to know what kind of charges this unit will generate. Let’s grab this list of short-stay cardiovascular patients (rightclick on the Account field and select “Copy Distinct Values”). Going into the Amalga Financials application, we will use this list of accounts so we can use the same set of shortstay cardiovascular patients
Right-click on the column heading for Svc Select Stats
Click Counttwice to sort in descending order Click Close to return to the grid after done with this display
Right-click the Insurance column heading Select Stats Click Count twice to sort in descending order Click Close to return to the grid after finished with this display Right-click the Account column heading (scroll to right) Select Copy Distinct Values to Clipboard Click Apps in the top-right corner of the Amalga console Select Amalga Financials
© 2008 Microsoft Corporation. All rights reserved.
This view shows every charge for every patient during the week of February 5th.
Open the View Manager Select 001:One row per charge w/DRG Click Apply
We can now paste in the account numbers that we want to filter on – the ones representing the short-stay cardiovascular patients.
Click Filter Select Account Click Add Filter Select Contains text for the Operator Right-click in the Values section and select Paste Click OK to add the filter Click OK to apply the filter
I can right-click on the Charge Amount column to determine the total and average charges this unit might generate in a 1 week time period.
I can also determine what I need to stock this unit. In that short amount of time we can gather a large amount of information about a potential new unit
Right-click the Charge Amount Select Stats Click Close once done talking about this part Right-click the Charge Description column heading Select Stats Click Count twice to sort in descending order Click Close once done with this window
© 2008 Microsoft Corporation. All rights reserved.
If we find the new cardiovascular unit viable, we might see if we can support a new gastrointestinal unit as well.
Return to the Sample Hospital application, which should return you to the 04 UMLS Mapped CV Complaintsview Click Filter Select the"1> Hierarchies_Index Contains text ‘cardiovascular’" filter and click Edit Filter Replace ‘cardiovascular’ with gastrointestinal Click OK to add the filter Click OK to apply the filter
It is easy to do an analysis on any kind of unit we would want to open. And we can even see how the staffing will need to vary based on seasonal patterns. Here is a graph of the monthly count of short stay GI patients during 2005. We can see there was a particular spike in activity around September and that demand slowly increases into December.
Click Dashboard
Select Short Stay GI Patients dashboard
If the dashboard does not exist in the “My Private Dashboards” area (top-half of screen), then click Clone
Select the newly created Short Stay GI Patients dashboard from the “My Private Dashboards” area
Click GI Patients By Day Chart
© 2008 Microsoft Corporation. All rights reserved.
Click Edit Chart
Click Close
Click the x in the upperright hand corner of the Dashboard window to close
Click Log Out at the top right corner of Amalga
This concludes the New Unitdemonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
© 2008 Microsoft Corporation. All rights reserved.
Amalga UIS Demo Scenario Amalga UIS – Organization Hierarchy driven Data Management Microsoft Corporation Published: Version History: 2/18/11 Created by M. Bortnick
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Organization Hierarchy driven Data Management Security is paramount in the healthcare setting especially when bringing together data across the entire organization. Amalga is built on a strong foundation that supports robust Authentication (who should access), Authorization (what each person should access), and Auditing (record what that person is doing).
Amalga Value:
In this scenario, we will demonstrate how Amalga controls use r access to data. Amalga restricts user access based on the IT and Compliance policies that have been configured on the system. The underlying data sources are the same in many cases, but the user’s righ to view the data vary across the example accounts.
•
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
Demo Introduction / Story:
•
Does your organization have MS Access databases in use? How prominent? What type of security control is in place? What’s the incremental cost to sharing new data to existing roles and groups?
In this scenario, we highlight the following: (1) Amalga Security. All user access to data flows through the application servers where data policies are enforced. (2) Advanced View Editor – The Data Catalog is defined by the organization to show data in a user meaningful way – geographical, organizational, functional (patient, meds, labs, etc…) (3) Grid customization. The background colors have been changed across the user accounts to reinforce the difference in views.
2
Role(s):
All End Users
Processes:
All
HSG Customers who have implemented similar scenario:
All
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\user1 Password: HSGP@ssw0rd
2 Organization Hierarchy Driven Data Management Talking Points
Amalga brings together data from systems that would otherwise be isolated. This data is correlated together, such as by the patient entity across systems that don’t share an Master Patient Index (MPI). While users can have access to all the data, organizations typically want to limit access based on user roles.
Click Steps
Screenshots
PPT: Amalga UIS Organization Hierarchy driven Data Management
In this demonstration, we will show how Amalga UIS is used as part of an IT architecture to control access to the data assets you have aggregated.
3
We have configured multiple user accounts across three facilities – 1, 2 and 3. These highlight the various combinations of access that an organization may want to assign. Let’s take a look.
The demo has been configured to change the grid colors to further emphasize the different user views.
PPT: Amalga UIS Organization Hierarchy driven Data Management
Before I get into the demo I want to emphasize what is going on from a security and policy perspective.
PPT: Amalga UIS Organization Hierarchy driven Data Management
All access to the data assets in Amalga go through the Application Server layer. Authentication, Authorization (Policies), and Auditing all occur at this layer. The rows and columns of data that a user views are all controlled and recorded here. For example, User1 would see Facility #1 data but would not see Facility #2 or #3 data. Let’s get to the demo. I’m logged in as User1. You can see in the first colum that only Facility #1 (HHH1) is shown for this user. User1 only has access to data for this facility. To further emphasize this, let’s look at what the user sees when they build a new view. Users do this by using our View Manager. The Data Catalog allows users to see data organized in a way that is meaningful to them. This may be by organization structure,
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\user1 Password: HSGP@ssw0rd Open View Manager Select the Advanced View button. Expand out the “Midwest Market” tree node.
4
geography, or functional entities such as patient, labs, meds, etc… IT sets this structure up with business users in order for users to make finding data intuitive. They configure the structure, metadata, and correlations between data so that the user is not burdened with this complexity. The end result is a shopping cartlike experience to your organization’s data. Repeat the scenarios for the other users. Highlight the different facility numbers that are show in the grid and that are show in the Data Catalog.
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\[user2, user12, user_All] Password: HSGP@ssw0rd Open View Manager Select the Advanced View button. Expand out the “Midwest Market” tree node.
5
Amalga UIS Demo Scenario Amalga UIS – Radiologist Workspace – Providing Clinical Context Microsoft Corporation Published: Version History: 2/14/11 Created by O. Chen
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Demo Scenario:
Amalga UIS – Radiologist Workspace – Providing Clinical Context
Amalga Value:
For a variety of reasons, radiologists have historically operated within a separate information domain from non-radiologist clinicians. The value of clinical context to radiologists is becoming increasingly apparent. National organizations and industry experts have begun promotion and implementation of this informational integration and have been proposing its inclusion in Federal Meaninful Use guidelines. In this demonstration scenario, we will demonstrate how a radiology practice can provide in depth and relevant clinical information to a radiologist to provide pre-interpretation context, enhance diagnostic accuracy, and improve workflow throughput.
Questions to tailor demonstration to audience pain/requirements and long-term enterprise goals?
Demo Introduction / Story:
• • •
How can you increase the quality and quantity of radiology reporting? How can you enhance both radiologist and referring physician satisfaction while improving the quality of patient care? What is your enterprise doing to mitigate the increasing financial and workflow pressure on radiology practices and imaging usage.
In this scenario, we demonstrate rapid automatic presentation of clinical data in concert with navigation on a third party PACS system. Given the importance of clinical context to radiological interpretation, we will focus our scenario on the key processes. 1. Automatic context passing and launching of the Amalga component 2. Overview, navigation and in depth review of clinical data 3. Discussion of thought processes and analysis leading to potential changes in management 4. Workflow enhancements and improved accuracy and value to referring clinicians
2
Role(s):
Diagnostic Radiologist
Processes:
Context passing from third party PACS software Automatic loading of Radiologist Workspace module for patient being viewed in PACS Review of patient clinical data in multiple widgets Launching of dedicated viewers for some data types Workflow enhancement and integration with interpretation and dictation
HSG Customers who have implemented similar scenario:
Pending
DEMO SETUP
1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
SelectAmalgaWeb under the “Demonstrations” menu selection Login to Amalga Web Userid: demo\ Password: HSGP@ssw0rd
Login to PACS
Login to PACS Application Userid: (from PACS vendor) Password: (from PACS vendor)
2 Radiologist Workspace – Providing Clinical Context Talking Points
Click Steps
Screenshots
3
For various technical and organizational reasons, radiologists and their data have developed a parallel environment. Image data is more amenable to digitalization than general clinical data. Radiology departments operate as largely distinct organizations within the greater health care enterprise. This led to earlier adoption of information and organizational management software by radiology departments. As the rest of health IT adoption caught up, the proprietary systems and barriers to integration were already in place and thus forth have been daunting enough to prevent large scale systems integration.
PPT: Amalga UIS – Radiologist Workspace – Providing Clinical Context
As a result, communications and data access across this divide are more difficult and time consuming than they need to be. Different systems with distinct sign-on and navigation procedures create needless time and effort sinks during a busy work day. Lack of communications integration hinders fluid transfer of information. Thus, many radiologists work in a relative information vacuum, preferring lack of full information to the time and effort cost required to address it. In this demonstration, we will show how Amalga UIS in concert with third party PACS software can transcend many of these barriers and allow radiologists and their referrers the benefit of clinical data access and integration.
4
With the advent and rapid proliferation of increasingly complex imaging studies, radiologists have become increasingly dependent on nonradiological clinical data for interpretation. These data are not merely supporting evidence, but are critically necessary for proper image interpretation.
PPT: Amalga UIS – Radiologist Workspace – Providing Clinical Context
Although perhaps somewhat of a misallocation of resources, clinical context gathering has sufficient importance to have been delegated to post-graduate radiology fellows. Two prominent examples of these types of complex studies are Cardiac CT/MR and Body MR. For cross sectional cardiac studies, cardiology data such as echocardiograms, EKG, cardiac catheterization images and reports and consultation notes from cardiologists are critical to interpretation. For Body MR, clinical context is also vital. GI consult notes, pathology and endoscopy reports and images are all often necessary for proper interpretation. A second example of the potential import of clinical context is its ability to improve diagnostic accuracy. Although generally, image data is sufficient to generate a complete impression, additional clinical information can often refine differential diagnoses and prompt valuable pertinent positives and negatives.
PPT: Amalga UIS – Radiologist Workspace – Providing Clinical Context
For example, a patient presents with imaging findings of a small bowel obstruction. Without further clinical information, the differential diagnosis can be quite large. However with access to clinical data, more directed impressions can be made. This greatly
5
increases the value of radiology reports to the referring clinicians. Furthermore, with a narrower differential, more relevant supporting or consequential findings can be reported, further augmenting patient management. Radiologists are under increasing pressure to work quickly and efficientlywhile maintaining their accuracy and commitment to patient care. In a typical day, a radiologist may encounter several roadblocks to their progress. These include incomplete or contradictory reasons for studies, ambiguous findings, foreign bodies or surgical changes, questions of whether findings are known by the referring provider and seeking to avoid easily contradicted statements on reports. With access to progress reports and operative notes, and other types of clinical data, many of these potential roadblocks can be quickly resolved, obviating the need for time consuming phone calls or imprecise statements in dictations.
PPT: Amalga UIS – Radiologist Workspace – Providing Clinical Context
The radiology industry literature has identified the comoditization of radiology image presentation and storage. To differentiate and provide value and support to radiologists, systems must focus on workflow. Radiologists can drive their workflow using PACS. A worklist of studies needing to be read is generated, potentially filtered by modality, facility or specialty. When a patient is selected, the PACS system can automatically launch the Radiologist Workspace in Amalga for that patient. The radiologist can continue to review images and
Third party PACS system
Open patient’s images, automatically launching Radiologist Workspace for that patient in Amalga UIS
6
generate a report and only needs to refer to the Radiologist Workspace if necessary.
Multiple modules are automatically loaded and arranged. These include: Active Problems, Active Medications, Laboratory, Reports (Radiology, Pathology and Clinical Notes), and ECGs. These contain up to date information from the Amalga database drawn from multiple sources.
Amalga UIS – Radiologist Workspace
We can quickly review the information presented in the multiple modules to get a quick overview of the patient’s condition. Furthermore, we can scroll within any of these modules to get more information about that data type.
Amalga UIS – Radiologist Workspace
Scroll down in Problem List to see more data.
To see prior reports, we can select Radiology, Pathology or Clinical Notes to review. Once selected, a preview of the text is displayed in the panel below.
To drill down to get more information about a data type, we can click on the title and launch a dedicated viewer. For example, medications or laboratory both have more in depth dedicated viewers.
Amalga UIS – Radiologist Workspace
Select Clinical Notes and select a note to preview.
Amalga UIS – Radiologist Workspace
Click “Medications” or “Laboratories” to launch dedicated viewer (will close Radiologist Workspace). Relaunch Radiologist Workspace from the list on the left side.
7
Armed with this additional information, the radiologist can return to the images and dictation and further refine and adjust his/her impressions and report.
Third party PACS system
Open next patient to launch Radiologist Workspace for that patient
A next patient can be selected to show the generalizability of the process. Using the Radiologist Workspace we have improved radiologist workflow via automatic: Pre-interpretation information gathering Aggregation and clear presentation of potentially relevant clinical data Quick access to clinical data to resolve potential workflow roadblocks The radiology industry literature has identified incorporating clinical context as critical to radiology value and survival.
PPT: Amalga UIS – Radiologist Workspace – Providing Clinical Context
8
Microsoft Amalga Demo System Turn-Around Analysis Microsoft Corporation Published: February 2009
Summary This demo is designed to show how Amalga may be used to provide better feedback on the time taken to perform various procedures and tests in a hospital. The turn-around time, calculated by subtracting the procedure order time from the procedure time can provide an idea of how long it took for each procedure to be completed. Role:
Personas:
Table of Contents 2 3
Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log in to Microsoft Amalga ................................................................................................. 3 2.2 Turn-Around Analysis ............................................................................. Error! Bookmark not defined.
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Demo Overview Amalga value:
This demo highlights the value of immediate and flexible access to health data to help understand inefficiencies in hospital processes or break-downs in quality of care. Armed with this information, our Amalga customers are equipped to optimize clinical processes, improve patient care and drive improved clinical / financial performance.
Demo scenario:
Amalga UIS - Turn Around Analysis
Questions to tailor demonstration to audience long-term enterprise goals:
1. What systems do you use to help you understand process failures
Demo Introduction / story:
Improving quality of care and optimizing use of hospital resource is a continuous challenge in any healthcare system. In this demonstration, we demonstrate the value of Amalga in supporting the critical decisions required to deliver best practice medical care, supported by appropriate education for our clinical staff and inventory of drugs and medical devices. In this specific example, we will analyze and identify potential process improvements that can be made to further improve upon the care received by our cardiac patients. As a result of this analysis, we will discuss potential changes that could be implemented to improve our cardiac care.
Role(s):
Physicians / Clinicians Healthcare Executives
Processes:
Clinical / Business Process Turn-Around Time Cardiac Care for Heart Attack Patients Staffing and Inventory Management Processes Clinical Education
HSG customers with similar scenario:
St. Joseph’s - using Amalga to support their “Perfect Care” initiative with a focus on delivering optimal care for every patient and consistency in every process
and improvements that can be made in your hospital?
2. How do you measure the time required to complete a particular test
or medical procedure to help ensure both consistency and quality of care? As an example, what improvements could you make in the turn-around of troponin tests for your patients with heart attacks? 3. How do you measure your delivery of best practice medical care?
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup 2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo laptop if necessary using provided login credentials
Enter laptop credentials
Screenshots
Click
2.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Troponin Lab Test Turn Around Analysis Talking Points
Click Steps
This view shows one row per Troponin test. Troponin is a test for heart attacks. When the Troponin level is high, the patient is having a heart attack In this view, we’re only looking at Stat tests, meaning urgent tests. What is our average and median turn-around time? Here we can see the patient’s name, the test type, the description, when the test was ordered and completed, the results, whether there are any abnormal results, and other important information
Click the User View manager
So what is our average turnaround time for a stat emergent Troponin heart attack test on this particular day? We can right-click on the turnaround time column and select stats We can see that on average, we turn around the tests in about 2 ½ hours with a median of about 2 hours. We can also see a maximum of 416 minutes. We can see that unfortunately there are times when it takes longer than two hours to get a heart attack test result back
Select One Row Per Troponin Test user view from the list of available user views Click Apply
Right-click the TimeMins column Select Stats
Click Close once finished with this screen Please note: the time stats displayed for your data may differ from the script.
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
What is the clinical impact of those times we take too long to turn around a test and later find out the patient is having a heart attack? Using a filter, we can locate all the tests that are abnormally high and all the turn-around times are greater than 180 minutes.
Click Filter Add a filter for ABNORMALFLAGS where it BEGINS with H Add a second filter on TURNAROUNDTIMEMIN where it is GREATER THAN 180 Click OK twice to apply the new filters
This shows us four patients who had an abnormally high Troponin test that took longer than 3 hours to turn around. That’s just for a single day. How often does that happen in a month? Now we can see all 134 patients during the month of January who took too long to return a heart attack test. Looking at the stats on the time and see what our average was for the month on stat tests that took longer than 3 hours We can see opportunities where we could turn-around faster and that it would make a clinical impact to do so
Click the Date Scope button Select Range of Dates Enter 1/1/2006 and 1/31/2006 Click OK Right click on TimeMins Select Stats Click close when finished with the screen
© 2008 Microsoft Corporation. All rights reserved.
We can check to see if there’s a correlation between who collected the specimen and how long it took to return. We can look up stats on any of these factors to identify were problems are and create solutions for that.
Right-click on the CollectedBy column Select Stats Click twice on Count to sort in descending order Click close when finished with the screen
4 ClotBuster Medication Turn-Around Analysis
We are also very interested in the turn-around time for ClotBusters. If they have a clot in their heart, we want to bust it up as quickly as possible. In this view, we see all the patients in January given a ClotBuster drug. We can see their name, the dose, priority, when it was requested and given, and how long that turn-around was.
Open the View Manager
Apply the 17: One Row Per STAT ClotBuster user view
Let’s filter to show only the Stat priority patients. Here we see 108 ClotBuster administrations.
Click Filter
Add a filter on PRIORITY that BEGINS WITH S
Click OK to apply the filter
Right-click on TurnaroundMins
Click Stats
Click Close when finished with this dialog
Looking at the stats on the Turn Around Minutes column, we can see that our median time is 0.00. 88.9% of the time, we see we have a 0 minute turn-around time in giving ClotBuster drugs when we need to. We can see we’ve got some room to improve on
© 2008 Microsoft Corporation. All rights reserved.
diagnosing the heart attack by turning around the Troponin test more quickly, but we’re doing a great job in providing Stat ClotBuster drugs immediately.
Do we do a better job on any particular day of the week than another? Using a larger date scope of two years, we can get stats on a large set of data.
Click the Date Scope button
Enter a date range of 1/1/2004 to 12/31/2005
Click OK
We might hypothesize that things go more slowly on weekends, as opposed to weekdays. Using the Day of the Week column, we can look at the stats dropdown. We can see that Tuesday is our busiest day for ClotBuster drugs, and the least busiest day is Sunday. This shows us that we GIVE fewer ClotBuster drugs to patients on weekends.
Right-click on Day
Select Stats
Click the % column twice to sort in descending order
Click Filter
Add a filter on TurnaroundTimeMins for GREATER THAN 15
Click OK to apply the filter
Now, do we administer ClotBusters any slower on Saturday and Sunday? Adding another filter, we look at all the records where it took more than 15 minutes to be given the ClotBusters. ClotBusters should never take more than 15 minutes to be administered
© 2008 Microsoft Corporation. All rights reserved.
This view now shows us the 211 records where it took longer than 15 minutes to administer ClotBusters. Checking the stats on the Day column again, we can see what days are our best and worst
Right-click the Day column
Select Stats
Click the % column twice to sort in descending order
Click Close when finished with this screen
Looking at the stats, we see that Sunday is actually our BEST day in which we have the fewest cases of slow turnaround. Monday and the rest of the weekdays appear to be where our problem lies.
In this demonstration, we have shown how we can use the integrated view of data available in Amalga
to help inform and change the clinical and business processes across the hospital. As a result of the information that we’ve gathered, we can drive incremental improvements in the quality of care available for our cardiac patients by o driving targeted improvements in the education of our clinical staff, o improving on the availability of drugs and medical devices to deliver timely patient care
We can also communicate and congratulate our staff on the delivery of quality cardiac care and provide specific insight into the consistency of care delivered by leveraging the information made available in Amalga.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Turn-Around Analysis Microsoft Corporation Published: February 2009
Summary This demo is designed to show how Amalga may be used to provide better feedback on the time taken to perform various procedures and tests in a hospital. The turn-around time, calculated by subtracting the procedure order time from the procedure time can provide an idea of how long it took for each procedure to be completed. Role:
Personas:
Table of Contents 2 3
Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log in to Microsoft Amalga ................................................................................................. 3 2.2 Turn-Around Analysis ............................................................................. Error! Bookmark not defined.
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Demo Overview Amalga value:
This demo highlights the value of immediate and flexible access to health data to help understand inefficiencies in hospital processes or break-downs in quality of care. Armed with this information, our Amalga customers are equipped to optimize clinical processes, improve patient care and drive improved clinical / financial performance.
Demo scenario:
Amalga UIS - Turn Around Analysis
Questions to tailor demonstration to audience long-term enterprise goals:
1. What systems do you use to help you understand process failures
Demo Introduction / story:
Improving quality of care and optimizing use of hospital resource is a continuous challenge in any healthcare system. In this demonstration, we demonstrate the value of Amalga in supporting the critical decisions required to deliver best practice medical care, supported by appropriate education for our clinical staff and inventory of drugs and medical devices. In this specific example, we will analyze and identify potential process improvements that can be made to further improve upon the care received by our cardiac patients. As a result of this analysis, we will discuss potential changes that could be implemented to improve our cardiac care.
Role(s):
Physicians / Clinicians Healthcare Executives
Processes:
Clinical / Business Process Turn-Around Time Cardiac Care for Heart Attack Patients Staffing and Inventory Management Processes Clinical Education
HSG customers with similar scenario:
St. Joseph’s - using Amalga to support their “Perfect Care” initiative with a focus on delivering optimal care for every patient and consistency in every process
and improvements that can be made in your hospital?
2. How do you measure the time required to complete a particular test
or medical procedure to help ensure both consistency and quality of care? As an example, what improvements could you make in the turn-around of troponin tests for your patients with heart attacks? 3. How do you measure your delivery of best practice medical care?
© 2008 Microsoft Corporation. All rights reserved.
2 Demo Setup 2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo laptop if necessary using provided login credentials
Enter laptop credentials
Screenshots
Click
2.2 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
Open Amalga Console from the site.
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
© 2008 Microsoft Corporation. All rights reserved.
Screen Shots
Connect to the Remote App
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2008 Microsoft Corporation. All rights reserved.
3 Troponin Lab Test Turn Around Analysis Talking Points
Click Steps
This view shows one row per Troponin test. Troponin is a test for heart attacks. When the Troponin level is high, the patient is having a heart attack In this view, we’re only looking at Stat tests, meaning urgent tests. What is our average and median turn-around time? Here we can see the patient’s name, the test type, the description, when the test was ordered and completed, the results, whether there are any abnormal results, and other important information
Click the User View manager
So what is our average turnaround time for a stat emergent Troponin heart attack test on this particular day? We can right-click on the turnaround time column and select stats We can see that on average, we turn around the tests in about 2 ½ hours with a median of about 2 hours. We can also see a maximum of 416 minutes. We can see that unfortunately there are times when it takes longer than two hours to get a heart attack test result back
Select One Row Per Troponin Test user view from the list of available user views Click Apply
Right-click the TimeMins column Select Stats
Click Close once finished with this screen Please note: the time stats displayed for your data may differ from the script.
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
What is the clinical impact of those times we take too long to turn around a test and later find out the patient is having a heart attack? Using a filter, we can locate all the tests that are abnormally high and all the turn-around times are greater than 180 minutes.
Click Filter Add a filter for ABNORMALFLAGS where it BEGINS with H Add a second filter on TURNAROUNDTIMEMIN where it is GREATER THAN 180 Click OK twice to apply the new filters
This shows us four patients who had an abnormally high Troponin test that took longer than 3 hours to turn around. That’s just for a single day. How often does that happen in a month? Now we can see all 134 patients during the month of January who took too long to return a heart attack test. Looking at the stats on the time and see what our average was for the month on stat tests that took longer than 3 hours We can see opportunities where we could turn-around faster and that it would make a clinical impact to do so
Click the Date Scope button Select Range of Dates Enter 1/1/2006 and 1/31/2006 Click OK Right click on TimeMins Select Stats Click close when finished with the screen
© 2008 Microsoft Corporation. All rights reserved.
We can check to see if there’s a correlation between who collected the specimen and how long it took to return. We can look up stats on any of these factors to identify were problems are and create solutions for that.
Right-click on the CollectedBy column Select Stats Click twice on Count to sort in descending order Click close when finished with the screen
4 ClotBuster Medication Turn-Around Analysis
We are also very interested in the turn-around time for ClotBusters. If they have a clot in their heart, we want to bust it up as quickly as possible. In this view, we see all the patients in January given a ClotBuster drug. We can see their name, the dose, priority, when it was requested and given, and how long that turn-around was.
Open the View Manager
Apply the 17: One Row Per STAT ClotBuster user view
Let’s filter to show only the Stat priority patients. Here we see 108 ClotBuster administrations.
Click Filter
Add a filter on PRIORITY that BEGINS WITH S
Click OK to apply the filter
Right-click on TurnaroundMins
Click Stats
Click Close when finished with this dialog
Looking at the stats on the Turn Around Minutes column, we can see that our median time is 0.00. 88.9% of the time, we see we have a 0 minute turn-around time in giving ClotBuster drugs when we need to. We can see we’ve got some room to improve on
© 2008 Microsoft Corporation. All rights reserved.
diagnosing the heart attack by turning around the Troponin test more quickly, but we’re doing a great job in providing Stat ClotBuster drugs immediately.
Do we do a better job on any particular day of the week than another? Using a larger date scope of two years, we can get stats on a large set of data.
Click the Date Scope button
Enter a date range of 1/1/2004 to 12/31/2005
Click OK
We might hypothesize that things go more slowly on weekends, as opposed to weekdays. Using the Day of the Week column, we can look at the stats dropdown. We can see that Tuesday is our busiest day for ClotBuster drugs, and the least busiest day is Sunday. This shows us that we GIVE fewer ClotBuster drugs to patients on weekends.
Right-click on Day
Select Stats
Click the % column twice to sort in descending order
Click Filter
Add a filter on TurnaroundTimeMins for GREATER THAN 15
Click OK to apply the filter
Now, do we administer ClotBusters any slower on Saturday and Sunday? Adding another filter, we look at all the records where it took more than 15 minutes to be given the ClotBusters. ClotBusters should never take more than 15 minutes to be administered
© 2008 Microsoft Corporation. All rights reserved.
This view now shows us the 211 records where it took longer than 15 minutes to administer ClotBusters. Checking the stats on the Day column again, we can see what days are our best and worst
Right-click the Day column
Select Stats
Click the % column twice to sort in descending order
Click Close when finished with this screen
Looking at the stats, we see that Sunday is actually our BEST day in which we have the fewest cases of slow turnaround. Monday and the rest of the weekdays appear to be where our problem lies.
In this demonstration, we have shown how we can use the integrated view of data available in Amalga
to help inform and change the clinical and business processes across the hospital. As a result of the information that we’ve gathered, we can drive incremental improvements in the quality of care available for our cardiac patients by o driving targeted improvements in the education of our clinical staff, o improving on the availability of drugs and medical devices to deliver timely patient care
We can also communicate and congratulate our staff on the delivery of quality cardiac care and provide specific insight into the consistency of care delivered by leveraging the information made available in Amalga.
© 2008 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q3 FY09 VIP Flag Microsoft Corporation Published: February 2009
Summary This demo shows how the VIP field can be used to restrict access to specific patients through the use of quick edits and user views. Role:
[login name(s) used in this script]
Personas:
[People the login names represent]
Table of Contents 1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Start Demo Laptop and log in ............................................................................................. 3 2.1 Log into Microsoft Amalga .................................................................................................. 3 2.2 Using the VIP Flag .................................................................................................................................. 5 VIP Flags and Reports ........................................................................................................................... 7
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to Steven Malme [email protected]
© 2009 Microsoft Corporation. All rights reserved.
1
Value, Scenario, Story, Roles, Processes
Amalga Value:
Talks to security concerns over capturing personal health information, the controls that Amalga already has in place and how those can be augmented. Also demonstrates role-based security and how that is controlled through baseviews.
Demo Scenario:
Show how a view that an ordinary user might see does not have any VIP patients in the view. Show how a view with privileges can not only see the VIP patients but also can use a quick edit field to flag someone as VIP. Go back to the ordinary user view to show the newly marked VIP patient no longer appears there. Then go to a report that tallies all VIP access using the VIP flag and the audit logs (note report is not real time – explain that changes just made will appear next time report job runs). Explain how all patient accesses are logged in Amalga.
Questions to tailor demonstration to audience pain / requirements?
1. Is meeting HIPAA requirements on access to personal health information (PHI) a concern with your IT systems? 2. Do you treat special patients, VIP’s, sometimes and need to apply extra precautions to control access to those records?
Demo Introduction / Story:
The hospital treats a significant number of high profile patients and became very concerned when there was a news article about a neighboring hospital and employees gaining access to VIP records. They are already pleased with the extensive auditing capabilities in Amalga but want to take this even further. They would like for an Administrator to be able to very simply flag a VIP patient and have that immediately remove that patient from the views of users who are not authorized to access VIP records. Additionally there should be a report using the audit logs and the VIP flag to see who has been accessing VIP records.
Role(s):
Ordinary user who should not be allowed VIP access, and administrative user who can both see and flag VIPs.
Processes:
HSG Customers who have implemented similar scenario:
Most customers are using the Amalga audit logs (but not the VIP flag).
© 2009 Microsoft Corporation. All rights reserved.
Demo Setup
2
The actual demo starts at section 4. Talk about the following pre-demo sections and what happens in those sections. In section 3.1, we start the demo laptop and log in to start the demonstration. In section 3.2 we log into Amalga to start the demonstration.
2.1
Start Demo Laptop and log in
In this section, we start the demo laptop and log in to start the demonstration. Talking Points
Click Steps
Start Demo Laptop
Start Demo Laptop
Log in to demo machine
Log in using provided demo machine credentials.
Screenshots
Click
2.2
Log into Microsoft Amalga
In this section, we log into Microsoft Amalga Talking Points
Click Steps
Open Amalgademos.com Use your DEMO credentials to Enter into the site
From Internet Browser Open www.Amalgademos.com
Navigate to ProductionDemos page
Click on Demonstrations Dropdown Select “Production Demos” from the dropdown
© 2009 Microsoft Corporation. All rights reserved.
Screen Shots
Open Amalga Console from the site.
Connect to the Remote App
In Production Applications section Click on “Amalga UIS R2SP2” shortcut from the list.
Enter Your Credentials to authenticate to the RD Gateway and launch the remote App Use “DEMO” as Domain. Click->OK
Ignore warnings (if necessary)
Click ->Yes
Login to the Amalga Console.
After successful login to Remote App. In Amalga Console it will populate your Credentials Automatically no need to enter your credentials Click on “Login” button.
© 2009 Microsoft Corporation. All rights reserved.
3
Using the VIP Flag Talking Points
Amalga maintains an audit trail of all queries to patient data. The time, date, user credentials, IP address, machine MAC address, are all logged together with information about what patient data was queried. All of our customers have found this highly useful in assuring that they are complying with HIPAA requirements for safeguarding patient privacy. Sometimes just knowing who accessed a patient’s records is not enough. One hospital that treats a significant number of celebrity patients became very concerned when there was a news article about a neighboring hospital and breaches of VIP information with employees having unauthorized looks at celebrity medical data. To add an extra layer of security, this hospital wanted a way for an administrator to quickly flag VIP patients and have those patients no longer appear on screens of users who are not authorized to view VIP data. Additionally they wanted to make use of the audit tracking already in Amalga and couple it with the new VIP flag, so an administrative report could be drawn up of all accesses to VIP patient data. To accomplish that, an Amalga Quick Edit field was added to allow and administrator to easily flag someone as a VIP patient. Quick Edits are a simple way to do direct entry of data into Amalga when that data doesn’t come from an underlying source system. For this example, a certain patient needs to be flagged as VIP and have access to their records restricted to a select list of physicians.
Click Steps
Open the View Manager Select Clinical Baseview w VIP Click Apply
© 2009 Microsoft Corporation. All rights reserved.
Screenshots
This view shows who last updated the VIP status of a patient, when they did that, and what the current status of the VIP flag is The use of quick edits allow for changing this flag as needed. The view will refresh, showing your patient has been flagged as a VIP. Point out the view current shows ## patients, with one now flagged as VIP (look at top right for the total number of patients)
Right click on the VIP column
Now we are switching to another view that shows what a user who did not have access to VIP records would see. There are only 16 patients on the screen this user would see. The security here is role-based with credentials passing over from the hospital’s Active Directory. A user can only see rows and columns of data from Amalga baseviews that are associated with their role. Clinical users can be prevented from seeing financial data and vice-versa. It is easy to construct a view that has no PHI data on it at all that a researcher might use.
Open the View Manager
This view represents one which does not allow the user to see those who have been flagged as VIPs
Note the total rows is now 15 and that the previously flagged patient is not on the list.
Let’s go back and turn off the VIP flag for that user.
for one of the patients.
Select Y from the list
Select Clinical Baseview wo VIP
Click Apply
Open the View Manager Select Clinical Baseview w VIP Click Apply Right click on the VIP column for the patient previously marked VIP.
© 2009 Microsoft Corporation. All rights reserved.
Select N from the list
4
VIP Flags and Reports Talking Points
Click Steps
Let’s return to that view that a user without VIP access would see. Point out that the user who is no longer a VIP now appears on this screen, and there are now 17 patients in the view.
Open the View Manager
As I mentioned all query access on patient’s data (independent of the VIP flag) are logged by Amalga. This hospital created a report in Amalga that uses the audit data combined with the new VIP flag to show all accesses to VIP patient data. The report only updates when the audit logs are processed so what I will show you here is only past VIP accesses. The next time the audit logs are run, any access to newly marked VIP patients will show up here as well. Show the report and ask what other questions they might have.
Click Admin Click Report Builder – V2 in
Select Clinical Baseview wo VIP
Click Apply
the left-hand menu of the Admin screen Click “Audit VIP Patients Viewed Report” Click View Report Click Run Report * keep in mind new data will not be created until the PostProcessing Auditing tool is executed
© 2009 Microsoft Corporation. All rights reserved.
Screenshots
Click Logout at the top-right of the screen
This concludes the VIP Flag demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2009 Microsoft Corporation. All rights reserved.
© 2009 Microsoft Corporation. All rights reserved.
Microsoft Amalga Demo System Q2 FY11 Cohort Set Manipulation Microsoft Corporation Published: February 7, 2011
Summary The purpose of this document is to demonstrate how Amalga can assist research staff in identifying patients who may qualify for research protocols. Users can examine de-identified patient demographic, diagnosis lab results data, creating user-specific static sets of patients and observing relationships among the patients in these static sets. This demo script will walk you through the Cohort Set Manipulation Baseviews and Components in Microsoft Amalga.
Table of Contents
1 2 3 4 5 6
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Pre Demo Setup ..................................................................................................................................... 3 Cohort Discovery Userviews Filtering..................................................................................................... 4 Create a static, user-specific set based on Amalga Grid contents......................................................... 6 Create new sets based on combinations of existing Sets .................................................................... 10 Examine Diagnoses and Lab Results for patients who meet our criteria ............................................. 12
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed [email protected].
© 2010 Microsoft Corporation. All rights reserved.
Page 1 of 13
1 Value, Scenario, Story, Roles, Processes Demo Scenario:
Amalga Monitors and Notifications System
Questions to Tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
In this demonstration, we examine de-identified demographic, diagnosis and lab results data and create static sets of patients who meet user-defined criteria. A set of patients defined based on demographic criteria can then be applied to diagnosis or lab results data to see this information for the patients in this set. In addition, Untion, Intersection and “In A but not B”-type operations can be performed on Sets, saving the results as new sets. Through these techniques, researchers can find patients who meet a variety of complex criteria.
Role(s):
Researchers
Processes:
HSG Customers who have implemented similar scenario:
© 2010 Microsoft Corporation. All rights reserved.
Page 2 of 13
2 Pre Demo Setup
The steps in this section should be completed before beginning the scenario demo. In this section, we log into Microsoft Amalga through the link published on www.amalgademos.com Talking Points
Open the Amalga Demos website and login.
Navigate to Demonstrations web part
Launch Amalga Console
Click Steps
Screen Shots
Open www.Amalgademos.com in Internet Explorer
Use your DEMO credentials to Enter into the site
Click on Demonstrations Dropdown
Select Production Demos
In Production Applications section, click on Amalga UIS R2SP2
© 2010 Microsoft Corporation. All rights reserved.
Page 3 of 13
Connect to the Remote Application
Enter your credentials (username should be like demo\<username>)
Click OK
Ignore warnings (if necessary)
Click Yes for warnings.
After successful login to Remote Application, in Amalga Console system will populate your Credentials automatically (no need to enter the password here).
Click on Login button.
3 Cohort Discovery Userviews Filtering In this section, we take a look on the userviews that displays de-identified demographic, diagnosis and lab results data. We will create sets of patients that meet various criteria and filter userviews by the patients in these sets Talking Points
Click Steps
Screenshots
Click on the User View Manager. (You should be in the US – Sample Hospital application)
© 2010 Microsoft Corporation. All rights reserved.
Page 4 of 13
Select Cohort Discovery Demographics from the MKT – Research group. Click Apply
Show the view and the total number of records.
Right click on an F in the Sex column and choose Filter on Selection
Click Ok in the Filter Editor to create the Sex=F filter
Add an Age filter in the Filter Editor by clicking on Age and then Add Filter
© 2010 Microsoft Corporation. All rights reserved.
Page 5 of 13
Select Between for the Operator, and enter 60 and 75 for the values
Click Ok
Add a Race filter by clicking on Race and Add Filter
Select In for the Operator Enter 1 in the box to the left of the Add button and click Add Replace the 1 with a 3 in the box and click Add again Click Ok and Ok again to close the filter editor.
Wait for the Amalga grid to show the new results
4 Create a static, user-specific set based on Amalga Grid contents
In this section, we will demonstrate how to create a set that contains the identifiers for the patients currently showing in the Amalga Grid. This set is visible only to the current user. We will see how this set can be applied to other userviews Talking Points
Click Steps
Screenshots
Click on Input Tab or Click the Arrow beside it Select Create Set The Create Set dialog will open. Wait for it to show the number of unique patients showing in the Amalga Grid
© 2010 Microsoft Corporation. All rights reserved.
Page 6 of 13
Enter a name for the new Set of patients. For example, F race 1 or 3 age 60-75 Note, the set name can contain spaces, hyphens and underscores but no other special characters. 50 character limit Click Save
Click OK in the “Patient Set was created” pop-up
Close the Component Launcher holding the Create Set dialog
Repeat this process, creating a Set for diabetic patients who had this diagnosis documented in 2005
Do this by first opening the Cohort Discovery Diagnoses userview in the MKT-Research group Filter the userview for Diagnosis Code between 250 and 255.9 Add a second filter for Diagnosis Entry Date between 1/1/2005 and 12/31/2005 Open the Create Set component on the Input launcher and create the set
© 2010 Microsoft Corporation. All rights reserved.
Page 7 of 13
Repeat this process, creating a Set for diabetic patients who had this diagnosis documented in 2006
Edit the existing filter by clicking the Filter button to open the Filter editor Select the Diagnosis Entry Date filter criteria on the right and click Edit Filter Change the dates to 1/1/2006 to 12/31/2006 Close the filter dialog and wait for the Amalga grid to show the new data Open the Create Set component and create the new Set
Repeat this process, creating a Set for patients who have been seen in the Emergency Department
Open the Filter Editor, remove all existing filters clauses, and add a new filter clause for VisitType=EMR Create a Set from the rows now present in the userview
The “(w/ Set Names)” userviews are modified versions of the userviews with the same name but which don’t have “(w/ Set Names)” in the name
Open the View Manager and choose the Cohort Discovery Diagnoses (w Set Names) userview in the MKT-Research group For the patients in the Sets we just created, their diagnoses will appear. If any other Sets had been created, diagnoses for all patients in all Sets will appear
These userviews filter the data to show rows that match the patients in all of the user’s Sets, showing the name of the Set for the match If a patient is in more than
© 2010 Microsoft Corporation. All rights reserved.
Page 8 of 13
one Set, multiple rows will show, one row for each Set the patient is in.
Find the other diagnoses that diabetic patients in 2005 have We will first filter the Cohort Discovery Diagnoses userview, limiting it to patients who are in the Diabetes 2005 Set. For these patients, we can then perform Stats to find their other diagnoses
Find in the Set Name column the name of the set of patients with diabetes in 2005 Right click, Filter on Contents and execute the filter Perform Stats on the Diagnosis Description Column Sort the Stats display to show the most common diagnoses on top Observe the most common diagnoses for patients in this Set
© 2010 Microsoft Corporation. All rights reserved.
Page 9 of 13
5 Create new sets based on combinations of existing Sets
In this section, we will examine how the members of different Sets overlap. We will choose regions of overlap and create new Sets from selected overlap regions Talking Points
This dialog shows a Venn Diagram for three Sets There are seven distinct regions in the Venn Diagram, corresponding to patients who are on one, two or all three of the selected Sets A region reference is shown on the right
Screenshots
Open the Venn Diagram component on the Input launcher
Click Steps
Find patients who are in the Diabetes and Demographics Sets but not the EMR set Note that as Regions are selected, the checkboxes below the graph turn on and off
In the three drop down boxes at the top of the screen, select these Sets: --Females age 60-75 race 1 or 3 -- Diabetics 2005 -- Emergency Department
There are two regions containing the overlap between the diabetic circle and the demographic circle. Select both of these regions Observe the count shows how many patients are both diabetic and meet the demographic criteria Click again in the region that overlaps with the EMR circle to exclude these patients
© 2010 Microsoft Corporation. All rights reserved.
Page 10 of 13
Save the patients in the selected region into a new Set
Enter a name for the new Set, such as “Met criteria”, and click Save Set
Find patients who were diagnosed with diabetes in 2006 who did not get this diagnosis in 2005
Change set set selections at the top of the dialog to Diabetics 2005 in one dropdown, and Diabetics 2006 in the other The third dropdown should have the top choice of “Select-“ chosen
Observe two circles, with one region of overlap Select the region corresponding to patients in the Diabetics 2006 circle who are not also in the Diabetics 2005 circle Create a new Set for these new 2006 diabetics
© 2010 Microsoft Corporation. All rights reserved.
Page 11 of 13
6 Examine Diagnoses and Lab Results for patients who meet our criteria
In this section, we will filter the Diagnoses and Lab Results userviews based on patients who are in the Set we just created containing patients who meet our criteria Talking Points
Find Hemoglobin A1C summary statistics for patients in our Met Criteria Set
Click Steps
Screenshots
Open the Cohort Discovery Labs (w/ Set Names) userview Filter this for Set Name = “Met Criteria” (or whatever name you used in the last step) Add another filter for Lab Type=”HGB-A1C”
Perform Stats on the Numeric Result column Observe the Min, Max and Average Hemoglobin A1C value for the patients in the Met Criteria Set
© 2010 Microsoft Corporation. All rights reserved.
Page 12 of 13
Find Age and Race statistics for patients diagnosed with diabetes in 2005
Perform similar operations on the Cohort Discovery Demographics (w/ Set Names) userview. Filter for Set Name = “diabetics 2005” Perform Stats on Race and Age
This concludes the Cohort Set Manipulations demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2010 Microsoft Corporation. All rights reserved.
© 2010 Microsoft Corporation. All rights reserved.
Page 13 of 13
Microsoft Amalga UIS 2010 Demo Scenario Data Ingestion Microsoft Corporation Published: February 2011 Revised: February 2011 Version History: v1.0 Script Created by Brian Gaffney
Demo Scenario Summary This demo scenario shows how Amalga UIS can ingest data from both HL7 and flat file data sources. Role(s): Information Technology professionals Person(s): IT professional uses Amalga UIS Data Ingestion Wizards to create the parsing scripts needed to ingest both sample HL7 and flat file data. Quick Step Instructions: Not applicable. Applicable Region/Country: All
Table of Contents 1 2 3
DEMO SCENARIO ................................................................................................................................. 2 DEMO SETUP ........................................................................................................................................ 3 Log in to Microsoft Amalga to Reset the Demo .................................................................. 3 2.1 Log in to Microsoft Amalga ................................................................................................. 3 2.2 30 Day Readmision Analysis Demo Scenario........................................................................................ 4
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1
DEMO SCENARIO
Amalga Value:
The ability of Amalga to easily ingest data from a variety of sources using wizards. The wizards inspect the incoming data and automatically generate parsing scripts that can be used as the basis for the actual scripts used for a production system.
Demo Scenario:
Data Ingestion
Questions to tailor demonstration to audience pain / requirements? Demo Introduction / Story: Role(s):
• How can you easily ingest data from a variety of source systems? • How do you deal with HL7 data that may need to be incorporated into your data warehouse? • How can you have a flexible mechanism (ie…parsing scripts) to deal with the business logic that surrounds your ingestion of data? Using the data ingestion wizard, pull in some ADT based HL7 data. The wizard automatically recognizes the various segment types of the sample HL7 messages and then generates the parsing scripts. Go into Visual Studio to then inspect those generated scripts. • IT professionals, Integration Analysts
Processes:
Processes include: • Automatic generation of parsing scripts • Visual Studio environment for the inspection and completion of those scripts
HSG Customers who have implemented similar scenario:
Most existing Amalga customers will have used the wizards at some point
2
2 DEMO SETUP The actual demo starts at section 3. This section should be completed before beginning the actual presentation/demo. In section In section 2.1, we log into Amalga to start the demonstration.
2.1 Log in to Virtual Machine In this section, we log in to Microsoft Amalga Talking Points
Click Steps
The current VM for the Data Ingestion demo is found in www.amalgademos.com and it is the ‘HSG Sbox Parsing Training’ VM
Click on the ‘HSG Sbox Parsing Training’ VM
Once you login you should see a VM screen like this
You may see some various start ups of different services
Let all those services start up and then you can close whatever screens are left
Screenshots
You will need your amalgademos login id to login to the VM None
3 Data Ingestion Talking Points
We are starting the Script Engine Editor which is the Amalga tool used to run the wizards which we will be using to show Amalga data ingestion
Click Steps
Screenshots
Click on Start – the find the Script Engine Editor tool in the start list and start that tool
3
Once logged into SEE, you should see the following start up screen We are going to start with the wizard creation of an HL7 parsing script
None
Brings up the initial HL7 Feed Wizard dialogue box
Click on the ‘HL7 Feed Wizard’
Location of test messages are in ‘c:\testdata’
Click on ‘Message Files’ in the upper left Navigate to the ‘c:\testdata’ location to find some test messages
We are going to start with some of the ADT messages There are other message types in there as well but for this scenario, we are going to use ADT messages
Select a series of ADT messages The exact number does not matter
4
After you select those messages, you will be in the first step of the process This is just a preview of some of the messages. It does not show all the messages.
None
In order to continue, we need to give this message a name and a description.
Type in a name and a description
This would be used in an actual deployment if you wanted more granular control over the naming of various entities
You can toggle on the advanced fields if you want by clicking on the ‘Advanced’ toggle arrow
Once you click ‘Next’, Amalga analyzes the message stream to determine what sorts of HL7 messages you have just analyzed Amalga automatically recognizes these HL7 messages On the right side are the message segments that actually occurred in these messages On the left side are all the message segments available for these types (in this case ADT) of messages
Click ‘Next’ to get to this screen on the right
5
If you know that you were likely to see other segments as part of a production data stream, you could add the segment types from the left over to the right
Similarly, Amalga has analyzed all of the incoming test messages to not only determine what segments actually existed, but what fields within those segments actually existed. Again, if we chose to do so because we know production data has more fields, we could add other fields that are known to exist for these segment types
Click ‘Next’ to get to this screen.
In the final step, Amalga now presents to us the final layout for all of the test messages that were analyzed for this particular (ADT) message type
Click ‘Next’ to get to this screen
Click ‘Finish’ to get back to the main screen for SEE Now click on ‘Packages’ to find the test message package that you just created
6
The test message package should be at the bottom of the list
Double click on that package that you just created
The double click brings up the following view
Launch Visual Studio to the left by clicking on ‘Visual Studio’
You might get a message like this if this is the first time you have ever launched Visual Studio from your VM
Click to continue
You might get a message like this depending where you left off before
Click to continue
7
You are now in Visual Studio and can explore the various parsing scripts that have been automatically generated
Double click on any message script
A double click opens the code for this particular message script
None
(OPTIONAL STEP FOLLOWS) The next section covers ingesting sample flat file data The flow is basically the same, so not all screen shots will be provided here for brevity The sample data used in the flat file is actually an extract out of the Amalga demo data base so we are simply ‘re-ingesting’ the same data that already exists in Amalga.
Get back to the Script Engine Explorer (SEE) as detailed above
Start at the Script Engine Explorer
8
We are going to select a flat file which is a ‘CSV’ of rows taken from the existing Amalga UIS demo database
Click on the ‘XML and Flat File Wizard’
This is where we select some data for ingestion. For this test / practice system, there is a csv file that was pulled out of Amalga UIS demo system to feed back into the parsing engine
Change the message type to ‘flat file’…this is in the selection area in the upper left Click on ‘message files’ We are going to use the test data that is in c:\TestDatav2 and the name of the file is ‘Test Data V2 CSV’ Select that file
Simple step here to make sure you use a comma as the separator of data values from the flat file
This window pops up Before proceeding, make sure you 1) change the delimiter to a ‘,’ and also 2) click the check box to use a header row Then make sure you give this a ‘Feed Name’ and a ‘Feed Description’ and then click next
Notice how column names have been picked up off of the header row
Give the table a name Then click next
9
Simple wrap up
Step 3 is a review screen Click Finish
This pop up informs you the Scripts were generated successfully
Click ok
You have to save the workspace changes before seeing the parsing scripts
Click in the upper right to save workspace changes Then click on packages
Select the package you just created And then launch Visual Studio on the left side of the screen
10
Back in Visual Studio you can explore the parsing scripts as was done above
Click Ok a couple of times to load the project You can now select on various scripts as was done above with the HL7 parsing scripts End of Demo
11
Microsoft Amalga Demo System Q3 FY11 Business Analytics for Imaging Scenario Microsoft Corporation Published: February 2011
Summary Today, more data is being stored electronically at imaging facilities that ever could have been imagined. With the emergence of specialized imaging, reporting, collaboration and other specific solutions, this issue is exacerbated in that the data is spread across multiple siloed IT systems. The challenge is how to make sense of all this data to improve the process of healthcare delivery. Business Analytics is defined as the technique used to interactively explore massive amounts of data to gain insight into past and current performance to help with future strategic planning. In this scenario we demonstrate the power of Amalga UIS to intelligently aggregate the data across these disparate IT silos and leverage Microsoft visualization tools to manage Key Performance Indicators for the department to drive towards clinical, financial, service and research excellence.
Table of Contents 1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 4 Pre Demo Steps .................................................................................................................. 4 2.1 Introduction ............................................................................................................................................. 5 Business Analytics Demo ....................................................................................................................... 8 Imaging BI Walkthrough ...................................................................................................... 8 4.1
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed [email protected].
© 2011 Microsoft Corporation. All rights reserved.
Page 1 of 18
1 Value, Scenario, Story, Roles, Processes Amalga Value:
Using Amalga to integrate data across various entities and IT systems and transform it to manage Key Performance Indicators (KPIs) for Imaging departments.
Demo Scenario:
In this demonstration we use Amalga for managing Key Performance Indicators across 4 primary areas – Clinical, Financial, Service and Research.
Questions to Tailor demonstration to audience pain / requirements?
1. What is my Critical Results TAT? Am I meeting my TAT objectives? 2. What is my trend over the past year/ month? Which entity has the lowest vs highest TAT? 3. What is my report TAT? 4. Who are my most efficient Radiologists especially within each site so I can leverage them as Rad champion 5. What percentages of studies are being sent to transcription? What is their average TAT? 6. Who are my top referrers? 7. Has their referral volume increased or decreased?
Demo Introduction / Story:
Today, more data is being stored electronically at Imaging facilities that ever could have been imagined. With the emergence of specialized imaging, reporting, collaboration and other specific solutions, this issue is exacerbated in that the data is spread across multiple siloed IT systems. The challenge is how to make sense of all this data to improve the process of healthcare delivery. Business Analytics is defined as the technique used to interactively explore massive amounts of data to gain insight into past and current performance to help with future strategic planning. In this scenario we demonstrate the power of Amalga UIS to intelligently aggregate the data across these disparate IT silos and leverage Microsoft visualization tools to manage Key Performance Indicators for the department to drive towards clinical, financial, service and research excellence.
Role(s):
Enterprise Executive Radiology Director RIS/PACS Administrator Chief Radiologist
© 2011 Microsoft Corporation. All rights reserved.
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Processes:
Clinical Excellence Financial Excellence Service Excellence Research Excellence
HSG Customers who have implemented similar scenario:
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Demo Setup
2
This section should be completed before beginning the actual presentation/demo.
2.1
Pre Demo Steps
The steps in this section should be completed before beginning the scenario demo. In this section, we log into Microsoft Amalga through the link published on www.amalgademos.com
Talking Points
Open the Amalga Demos website and login.
Click Steps
Screen Shots
Open www.Amalgademos.com in Internet Explorer
Use your DEMO credentials to Enter into the site
Navigate to PowerPivot web part
Select PowerPivot
Launch PowerPivot Gallery
In Libraries section, click on PowerPivot Gallery
Navigate to RSNA Critical TAT
Select RSNA Critical TAT icon link
© 2011 Microsoft Corporation. All rights reserved.
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The RSNA Critical TAT PowerPivot chart will open up in Microsoft Excel 2010
3 Introduction PowerPivot is one of the Business Analytics techniques from Microsoft. Business Analytics is a technique used to interactively explore massive amounts of data to gain insight into past and current performance to help with future strategic planning. PowerPivot for Excel is a data analysis tool that delivers unmatched computational power directly within the application that you already know and love—Microsoft Excel PowerPivot is an add-in for Microsoft Excel 2010 that enables you to import millions of rows of data from multiple data sources into a single Excel workbook, create calculated columns and measures using formulas, build PivotTables and PivotCharts, and then further analyze the data so that you can make timely business decisions without requiring IT assistance. The goal of this demo is to walk you through scenario of how you can leverage Amalga UIS along with its integration with the other MS Office tools you are more familiar with (e.g. Excel) to perform analysis across Key Performance Indicators that are important for Radiology departments to manage their growth, cost position as well as operational aspects of the business. To walk through this we are going to look at an enterprise that has three sites each offering Radiology services. Talking Points
In this demo, we will try to analyze the data through Pivot charts that we have created for Report TAT and Critical TAT. We can see two Pivot charts – first one shows the average Report TAT and average Critical TAT for each yearmonth over a period of three years i.e. from 2007 to 2009. Here, Report TAT is shown in Red color and Critical TAT is shown in Blue color.
Click Steps
Screen Shots
Show Turnaround Time (hrs) chart
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In this chart, if we want to view only Report TAT or only Critical TAT then we can change some settings.
Click on Turnaround Time (hrs) chart.
From PowerPivot Field List check or uncheck any one of the checkboxes for Average Critical TAT and Average Report TAT items in the list.
Second chart displays the volume of reports for each year-month over a period of 3 years i.e. from 2007 to 2009.
Show Procedure Volume Chart.
To analyze Report TAT further, we have some more charts that clearly focus on turnaround time distribution by processes.
Show Report Turnaround Time Comparison across Sites Chart on Turnaround Time Analysis worksheet.
For each site we have a bar chart (that displays the TAT breakup for three years so that we can easily see the highlighted trend) and a pie chart (that displays the distribution of TAT among different processes).
Show Report Turnaround Time for HHH1 chart.
Show Report Turnaround Time breakdown for HHH1 chart.
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Along with these charts we have some slicers that will allow us to filter the charts’ data. Slicers are one-click filtering controls that narrow the portion of a data set shown in PivotChart Let us look at these slicers in a bit detail one by one.
Show the slicers area
This is YEAR slicer that through which we can view the data of desired year(s).
Show the YEAR slicer.
Next we have the Month Slicer that will help us to drill down for a specific month(s).
Show the MONTH slicer
The Institution Slicer can be used to view the data for specific site(s).
Show the Institution slicer.
Next we can see is Radiologist slicer which we can use to drill down the data related to particular radiologist(s).
Show the Radiologist slicer
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The last slicer that we can see on this chart is Physician Slicer that will help us in getting the data for desired Referring doctor(s).
Show the Physician slicer
4 Business Analytics Demo 4.1
Imaging BI Walkthrough
In this section, we look at Critical Results Turnaround Time (Time from identifying a Critical Finding to communicating to Ref Physician) and Report Turnaround Time (Elapsed time between exam performed and report availability) Talking Points Click Steps Screen Shots
In this demo, we will look at is Critical Results Turnaround Time and Report Turnaround Time management using PowerPivot charts. Critical TAT is important both from a patient care standpoint as well as a regulatory standpoint related to Joint Commission. Report TAT is important for Referring Physician satisfaction and Department productivity. The essence here is to ensure timely and prompt communication of critical findings back to the Referring Physician based on when the finding is identified. For this demonstration, we are going to look at an enterprise that has three sites each offering Radiology services and will try to analyze the data for a period of 3 years i.e. from 2007 to 2009.
© 2011 Microsoft Corporation. All rights reserved.
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As we can see that the overall Report Turnaround Time for the enterprise has significantly undergone and has improved from 28 hrs to 14 hrs which is really good.
However, in the same time range Critical Turnaround Time have only marginally improved from 6 hrs to 3 hrs
If we see individual sites in detail we find that Site 1 critical TAT has gradually improved from 4 hrs in 2007 to just 45 minutes in 2009.
If Red line graph is not visible, then Click on Turnaround Time (hrs) chart. From PowerPivot Field List check the checkboxes for Average Report TAT and uncheck the checkbox for Average Critical TAT items in the list.
Show Red line in the Turnaround Time (hrs) Chart
To hide the Report TAT (Red Line), click on Turnaround Time (hrs) chart From PowerPivot Field List uncheck the checkbox for Average Report TAT item in the list.
Show Turnaround Time (hrs) Chart
Select HHH1 from Institution slicer
Show Turnaround Time (hrs) Chart
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Site 2 critical TAT has remained the same 8 hrs for 2.5 years i.e. from Jan 2007 to mid-2009 and then suddenly fell to 1 hr in a specific week.
Select HHH2 from Institution slicer
Show Turnaround Time (hrs) Chart
Site 3 critical TAT has remained constant with an average of 6 hrs with some spikes intermittently.
Select HHH3 from Institution slicer
Show Turnaround Time (hrs) Chart
Select HHH2 from Institution slicer
When I look closer into site 2 to see when it had gotten drastically better (so that I can try to institute similar processes at other sites), I found that there was a
© 2011 Microsoft Corporation. All rights reserved.
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specific week where the Report TAT and Critical TAT had a sudden decrease.
Let’s take a closer look to drill down a little deeper. We can see the Turnaround Time fell sharply from May to June. This is very interesting as it correlates with the time when the site may have moved to Voice Recognition process and this had a significant impact on the critical TAT. I can also see that this new VR process also improved the Report TAT that fell down from 15 hrs to 5 hrs.
Show the sudden decrease in TATs in Turnaround Time (hrs) Chart
Select 2009 from YEAR slicer.
Select 4,5,6,7 from MONTH slicer by holding Ctrl key
Show the sudden decrease in TATs in Turnaround Time (hrs) Chart
Since both site 1 and 3 were already on VR, it would be interesting to see how those two sites stack up.
If we see report TAT for site 1, it has come down from 28 hrs to 12 hrs. This facility is using VR process from last 3 years still report TAT fell down further.
Remove existing filter from all slicers by clicking on the filter cancel button.
Select HHH1 from Institution slicer.
On looking closer to this, we found that some of the gradual improvement is correlated with Report TAT and an additional decrease seems to coincide with a process initiative to improve departmental collaboration.
Show Turnaround Time (hrs) Chart.
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Also, we notice a similar correlation between Critical TAT and Report TAT. It seems like the faster our Radiologists complete the reports; the faster the findings are being communicated. We see that the decrease was over a period of time (6 months) and not a specific week.
Select 2009 from YEAR slicer.
Select 3, 4, 5, 6, 7, and 8 from MONTH slicer by holding Ctrl key.
We can see that this 6 months co-incided with process changes to improve departmental collaboration which seems to have had a positive impact to Critical TAT Note that the Critical TAT for this site is even better then site 2. This means it might be beneficial seeing what they are doing specific to Critical TAT reporting that we can share with other sites to improve them as well.
Show Turnaround Time (hrs) Chart.
Now viewing Site 3, we notice that this site have also been on VR over the past 3 years however the Report TAT isn’t as good, it remained at an average of 28 hrs.
Remove existing filters from by all slicers by clicking on the filter cancel button.
Select HHH3 for the Institution Slicer
Show Turnaround Time (hrs) Chart.
This looks like this can be addressed in two ways.
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Site 2’s Report TAT is the best and seems to have directly improved Critical TAT. Would be good to look closer into Report TAT to see where they reduced the most time and try to institute similar changes at the other two sites. Also definitely seems to be a correlation between Report TAT and Critical TAT so it is important for us to see where the specific bottlenecks here are and eliminate them. This should significantly help reduce Critical TAT like it seems to have done for Site 2.
Select HHH2 for the Institution Slicer.
Show Turnaround Time (hrs) Chart
Also Site 1’s departmental collaboration initiative seems to have positively impacted its Critical TAT. It would be a good idea to explore those at my other sites. A combination of best practices from Site 2’s (Report TAT efficiency) and Site 1’s (process efficiency) should help get Site 3’s Critical TAT to where we need it to be.
The other interesting trend here is the amount of variation in Report TAT across these 3 sites. Let’s take a closer look into this.
Goto Turnaround Time Analysis worksheet
Show the Pie charts for the institutions.
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Here we can see that this pie chart shows the distribution of Report Turnaround Time into various stages or tasks (Signed Time, Performed Time, Read Time, and Transcribed Time). We can clearly see how much time is spent in these sub-processes and identify the bottleneck, if any.
Looking at the new set of graphs, we can clearly see that a significant amount of site 1’s TAT is spent on transcribed and signed times, so this is definitely an area of improvement.
Also we see that Site 2 has undergone the most change. The overall Report TAT has fallen from 25 hours to 4.5 hours with the biggest reduction in transcribed and signed times from June 2009 onwards. Here you see that this site has taken VR extremely well and would be good to see what the department did from a training/ roll-out standpoint to achieve this.
Show Pie chart for HHH1 or HHH2
Goto Turnaround Time & Volume Trends worksheet
Select HHH2 from institution slicer.
Show Turnaround Time (hrs) Chart
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It would be good to share with the other sites as well.
It might be interesting to see if we can see any correlation with this improved service quality with referral volume.
Goto Turnaround Time Analysis worksheet.
Select 6, 7, and 8 from the MONTH slicer.
Select 2009 in the YEAR slicer.
Show the charts for HHH2
Goto Turnaround Time & Volume Trends worksheet.
Remove existing filters from by clicking on the filter cancel button.
Show the Procedure Volume chart
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Now we filter by Referring Physician that had increased referral volume.
Also, we reference Report TAT and Critical TAT chart.
Select ABERNETHY,FRANCISCO from the Referring MD slicer
Select 2009 from the YEAR slicer.
We here find that the improved service have increased the referral volume. We can clearly see for the specific referring physician the critical TAT has decreased while volume has increased gradually.
Show the Procedure Volume chart
Now if we see the overall volume, it is up by 5% from last year. In 2007 it was 2277, in 2008 it is 2481 which in 2009 gone up to 2819.
Remove existing filters from by clicking on the filter cancel button.
Show the Procedure Volume chart.
Filtering the chart by Institutions, We see that Site 1 and 2 have been fairly consistent with the market average with a growth rate of around 10%.
Select HHH1 from the Institution slicer.
Show the Procedure Volume chart.
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Site 3 on the other hand has not been able to keep pace.
Select HHH2 from the Institution slicer.
Show the Procedure Volume chart.
Select HHH3 from the Institution slicer.
Show the Procedure Volume chart.
This was just one use case we touched upon but helps show the flexibility and power of such analytic tools. By creating specific views and slicing and dicing data just
© 2011 Microsoft Corporation. All rights reserved.
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focused around this use case I can help analyze a number of interesting questions.
This concludes the Imaging BI drill down demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2011 Microsoft Corporation. All rights reserved.
© 2011 Microsoft Corporation. All rights reserved.
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Microsoft Amalga Demo System Q2 FY11 Monitors and Notifications Demo Drill Down Microsoft Corporation Published: February 7, 2011
Summary The purpose of this document is to demonstrate how Amalga can assist hospitals in more effectively managing their beds and patient throughput by using Monitors and Notification System. This is an important aspect for hospital management with financial, quality and performance impacts. Achieving the right level of occupancy rates and using beds in the most effective way is a key to the effective operation of hospitals. This demo script will walk you through the Monitors and Notifications system in Microsoft Amalga with focus on its use for bed management.
Table of Contents
1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Pre Demo Steps .................................................................. Error! Bookmark not defined. 2.1 View Beds status .................................................................................................................................... 4 Creating Monitors and Notifications........................................................................................................ 7
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed [email protected].
© 2010 Microsoft Corporation. All rights reserved.
Page 1 of 14
1 Value, Scenario, Story, Roles, Processes Demo Scenario:
Amalga Monitors and Notifications System
Questions to Tailor demonstration to audience pain / requirements?
Demo Introduction / Story:
In this demonstration, we provide an overview of the Monitoring and Notifications system in Amalga UIS. Real time messages flowing through Amalga create events which can be detected and trigger-actions specified. Amalga users have to decide which events they want to monitor and what actions should happen when these events are detected. The users interact with a dialog in Amalga to specify an event that they are interested in and fill in the required information for the event and about the actions that should happen when the event is detected. In this demo, we are going to monitor patient discharge from a facility which results in turn emptying a bed. A patient discharge event is tracked to create an email notification that starts the process of bed cleaning and subsequent tracking and completion of the bed cleaning job.
Role(s):
Hospital Managers System Administrators
Processes:
HSG Customers who have implemented similar scenario:
© 2010 Microsoft Corporation. All rights reserved.
Page 2 of 14
2 Pre Demo Setup
The steps in this section should be completed before beginning the scenario demo. In this section, we log into Microsoft Amalga through the link published on www.amalgademos.com Talking Points
Open the Amalga Demos website and login.
Navigate to Demonstrations web part
Launch Amalga Console
Click Steps
Screen Shots
Open www.Amalgademos.com in Internet Explorer
Use your DEMO credentials to Enter into the site
Click on Demonstrations Dropdown
Select Production Demos
In Production Applications section, click on Amalga UIS R2SP2
© 2010 Microsoft Corporation. All rights reserved.
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Connect to the Remote Application
Enter your credentials (username should be like demo\<username>)
Click OK
Ignore warnings (if necessary)
Click Yes for warnings.
After successful login to Remote Application, in Amalga Console system will populate your Credentials automatically (no need to enter the password here).
Click on Login button.
3 Beds Status Userview In this section, we take a look on the userview that displays the Beds’ information of the facility or hospital. Talking Points
The demo focuses on monitors and notifications through the example of patient discharges.
We begin by viewing and analyzing the Beds userview.
Click Steps
Screenshots
Click on the User View Manager.
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Page 4 of 14
To view the Bed information, we open the View Manager to select the Beds Userview.
The Beds userview is part of the MKT – Other group.
Select Beds from the MKT – Other group. Click Apply
The Beds userview shows the current status of all the beds in the hospital facility.
There are 127 beds shown in the view currently
DischargeDtTm column displays the date and time on which patient was discharged from the hospital. A blank value means that patient is still admitted.
Show the view and the total number of records.
Show column DischargeDtTm
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Cleaning Status column shows the current status of the bed/room. The cleaning status can be DIRTY, BEING CLEANED or CLEAN. A blank value signifies that the bed/room is still occupied.
Show column Cleaning status
Cleaned By column displays the user who cleaned the bed.
Show column Cleaned By
CleanedDtTm column displays the date and time on which the bed was cleaned.
Show column CleanedDtTm
Cleaning Wait Minutes column displays the time (in minutes) from which the bed is dirty and is waiting to be cleaned up.
Show column Cleaning Wait Minutes
Cleaning Minutes column displays the time (in minutes) taken to get the bed cleaned.
Show column Cleaning Minutes
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Cleaning Comments column displays the comments left by user after cleaning the bed.
Show column Cleaning Comments
By using the Monitoring and Notifications system of Amalga, we can create monitor on Patient discharge so that whenever the patient is discharged from the hospital, a notification will be generated for the concerned user to inform that the patient has been discharged and the room/bed is ready for cleaning. When user gets the notification via Email, he/she can quickly take the relevant action for cleaning the room and update the cleaning status of the room to Cleaned so that a new patient can be admitted in the same room/bed without delay.
Stay on the userview.
4 Creating Monitors and Notifications
In this section, we will demonstrate how to create the monitors and notifications in Amalga. Talking Points
An ADT message is normally received that indicate that patient has left the hospital or has been discharged. For the purpose of the demo we are going to simulate the ADT message with an edit on a DischargeDtTm column.
Click Steps
Screenshots
Click on Input Tab or Click the Arrow beside it Select Monitors and Notifications
Let us go ahead and create a Monitor for ward 3C. A monitor can be created by using the Monitors and © 2010 Microsoft Corporation. All rights reserved.
Page 7 of 14
Notifications dialog. It opens up a new dialog window that list all the active monitors. To create a new Monitor, we need to click on Add.
Click on Add
The Monitors Configuration window opens up. Here we can create monitors for different events. For our demo we are going to create a BedClean monitor.
Focus on Bed Clean section.
We are going to create the monitor for ward 3C. When we click on ward textbox, it drops a list of all the wards in the facility, We choose 3C
Select 3C
The notification email address is populated automatically based on previous entries.
Enter an email address to receive notifications
Any email address can be entered. The box autopopulates with the last email address entered. To see the notification being generated, make sure you have credentials to access the email account and can access the email server from the device you are running
Enter the time interval to keep this Notification alive in the textbox Click Activate and close
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the demo on.
Last, we enter the time
interval for which we want to keep this notification alive. Any number of minutes can be entered. 240 (= 4 hours) is a convenient number.
We now see our monitor created - BedClean monitor for unit 3C for 240 minutes to send email notification and the status is active. Users can create as many monitors as they want and keep them active. Monitors can be terminated by clicking on the Terminate button.
Show the monitor just created. Show that Terminate button.
We have logged in to the email account to ensure that any emails that come as notifications can be viewed. As we can see we do not have any notification emails waiting for action.
Show the Email Inbox.
Our monitor is now active. We will close this window and discharge a patient who is in 3C ward to test our monitor.
Click on any patient of ward 3C Ensure that the patient does not have a Discharge Date.
We can enter a discharge date by right clicking on the DischargeDtTm column through a quick edit.
Right-click on DischargeDtTm column Select QEdit Edit option
© 2010 Microsoft Corporation. All rights reserved.
Page 9 of 14
We enter the date time for discharge. Make sure to enter a date in the format m/d/yyyy hh:mm
A status of DIRTY is automatically generated in the Cleaning Status column.
Enter current date time Click OK
Show the columns Cleaning Status and Cleaning Wait Minutes
The time difference between discharge date-time and current date-time is displayed in Cleaning Wait Minutes column.
If we now look at our Inbox we can now see our notification email waiting in the inbox.
The email is a Bed Cleaning Notification and it says patient in bed 3C02-B has been discharged, the room is ready for cleaning
Show the unread email titled Amalga Notification in the Inbox. Open the email to show its content.
Show the email content.
© 2010 Microsoft Corporation. All rights reserved.
Page 10 of 14
After receiving the email notification, the cleaning staff can change the Cleaning Status from DIRTY to BEING CLEANED before starting the cleaning task.
Right click on Cleaning Status column for the selected row and select BEING CLEANED status.
After cleaning the room, the user can update the Cleaning Status to CLEAN.
Right-click on Cleaning Status column and select CLEAN status
When the user is done with the cleaning and user changes the cleaning status to cleaned, Amalga automatically fills up the user in the Cleaned by column. The current date time is filled in CleaningDtTm column
Show columns Cleaning Status, Cleaned By, CleanedDtTm, Cleaning Wait minutes and Cleaning Minutes
Cleaning minutes value is calculated and shown in the column. This is the actual time it took to get the bed cleaned. We can do a stats operation on the Cleaning Minutes column to know the average time it takes to get a bed cleaned.
Right-click on the Cleaning Minutes column header and select Stats
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Page 11 of 14
The statistics window displays various information like Min, Max, Average time taken in bed cleaning task.
Show the Stats window.
This stats info can be printed or exported to excel for further reference and action.
There are some other beds from some other ward in our view. If we put discharge date for any of these, notifications will not be received for it since our monitor is only looking for discharges from ward 3C.
Select a patient record from ward 3EB
We can try this out by selecting a patient from ward 3EB. We do not have a monitor set for this ward. We again select the discharge date column and use the quick edit to enter the discharge date.
We enter current date as the discharge date for this bed. A status of DIRTY is automatically filled in.
Right-click on DischargeDtTm column Select QEdit Edit option
Enter current date time Click OK
© 2010 Microsoft Corporation. All rights reserved.
Page 12 of 14
Let us now check if we have received any notification for this patient discharge.
Show the Inbox
We see no notifications as our monitor was looking for discharges in ward 3C only.
We could create a new monitor for ward 3EB to monitor discharges for this ward as well.
Click on Input Click on Monitors and Notifications.
Let’s add one there.
Select ward 3EB from the ward list.
We also want to know when discharges happen in ward 3EB and activate that one.
We can see that our monitor for ward 3EB is created. We can also see that ward 3C has had one message sent while ward 3EB is just active and does not have any messages sent.
Click on Activate
Show the created monitor and the Status column for the 3C monitor row.
© 2010 Microsoft Corporation. All rights reserved.
Page 13 of 14
Let’s go ahead and discharge a patient from ward 3EB.
Right-click on DischargeDtTm column Select QEdit Edit option Enter current date time Click OK
As you can see now that we have received a new email from our monitor for ward 3EB which just went active.
Show the email in the Inbox.
This concludes the Monitors and Notifications demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2010 Microsoft Corporation. All rights reserved.
© 2010 Microsoft Corporation. All rights reserved.
Page 14 of 14
Pre-Registration & Post Discharge
Demonstration Scenario
Last updated: 1 December 2011
For additional information on HealthVault Community Connect, please visit http://www.microsoft.com/communityconnect Comments, questions, and feedback may be directed to [email protected] or [email protected].
Table of Contents Summary ....................................................................................................................................................... 2 Roles and Personas ...................................................................................................................................... 2 Value, Scenario, Story, Roles, Processes .................................................................................................... 2 Chapter 1. <Patient Name> logs in to Contoso Medical Center Online to submit pre-registration information for the upcoming surgery ........................................................................................................... 3 Chapter 2.
<Patient Name> views and prints the pre-registration information ......................................... 6
Chapter 3.
Contoso registration staff views and processes incoming pre-registration information .......... 7
Chapter 4. Using Contoso patient portal, <Patient Name> requests connection to her patient file to view visit records 8 Chapter 5.
Contoso Medical Records clerk verifies the incoming connection to a patient record ............ 9
Chapter 6.
<Patient Name> views recent visit CCR using Contoso Patient Portal ................................ 10
Chapter 7.
<Patient Name> views her HealthVault account ................................................................... 12
Summary Read the Demo Scenario section
Roles and Personas Role
Name
User Name
Patient
<Patient Name>
<Patient E-mail Address>
Registration
jsmith
Records Manager
<Manager Name>
jsmith
Provider
Dr.
Value, Scenario, Story, Roles, Processes HealthVault Community Connect Value:
Demo Scenario:
•
Simplifies the registration process for patients, enabling them to store data once and use it many times • Helps facilitate better health outcomes by getting the relevant information into the hands of the people who need it most, improving communication, collaboration, and coordination of care • Simplifies the post-discharge process by providing patients with a way to view and get a copy of their discharge summaries remotely while providing the care team with timely information and communications Patient requests to share records with a Community Provider
Questions to tailor demonstration to audience pain / requirements? Demo Introduction / Story:
Page 2 of 12
<Patient Name>, a 60 year old patient, has developed a heart problem and begins working with a specialist at a referral clinic. , the specialist at the referral clinic refers the patient to Contoso Medical Center for a heart surgery. Contoso Medical Center sends an email to patient asking to register for the procedure. Using HealthVault Community Connect, <Patient Name> pre-registers with Contoso Medical Center for the upcoming visit. She provides basic information such as demographics, insurance and medical history. Registration staff at Contoso Medical Center receives and processes the inbound registration information to approve the information to flow into Contoso’s hospital information system. <Patient Name> uses Contoso Patient Portal to request connection to her medical records at Contoso Medical Center. The medical records staff at Contoso Medical Center matches her request to her patient record in the © 2010 Microsoft Corporation. All rights reserved.
hospital information system. <Patient Name> can then view any of her previous or present hospital visit records. <Patient Name>’s surgery takes place at Contoso Medical Center and after a few days of recovery <Patient Name> is discharged from the hospital. On discharge, a copy of the patient’s Continuity of Care Record (CCR) is sent to the patient’s account on Contoso’s patient portal, the authorized providers in Contoso’s provider portal and the patient’s HealthVault account. <Patient Name> views her Contoso Medical Center visit CCR using the patient’s portal. Patient: <Patient Name> Community Physician: Dr. Registration: Records Manager:
Role(s):
Processes: HSG Customers who have implemented similar scenario:
Brooks Health (HealthVault Community Connect EAP) announced their progress at HIMSS.
Chapter 1. <Patient Name> logs in to Contoso Medical Center Online to submit pre-registration information for the upcoming surgery Talking Points
Click Steps Login to the VM for HCC
Once in this VM, the ‘Patient Portal’ can be accessed right from the desktop via the quick link to the web based patient portal
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© 2010 Microsoft Corporation. All rights reserved.
SharePoint based portal, customizable by integrators and customers. Patients log in with their HealthVault credentials.
Sign in to the patient portal with the login id that you have for HCC demo purposes
You may or may not be prompted.
Email address – , continue
HealthVault login talking points – patients log in with HealthVault. Eliminates credential management, provides patient repository for discharge data and pre-fill info for discharge
Email address – Password: Click Sign In
HealthVault Community Connect provides a set of basic tools to manage patient consent. This language can be modified by customers or integrators. HealthVault Community Connect will automatically collect consent from patients when the language is updated, or periodically – i.e. once per year according to policy.
On the consent form, type <Patient First Name>in the name box. Click I agree.
<Patient Name> now has access to the Contoso Patient Portal.
Click Pre-register now.
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© 2010 Microsoft Corporation. All rights reserved.
Solution is hosted on premises, based on SharePoint and customizable. Out of the box we provide a basic portal experience for all use cases. Date: Facility: Department: Doctor: Dr. Click Continue.
Allows hospitals to have multiple, customized pre-reg forms based on the selections that patients make at this step.
Data elements are being pulled from HV to pre-fill forms. This will reduce errors like transposed digits that lead to business office rework. Pre-registration forms include information you’d expect out of the box. Demographic, Insurance, Medical History. Forms are customizable by integrators and customers Each form section pre-fills from HV when it loads And saves back to HV when it closes
Under Basic Information, confirm or enter the following:
Insurance.
Under Insurance, confirm or enter the following:
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Email: <Patient E-mail Address> Phone number: <Patient Phone Number> Address line 1: <Patient Address> City: <Patient City> State: <Patient State> Country: US Postal code: <Patient Postal Code> Date of birth: <Patient DOB> Gender: <Patient Gender> Ethnicity: <Patient Ethnicity> Marital Status: <Patient Marital Status> Height: <Patient Height> Weight: <Patient Weight> Click Save & continue.
Insurance Plan Name: Contoso Insurance Group number: 1234 Expiration date: 1/10/2012 Subscriber ID: 123456789 Subscriber Name: <Patient Name> Subscriber date of birth: 7/3/1945 Click Save & continue.
© 2010 Microsoft Corporation. All rights reserved.
Allergies and medications. These form fields make use of standard forms from HealthVault.
Under Medical History,
At this point integrators can help to link pre-registration data to hospital systems.
Under Review and submit, click Submit pre-registration.
Click Add an allergy. Allergy: Dust Type: environmental Reaction: cough Click Save.
Chapter 2. <Patient Name> views and prints the pre-registration information Talking Points
Click Steps
After registration hospitals can customize this page to provide additional instructions. Patients know that they can return to the portal for all pre-encounter information and copies of previous pre-reg forms for records.
Click on Print a copy of your pre-registration form for your records.
Click Cancel Scroll down Close the pop-up window Click on View a list of previous pre-registration forms Click on View
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© 2010 Microsoft Corporation. All rights reserved.
Chapter 3. Contoso registration staff views and processes incoming preregistration information Talking Points
Click Steps
The staff console allows hospital staff to manage user data and account connections using intuitive tools. Doesn’t require a DBA to manage day-to-day activities on the sites.
Click on the Amalga Console icon on the desktop. Login with your login credentials for Amalga for HCC demo purposes
Staff roles mean that tasks can be assigned to different personnel within the hospital Open View Manager. All Views > yourid > Pre Registration > Apply Each incoming pre-registration appears in a queue for processing
Double-click on the new entry for <Patient Name>
Note status of each section that needs to be verified. Staff can review and manage each section of preregistration.
Under Demographics, click on Review Select the checkbox > Reviewed and updated patient file Click Save
Now we can see at the top of the Pre-registration Checklist that the status for Demographics as changed to Reviewed.
Under Insurance, click on Review Select the checkbox: Reviewed and updated patient file Click Save Under Medical History, click on Review Click the Conditions tab Click the Allergies tab
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© 2010 Microsoft Corporation. All rights reserved.
Select the checkbox > Reviewed and updated patient file Click Save Under Additional Info, click on Review Select the checkbox > Reviewed and updated patient file Click Save Click Done Note that the status for each section verified has changed to true.
Click Refresh
Click Logout Close the Amalga Console
Chapter 4. Using Contoso patient portal, <Patient Name> requests connection to her patient file to view visit records Prerequisite: Patient used in this demo should not already be linked to a hospital record. However, patient must have already authorized Contoso Medical Center to access their HealthVault records. Talking Points
Click Steps Go back to Internet Explorer On the Overview tab, click on Request access to visit records
Patient matching connects hospital patients to their discharge information. This form is customizable by SIs and customers. ** reinforce SharePoint platform
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Under Patient Information, type the following Patient’s first name: <Patient First Name> Patient’s last name: <Patient Last Name> Date of Birth: <Patient DOB> Gender: <Patient Gender>
© 2010 Microsoft Corporation. All rights reserved.
This is an example of unique code provided on bills and billing record number.
Last four digits of SSN: <Patient Last 4 SSN> Postal code: <Patient Postal Code>
This is an example of manual matching. Automatic is also an option for customers. Click Submit
Chapter 5. Contoso Medical Records clerk verifies the incoming connection to a patient record Talking Points
Click Steps Double-click on the Amalga Console desktop icon. Login with HCC amalga demo id Open View Manager.
The staff console allows hospital staff to manage user data and account connections using intuitive tools. Doesn’t require a DBA to manage day-to-day activities on the sites.
All Views > yourid > Patient Matching > Apply
Talk about pending requests that could be manually approved in case there was no auto approval. Reference the status column.
Double-click on the new entry for <Patient Name> with the status of Pending.
<Patient Name> provided enough information for HealthVault Community Connect to automatically match with her hospital visit records. Page 9 of 12
Click Link to this patient file. Click Confirm. Click Refresh.
© 2010 Microsoft Corporation. All rights reserved.
Contoso Medical Center has configured HealthVault Community Connect to require staff validation before sharing visit records with patients. Close Amalga Console
Chapter 6. <Patient Name> views recent visit CCR using Contoso Patient Portal Talking Points
Click Steps Go back to Internet Explorer Click on the Hospital Visit Records tab Click on View visit record
Hospitals can choose to include data as file attachments if preferred. EKG examples provided. Hospitals can choose to include various types of data to provide to patients through the portal. HealthVault Community Connect does the work of converting data to CCR format and displaying it in the portal. Integration partners can help to do the work required to connect internal systems.
Under Attachments, click on a PDF document Click Open Close the opened document Scroll down to see Medications and Lab Test Results
Scroll up and click on Print reports from this visit
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© 2010 Microsoft Corporation. All rights reserved.
Patients can print discharge information for their records or choose to bring it to their physician. The HealthVault Community Connect provider portal also provides access to patient information.
Under Print reports from this visit, select Print all check box Click Print Click Cancel Close the opened pop-up window
CCR is being copied to HV as an XML Click on Copy to HealthVault doc. It can now be reconciled into individual data fields for other HV apps to make use of or to benefit preregistration. Click Integrate items into HealthVault You may be required to validate your identity by signing in to HealthVault again.
*** HV SIGNIN STEPS HERE ***
For our demo, we’re going to look at Click Choose items to add the interface that allows us to selectively add items. <Patient Name> could also just click on Add all new items. After reviewing and selecting items to Scroll to the bottom of the page add, not add or replace to her HealthVault record, <Patient Name> Click Save changes to record adds all items from the Contoso CCR into her record. Click Return to Contoso Medical Center Click Sign out to sign out of the portal
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© 2010 Microsoft Corporation. All rights reserved.
Chapter 7. <Patient Name> views her HealthVault account Talking Points
Click Steps Open Internet Explorer Log in to http://account.healthvault-ppe.com Email address: <Patient E-mail Address> Password: <Password> Sign In Click on Health Information tab
We can see that this CCR has just been added to <Patient Name>’s HealthVault record and that items have already been added from the CCR as well.
Under Files, click on Continuity of Care Record (CCR)
Under Files, click on Documents (File)
This concludes the demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, e-mail address, logo, person, place, or event is intended or should be inferred.
Page 12 of 12
© 2010 Microsoft Corporation. All rights reserved.
Microsoft HealthVault Demo System Admit-Discharge Microsoft Corporation Published: February 2009
Summary This demo script will walk you through a sample HealthVault connected web application utilized in a patient pre-admission and post-discharge scenario. Role:
Patient.
Personas: See Roles.
Table of Contents 1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 Demo Setup ............................................................................................................................................ 3 Pre-Admission ........................................................................................................................................ 3 Post-Discharge ....................................................................................................................................... 7
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/healthvault. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes HealthVault Value:
Reduction of procedure cancellations due to insufficient or incorrect patient information at the time of the procedure, as well as increased patient care continuity once the patient has been discharged. Hospitals can improve the accuracy and timeliness of the information they receive on incoming patients. Cancel fewer procedures, provide better care. Patients get the information they need to manage their condition and their recovery Caregivers closer to the patients (such as the cardiologist in this scenario) get the data they need to provide the appropriate follow-up care Hospitals create stronger working relationships with referral sources
Demo Scenario:
Patient scheduled for Cardio-Thoracic procedure utilizes patient portal to enter and retrieve personal health information.
Questions to tailor demonstration to audience pain / requirements?
1. Does your institution incur procedure cancelations due to incorrect patient data? 2. What systems are currently in place to collect, maintain and distribute patient information within your organization? 3. Would you like to reduce the amount of paper based patient data collection you currently use? 4. Would having current and correct patient data reduce the occurrence of cancelled procedures within your institution? 5. Would you like to build stronger relationships with referring physicians?
Demo Introduction / Story:
In this scenario, we’re following a patient who has been referred by his cardiologist to the NYP cardio-thoracic surgery team to receive a left ventricular assistive device (LVAD) implant as he awaits a heart transplant. The cardiology practice uses an EMR from Allscripts, so it’s possible for the patient, through CCD integration, to pull a lot of information automatically into HealthVault. What’s more, it also means that data written by the MyNYP.org portal can be read by the cardiology practice from the patient’s HealthVault record.
Role(s):
Patient / Consumer Hospital Execution / Clinician
Processes:
Patient health records management.
HSG Customers who have implemented similar scenario:
New York Presbyterian
Page 2 of 11
2 Demo Setup
The actual demo starts at section 3. Talk about the following pre-demo sections and what happens in those sections. Open Internet Explorer Open http://www.healthvault.com/hvdemor2/ In a new tab, open https://account.healthvault.com/ and log in with your HealthVault demo account credentials.
3 Pre-Admission In this section, we demonstrate how Brian would allow access to his health information from HealthVault and supply it to MyNYP.org. Talking Points
Patient with CHF is referred by his cardiologist to a cardiothoracic surgeon at NYP for an LVAD implant. The cardiology clinic has a patient portal that allows the patient to get his chart as a CCR; he goes to the clinic patient portal and pulls his chart into his HealthVault record.
Page 3 of 11
Click Steps
Switch to the tab with Brian’s HealthVault record Click the “Health info” tab on Brian’s HealthVault home page Under “See items in this record” click on the “Continuity of Care Record” link
Screenshots
Here we can see some of the information Brian’s cardiologist has put into his account, including things like conditions and medications. Brian can add individual elements from this CCR to his HealthVault record, while keeping the original document intact. So, now Brian has a HealthVault record with the latest information from his cardiologist
Click on “ccr_Welcker_Brian…” to show the CCR in HealthVault
The surgeon’s staff has instructed Brian to preregister at the MyNYP.org site—filling out the required forms at home means one less thing to worry about, and more accurate data in advance for the cardiothoracic surgeon.
N/A
Patient pre-registers at the MyNYP.org site, which guides him through the information he’ll need to collect and provide
Click Continue to begin the process of signing up.
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In preparing for his visit to NYP Hospital, Brian’s information is pre-loaded from his HealthVault record. Patient signs into his HealthVault Account, and allows access to his records from the MyNYP.org site.
Click the Create an Account button
Brian agrees to the MyNYP.org consent form.
Check the checkbox next to Brian’s name. Brian’s name does not come up.
Click Continue.
Brian has been treated at NYP before, and part of the process asks if he’s a current NYP patient; he goes through the patient matching process
Click the Yes button.
Fills information in the patient matching form on the patient matching page Successfully registered, Brian can continue
Fill in patient information for Brian Welcker.
Click the Submit button.
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Now Brian has successfully completed the registration process on the MyNYP.org site and is redirected to the Medical Records page.
Here Brian will be able to enter his pre-admission information on the hospital’s portal by entering necessary information in Brian’s HealthVault Profile.
Here we can see the medications Brian added to his HealthVault record,
And we can also see how we can add other data, such as allergies, into myNYP Any data Brian enters here becomes part of his HealthVault record, which means he can use it in other applications, too.
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Click Prepare for a visit
Scroll down the page and click on Add or delete food or drug allergy This is the page where the Allergies are listed and can be modified or added.
Brian can enter in any other necessary profile information needed for pre-admission by clicking any of the other Profile links. Once he’s done, he has all the information he needs when he visits NY
Click Return To My Medical Records
Click Sign Out to return to the Sign Up page.
4 Post-Discharge Talking Points
After his procedure, Brian is discharged and he returns home. He’s been trained how to care for himself, how to care for his LVAD, how to rehab after surgery, and how to make sure that he maintains his battery charge. He’s also been told he can get all his medical records out of his account on MyNYP.
Page 7 of 11
Click Steps
Click SIGN IN button.
Screenshots
This time Brian isn’t going to be entering/viewing data in his profile, but rather he will be navigating so his visit records that will display details about each of his visits.
Here Brian sees a history of his visits which can be sent as a summary in CCR form to his HealthVault record When Brian has a new visit posted here, he can simply save it to his HealthVault record and it will be available in HealthVault immediately. Brian can also view the details of a visit which is actually a CCR record produced by Amalga. Brian requests his summary, which is viewable in the myNYP.org CCR viewer.
Click View my visit records
Click View record on the Dec 8 – Dec 12, 2008 visit
Click Discharge Summary under Clinical Reports.
Here you can see all the instructions that Brian has coming out of his visit with NYP. Brian can now navigate to HealthVault and view his CCR records and notice that the NYP visit will be listed.
Click My Medical Records in the navigation menu at the top. Click Manage your HealthVault account from the bottom right of the Medical Records page.
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c
If asked to login to HealthVault, use the following credentials: Username: [email protected]
or your given demo account Password: hv.demo
Brian will need to make sure his name is selected.
Confirm that Brian is selected.
Brian can manage other persons and their information that he may have access to such as a spouse’s HealthVault data.
If not, select Brian under the Switch To header.
Click the Health info to get to the patient’s health information.
Click the Continuity of Care Record (CCR) link.
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It’s not just about viewing the data within MyNYP.org, but this data is now portable.
Select the NYP visit.
Here is a CCR from Amalga UIS created by NYP Hospital that contains all the information that Brian could see before on the MyNYP.org site.
Scroll through the details of the CCR to display Discharge Instructions that were displayed on the MyNYP site.
Everything that comes out of that CCR record is now available for future use. Brian can integrate elements of the CCR (such as medications, ECG reports, or Discharge Instructions) into his HealthVault record. The difference here is while two institutions may want to exchange standard documents such as a CCR (useful for communicating from one hospital to another), Brian may specifically and discretely add data into his HealthVault record so the it is available to other HealthVault applications.
Page 10 of 11
Click the Integrate link under the Integrate data column in the grid.
When it’s time for a follow up with the cardiologists at NYP, Brian can quickly pre-register by signing into his myNYP.org account; because he’s used the service before, his data is pre-entered, so the adjustments to medications, etc, made by his cardiologist are automatically reflected
This concludes the MyNYP.org HealthVault demonstration. The example companies, organizations, products, domain names, e-mail addresses, logos, people, places, and events depicted herein are fictitious. No association with any real company, organization, product, domain name, email address, logo, person, place, or event is intended or should be inferred. © 2008 Microsoft Corporation. All rights reserved.
Page 11 of 11
Microsoft HealthVault Demo System HealthVault - Emergency Case Microsoft Corporation Published: February 2009
Summary This demo walks through some of the capabilities of HealthVault used in an emergency scenario Role:
Family caretaker, patient
Personas:
Henriette, Mary
Table of Contents 1 2 3 4
Value, Scenario, Story, Roles, Processes .............................................................................................. 2 HealthVault login..................................................................................................................................... 3 Emergency Case – Heart 360 ................................................................................................................ 3 My Vital Data .......................................................................................................................................... 5
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected].
© 2008 Microsoft Corporation. All rights reserved.
1 Value, Scenario, Story, Roles, Processes Amalga Value:
In this demonstration scenario we highlight the value of HealthVault, for both the patient and provider, in support of an emergency health episode.
Demo Scenario:
HealthVault – Emergency Case
Questions to tailor demonstration to audience pain / requirements?
•
Demo Introduction / Story:
In this scenario, we’re following two personas: a woman caring for her elderly mother, living alone a few hours away. The woman has been increasingly involved in mom’s care, to the point of finding her in-home care a few times a week. Mom’s generally doing OK for her age, but has a host of minor chronic problems, such as arthritis, and a family history of stroke. With help from her daughter and the visiting caregivers, mom keeps track of a few things using HealthVault-compatible devices, such as her blood pressure, weight, and steps. She also notes her cholesterol readings.
•
What information is available to your clinical team when treating an emergency patient who is not affiliated with your hospital? What steps are you taking to better equip your emergency department with the information they require to deliver best practice care?
One day, with the woman at work, mom has a seizure and 911 is called. This is where the scenario picks up.
Role(s):
Healthcare Executives / Clinicians Consumers / Patient
Processes:
Emergency Care Home Care & Remote Management
HSG Customers who have implemented similar scenario:
New York Presbyterian Consumers using Heart360 Consumers using MyVitalData
© 2008 Microsoft Corporation. All rights reserved.
2 HealthVault login Talking Points
Begin by logging in to the demo HealthVault account.
Click Steps
Screenshots
Log in to HealthVault by visiting the following site: https://account.healthvault.com
Enter the following information:
User name: [email protected] Password: hv.password
Switch to Mary’s account
Click Mary on the left
3 Emergency Case – Heart 360 Talking Points
Henriette, the daughter and caretaker of Mary, is using HealthVault to track information about her mother. From their family HealthVault account, Henriette is able to manage her mother’s information as well.
Click Steps
Start by visiting the Heart 360 site by clicking the American Heart Associate link on Mary’s page
© 2008 Microsoft Corporation. All rights reserved.
Screenshots
Heart 360, which is sponsored by the American Heart Association, allows us to track and view her health information including blood glucose readings, cholesterol, blood pressure, medications, weight, and physical activity.
If prompted to sign in, use the same Live login: User name: [email protected] om Password: hv.password Your login credentials may differ The banner should say “Welcome, Mary” if not, click Change User and select Mary
Looking at her Blood Pressure, we can see all the readings over the past month
Click My Tools Click Blood Pressure Select Table & Consolidated Chart Select Last 3 Months Click View Please note: there is no data here for this time frame. Suggest going directly to 6 months.
© 2008 Microsoft Corporation. All rights reserved.
All this data can be charted in a variety of ways over multiple time periods
Select Table & Consolidated Chart
Select Last 6 Months
Click View
Once Henriette is finished in Heart 360, she can easily return back to HealthVault to look at other information
Heart 360 should have opened in a new IE window. Leave the window open, but return to the open HealthVault window. If this is not open anymore, visit the following link and return to Mary’s page: https://account.healthvault.com
4 My Vital Data
My Vital Data is a service from a HealthVault partner called Vital Data Technologies. This service allows Henriette to collect all the vital data that would be needed in an emergency situation that can be made available to over 4000 service providers, including emergency care providers Providers who do not have a registered MyVitalData account are even able to called a 1-800 number, verify themselves, and obtain the necessary information for a patient.
From Mary’s HealthVault page, click the MyVitalData From the MyVitalData page, click MyAccountLogin Above the Customer Log-in section is a link for HealthVault users – click where it says Here If prompted, enter your credentials Username: [email protected] Password: hv.password
© 2008 Microsoft Corporation. All rights reserved.
Looking under Account Management (img 1), we can see all the profiles managed by this account (img 2)
Mary has been feeling well today, but later, while a neighbor is visiting, she has a seizure. The neighbor calls 911, and since Mary has her MyVitalData card in her wallet, they’re able to pull up her information
All the information in MyVitalData is pulled from HealthVault allowing for a single repository of data, eliminating the need to enter and manage data in multiple locations. Here, the hospital or emergency services can see any medications she’s on, allergies, and current doctors
Additionally, MyVitalData picks up the emergency contact numbers and can automatically notify Henriette via phone or SMS MyVitalData can also retrieve Mary’s insurance information
Click Account Management Scroll to bottom to see Profiles section
Click Vital Data
© 2008 Microsoft Corporation. All rights reserved.
Once Mary has been notified, she wants to get the latest information on her mother, so she goes back to Heart 360 to print off some reports.
Leaving the MyVitalData tab open, return to the Heart 360 tab. Click Generate Reports
This report generator allows Mary to generate a report using Heart 360’s format. The data Mary and Henriette have been tracking and recording in HealthVault is automatically pulled. The report is generated in an easily-printable PDF format. Her core information, family history, medication history, charts of blood pressure and other readings, and other vital information are all displayed in the report.
Uncheck blood glucose
Select Last 6 Months for the date range
Click Create Report
Go to the following link: http://www.healthvault.com/ hvdemor2.com
This does not work as scripted
Using her MyVitalData and her Heart 360 report, doctors are able to rapidly confirm that Mary has suffered a stroke With a confirmed diagnosis, Henriette can now focus on admitting Mary to the hospital This can be simple if we have a hospital using PreAdmission built around HealthVault.
© 2008 Microsoft Corporation. All rights reserved.
Coordinated Care Demo Scenario Amalga UIS – HealthVault Coordinated Care Microsoft Corporation Published: Version History: Created by C. Glenz and J. Leviss 2/7/11 version 1 2/11/11 version 2 2/13/11 version 2.1 2/15/11 version 2.2 4/9/2011 version 3
For additional information on Microsoft Amalga, please visit http://www.microsoft.com/amalga. Comments, questions, and feedback may be directed to [email protected] or [email protected]
© 2008 Microsoft Corporation. All rights reserved.
1 DEMO SCENARIO Demo Scenario:
Amalga UIS – HealthVault Coordinated Care Demonstration
Amalga / HealthVault Value:
In this demonstration scenario, we will demonstrate: caregiver, patient and consumer communication and collaboration.
Questions to tailor demonstration to audience pain/requirements and longterm enterprise goals?
Demo Introduction / Story:
What are the key changes to clinical processes that you have prioritized to ensure a coordinated care strategy? How will you empower patients and their caregivers to improve care and promote wellness?
In these scenarios, we highlight the approach to improve on the care of a two chronic disease patients. We will show key activities possible to engage and manage these patients and their families in their own care.
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Role(s):
Primary Care Physician Nurse Case Manager Patient and Family Member (Custodian of care)
Processes:
Medical care for chronic patient Case Management for high risk chronic patients Patient empowerment to manage their own health & wellness with family member assistance.
HSG Customers who have implemented similar scenario:
New York Presbyterian Mayo Clinic
DEMO SETUP 1.1 Log in to Microsoft Amalga In this section, we log in to Microsoft Amalga to set up the demo Talking Points Login to Amalga UIS
Click Steps
Screenshots
Select R2SP2 under the “Demonstrations” menu selection Login to Amalga UIS Userid: demo\ Password: HSGP@ssw0rd
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2 Amalga UIS – HealthVault Coordinated Care Talking Points Introduction
Connected health- bringing together information from across the healthcare ecosystem. Access to longitudinal patient information gives providers the ability to make informed decisions, improve care, and promote healthier lifestyle. Amalga creates a data asset. The value is: Agility – the technology can grow with your strategy; Future flexibility – the power of MSFT; Democratization of data / reusability of data; Deliver assets that allow you to quickly deploy apps
Click Steps
Screenshots
PPT: Amalga UIS – HealthVault Coordinated Care
PPT: Amalga UIS – HealthVault Coordinated Care
PPT: Amalga UIS – HealthVault Coordinated Care
First scenario Begin in Amalga
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Providers have view of all patients.
Select Alexander Bogue in patient list- Visuals view
(Shown: Inpatients)
Ready access to comprehensive data (including images) to improve quality of care.
Click Info to expand detailed patient view
Chronic diabetic patient, poorly controlled diabetic, with multiple infections and resultant surgeries.
Click on Diagnosis and Procedures
Quick view of all orders. Prevents duplication of exams, and provides overview of orders from all providers.
Click on Orders
View of lab values from current visit or all patient episodes is possible.
Click on Labs
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Amalga is versatile and includes metadata that gives meaning to results.
Click on Heme then WBC result to bring up Lab details
Different reference values are shown as well as trending in this patient related to diabetic management and compliance.
Click Merge, then Graph and Space points equally Highlight highest data point to show metadata. Click cancel to close graph and cancel again to close table.
Full history of images:
Click Images and scroll to bottom to display foot xrays
Along with ability to manipulate and view images in unique ways
Show Image viewer and other images across top
Radiology report immediately available without leaving image viewer.
Click Report in top upper corner to show report. Click X to close report and X again to close viewer.
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Ability to see EKG waveform data and scanned documents.
Click EKG to show electronic and scanned tracings.
Patient information can be sent to and received from HealthVault to maintain up to date patient information.
Click HealthVault to show connection and data to be downloaded to Amalga.
Describe HealthVault: Patient has own HealthVault account.
Sign into www.healthvaultppe.com with [email protected] as ID and amalga@15 as password.
Patient can include family members in HealthVault account.
Show Alexander Bogue and his wife Mona, on same account
Health information is entered and maintained by patients and/or custodians of care. Information may also be shared with authorized partners in one or more PHR’s.
Show Mrs. Bogue’s own account.
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Easy to use interface for patients to see and enter information.
Click Switch to Alexander and Health Information. Show Alexander’s Health Information summary
At provider’s request, information can be entered and then either uploaded or printed out to share with provider.
Click on Blood Glucose Measurement. Show August 24-27, 2010 that blood glucose measurements done 2 x/day.
Management of OTC and prescribed medications to ensure all medications are noted and avoid ADR or potential side effects.
Click Health Information again then Medications.
Providers can send patient records (meds, allergies, diagnoses, etc.) to HealthVault account. Patient can incorporate all information or limit what is included. Key: Patient has control.
Click Continuity of Care Record and show additions can be made to record. Families like Alexander have similar needs. One person manages care for the family. In this instance, Alex and Mona have better control of his diabetes and the healthcare team is better informed.
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Second Scenario: Return to Amalga to begin it.
Providers have view of all patients.
Select Shelley Papenfuss in patient list- Visuals view
(Shown: Inpatients)
Ready access to comprehensive data (including images) to improve quality of care.
Click Info to expand detailed patient view
Chronic cardiac patient, with Acute MI shown.
Click on Diagnosis and Procedures
Quick view of all orders. Prevents duplication of exams, and provides overview of orders from all providers.
Click on Orders
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View of patient’s PMH can reveal pertinent history that influences care decisions.
Click on Past Medical History
View of lab values from current visit or all patient episodes is possible.
Click on Labs
Scanned documents can be viewed by document type or by visit date.
Click on Scanned documents
Images are quickly available along with radiology reports which can prompt appropriate care decisions.
Click on Images, scroll down and pick CXR.
Dictations provide summary information that is not readily available from other sources but key to patient care.
Click on Dictations
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Patient information can be sent to and received from HealthVault to maintain up to date patient information.
Click HealthVault to show connection and data to be downloaded to Amalga.
Patient has own HealthVault account.
Sign into www.healthvaultppe.com with [email protected] m as ID and amalga@15 as password.
Patient can manage his/her own information in HealthVault.
Show Shelley’s Health Information summary. She only has access to her own acct.
Easy to use interface for patients to see and enter information.
Click Health Information.
Patients can share information with a trusted family member or friend. Email link sent and can be accepted or rejected.
Sign into www.healthvaultppe.com with [email protected] as ID and amalga@15 as password.
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Custodian has own HealthVault account as well as relative’s account.
Show that Jill has access to both her and Shelley’s account.
Easy to switch from personal account to custodial account.
Switch to Shelley from Jill’s account. Then click to show Shelley’s Health Information Summary.
Patient has power to include or exclude any information or make it private.
Click on Conditions, then on details.
Management of OTC and prescribed medications by custodian to ensure compliance.
Click on Medications.
View of patient’s PMH can reveal pertinent history that providers should know.
Click on Family History.
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Care management easily supervised by custodian and can be reported to provider for follow up care.
Click on Blood Pressure Measurements. BP taken at Walmart May 6 to May 10 when discovered she had stopped taking her medication and was restarted.
Seemingly minor details are considered important and can be monitored.
Click on Weight
PHR partner sites can use information such as this to calculate BMI.
Click on Height
Blood pressure and weight management devices can be linked to HealthVault to track progress.
Click on Home and then see health sites that work with HealthVault. Click on Device tab. Scroll down to Omron for Pedometer and Blood pressure devices.
Patient can choose from more than 50 partners for tools to assist then in ongoing care.
Click on X to close that window and then got to HealthVault again as Shelley Papenfuss. Sign in as [email protected] m as ID and amalga@15 as password.
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One of partners targeting cardiac patients is the American Heart Association.
Using the same ID and password makes it easy for the patient and caregivers to remember.
These partners can also provide additional educational and preventive care knowledge for the patient.
In this scenario, we’ve demonstrated how you can use Amalga and HealthVault.
Show American Heart 360 icon.
Sign into http://heart360r3.qa2.grcdemo .com/Patient/MyHome.aspx with [email protected] as ID and amalga@15 as password.
Show information that is there regarding Shelley’s Blood pressure and medications. Shelley and Jill have increased role in care, control of her hypertension, and medication compliance. PPT: Amalga UIS – HealthVault Coordinated Care
Consumers play a greater role in directing their healthcare. Providers have real time information to impact care delivery. Innovation to provide additional tools to engage patients and their families in 14
ongoing and preventive care.
Questions?
PPT: Amalga UIS – HealthVault Coordinated Care
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