meditech 6.x rules: changing "working as designed" to "working as desired"

MEDITECH 6.X RULES

CHANGING “WORKING AS DESIGNED” TO “WORKING AS DESIRED”

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Confidential © 2015Galen Healthcare Solutions

*Kelly Del GaudioPrincipal Consultant with Galen Healthcare Solutions

Over 10 years of experience with MEDITECH’s Clinical Product SuiteWorked to roll out 6.x to beta hospitals in the US and UKMember of the Advanced Clinical Performance Team aka SWATResponsible for extensive training on 6.x Rules EngineImplemented Telemedicine Solutions for Enterprise Health SystemsClinical IT Consultant, Project Manager, Full Time Nerd

Today’s Presenter

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Confidential © 2016 Galen Healthcare Solutions

• What is a Rule?• What types of rules can be built for PCS, PCM and OM?• Basic Rule Logic• Rule Writing for Patient Care/Patient Safety

• Message, Calculate, Skip, Require, Suppress, Combination• Rule Writing for Physician Care Manager

• Message, Calculate, Require, Suppress, Combination• Rule Writing for Order Management

• Order, Order CDS Rules• Troubleshooting your Rule• Q&A

Today’s Agenda

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-Learning how to think logically about writing rules

-Identify where rules can alleviate frustration with clinical staff

-Learn how to combine different types of rules to achieve desired outcomes

-Basic rule writing skills for PCS, PCM and OM

-Troubleshooting hints, tips and tricks

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What is a Rule?Design Philosophy of the MEDITECH Rules Engine

- Reduce Clicks- Drive Care- Add Clinical Decision Support- Streamline Documentation and Ordering

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The MEDITECH 6.x Rules Engine

Path: CLINICAL-DICTIONARIES-ORDERING-RULE

Main Tab:

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Variables Tab: Every element of a rule has a value associated to it which is sometimes represented by a variable.

Internal Variables act as place holder inside the rule

External Variables represent queries or elements in the documentation:

Example: if you are wanting the result of a fall risk score, your questions: Mental Status, History of Falls, Activity etc would all be External Variables (A, B, C) These must later be mapped in the documentation section dictionary to their respective questions. The result of the score is an internal variable (D)

Variables need to be converted to the correct format (if any) before they can be used.

Example: If your variable is going to be linked to a group response, you must first convert the variable to the part of the group response you want to evaluate: Name, Value or Rank.

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Variables Tab: Fields

The Category on the Main Tab drives the fields lookup

If you are writing an OM Rule you might incorporate OM fields

If you are writing a Rule that evaluates registration intake, choose the Reg Category

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Variables Tab: Queries

Queries are only used when writing rules for CDS’s

Because CDS’s are built differently than Documentation Sections, their rules must also be built differently.

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Rule Tab: Selection Boxes

Expression- Compute or Calculate

Message- FYI or Critical/ Yes, No or Multiple Choice

String Manipulation: Join, Extract, Reformat, Finds Length, or Locates

If/Then: IF/THEN; IF/THEN/ELSE; IF/THEN/ELSE IF Typically used with operators:(exists, is equal to, is not equal to, is greater than etc)

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Types of Documentation Rules

Message Rules

Today’s Example: Pulse outside normal range for patient’s age presents FYI warning flag that display’s the patients age.

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Calculate Rules

Today’s Example: Surprise! It’s not a score!

Although many calculate rules can be used for scores, we are going to use the calculate function to default answers to a Neurological assessment based on normal limits. (WNL)

We will also address copying/editing rules to streamline build time!

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Types of Documentation RulesSkip Rules

Today’s Example: We will use a skip rule in combination with our calculate rule to not only default answers based on a response but make those answers uneditable based on hospital protocol.

This will demonstrate that questions on an assessment can have more than one type of rule attached, an important concept to advancing your rule skill set and overriding system restrictions.

*PCS ONLY

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Require Rules

Today’s Example: In sticking with our Neuro Physical we will now see how to require additional documentation if the patient does not fall within normal limits

This will demonstrate that Skip and Require rules can be built and used interchangeably in the system.

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Suppress Rules

Today’s Example: Suppress Documentation Smoking Status to patients over 10

Suppress Rules are the only type of rule that are evaluated and executed when a screen is opened, therefore only preknown data like age, sex, medical conditions, allergies, user types, etc can be the driver behind suppressing questions.

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Combination

Today’s Example: Force a Provider to add a Patient Problem before the patient can be discharged.

This PCM Rule uses a combination of two rules to achieve the desired outcome. The first rule adds confirmation text that a problem has been added to a patient. The second rule requires the text confirmation to proceed with the discharge.

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Types of Ordering Rules

OM Order

Today’s Example: Recommend also ordering a lipid panel with a Niacin medication order if a patient has an active problem of Coronary Arteriosclerosis and no recent test results

This order rule displays how a rule can evaluate the patients problem list and look at recent test results to add suggestions in an ordering session.

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Types of Ordering RulesOM CDS Rules

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Types of Ordering RulesOM CDS Rules: On Entry

Today’s Example: Flag a user that they are attempting to order a high cost drug and recommend an alternative

Not only is this Rule a money saver, it shows a great work around for adding CDS rules to Med Orders.

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Types of Ordering RulesOM CDS Rules: On Exit

Today’s Example: When transferring a patient from one location to another, reminder protocol can be embedded into a message based on the location chosen.

Clinical staff sometimes get busy, adding helpful reminders that are specific to the task at hand (transferring the patient) can make sure nothing gets missed!

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Types of Ordering RulesOM CDS Rules: Valid Response

Today’s Example: When transferring a patient from one location to the next we can define which locations patients can’t transfer to in the hospital.

Use the OM CDS Valid Response field in combination with NewQueryRepsonse in the Rules engine to define what will and will not let you proceed with an order (in other words: what is the NOT a valid response)

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Types of Ordering RulesOM CDS Rules: Default

Today’s Example: Drug Abuse Screening tool

Using default messages to pop up when ordering allows you to insert protocols to guide providers

These protocols can significantly reduce costs by making providers conscious about what they are actually ordering.

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Troubleshooting RulesUse Messages

Many times you are trying to evaluate a value that is stored in the system in another format.

For example, age is stored as YY.MM.DD so if my criteria is to include patients 6 months or less, my range would be 00.00.00 through 00.06.00

Use a message to display how the value is stored and then change your rule accordingly

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Troubleshooting RulesBuild, Test, Repeat

If you write a complex rule that’s more than 10 lines, chances are it’s not going to work right off the bat.

Our recommendation is to build, test, repeat until you achieve the desired outcome!

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Troubleshooting RulesOther Common Problems: Converting Values

Convert: Sometimes your query needs to be converted in order to be evaluated in a rule

Group Responses also need to be converted to either Name, Rank or Value

Temperature, Height and Weight all need to be converted to the form you want to evaluate (Fahrenheit or Celsius/English or Metric)

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Troubleshooting RulesOther Common Problems: Group Multiples

Create List: When Creating a “calculate” rule to populate an answer to a group multiple question, use create list

Series Sum: When adding up Group Multiples in a score make sure to use series sum

Offsets: Group multiples or Yes/No Comment queries need to be built with offsets in order for the rule to execute! Lets take a look at an example

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Troubleshooting RulesOther Common Problems

This Functional Status Rule is

evaluating group multiples

PS= Prior Status

CS=Current Status

The system needs to know the

order in which the values are

selected in order to execute the

end result.

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Troubleshooting Rules

Still Stuck?!

Ask me about Operation: Nerdy Work and get on the fast track to a more

efficient system.

Or email your questions to:[email protected]

mailto:[email protected]


SOLVING FOR TODAY. PREPARING FOR TOMORROW.

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