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TRANSCRIPT
Analysis and Recommendationsof the Billing Process for
Pediatric CardiologyFinal Report
December 16, 1996Industrial and Operations Engineering, Hospital Practicum
University of Michigan, Ann Arbor
by:Melissa Petrucci
Gary SchwartzbardC. Elena Szymanski
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Table of Contents
Executive Summary - Page 2
Introduction Page 3
Background Page 3
Purpose Page 3
Method Page 3
Current System Page 5
Alternatives Page 5
Findings Page 6
Conclusions Page 8
Recommendations Page 9
Action Plan Page 11
Appendix Page 13
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Executive Summary
This report will focus on the billing process for Pediatric Cardiology at the University of Michigan MedicalCenter. The motivation of the project is to achieve 100% billing of non-invasive procedures, minor procedures, andcatheterization laboratoxy hospital charges. With this goal in mind, we will look to improve the accuracy of thecharge ticket information and increase the efficiency of the billing process. Obtaining 100% billing is not onlyimportant because of the loss of charges but also from a budget standpoint. The division’s hospital budget is basedon the number of procedures that are billed. Therefore missed billing also reduces the division’s hospital budget.This report will illustrate the current system and define the problems through the analysis of data for the month ofJuly.
In the current system, for each patient that enters the clinic the clerk creates a charge ticket. On this ticketan office visit charge as well as any necessary procedural activities should be identified by placing a check in theappropriate box. All of charge tickets are located at the nurses station. At the end of each day the charge tickets arecollected and entered into the University’s billing system the following morning.
The first step in our approach to improving the billing process was to identify how many procedures werenot being billed. More specifically we wanted to find out which laboratories were affected and the financial impactof the missed procedures. The time period from 1, 1996 through July 30, 1996 was audited.
The first aspect of billing that was looked at was the general office visit. However, the Medical ServicePlan (MSP) component will not be addressed either in the process nor in the lost charges because the necessarypatient specific data was not available. The MSP portion of the billing should be reviewed in the future.
Next, the laboratory procedures were analyzed for lost billing. The echocardiogram report and the logbooks were then compared against the Falcon billing sheets for each patient. The days surrounding the date ofservice were also checked to ensure the patient’s billing had actually been missed and not posted on a later date.Patients that had procedures that were not billed were identified.
This analysis revealed that the division does not bill for all procedures performed but the reason why stillremained in question. The problem had to be further identified. For each patient that had not been billed, theircharge ticket for the date of service in question was reviewed. Three possible situations were found. First there wasno check mark in the box. This clearly shows the patient was not billed because the person who performed theprocedure did not mark it. Secondly, there were many cases in which the procedure had been checked but had notbeen billed. This was attributed to a data inputting error. Lastly, the charge ticket was missing. The cause of this isalmost impossible to identify. Since for the echocardiogram laboratory a list of reports that were generated was usedin place of the log books, an additional check was performed to ensure the validity of the data.
Using the data we analyzed for the targeted procedures we have found that Pediatric Cardiology is onlybilling 89% of their procedures. The total amount of monetary facility charges that has been found to have been lostbased on the audit of July’s activity comes to a total of $28,085. Assuming that July is fairly representative of anaverage amount of activity the total charges lost over the span of a year would equal $337,020. The actual loss tothe clinic is more than shown due to the fact that the expense budget provided to the division from the University ofMichigan Hospital is based on the activity that is billed.
After close scrutiny and meticulous collection of all of the data it has been determined that an electronicbilling system directly tied to the billing system of the University of Michigan should be implemented. This type ofsystem is currently used for 80% of the billing at the Hospital. There are some problems that are inherent to anelectronic system. These problems are not a common occurrence and can be remedied if the proper backups areinstituted.
The log books should be electronic and be the point of entry for a charge to be electronically sent to theUniversity’s billing system. This is the only possibility that would eliminated the three sources of missed billing. Itwould also reduce the workload as well as offer additional capacities.
The action plan for the system would begin with the benchmarking of a current system. From here all of thenecessary fields and functionality needed for the Pediatric Clinic would have to be identified. The interaction withother software both within the clinic and with the Hospital will also need to be recognized. Once this preliminarydesign has been completed the system must then be designed, tested, implemented, and maintained. All users shouldalso be trained.
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Introduction
This report will focus on the billing process for Pediatric Cardiology at the University of Michigan Medical Center.It will illustrate the current system and define the problems through the analysis of data for the month of July. Themethod for this study and the conclusions reached will also be included. Finally, in consideration of all the data, arecommendation will be made and an implenientatIon plan will be provided.
Background
Over the past few years, Pediatric Cardiology has been attempting to identify an efficient billing process. Thecurrent system uses a charge ticket that has information about a patient as well as the procedures that wereperformed. When a patient has a procedure performed the appropriate box is to be checked off.
The billing process is composed of two components. The University of Michigan Hospital side (facility) and theMedical Service Plan (MSP) side. At the request of our client, an audit of missed billing for the office visits will bedone. However, the MSP component will not be addressed either in the process nor in the lost charges because thenecessary patient specific confirmatory data was not available from the MSP billing office. The scope of the projectwas limited to the Hospital billing aspect and the true loss may actually be more because of the omission of the MSPcomponent.
Achieving 100% billing is not only important because of the loss of charges but also because of budgetconsiderations. The division’s hospital budget is based on the number of procedures that are billed. Thereforemissed billing also reduces the division’s hospital budget.
Purpose
The motivation of the project is to achieve 100% billing of non-invasive procedures, minor procedures, andcatheterization laboratory hospital charges. With this goal in mind, we will look to improve the accuracy of thecharge ticket information and increase the efficiency of the billing process. The systems involved are the billingprocess and possibly the procedure log books. Along with the modification of these processes, the responsibilitiesof the employees may shift under a new system. Our final outcome will be a recommendation for a more efficientbilling process for Pediatric Cardiology. The major implication of this process will be the elimination of lostcharges. Additionally, the hospital budget will be reflective of the true workload of the unit.
Method
The first step in our approach to improving the billing process was to identify how many procedures were not beingbilled. More specifically we wanted to find out which laboratories were affected and the financial impact of themissed procedures. Our client suggested that we audit the month of July and provided us with the necessaryinformation for July 1, 1996 through July 30, 1996. The hospital billing data for July 31, 1996 was not available.Although July is a change over month it should not have influenced our data since the technicians, faculty, and dataentry positions did not change.
The first aspect of billing we looked at was the general office visit. Each patient that came into the clinic shouldhave an office visit charge. Since the specific patient billing data needed from the billing office was not available,
( the patient’s charge ticket was used. The clinic scheduling sheets for July were also used because they containedevery patient that arrived for an appointment. The patients that were marked as cancelled or as “no-shows” weredisregarded. For each patient that arrived their charge ticket was reviewed to see if a consultation or return visit box
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was checked for the given date of service. All office visits that were not billed were identified to be either asmissing the entire charge ticket or missing the check on the charge ticket in the related box. For each missing ticketor missing charge on the ticket the name of the patient, the resource, the date, the time, and the day of the week werenoted. Our client will follow up with the billing office to verify these charges are not in the MSP system.
Next, the laboratory procedures were analyze.d for lost billing. The most accurate account of the activity in theselaboratories was identified to be the log books, with the exception of the echocardiogram lab. With the help of Dr.Vermillion, it was decided that the most complete data was that of the reports generated for the echocardiogramprocedure. The log books from the other labs and list of patients from the echocardiogram lab that had a reportgenerated for the month of July were used. A copy of the Falcon billing compiled by the University of Michigan’sbilling system was also used. It contained names and procedure descriptions for every patient that had a laboratoryprocedure billed during the month of July. The echocardiogram report and the log books were then comparedagainst the Falcon billing sheets for each patient. The days surrounding the date of service were also checked toensure the patient’s billing had actually been missed and not posted later due to a technician delay, a data entry erroror an inefficiency in the University’s billing system. Patients that had procedures that were not billed wereidentified. Since our data only went until July 31, 1996, our client is currently checking to see if any of the patientsthat are identified as having procedures that were not billed may have been billed at a later date.
This analysis revealed that the division does not bill for all procedures performed but the reason why still remainedin question. The problem had to be further identified. For each patient that had not been billed, their charge ticketfor the date of service in question was reviewed. Three possible situations were found. First there was no checkmark in the box. This clearly shows the patient was not billed because the person who performed the procedure didnot mark it. Very infrequently there was a check mark that was hard to identify. It was either very faint or it wasnot in the box and was difficult to tell which procedure was checked. This error was also attributed to the personperforming the procedure. Secondly, there were many cases in which the procedure had been checked but had notbeen billed. This was attributed to a data inputting error. Lastly, the charge ticket was missing. It is almostimpossible to identify the cause of this.
Since for the echocardiogram laboratory a list of reports that were generated was used in place of the log books, anadditional check to ensure the validity of the data was necessary. Dr. Vermilion looked over the list of missedbilling and compared it to the log books to make sure that the procedures were supposed to be billed. An additionalfactor that was checked was that each patient identified had a valid name and a valid report.
There is a safeguard in place in the current system in which the person is to indicate in the log book that a procedurewas checked on the charge ticket. To evaluate the effectiveness of this, for those patients that were not billed for theprocedure and the corresponding box was not checked on the charge ticket, the log book was again looked at. Thosethat were marked as having been checked on the charge ticket but in reality had not been checked were identified.In the case of the echocardiogram laboratory, the actual log books were looked at to see if the technician had placedan “M” or an initial in it, indicating that it had been billed.
Using the gathered information we were able to identify the procedures that needed to be targeted. Severalprocedures were eliminated from our project. The catherterization laboratory and minor procedures were not lookedat further because all of their procedures were checked and they appeared on Falcon. The ProTime procedure wasalso ignored because the procedure did not generate a facility charge. The ECG-UH procedure was also notaddressed because it did not appear on the Falcon billing sheets. Lastly the Holter analysis procedure was notincluded because of the variable and possibly extensive time period from the beginning of a test to the end of it.Although these procedures are not specifically addressed in this report the recommendations provided are for theentire clinic and would apply to these procedures as well.
Interviews with the employees of Pediatric Cardiology were also conducted. The interviews were done withdifferent positions throughout the division so as to receive information from different perspectives and because the
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new system will most likely affect staff in many areas. Members of the faculty, such as Dr. Rosenthal and Dr.Vermillion, provided much guidance as to how the division’s billing process works now and how it should ideallywork. We also met with Mike Pearistein, a senior laboratory technician. He helped to document the technician’srole in the current billing process. We frequently met with Dorothy Nalepa, our client. She helped us to attain andcompile the information as well as provided us with direction.
The results of the data from the remaining laboratories was then tallied and entered into a spreadsheet using Exceland charts were made to graphically represent the findings.
The information regarding the process flow that was collected through interviews was then documented. The flowof the charge ticket for each of the procedures was flow charted using Visio software. The flow charts may be foundin Appendix C.
A rough layout of the clinic was drawn in Visio. This was done so that the interaction between the charge ticketlocated at the nurse’s station and the various laboratories could be shown. This drawing may be found in AppendixD.
Current System
For each patient that enters the clinic the clerk creates a charge ticket. On this ticket an office visit charge as well asany necessary procedural activities should be identified by placing a check in the appropriate box. The person thatperforms a procedure is responsible for marking the charge ticket accordingly. All of charge tickets are located atthe nurses station. After the charge ticket is marked for the procedure performed the log books should be markedwith an M or an initial to indicate that the procedure was billed. For the echocardiogram lab throughout the day, astim& permits, the log books are compared to the charge tickets and the log books are marked indicating that theprocedures were billed. The flow of the billing process and the interaction with the charge ticket that is presently inplace has been documented for each of the targeted laboratories. The charts are included in Appendix A.
The most accurate account of the patients activity are the log books. Each procedure and in some cases, i.e. theechocardiogram lab, each machine has it’s own paper log book that is located in the appropriate room. Thetechnicians manually log in each patient.
At the end of each day the charge tickets are collected and entered into the University’s billing system the followingmorning. The day after they have been entered the division will receive two reports. One of which is an error reportspecifying any inconsistencies that were detected. These errors are then at this point to be corrected. The secondreport is the accepted procedures that have been posted to a patients account. Recently the clinic has instituted aprocedure to check the charge tickets that were entered the day before to the report of charges posted. Any of theprocedures that were missed are to be put in. This causes some problems because the system may simply not haveprocessed a patient and the patient may be billed twice if another charge is entered.
Alternatives
Their were two paths that we felt that we could follow in our recommendations for Pediatric Cardiology. The firstwe considered was to carefully examine the process that we had charted. We brainstormed many alternatives forthis type of direction. Possibly come up with standard procedures that must be followed for each laboratory. Placereminders or checklists in each of the laboratories. Examine the flow of the process and find the trouble spots in theprocess and fix them. Implement some type of a double checking throughout the process. Possibly even scratch theentire process and come up with a new one or revert back to a variation of their previous system in which the chargeticket followed the patient’s chart. This alternative could significantly reduce the technician error but could not
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absolutely eliminate it, nor could it eliminate the problems of data entry error or missing charge tickets. It wouldalso create more work that would need to be distributed.
The second path we saw was one that would take considerably more effort to develop and implement but would bedramatically more efficient than any other. It would also reduce the workload of the clerk, technician and data entrypersonnel. This path was to automate the process electronically by having the log books be on-line and having thembe the point of entry for a charge to be electronically sent to the University’s billing system. This would eliminatethe technician error since it would no longer be necessary to go find the charge ticket to check off. The datainputting error would also be eliminated because this part of the process would be removed. This alternative was notwithout hesitations. The development of such a system would be time consuming to develop and then to maintain.It would also be something that would be very unfamiliar to the entire clinic.
Findings
After the data had been compiled it became clear that something strange had occurred on July 22, 1996. Almost allof the procedures that had occurred on that day had not been billed. This significantly altered the data and did notcontribute to helping us identify the standard causes of missed billing. Statistically the date in question was anoutlier and was eliminated to show a more accurate representation. The findings that include this date can be foundin Appendix B. Except for this Appendix, the recommendations and findings in the report do not include this date.This does bring about the possibility that the data used may have slightly more missed billing than actually shownbecause what was meant to have been billed on that day is not known.
The data in Table 1.1 shows a breakdown of the procedures that were not billed by the specific laboratories. Theactual number may be found in Appendix A. The echocardiogram laboratory is losing the greatest number ofcharges, but all of the laboratories must be considered. The fmal recommendation will apply to them all..
Total #Procedure Performed
Oxygen Saturation 118Transtelephonic 28
Echo 389EKG 502Pace Maker 21AnalysisExercise Lab 18Catheterization 42Minor Procedure 22
TOTALS 1140
Not checked on Charge Ticket
NotChecked in Checked inLog Book Log Book
5.1% 5.9%0.00% 0.0%3.1% 2.1%8.0% 0.0%
0:00% 4.8%
N/A N/A0.0% 0.0%N/A N/A
5.1% 1.4%
Table 1.1 Laboratory Procedures Percentages That Were Not Billed
C.6
The Graph 1.1 show the percentage of the not billed charges in the month of July versus those that were billed.
Graph 1.1 Percentage ofNot Billed Charges
Graph 1.2 graphically displays a further breakdown of the reasons behind the not billed charges.
Graph 1.2 Breakdown of the Not Billed Charges:
July ChargesTotal Not
Billed11%
Billed89%
Not BilledMissingTicket Checked on11% Charge
Ticket31%
NotChecked on
ChargeTicket
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Graph 1.3 displays the reasons behind the charges not billed by procedure.
Graph 1.3 Breakdown ofNot Billed Charges by Procedure
The data in Table 1.2 shows the number and percentages of the office visits that were not billed for in the month ofJuly.
Table 1.2 Office Visits Not Billed
Missing Charge Tickets Not Checked Total VisitsNumber 27 6 531
Percent 5.1% 1.1%
Conclusions
Using the data we analyzed for the targeted procedures we have found that Pediatric Cardiology is only billing 89%of their procedures. We have attributed the remaining 11% to one of three reasons. First is the technician error.This is the case when a charge is missed because the procedure was not checked off on the charge ticket. Secondlycharges could be missed due to a data inputting error. The procedures were marked on the charge ticket but notentered into the University’s billing system. The University’s billing system could also be responsible. Lastly, thecharge ticket was missing and if the procedure was checked or not is unknown.
16%D Missing Ticket
• Not Checked on Charge Ticket
• Checked on Charge Ticket
Oxygen Transtelephonic Echo EKG Pace Maker Exercise Lab CathSaturation Analysis
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The data also suggest that the mark made when the charge ticket is reconciled against the log books is not effective.Many of those that were indicated in the log books as having been marked in fact were not. This safety check hasnot proved to resolve the problem.
These numbers and percentages may also be translated into actual monetary loss of facility charges. Table 1.3converts the missed billing numbers into actual lost hospital charges.
Table 1.3 Charges Lost in July
_________ _________
Facility Total # Total NotProcedure Charges Performed Billed
Echocardiogram $445 389 13.62%
Electrocardiogram $37 502 10.16%
Catheterization $1621 42 2.4%
Oxygen Saturation $34 118 14.41%
Exercise Lab $180 18 5.56%
Transtelephonic $37 28 14.29%
Pace Maker Analysis $43 21 9.52%
Minor Procedures $1,621 22 0.00%
TOTAL 1,140 11.3%
The total amount of charges that has been found to have been lost based on the audit of July’s activity comes to atotal of $28,085. See Table 1.3 for a breakdown by procedure. Assuming that July is fairly representative of anaverage amount of activity the total charges lost over the span of a year would equal $337,020.
The loss to the division from these findings is greater than simply the lost charges. The expense budget provided tothe division from the University of Michigan Hospital is based on the activity that they bill. Since they are missing11% of their billing their budget is much lower than it should be to cover the procedures that actually are performedin the division.
The data from the office visit audit show that there is potentially a problem in this area. From our data collected wefound no correlation between missing charges and day of the week, time, or resource. Lack of patient specific datafrom the MSP billing office prohibited us from proceeding further.
Recommendations
After close scrutiny and meticulous collection of all of the data it has been determined that an electronic billingsystem directly tied to the billing system of the University of Michigan should be implemented. This is the only waythat both the technician billing errors, lost charge tickets, and the data entry errors may be corrected and the ultimategoal of 100% billing be achieved. Simply improving the process would still not ensure that the charge tickets wouldindeed be checked nor would it ensure that a mistake in the entry of the data into the University’s billing systemwould not occur.
The physical requirements for this system would not be extensive. Their are currently IBM computers in each of thelaboratories. The program would be loaded onto a server and be accessible from all of them.
In April of 1997 the University of Michigan’s facility billing system will be switching from FALCON billing toHQ3.0 (Healthquest 3.0). This is an on-line system that will allow for charges to be posted directly to a patients
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account. This system differs significantly from the current system and all interfaces between the recommendedelectronic system and the University’s billing system should be done with respect to HQ3.0 and not FALCON.
The point of entry for the system will be the log books since every patient that has a test must be logged in. In thecurrent process, the patient is logged in so an extra step would not need to be added. A major change with the newsystem is that instead of manually writing in the patient’s information they would enter it into a computer. Thiswould eliminate the technician having to remember to check the charge ticket, walk over to the charge ticket, andthen mark it clearly in the appropriate box. This eliminates the possibility of the charge ticket not being checked aswell as the possibility of missed billing due to a lost charge ticket.
The electronic log book would be standard procedure for each laboratory. The main screen for each laboratorywould look the same except for the fact that the field would be individually tailored to meet their specific needs.Each employee would be given a name and password to gain access into the system. Depending on their accessprivileges, they would be allowed into different parts of the system.
The change to an electronic system is significant but many aspects would remain similar. The electronic log bookwould look and function similarly to the log books currently in place. All of the fields that are in the current logbooks would be designed into the electronic system. The relevant information concerning they type of procedurewould also be available. Their would still be a list of the patients with the option to add the most recent patient at thebottom of the list. Once a patient is entered their information will be stored in a database.
The time spent to log in a patient would be decreased because all of the information would not need to be added.Simply entering one field would bring up the necessary information from the database relating to the patient. Thiswould not only decrease the time but the accuracy as well. Safety checks in the program would catch any mistakesmade about a patient. For example if a registration number was not valid an error message would appear indicatingthis. The patient name would also be automatically entered and any confusion caused by misspelling would beeliminated.
The entire step of having to reconcile the log books with the charge tickets would also be eliminated. Each patientin the log books would no longer have to be initialed as having been billed. This step was shown in the data to beineffective.
Additional capacities could also be added that are not possible in the current system. The option to count thenumber of a procedure performed in specified months could be available. In addition, reports could be generatedthat show any specified compilation of data that would be useful to the employees in the division. For example areport could be made to display all of the procedures a patient had for a given date of service. Queries concerningany aspect of the database could also be made. Another possibility is to included additional fields that do not occurin the log books but would be useful, such as the diagnostic code. The above are only possibilities to demonstratethe capacity of the suggested system. The actual capacities should be decided upon by the division.
After the essential information had been entered it is then to be sent directly to the University of Michigan’s billingsystem. This bypasses the necessity for a clerk to manually input all of the days activities into the system. Bysending them directly it will not only eliminate the time spent but will eliminate the chance of a data entry error.
This type of direct electronic system is currently used in 80% of the clinics at the University of Michigan Hospitalincluding the Adult Cardiology Clinic. The transfer process is already known, so the clinic needs only to follow theformat of the other clinics. In general terms, after the patients data has been logged in and stored in a database itwill need to be formatted in a standard way specified by the Hospital. For example the registration number wouldneed to be eight characters in length, the visit number 4 characters, etc. From here the formatted information wouldbe saved as a file and sent by a file transfer program to the mainframes of the Hospital. This formatting and sendingof files would be done after each working day. To ensure that the billing had been accurate a report of the activity
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of the given day could be generated from the new system and reconciled against the printout from the Hospital’sbilling system.
There are some problems that are inherent to an electronic system. These problems are not a common occurrenceand can be remedied if the proper back ups are instituted. The server that Pediatric Cardiology uses at the presenttime backs up all of its information once a daS’. This process should be continued. A hard copy of the logbooksshould also be printed out at the end of the week so if something were to happen to the system a copy of all of thepatients for each laboratory would still be available. Additionally a paper log book having the same fields as theelectronic system should be kept in each of the laboratories. This is in case the system is ever down and it isnecessary to log in a patient. However once the system is up again, the information should be transferred from thelog book into the system.
The automated system would make many jobs in the division a lot easier. Those employees that would experiencethis reduction in work load could then focus their time in other areas. The extra time would not go to waste, butshift the focus into areas that my have been previously neglected.
It is additionally recommended that the Medical Service Plan portion of the billing be reviewed. This includes theMSP portion of the laboratory procedures as well as the office visit charge in it’s entirety. The loss of billing due todata entry error was not able to be quantified but should be in the future. The automatic billing should be astandard procedure that applies to all aspect of the billing process including eventually the MSP side. We wouldassume that if a charge ticket was not checked then the MSP side would also not get the charge contributing to agreater loss.
All of the above recommendations will assist in the attainment of the goal of 100% billing as well as improve
( accuracy, data and report generation and budgetary planning. Assuming July is a typical month, they will assist incapmring at the least, the $28,085 of lost charges for a month and the $337,020 lost annually.
Action Plan
The Pediatric Cardiology Clinic should immediately begin planning for the electronic system. There are severalareas that need exploring in the development and implementation of the new system.
A project team will be necessary. The project manager should be named that will plan a feasible time schedule,oversee the progress, and help to have a timely completion. There will also have to be members that have technicalknowledge in the following fields; database management systems, programming languages, server knowledge, andgeneral networking knowledge. These technical members will have a number of responsibilities. They will set upthe database, design, program, debug, test, and implement the system. There should be several technical membersdue to the amount of work that will be required in this area. The input of the entire clinic will be needed, especiallythose that will be significantly effected.
As a beginning point, Adult Cardiology’s electronic system should be benchmarked. The construction of theirsystem should be closely examined. The interaction between their interface and the Hospital’s mainframes shouldbe documented. Contact should be kept with the clinic throughout the project when complications arise since theAdult clinic already has a proven system. It may even be possible to replicate some of the system for pediatrics.
The next information source that should be contacted is one that could define the requirements for the file transfermethod and formatting that are required by the University of Michigan Hospital’s billing. There are several relateddepartments that may need to be contacted. The system should be created to interact with the new HQ3.0 billing
( system. The possibility of verifying that files have been received should also be investigated. Once this iscompleted the focus can then shift to the construction of the electronic billing system.
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The specific needs of Pediatric Cardiology will need to be identified. This includes the state of the current logbooks as well as any additional features that would be desired. Each of the laboratories needs to submit exactlywhat fields they think would be useful in the new system. This would included the columns that are currently inplace. They would also include any additional information that would be helpful. They would also submit any typeof report that would be helpful to them if generated by the system.
The physicians should also contribute their suggestions. Additional fields should be added, such as diagnosticcodes. They would also request that the system have the capacity to generate certain types of reports that would behelpful to them.
The other positions in the clinic should also be consulted as to any capabilities they may need.
Once all of the suggestions had been collected and compiled, the design of the system should be outlined. Thisdocumentation should be flow charted and all of the relationships in the program defined. The design should thenbe shown to the faculty and senior laboratory technicians to receive any additional input.
The database management system should then be decided upon. The type of software that is desired should beinstalled. The database relationships among the desired fields should then be made, From these relationships themost optimal database should be constructed.
With the database constructed and the system design complete, the development phase of the project may begin.This will be one of the most difficult and time consuming aspect to the project. The programming in the chosenlanguage should begin. This coding should be broken down into different phases and a timeline set for thecompletion of each. This breakdown will make the progranmiing more manageable. As the program is developeddebugging should be occurring simultaneously. After the program is able to run, error handling should be invoked.
After a version of the program is ready a fairly extensive amount of testing should be performed. A testing softwaremay be purchased or manual testing may be done. Every possible combination of information and every avenuepossible should be explored. This is critical step in the quality of a system once it has been implemented.
Once all of the above steps have been executed the system is ready to “go live”, or in other words ready to be used.The fully developed program should be placed onto the server at Pediatric Cardiology so that all of the computersthrough out the facility will have access. Training sessions should be held so that all employees are aware of thechange and understand how to use the system. A manual should also be written so that it may be referenced shouldproblems occur.
During the first few weeks of implementation the hand written log book and checking of the charge tickets as well asthe electronic system should be run simultaneously. This is to test the system in a real situation and this is also sothat if a problem occurs no data will be lost.
After the system is running without problems the hand written log books should be filed away. A single log bookshould be placed in each lab in case the system goes down. A binder for the weekly printouts should also be placedin each laboratory.
The final documentation and code should also be filed and a copy of the program stored. This is so that ifadjustments or additions need to be made in the future they may be done.
The last hurdle that the new system will encounter is the maintenance of the system. This is not a small job and anemployee should be responsible for it. The division will hold the responsibility for the system and will be primarilyresponsible for handling all maintenance concerns internally.
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Appendix A• • Actual Numbers
Appendix BData with July 22, 1996
Appendix CFlow Charts
Appendix D
c Diagram of the Pediatric Cardiology Clinic
Appendix EPediatric Cardiology Charge Ticket
Appendix FSource Code for Demonstration Program
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Appendix A
Actual Numbers
Actual Numbers for the percentages found in Table 1.1
Not checked on Charge Ticket
Test Checked on Checked in Not Total Not Missing Total Not Total #Charge Log Book Checked in Checked Ticket Billed PerformedTicket Log Book
Echo 23 12 8 20 10 53 389Pace Maker 1 0 1 1 0 2 21AnalysisTTX 4 0 0 0 0 4 28
02 1 6 7 13 3 17 118Minor 0 N/A N/A 0 0 0 22ProcedureExercise Lab 0 N/A N/A 1 0 1 18Catheterization 1 0 0 0 0 1 42EKG 10 40 0 40 1 51 502TOTALS 40 I 58 16 75 14 129 1140
Appendix F: MD Data Collection Form for Establishing andMonitoring Scheduling Templates
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Data Cal1ction Form for Establishing & Monitofing Scheduling Template
Doctor:
_____________
IndirectEnd
• TotalIndirectService
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Appendix B
Actual Count
Data with July 22, 1996
Not checked on Charge Ticket
Test Total # Checked on Checked in Not Checked Total Not Missing Total NotPerformed Charge Ticket Log Book in Log Book Checked Ticket Billed
Oxygen Saturation 128 10 6 7 13 4 27
Echo 408 41 12 9 21 10 72
Transtelephonic 29 5 0 0 0 0 5
Pace Maker 22 2 0 1 1 0 3AnalysisEKG 531 10 40 0 40 1 51
Minor Procedure 24 0 N/A N/A 2 0 2
Exercise Lab 18 0 N/A N/A 1 0 1
Catheterization 44 2 0 0 0 0 2
TOTALS 1204 70 58 17 78 15 163
Percentage
Not checked on Charge Ticket
Test Total # Checked on Checked in Not Checked Total Not Missing Total NotPerformed Charge Ticket Log Book in Log Book Checked Ticket Billed
Oxygen Saturation 128 7.8% 4.7% 5.5% 10.2% 3.1% 21.1%
Echo 408 10.0% 2.9% 2.2% 5.1% 2.5% 17.6%
Transtelephonic 29 17.2% 0.0% 0.0% 0.0% 0.0% 17.2%
Pace Maker 22 9.1% 0.0% 4.5% 4.5% 0.0% 13.6%AnalysisEKO 531 1.9% 7.5% 0.0% 7.5% 0.2% 9.6%Minor Procedure 24 0.0% N/A N/A 8.3% 0.0% 8.3%
Exercise Lab 18 0.0% N/A N/A 5.6% 0.0% 5.6%
Catheterization 44 4.6% 0.0% 0.0% 0.0% 0.0% 4.6%
TOTALS 1204 5.8% 4.8% 1.4% . 6.5% 1.3% 13.5%
-
Appendix C
Flow Charts
C,
Echocardiogram Patient requiresEchocardiogram
Exit lab and findcharge ticket while
finding chart to placereport
Check off log book that patient was billed(Does not occur immediately)
Place report with chartand place charge ticket
in outbox
Electrocardiogram
rohate box
C
(
Patient requiresElectrocardiogram
Yes
Make a new chargeticket and place tracing
in chart
Take tracing to chartand find charge ticket
ticket
Yes
V
Exercise Test
Report place in box forreviewing and to be
typed
Find charge ticketwhile placing report in
chart
Mark appropriate boxon charge ticket
Charge Ticket and Chart(enedule
______
nCharts are brought
from medical recordstôaboxnearthe
clerks
Patient arrives
V
Charge ticket iscreated and the
appropriate office visitcharge marked
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station
Charts travel withpatient to the exam
room
1.During testing the chart
either stays in theexam room or is
placed in the nurses’station or in the
physicians’consultation room
The following morning thecharge tickets are collected
V
and entered into Falcon billing (system by clerk
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Physicians’LibraryConsultation Room
Echo
__________ _________________ ____________
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Clinicians
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Source Code for Demonstr Progr
C
C.
Form: EditPatient
Oblects
Section: Detail
Rectangle: Box5
Command Button: cmdCancel
Command Button: cmdupdate
Text Box: DOB
Text Box: First
Label: LabeIO
Label: Labell
Label: Label2
Label: Label3
Label: Label4
Text Box: Last
Text Box: Middle
Text Box: RegNumber
Code1 Attribute VB_Name = “Form_EitPatient”2 Attribute VE_Creatable = True3 Attribute V3_Exposecl = False4 Option Compare Database
5 Option Explicit
6
7 Sub cmdupdate_Click()8 On Error GoTo Err_cmdupdate_Click9
1011 Dod.DoNenuItem acFoziBar, acflecordsMenu, acSaeRecord,
12 MsgBox “Record successfully updatedi”, 64, “Saved
13 Dod.C1ose1415 Zxit_cmdUpdate_Click:16 Exit Sub1718 Err.dUpdate_C1ick:19 MsgBox Err.Description 20 Resie Exit_cmdUpdate_Click
2122 End Sub23 Sub cmdCancel_Click()24 On Error GoTo Err_cmdCancel_Click25 Di Answer As Integer2627 Answer = MsgBox(”Cancel any changes?”, 36, “Cancel”)28 If Answer = 6 Then29 DocmdC1ose
30 End I3132 Exit_dCane1_C1ick:33 Exit Sub3435 Err_Cance1_C1ick:36 MsgBox Err.Deseription37 Resume Exit cxndCa.ncel C1ik.3839 End Sub
Form: EKG
Objects
Section: Detail
Rectangle: Box32
Command Button: cmdClose
Command Button: cmdreport
Command Button: cmdReview
Option Group: frmOptions
Label: Labell
Label: Labelil
Label: Labell3
Label: Label2S
Label: Label27
Label: lblTotal
Line: LinelO
Line: Lrne36
Line: Line37
Line: Line3B
Line: Line4
Line: LineS
Line: Line9
Label: Month:_Label
Option Button: optAll
Option Button: optSome
SubformlSubreport: subAll
Subform/Subreport: subSelect
Combo Box: txtMonth ;.- .......J
Combo Box: txtYear,.,. ...... j...
Label: Year_Label
Form: EKGCode
1 Attribute ‘lB_Name = “Form_ERG”2 Attribute VB_Creatahle = True3 Attribute VB_Exposed = False4 Option Compare Database
S Option Explicit6789
10 Private Sub omdClose_Click()11 DoCmd.Clese12 End Sub13141516 Private Sub cmdrepozt_Click()
17 DoCmd.OpenFoxm “Lab Reporting”
18 Forms! [Lab Reporting] ! [ReportRequestedl .Caption = Me.Captiou
19 End Sub2021 Private Sub Form_Load 022 ‘ Initialize variables
23 t,xtMonth = Val(Format(Now, “mm”))24 txtYear = Val(Format(Now, “yyyy”))
25 lblTotal.Width = 2500
26 lblTotal.Caption = “Total 4 of Records for “ & txtMonth a “I” &
27 End Sub2829 Private Sub fmnOptions_Click()
30 If fzmOptions.Value = I. Then ‘ All records
31 subAll.Visible = True
32 subSelect.Visible = False
33 txtNonth.Enabled = False
34 txtyear.Enabled = False
35 lblTotal.Caption = “Total * of Records”
36 lblTotal.Width = 150037 End If3839 If !rmDptions.Value = 2 Then ‘ Selected month
40 subAll.Visible = False
41 subSelect.Visible = True42 txtMonth.Enabled = True
43 txtyear.Enabled = True44 lblTotal.Caption = “Total * of Records for “ a txtMonth a “/‘
a txtYear
45 lblTotal.Width = 2500
46 End If47 End Sub484950515253 Private Sub txtxonth_Change ()54 lblTotal.Caption = “Total * of Records for “ & txtMonth & “I” &
55 End Sub
5758 Private Sub txtYear_Change 059 lblTotal.Caption = “Total * of Records for “ a txtMonth a “I” a60 End Sub6162
63 Sub cmdReview_Click()64 On Error Goro Err_dReview_Click6566 Dim stDocName As String67 Dim stLinkCriteria As String “-- -
6869 stDocNasie = “Patient Into
70 Dod. OpenFozm stDocName, ,, stL.inJCriteria7172 ExitcmdReview_C1ic):73 Exit Sub7475 Err_cmdRview_C1ick:76 MsgBox Err.Description77 Resume Exit_cmdReview_Click
7879 End Sub
-
.;7-.--
(
Form: Lab Reporting
Oblects
Section: Detail
Rectangle: Box7
Check Box: Check3O
Check Box: Check32
Command Button: cmdCtose
Command Button: cmdPreview
Option Group: frmPrint
Option Group: frmsort
Label: LabelO
Label: Labell2
Label: LabeIl7
Label: LabeIl9
Label: Label2l
Label: Label25
Label: LabeI28
Label: LabeI3
Label: Label3l
Label: LabeI33
Label: LabeI6
Option Button: Optionl6
Option Button: Option 18
Option Button: Option2O
Label: ReportRequested
Text Box: txtFromDate
Text Box: txtSOL
Text Box: txtToDate
Form: Lab Reporting1 Attribute VB_Nane = “Yomjab Reporting
2 Attribute VBCreatable = true
3 Attribute VBExpesed = Ealse
4 Option Compare Database
5 Option Explicit
67 Private Sub cmdClose_Click()
8 Dond.C1ose9 End Sub
101112 Private Sub cmdPreview_Click()
13 Dim OrderBy As String
14 Dim SQLWhere As String
15 Dim optpreviaw As Boolean
1617 ‘ Determine sort request18 Select Case frmSort.Value19 Casel
20 OrderBy = “Date, RegNumber”21 Case 222 OrderBy = ‘RegNumber, Date”
23 Case 3
24 OrderBy = “Name, Date”
25 End Select
26
27 ‘ Print or Preview28 If frmprint.Value = 1 Then optPreview = True Else optPreview = False
2930 ‘ Generate SQL for specific dates31 SQLWhere = “Date > #“ & Fornat(tzctpromDate, “tmu/dd/yy”) a * and
Date <= #“ a Format(txtToDate, “rma/dd/yy”) a “*“
3233 ‘ Open appropriate Report
34 Select Case ReportRequested.Caption
35 Case ‘PaceMaker”
36 ReportSQL = “Select * from qrypacemaker Order by a OrderBy
37 If optpreview Then
38 Docmd.OpeuReport “PaceMaker LogBook’, acPreview,
39 Else40 Dond.OpenRepert “PaceMaker LegBook’, acNormal,41 Endlf42 Case ‘EKG”43 ReportSQL = “Select * from qryEKG Order by a OrderBy
44 If optPreview Then
45 Docmd.OpenReport “EKG LogBook”, acPreview, , SQLWhere
46 Else47 Docmd. OpenReport “ERG LogBook”, acNormal, , SQLWhere
48 End If
49 End Select50
51
52 End Sub535455 Private Sub Form Load()56 ‘ Init. variables57 Dim TempDate As String58 TempDate = Pormat(Date, “om”) & “/01/” & Format(Date, “yy”)
59 txtFromDate = CDate(TempDate)
60 End Sub6162
Form: MainMenu
Objects
Section: Detail
Rectangle: Boxi
Rectangle: Box3
Command Button: cmdCath
Command Button: cmdEkg
Command Button: cmdExercise
Command Button: cmdPaceMaker
Command Button: cmdPatients
Command Button: cmdquit
Command Button: Command8
Label: LabelO
Label: Label2
Label: Label4
Image: OLEUnboundl2
Code1 Attribute VBName = “Foxm_MainNenu”2 Attribute VB_Creatabi.e = True3 Attribute yB_Exposed = False4 (ption Compare Database
5 Option Explicit67 Private Sub cmdcath_Click()8 MsgBox “tab book not yet implemented”, 16, “Under construction”
9 End Sub101112 Sub cmdEkg_Click()13 On Error Gopo Err_cmdEkg_Click1415 Dim stflocName As String16 Dim stt,inkCriteria As String1718 stDocName = “ERG”
19 Docmd OpenFom stDocName, , , stt.inkCriteria
2021 Exit_cmdBkg_Click:22 Exit Sub2324 Err_cxxzdEkg_Click:25 MsgBox Err.Description26 Resume Exit_cmdEkg_Click27
28 End Sub2930 Private Sub cmdxercise_C1ick()31 MsgBox Lab Book not yet implemented”, 16, “Under construction”32 End Sub3334 Private Sub cmdPaceMakerclick()35 Dod.OpenYorm “Pacemaker”36 End Sub3738 Private Sub cmdpatients_Cljck()39 Docmd.Openporm “Patient tne”40 End Sub4142 Sub dquit_C1ick()43 On Error GoTe Err_cmdquit_Cljck444546 Dod.Quit4748 Exit_cmdguit_Click:49 Exit Sub5051 Err_cmdquit_Click:52 EsgEox Err.Description53 Resume Exit_cmdquit_Click5455 End Sub5657 Private Sub Conimand8_Click()58 Dod.OpenForm “Patient Reporting”
59 End Sub6061
C
Form: Pacemaker
Objects
Section: Detail
Rectangle: Box32
Command Button: cmdClose
Command Button: cmdreport
Command Button: cmdReview
Option Group: frmOptions
Label: Labell
Label: Labell 1
Label: Labell3
Label: Label25
Label: Label27
Label: IbITotal
Line: LinelO
Line: Line36
Line: Line37
Line: Line38
Line: Line4
Line: Line5
Line: Line9
Label: Month:_Label
Option Button: optAll
Option Button: optSome
Subtorm/Subreport: subAll
Subform/Subreport: subSelect
Combo Box: txtMonth
Combo Box: txtYear
Label: Year_Label
Form: Pacemaker
Code -
1 Attribute yB_Name = “Form Pacemaker”
2 Attribute VBCreatable = True
3 Attribute VBExposed = False
4 Option Compare Database
5 Option cplicit6789
10 Private Sub cmdClose_Click()11 Dod.C1ose12 End Sub131415161718 Private Sub cmdxeport_Click()
19 Dod . OpenForm “Lab Reporting”
20 Forms (Lab Reporting I (RoportRequested] .Caption = Me.Caption
21 End Sub2223 Private Sub Form Load()24 ‘ mit. variables25 tmctMoath = Val(Pormat(Now, “un’))26 tmctYear = Val(Format(Now, “yyyy”))
27 lblTotal,Width = 250028 lblTotal.Caption = “Total * of Records for “ & txtMonth & “I” &
29 End Sub3031 Private Sub frnptions_C1ick()
32 If fxmOptions.Vaiue = 1 Then ‘ All Records
33 subAll.Visible = True
34 subSelect.Visible = False
35 txtMonth.Enabled = False
36 txtYear.Enabled = False
37 lblTotal.Caption = “Total * of Records”
38 lblTotal.Width = 1500
39 End If4041 If frxnOptions.Value = 2 Then ‘ Selected records
42 subAll.Visible = False
43 subSelect.Visible = True
44 txtNoath.Enabl.d = True
45 txtYear Enabled = True
46 lblTotaj..Caption = “Total * of Records for & txtMonth & “I”
& txtYear
47 lblTotal.Width = 2500
48 End If49 End Sub505152535455 Private Sub txtMonth_Change()56 lblTotal.Caption = “Total * of Records for “ & txtMonth & “F” &
57 End Sub58
5960 Private Sith txtYear_Chaqe 061 lblTetal.Caption = “‘ota1 # of Records for & txtMenth & /“ &
62 Ed Su
636465 Sith Review_C1ick()66 On Error GoTo Err_cmdRaview_C.ick6768 Dim stDocNae As String
69 Dim stLinkCriteria As String7071. stDocName = ‘Patient Info72 Dod . OpenFoxm stDocName, , , str4nkcriteria
7374 Exit_cmdReviewClick:75 Exit Sub
7677 Err_cmdReview_Click:78 MsgBox Err.Description79 Resume Exit_cmdReview_Click8081 End Sub
Form: Patient Info
Obiects
Section: Detail
Command Button: cmdClose
Label: Labell 1
Label: Label13
Label: Label2
Label: LabelB3
Line: LinelO
Line: Line6
Line: Line7
Line: Lineg
SubformlSubreport: Patient Data
Code1 Attribute VENaixze = Form_Patient Info’ - -
2 Attribute VE_Creatable = True
3 Attribute yB_Exposed = False4 Option Conpare Database5 Option Explicit67S Sub czndClose_Click()9 On Srror GoTo Err_ndC1ose_C1ick
101112 Docxnd.Clese1314 Exit_cmdClose_Click:15 Exit Sub1617 Err_cmdClose_Click:18 MsgBox Err.Description19 Resume Exit_zidC1ose_C1ick2021 End Sub
C
Form: Patient Reporting
Objects
Section: Detail
Rectangle: Box46
Rectangle: Box7
Check Box: Check3O
Check Box: Check32
Check Box: chkAll
Combo Box: cmbPatients
Command Button: cmdClose
Command Button: cmdPreview
Option Group: frmPrint
Label: LabelO
Label: Label28
Label: Label3
Label: Label3l
Label: Label33
Label: Label47
Label: Label48
Label: LabelSO
Label: Label6
Text Box: txtFromDate
Text Box: txtTo Date
Code1 Attribute VS_Name = ‘Pom_?atient Reporting’
2 Attribute VE_Creatable = True3 Attribute VS_Exposed = False4 Option Compare Database5 Option Explicit6
7 Private Sub chkA1l_AterOpdate()89 te chkAll.Value = True Then ‘ Disable date boxes
10 txtFromDate.Enabled = False
11 txtToDate.Eziabled = False12 Else ‘ Enable date boxes
13 txtFromDate .Enabled = True
14 txtToDate .Enabled True
15 End If16 End Sub1718 Private Sub cmbPatients_Change()19 cmdPreview.Enabled = True20 End Sub2122 Private Sub cmdCloseclick()23 Docznd.Close24 End Sub -
252627 Private Sub cmdPreview_Click()28 Dim SQLWhere As String2930 ‘ Generate SQL to select patient on form31 SQLWhere = “RegNumber = ‘“ & Format(cmbPatieats.Value) &3233 PatientWhere = “Date >= 4” & Format(tzctPromDate, “/dd/yy’) & “4 and
Date <= #“ & Format(txtToDate, “/dd/yy”) & “*“
3435 If frmPrint.Value = 1. Then36 Docmd.Openfleport ‘Patient Report”, acPreview, , SQLt’there37 Else38 Docmd. OpenReport “Patient Report’, acNormal, , SQLWhere ‘ Print39 End If40 End Sub414243 Private Sub Cozximand5lClick()44 Patientwhere = ‘Date >= 4” a Format (txtFromDate, “xzEm/dd/yy”) a “4 and
Date <= 4” a Format(txtToDate, “u/dd/yy”) a “*‘
45 End Sub4647 Private Sub Forin_Lead()48 ‘ mit. variables49 Dim Tempflate As String50 TempDate = Format(Date, “imn”) a “/01/” a Format(Date, “yy”)51 txtYromDate = CDate(TempDate)52 End Sub5354
Form: subEKG
Objects
Section: Detail
Text Box: Comments
Text Box: Date
Label: LabelO
Label: LabellO
Label: Labelli
Label: Labeil2
Label: Label4
Text Box: month
Combo Box: RegNumber
Label: RegNumber:_Label
Text Box: Technician
Text Box: Year
Code1 Attribute VS_Name = “Fom_siibERG”2 Attribute VB_Creatable = True
3 Attribute VS_Exposed = False4 Option Compare Database5 Option Explicit678 Private Sub Form_Error(DataErr As Integer, Response AS Integer)
9 ‘ Dispaly error if patient does not exist in patient table
10 If DataErr = 3201 Then
11 MsgBox “Xnvalid registration number. Patient does not exist!” &
Chr(13) & “(Hit ESC to abort record), 48, Error
12 Response = acDataErzContinue13 End If1415 End Sub1617181920 Private Sub RegNumber_DblClick(Cancel As Integer)
21 ‘ Open patient edit screen22 On Error GoTo 123 Dim SQLWhere As String2425 CuxRegnum = RegNumber26 SQLWhere = “Regnumber = ‘ & CurRegnum &
2728 DoQud.OpenPorm “EditPatient”, , , SQLWhere, , acDialog
2930 3. Exit Sub31 End Sub3233
Form: subPacemaker
Section: Detail
Text Box: Comments
Text Box: Date
Combo Box: Dual
Label: LabelO
Label: LabellO
Label: Labelil
Label: Label2
Label: Label3
Label: LabeI4
Text Box: month
Combo Box: RegNumber
Label: RegNumber:_Label
Combo Box: Single
Text Box: Year
Code1 Attribute VBName = “Form_subpacemaker2 Attribute VB_Creatable = True3 Attribute yB_Exposed = False4 Option Compare Database5 Option Explicit6 Dim SingleValue As Boolean7 Dim DualValue As Boolean89 Pri-ate Sub Dual_BeforeUpdate(Cancel As Integer)
10 If Me.Dual.Text = AYes” Then11 DualValue = True12 Else13 DualValue = False14 End If15 End Sub1617
1819 Private Sub Form_Error(DataErr As Integer, Response As Integer)
20 ‘ Display error if patient does not exist in patient table
21 If DataErr = 3201 Then22 MsgBox “Invalid registration number. Patient does not e.xist!” &
Chr(13) & “(Hit ESC to abort record)”, 48, “Error23 Response = acDataErrcontinue24 End If2526 End Sub
Private Sub Single_LostFocus()If Me.Single.Text = “Yes’ Then
SingleValue = TrueElse
SingleValue = FalseEnd If
End Sub
Private Sub R.gNutnber_DblClick(Cancel As Integer)Display petient edit form
On Error GoTo 1Dim SQLWhere As String
CurRegnum = RegNumberSQLWhere = “Regnunber = ‘ & CtrRegnum &
DoOnd.OpenForm “EditPatient”, , , SQLWhere, , aeDialog
1 Exit Sub
End Sub
272829303132333435363738394041424344
454647
484950515253
(
Form: subPatient
Objects
Section: Detail
Text Box: DOB
Text Box: First
Label: LabelO
Label: Labell
Label: Label2
Label: Label3
Label: Label4
Text Box: Last
Text Box: Middle
Text Box: RegNumber
Code1 Attribute yE same = “Form subPatient”
2 Attribute VB_Creatable = True3 Attribute VB_Exposed = False4 Option Compare Database5 Optioa Explicit
67 Private Sub Yorm_BeforeDelConfirm(Cancei As Integer, Response As Integer)
8 Response = acDataErrCoatinue9 End Sub
1011 Private Sub Fozm_Delete(Cancel As Integer)
12 ‘ Confirm deletion13 Dim Answer As Integer14 Answer = MsgBox(”Axe you sure you want to delete patient?’ & Chr(l3)
& “(All records relating to patient will be deleted!)”, 36, “Delete
15 If Answer = vbNe Then16 Cancel = True
17 End If
18 End Sub1920212223
24 Private Sub RagNumber_DblClick(Cancel As Integer)25 DocDmd.Openyorm “Patient Reporting”
26 Forms! [Patient Reporting] 1 [cmbpatiants] .SetFocus27 Formst[Patient Reporting]!fcmbPatientsl.Text = RegNumber & &
Trim(Last) & “, a Trim(First) & “ “ & Middle
28 Forms! [Patient Reporting] I [cmdPreview] 5etFocus29 End Sub3031
Form; TitieScreen
Objects
Section: Detail
Rectangle: Box7
Rectangle: Box8
Label: Label2
Label: Label3
Label: Label4
Label: Label5
Label: Label6
Image: OLEUnboundi
Code1 Attributa VBName = ‘Form_TitleScreen’2 Attribute VE_Creatable = True
3 Attribute yB_Exposed = False4 Option Compare Database5 Option ExplicitS7 Private Sub Form Click()8 Dotmd.Close9 DoCmd . OpenForm “MainZ4enu
10 End Sub111213 Private Sub Form_Timer 014 ‘ After timer is over close title screen and open main menu15 Docmd.Close16 Docmd.OpenForm ‘MainMenu17 End Sub1819