Presentation on theme: "What is Core? The common processes or tasks that are shared multiple times across clinical domains, technical activities, or project tasks. It is those."— Presentation transcript:
0 System Review CORE Concepts King Saud University HospitalsSystem Review CORE ConceptsIlham HobbaDecember 15, 2012
1 What is Core?The common processes or tasks that are shared multiple times across clinical domains, technical activities, or project tasks. It is those things that are required in order to get a Cerner Millennium™ application or applications installed.Core includes all the shared tables, standard code sets (as opposed to nonstandard or product-specific), and anything else that is used across the rest of Cerner’s products.Many groupings of shared information are used by HNA Millennium products. Some examples are security, event codes and event sets, person identification, locations, and organizations. Core also includes the alias pools used within these groupings.
2 Event Codes/Event Sets What is Core?OrganizationsSecurityLocationsAlias PoolsCode SetsEvent Codes/Event SetsCore is often thought of as “Reference Data”Once instance of this data exists in the database, and the various solutions refer back to that once instance.
4 Organizations in Millennium Organization: Any business entity that is affiliated with the health system.Organization TypesOrganizations are classified into different Organization TypesEach type drives functionality within the SolutionsExamples of Organization Types:Client FacilityEmployer Insurance CompanyHospital Physician OfficesMultiple Organization Types can be used to define an organization.Example: Cerner Hospital can be a Facility, Client, Hospital, and EmployerOrganizations are defined by being classified as different Organization Types. An Organization can be more than one Type, and the different Types drive different functionality within the system. For Example, if an Organization is a Facility, locations can be tied to it.
5 Organizations Organizations Facility Hospital Employer Ins. Company ClientEmployers and insurance companies usually don’t end up being facilities. A facility is a TYPE of organization.
6 Organization Types Possible “Employment/Billing” Organizations: EmployersInsurance companiesClients (e.g. Industrial accounts)Employer: An organization that may be given as a place of work or health plan sponsorInsurance Company: An organization with one or many health plans associated underneath it.Ask audience what organizations from their health system would be considered Employer? What would be considered Insurance Company?
7 Organization is a Client if : Organization TypesClient: An organization that is used to represent a specific patient population for patient numbering, billing or report distribution.Organization is a Client if :Charging processes occur (designation needed in order to show is Charge Services tools)The organization is used for client/industrial billingDestination for Clinical ReportingAsk audience what organizations from their health system would be considered Client?
8 What are Core Organizations? Possible “Patient Care” Organizations:HospitalPhysician Office/ClinicHome HealthHospiceFacilityPhysician Office/Clinic: Areas where health care services are given to patients who do not need to stay overnight. May include services usually provided in a Physician Office or Clinic.Ask audience what organizations from their health system would be considered Patient Care?
9 Core Organization Types FacilityAn organization at which patient care activity takes place.Organization is a facility if:Patient care takes placePatient registration occursIdentifiable patient population (Charting, Security)ProFit billing entity (one tax id)Facilities can contain:One Pharmacy formularyOne Order CatalogOne Charge Description Master (CDM)One of the main reasons you need facilities is to build locations beneath them. Locations, such as buildings, nurse units, rooms, and beds, need to have a facility associated with them. Otherwise, the system will not know whether Room 105, Bed A is located at Hospital A or Hospital B. Any organization that will be affiliated with a data feed must also be a facility.Facilities are also established for work routing and report routing. And the last reason for facilities is charging capabilities. Usually each facility has separate financial numbers and billing numbers.Ask audience what organizations from their health system would be considered a Facility?
11 Security Design Security Risks in Healthcare Security is not… Unauthorized disclosure of patient informationUnauthorized disclosure of sensitive informationSubstance abuse treatment, abortion, mental health, HIV/AIDS, geneticsUnauthorized disclosure of intellectual propertySecurity is not…An add-on to your solutionsBuilt after workflow is designedSoftware that protects the configurationRecommended to be set up at an user-levelSecurity for Cerner is not software that protects our build or something that lays over the Cerner Millennium components. Security is, in fact, inherent in the architecture of the core and application build and configuration. For example, you could look at Application/Task Security (the act of giving someone permission to access certain applications and their tasks) as a way of enabling someone to do their job. A radiologist needs access to the radiology applications and their tasks. But, that very act of enabling the radiologist to do her job also secures those applications and tasks against the Help Desk Clerk who should not have access.Security is not an add-on piece to Cerner Millennium. It is built into the architecture.
12 SECURITY Vital for Access Control in Millennium What Solutions Can You Access?What Tasks Can You Perform?What Data Can You View?What Organizations Do You Have Access To?
13 Positions Defined Role based access to Cerner Applications Should be based on the role the user has within scope of Cerner SolutionsNot based on job titlePosition determines authorization within CernerNOT the same as a job class or employee titlePositions are not the same thing as the HR titles granted to each of your employees. Positions are designed based on the access of what that particular group of end-users needs access to within the Cerner System. For example, if a Lab Supervisor needs the same access within Cerner as Lab Management roles, they can all be grouped in the same POSITON. End-users will not see their position, it’s built into the system to determine what that end-user will have access to and be restricted from.
14 Position CollectionPositions will be collected on Core Systems Positions DCWStart positions are outlined on the deliverableThis deliverable is assigned to the Core team to complete two weeks prior to Design ReviewSolution teams will be required to assist the client in designing their positions based on Start contentThis is to be completed on weekly calls between System Review and Design ReviewAddress position integration points between solutions as they ariseThe completion of this deliverable will ensure the successful design of position based security at Design Review
15 Encounter/Organization Security Broad Level of SecurityLimits what Patient visits (encounters) each User can view, based on what organization the visit occurs at.Users are “tied” to OrganizationsUsers may view information from Patient visit, if the visit occurs at an Organization they are associated withUsers can be associated to one or many OrganizationsWill specific patient populations, such as behavioral health, need to be secured?If yes, each applicable location will be built as a separate facility and therefore require its own organization.Talk about sharing of information between organizations when there is a merging of the organizations. Security is still in place and documents are not shared or tightly controlled between the merged sites.
16 Encounter Organization Security Information Available across all encounters/visits:AllergiesProblemsPowerNoteClincal NotesProceduresForm Browser (results)Histories (past medical, family, social)ImmunizationsMedication List (prescriptions and administrations)Encounter/visit-specific information:PowerOrdersDiagnosesProvider RelationshipsRestrict individual results- HIV results, but not encounter org..
17 Confidentiality Code Security IfAndUser associatedto FacilityANDUser assigned a Confid. LevelPatient encounter occursat FacilityANDEncounter assigned a Confid. LevelAnd12User’s Confid. LevelMeets or exceedsEncounter Confid. LevelThen>21User has access to view patient encounterBe familiar with fly in’s
18 Encounter/Organization Security Dr. BDr. ADr. CCerner ClinicCerner HospitalC.H. Psych UnitEncounter 3Encounter 1Encounter 2After First Arrow, ask client which doctor will have access to see Encounter 1. Repeat for Encounter 2 and Encounter 3.
19 Confidentiality Levels Prerequisite - Encounter Organization SecurityCompare user and patient encounter codes to determine accessLevels are client defined
20 Examples of Levels: Encounter Users Psych 7 Security 5 Sensitive 3 Routine Clinical 17 Psych users5 Partial Restricted/Regular Users3 Clinical Staff1 PMLocator Users(patient directory)User with a Confid. Level of 5 can viewany Encounters with a level 5, 3, or 1Maximum of 4 levels recommended due to maintenance considerations
21 Within ERM:The Confid level can be assigned to each encounter via the Registration Conversation. The User’s level is assigned when their account is created- only have to do this once. Each encounter needs an assigned level, however is it possible to have a level always default in the conversation.
22 Without Cerner ERMConfidentiality Codes can be sent from ADT (Registration System)Sent in HL7 Message- PV2:22
24 Positions Defined Role based access to Cerner Applications Should be based on the role the user has within scope of Cerner SolutionsNot based on job titlePosition determines authorization within CernerNOT the same as a job class or employee titlePositions are not the same thing as the HR titles granted to each of your employees. Positions are designed based on the access of what that particular group of end-users needs access to within the Cerner System. For example, if a Lab Supervisor needs the same access within Cerner as Lab Management roles, they can all be grouped in the same POSITON. End-users will not see their position, it’s built into the system to determine what that end-user will have access to and be restricted from.
26 LocationsGeneric term used to denote physical place in health care organization.Area where Patient Care takes place.Locations exist in the Location Hierarchy.Any Organization that is a Facility can have locations tied to it.Locations are nursing units, rooms, and beds. They also can be ambulatory care areas, such as Emergency Rooms, Clinics, and so on.
27 Location Hierarchy Facility (type of organization) Room Buildings Nurse UnitBedCerner HospitalWest Pavilion2 South202AThe diagram on this slide is an example of a location hierarchy. The hierarchy on the left shows the Cerner terminology. The hierarchy on the right shows the fictitious Cerner Hospital, with its West Pavilion building, Nurse Unit 2 south, and room 202, bed A. For each successive level of the hierarchy, the predecessor must be established. For example, you cannot build a bed without a room or build a room without a nursing station.
28 Buildings Defined Buildings A physical structure on hospital property “Houses” registration locationsDrives no product functionality (security, billing, etc.)Facility (type of organization)RoomBuildingsNurse UnitBedA building is a physical place within a facility. Buildings differentiate between locations with the same name. For example, the facility Cerner Medical System has two buildings: Cerner Hospital and Cerner Health Clinic.You must always have a building within the facility (which, again, is always an organization). The building is a prerequisite for establishing nursing units, rooms, and beds.
29 Nurse/Ambulatory Unit, Rooms, and Beds Core Units DefinedNursing UnitAmbulatory UnitFacility (type of organization)RoomBuildingsNurse UnitBedRooms and BedsRepresents physical Rooms and BedsHierarchy format allows for multiple Rooms and Beds with the same nameThe Location Hierarchy allows for multiple Rooms and Beds with the same names. For example, A Building May have two nursing units, 2 North, and 2 South. 2 North can have Room 101, Bed A. 2 South can also have Room 101 and Bed A. Because they are different in the Location Hierarchy, the system can accept multiple Room 101’s and Bed A’s.
30 LOCATION HIERARCHY INPATIENT FacilityBuildingNurse UnitRoom and Beds
31 LOCATION HIEARCHY DAY REHAB & OUTPATIENT FacilityBuildingAmbulatory Loc
32 Service Resources Core Locations Facilities Institutions Buildings Two SidesCore LocationsFacilitiesBuildingsNurse unitsRoomsBedsService ResourcesInstitutionsDepartmentsSectionsSubsectionsExam RoomsOrganizations, patient locations, and alias pools are used across products, and this is another component of the database for which Core/OCF is responsible. Core/OCF's goal is to maintain consistency among the applications and how they identify patient locations.In Core/OCF we build organizations, facilities, buildings, nursing units or ambulatory locations, rooms, and beds. The product-specific work locations--called service resources--can involve institutions, departments, sections, subsections, and testing sites. Core Locations represents where the patient is physically located. Service Resources represent where the work takes place.Where work takes place, rather than where patients are registered.Laboratory, Resp Ther
33 What solutions use Core Locations? RegistrationSchedulingPowerChartCareNetINetCharge ServicesPharmNetProFileProFitFirstNetClinical ReportingPathNet APLocations appear in most all Cerner solutions. It’s crucial that everyone understand what locations are, and that they have a good understanding of what Facilities, Units, Rooms, and Beds are built in your system. We suggest that everyone meet as a group to sign off on the final Location Hierarchy design.
34 What solutions use Core Locations? Encounter/Organization SecurityControls access to patient information by organization.Confidentiality Level SecurityAdditional function available with Encounter Org Security that can be set per facilityAs previously discussed, Encounter Org Security and Confid Levels are designed and built by Core.All patient searches are affected by Encounter Org Security and Confid Levels, if implemented.Are there any additional questions regarding how these relate to Locations, particularly facilities?
35 What solutions use Core Locations? RegistrationPatients registered to FacilitiesIf an inter-facility transfer needs to occur, the alias pools for those two orgs must be set up exactly the sameRegistration can filter out patients by facilityPMLocator (Cerner’s patient directory)Auto-discharge can be set up differently per facility (and by patient type) - but not per building, nurse unit, room, or bedCertain code sets can be filtered by facilityPatient TypeMedical ServiceAccommodation CodeDischarge DispositionDischarge LocationRemember from our Organization Discussion, a facility is an organization at which patient care takes place, or if patient registration occurs.
36 What solutions use Core Locations? RegistrationIn this screen capture, you are looking at an example of a “Registration Conversation.”This conversation is used to add new patients, or encounters to patients.Patients are registered to a facility, which will determine which Buildings and Units appear.The choice of Building and Unit determines the Rooms and Beds that a patient can be placed in, or registered to.
37 What solutions use Core Locations? Person Search WindowSearch by location or facilityCustomize encounter results window with location hierarchy fields.This is a screen shot of the Person Search Window, which is seen throughout all Cerner Solutions.It is possible, should you choose to do so, to search based by a particular Facility or Unit.The results of what you searched for will display in the screens on the right- the person and encounter results screens.You can see that the Facility and Room appear with the Patient’s Visit to Baseline East, in Room 201.The choice of search and return fields is something you’ll be able to customize.Locations can appear if that’s something your end-users expect to be able to search on.We will capture this in our Person Search Screen Deliverable, later on- owned by Core.
38 What solutions use Core Locations? SchedulingPatients will get scheduled to a “location”, this is typically an ambulatory location.The location and the facility can be passed into registration if the conversation is launched from the appointment.Relevant to outpatient process only
39 What solutions use Core Locations? PowerChartEncounter Organization level security.An encounter that is hidden by the use of this type of security will not be accessible on the PowerChart Visit List tab or anywhere else in PowerChart/PowerChart Office.Encounters will also be hidden in the Patient Search for that organizationLocations (nurse units/ambulatory) can be used to specifically lock down patient lists on individual computersSet up with a default location listLocation patient lists can also be used to help organize work
40 What solutions use Core Locations? PowerChartOrganize Patients by LocationThis is a screen shot of a PowerChart Patient List.You can view lists of patients based on what location they’re at, or where they’re registered to.
41 What solutions use Core Locations? CareNet OrdersLocations used for routing and printingOrders requisitionsConsent formsReportsPrinted chartsPatient location and ordering location can be used to flex order entry formats.Orderables can be virtualized to specific facilitiesOrdering is then controlled depending on whether patient is registered at that facility.
42 What solutions use Core Locations? Inet can flex views based on the patient’s locationPatient on the left is located in the adult ICUPatient on the right is located in the NICU
43 What solutions use Core Locations? Charge ServicesAny organization that will be used for charge purposes will need to be built as an organization type of “Client”Charges can be flexed based on a multitude of fieldsPatient locationPerforming locationFacilityAs mentioned earlier, any organization where charging processes occur must be an Org type of “Client.”
44 What solutions use Core Locations? RadNetService areas will be tied to existing locations from the hierarchy for routing.Organizations and facilities need to be built prior to building accession number site prefixes
45 What solutions use Core Locations? PharmNetFormulary products can be flexed based on availability of products per each facility.If a formulary product is stocked on a floor and available via Omnicell/Pyxis, the product can also be associated with a nurse unit/ambulatory location to indicate this.
46 What solutions use Core Locations? ProFileHIM Chart Tracking has the ability to track a paper chart based on both user-defined locations and locations defined in the hierarchy.
47 What solutions use Core Locations? ProFitRevenue can be reported by:Patient locationPerforming location
48 What solutions use Core Locations? FirstNetAny area where an emergency patient needs to be tracked (beds, hallways, waiting room, etc) will need to built as a location within the emergency departmentLab label printing can be routed to different printers in the ED based on location, if necessaryTracking List tabs can be organized based on locationOnly displaying patients in Fast Track area
49 What solutions use Core Locations? Clinical ReportingChart distributions and expedites can be routed by patient location, which includes routing by facility, nurse unit, ambulatory location, or outpatient location.Keep in mind that if you are routing a distribution or expedite by patient location and you would like the ability to print charts to 2 locations within the ED, for instance, you would need to create 2 patient locations for the ED so that the chart can be printed to the respective device in that location.The location where the patient is registered to can also be printed in the chart header/footer. Again, this includes the facility, nurse unit, ambulatory location, and/or outpatient location.
50 What solutions use Core Locations? Anatomic Pathology (AP)Uses the functions of Orders for all orders placed outside the pathology labAP uses the functions of Charge Services and Profit to charge based on patient locationAP uses Registration and Patient search functionsService resources are used to route internal orders to work lists and work queuesProcessing orders are added to work queues based upon routingWorklists and Labels are printed based on routingReports are sent to review queues based on routingCalendars and Service Areas added to benches allow internal AP orders to be sent to the proper lab if there are multiple pathology labs working from the same database.
51 What solutions use Core Locations? OutreachOSM Requisition Order Entry (ROE)Only Organizations built as clients and facilities are viewable.
52 What solutions use Core Locations? OutreachThings that can driven by client for Outreach:Encounter typeFinancial classMRN assignmentInsurance, health plan, subscriber (required vs not required)Registrations defaults (Client vs patient bill)Flexible registrationInsurance companiesChartingBilling
53 What solutions use Core Locations? ePathLinkOrganizations built as clients and facilities can be used in ePathLink.Things that can driven by client for ePathLink:Encounter typeFinancial classMRN assignmentInsurance, health plan, subscriber (required vs not required)Registrations defaults (Client vs patient bill)Flexible registrationInsurance companiesChartingBillingOptions for utilization of ePathLink (new orders, results view only etc..)
54 What solutions use Core Locations? RegistrationSchedulingPowerChartCareNetINetCharge ServicesPharmNetProFileProFitFirstNetClinical ReportingPathNet APLocations appear in most all Cerner solutions. It’s crucial that everyone understand what locations are, and that they have a good understanding of what Facilities, Units, Rooms, and Beds are built in your system. We suggest that everyone meet as a group to sign off on the final Location Hierarchy design.
56 Sets of alphanumeric identifiers Alias Pools?Sets of alphanumeric identifiersThese numbers are used as boundaries for checking for duplicate persons, encounters, orders, personnel, and organizations.How are alias pools related to organizations?Assigned at organization levelWe use alias pools to store and compare the aliases that can’t be predefined in the system.
57 Alias Pools Pete Smith Cerner Hospital Cerner Clinic Patient Pete visits Cerner Clinic.Pete checks into Cerner Hospital.PatientPete SmithPete visits Cerner Clinic for a second time.Cerner ClinicClinic assigns Pete a MRN and a FINHospital assigns Pete a MRN and a FINCerner HospitalCH MRN PoolCC MRN PoolCH MRN:223Matches SSN and CMRNCC MRN: 223Hospital adds his SSN and CMRNCH FIN: CH3334CC FIN: B890SSN:CH FIN PoolCC FIN PoolCC FIN: B2343CMRN: 34543CMCH3334B890SSN:CMRN: 34543CMMatches MRNB2343SSN PoolAdds FINCMRN Pool34543CM
58 Types of Alias Pools “Buckets” of numbers Examples of data elements that require aliasPersonnelOrganization Dr. #UPINProvider NumbersEncounterFIN numberVisit numberOrderPlacer order numberPersonSSNMRNOrganizationInsurance companyEmployerThere are actually five different types of alias pools. They are Person, Organization, Personnel, Order, and Encounter. These alias pools are used to identify a person or organization within the database, dependent on which type of information is being sent into the database.This data comes into Cerner, and we can’t predefine what the alias will be. We need to set up a pool (or think file cabinet) to see if the data already exists and we can match the person (encounter, order, prsnl,or org) or if we need to add it to the pool (file cabinet) and keep it for future transactions.
59 Alias Pools Association Think of aliases in terms of the organization types rather than at the organization level.Does every Organization need alias pools?No, just certain types of Organizations need pools.Define what pools will be needed for the different types of OrganizationsOccasionally, there will be an identifier that is unique to one organization, but not apply to all others of the same type.Example: Cerner Hospital Assignes a MRN. Cerner Clinic Assigns a MRN. If the patient goes to Cerner Hospital, will they recognize the patient’s Cerner Clinic MRN? If so- the pools are shared. If not- they each assign unique MRN’s, and each need their own pool.Alias pools are buckets of numbers. These numbers are used as boundaries for checking for duplicate persons. When the system receives a person alias, the system asks, “Within this set of identifying numbers--this alias pool--have we seen this person before? Do we need to establish another person row on the person table, or can we add the information to a row we already have for this person?”
60 Alias Pools ExplainedFin Number - If patients are being registered to the organization they will always have a FIN number pool. It will be system-assigned only if a client implements Cerner ERM. If it is system assigned you can identify a start number. The FIN number is an encounter alias.MRN - If patients are being registered to the organization they will always have a MRN pool. This works the same way as FIN as far as the start number and system assign. MRN is a person level and an encounter level alias pool. Some applications will look to the encounter specific MRN where other situations you will want to utilize person level or all MRNs.Health Plan - This is required if importing health plans. It is associated to the facility. This pool is used to store Health Plan aliases.This slide doesn’t need to be covered in-depth during the presentation. This slide is useful for auditing/assigning alias pools to organizations during the design phase. Whoever will be working with Cerner to design alias pools will find this information useful.
61 Alias Pools Explained cont… Employer Code - This does not need to be associated to each Employer because this is one of the values that we know ahead of time what will be sent. The Employer Code alias pool should be tied to the main facilities.Encounter Organization Alias - This will need to be associated to all facilities. This is required to correctly stamp the encounter table.Insurance Code - This is the same as the Employer code. You need to have the pool built, but only need to tie to the main facilities.SSN - This pool will be shared by all organizations that patients are registered too. Masking is typically used so the SSN displays with the proper format.DOCDEA, DOCUPIN, External ID, and Organization Doctor - These are all personnel aliases that need to be tied to all facilities.This slide doesn’t need to be covered in-depth during the presentation. This slide is useful for auditing/assigning alias pools to organizations during the design phase. Whoever will be working with Cerner to design alias pools will find this information useful.
62 Alias pools may be shared across organizations Social security number Shared Alias PoolsAlias pools may be shared across organizationsSocial security numberCommunity medical record numberCommunity doctor numberRemember that not all alias pools will be unique to an organization. Community medical record number may be shared. Social security number will definitely be shared across organizations.Why is this? Alias pools are designed to be associated to the organization that assigns them. The government or state will assign certain numbers, those are the same no matter which organization the patient goes to for care. For that reason, a social security number, for example, can be set up for only one SSN pool, shared across ALL organizations. That identifier, or alias, means the same thing to each organization, so they can all share one pool for matching.
63 Code Sets including Code Values and Code Value Aliases Core ServicesCode Sets including Code Values and Code Value Aliases
64 What are code sets and what do they do? Code Sets - DefinedWhat are code sets and what do they do?Code Sets are groupings of like sets of reference dataFor example: Gender is a code set. Male, Female, Unknown are all possible reference data elements within the Gender code set.Code Sets also allow you to normalize information to be used across all solutionsFor example: By using code sets, the end user will see Female in both PowerChart and FirstNet, not Female in PowerChart and Woman in FirstNetCode sets are tables of data elements. Cerner predefines some code sets to which information cannot be added. Within the context of the predefined code sets, only those items built by Cerner have meaning in applications. The majority of our code sets, however, are created by clients.
65 Two types of code sets Standard Solution-specific Code Sets Gender, state, marital status, Units of MeasureSolution-specificLaboratory Code Sets (Body Site, Organisms)Code sets may be either application- or Core/OCF-specific. Core/OCF concentrates on code sets common to all applications, known as standard code sets.
66 Code Sets are also used to map information via an Interface Code Sets - InterfacesCode Sets are also used to map information via an InterfaceEvery data element coming into or out of Cerner from a foreign system must have an aliasThink of these standard values coming in and out as descriptorsDemographic descriptors – race, religion, genderOrder Information descriptors – collection priority, mode of transportation, and report priorityThe first thing we have to do to begin the process of integrating disparate systems is to get everyone to agree on standard values. To return to the fast-food restaurant example, everyone has to understand what a cheeseburger is. In order to do this, we need standard code sets. Standard code sets are descriptors. For the person, think of demographic elements, such as race, religion, and gender. For an order or result, think of the elements used to describe the order, such as collection priority, mode of transportation, and report priority.Standard code sets are made up of code values and code value aliases. First we define a list of standard display values. For religion, these might be Baptist, Catholic, and Muslim. Next, we need to know what all the other systems use to represent these display values. When sending information about religion, one system might use “B” for Baptist, “C” for Catholic, and “M” for Muslim. These values would be the code value aliases, which provide the information necessary to interpret what is coming from other systems.
67 Code Sets - Interfaces Patient = John Smith Inbound Values Gender Code SetForeign ADT: “M”M = Male1 = MaleForeign ADT: “F”gender display = MaleF = Female2 = FemaleForeign Lab: “1”Foreign Lab: “2”The Core/OCF database can receive information from different feeder systems. Each feeder system may have a different way of indicating the same piece of information. For example, two feeds may use different methods to identify a person’s gender. In this picture, the registration system sends “M” for male and “F” for female. The lab system, however, sends “1” for male and “2” for female.In order to create a standardized set of information, the Core/OCF database needs to store the same code values for gender regardless of who sent the information. In this example, the Core/OCF database stores the code value “1” to indicate someone is male and the code value “2” to indicate female.To store the appropriate value for an individual, the database must be able to interpret the information coming from the feeder systems. Aliases allow for the interpretation of information from feeder systems. For example, after the aliases “M” and “1” are defined, the system knows to store the code value for male when it receives these aliases from the feeds. After “F” and “2” are defined, the system knows to store the code value for female when it receives these aliases. In this way, aliases normalize information coming into the Core/OCF database to the standardized display values.When requests are made for information from the database about a person’s gender, the system displays “male” or “female” based on the code value stored in the database as the gender for the person. The display values are defined in the standard code set for gender, where the labels “male” and “female.”
68 Allow for site customization of data elements Benefits of Code SetsAllow for site customization of data elementsCerner provides Start data elements for you to useProvide for standardization or normalization of data display across all solutionsCommon display valuesSets of data come into the Core/OCF database referencing individual codes. The sets of data are called contributor sources and the individual codes are called aliases. Therefore, each alias comes from a specific contributor source. Because of Standard Code Sets, the system can understand and translate each alias so the data can be stored and displayed in common terms.
69 Event Codes and Event Sets Core ServicesEvent Codes and Event Sets
70 What is a Flowsheet?This slide simply shows you the flowsheet view from PowerChart. This slide is first so you can capture the audiences attention. When you talk about the flowsheet, describe what it is an how it is used and what the benefits are of it.What is a flowsheet?allows clinicians to trend historical clinical events (graphing function for WBC Results)allows clinicians to view these clinical events in logical way (UA Dipstick Results are all grouped together)allows for ability to groups like clinical events together together (different flowsheets – Lab, Radiology, Vital Signs)
71 What is a Clinical Event? Often called a resultResult of a questionResult of a diagnostic testResult of an assessmentResult of a consultA clinical event is a result. It can be:the result of a question – such as “do you smoke?”or the result of a diagnostic test such as a chest x-rayIt can be the result of an assessment – such as the patient’s heart rageIt can also be the result of a consult – such as a consult noteAll clinical events are stored in Event Codes.
72 What is an Event Code?Event Code:It is the reference data element against which each clinical event is storedEvent CodeResultReference Data ElementActivity Data ElementSo, what is an event code?An event code is the reference data element against which each result in the clinical event table is stored. Without an event code, the result cannot be stored to the clinical_event table and an error is received, usually a “failure to ensure result” error. The system must be able to determine which event code should be used to store a result.Another way to think of event codes is this --- a result is just a number or a textual string or an image --- the event code defines the meaning of the result. The result is “13”… the event code tells us it is a “hemoglobin”. The integrity and clear definition of event codes is very important.
73 Only ONE event code should ideally exist per concept. More about Event CodesOnly ONE event code should ideally exist per concept.It is not a good idea to purposely build more than one event code that conceptually means the same thing.The GOAL and RECOMMENDATION is to strive for ONE event code for each result-able concept.Only ONE event code should ideally exist per concept.It is not a good idea to purposely build more than one event code that conceptually means the same thing.The GOAL and RECOMMENDATION is to strive for ONE event code for each result-able concept.The Cerner Millennium database can technically handle multiple event codes for the same concept in most situations.In some cases, however, multiple event codes for the same concept can lead to issuesThis will be discussed further throughout Clinical Event series
74 Event Code IntegrityOnce an event code is paired with a production result, the two must be an inseparable pair forever.Therefore, event codes that have a result against them on production patients on the clinical event table should:NOT be changed (meaning should not be changed)BE viewableEvent CodeResultReference Data ElementActivity Data ElementLet’s discuss event code integrity for a moment. It is important to know and remember that once an event code is paired with a production result, the two MUST be an inseparable pair forever.Once an event code written against a real production patient’s result on the clinical_table, then it is imperative that this event code NOT be changed to the point that it’s meaning is changed. Furthermore, this result needs to be viewable.
75 Flowsheet – Event Codes Event Code is the placeholder for resultBrining this slide back to demostrate where the event code is representedThe discrete result is NOT the event code. The event code is just the storage place for the result. For example, 8 is the result, not the event code. You do not actually see the event code when you look at the flowsheet
76 Viewing Event codes and results? Event codes are how results are stored in the system.For most solutions, however, we do NOT view event codes.Thus, we introduce the Event Set.Event Codes need to be paired with an Event Set for viewing.Event SetEvent CodeSo how do we view event codes and results? We now understand that event codes are how results are stored in the system.For most solutions, however, we do NOT view event codes.Thus, we introduce the Event Set.Event Codes need to be paired with an Event Set for viewing.
77 No activity data is stored against an event set. What is an Event Set?Event Set:Event Sets are used to group/organize event codes for viewing and printing (clinical reporting).The organization of event sets is hierarchical, thus called the event set hierarchy.No activity data is stored against an event set.Event Sets are used to group/organize event codes for viewing and printing. The organization of event sets is hierarchical, thus called the event set hierarchy.Event sets themselves are stored in the code_value table (code set 93) as well as the v500_event_set_code table.The hierarchical structure of the event sets is stored in the v500_event_set_canon table.No activity data is stored against an event set.
78 Event Sets are What You Can See Flowsheet – Event SetsEvent Sets are What You Can SeeAll rows here, BOTH dark and light blue bars, are event sets.So, event sets are what you can see. In this screen shot, the dark and light bars, whether they are green or blue, are event sets.
79 More about Event SetsEvent Set Hierarchy: The event sets are organized in a hierarchical structure called the event set hierarchy (ESH).Grouper Event Sets: Like event sets are grouped together into grouper event sets.Primitive Event Set: At the lowest level of the hierarchy, there must be a connection to an event code in order for results viewing to occur. This lowest level event set is called the primitive event set.Therefore, an event set within the ESH can be EITHER a grouper event set OR a primitive event set. It cannot be BOTH.ESHAs stated previously, the event sets are organized in a hierarchical structure called the event set hierarchy (ESH).Event sets are logically arranged within the ESH in a parent-child fashion. Like event sets are grouped together into grouper event sets.At the lowest level of the hierarchy, there must be a connection to an event code in order for results viewing to occur. This lowest level event set is called the primitive event set.Therefore, an event set within the ESH can be EITHER a grouper event set OR a primitive event set. It cannot be BOTH.
80 Diagram of the Required Event Sets All OCF Event SetsAll Result SectionsAll Specialty SectionsAll Service SectionsAll Document SectionsOther ResultsOther DocumentsThis diagram depicts the required core event sets as well as the required hierarchical structure for these required event sets.There are two sides to the event set hierarchy: All Result and All Specialty.These are the required building blocks of the event set hiearchy
81 ESH Structure Event Codes Grouper Event Sets Primitive Level ParentAll OCF EventsChildGrouperEvent SetsAll Result SectionsParentChildAll Service SectionsParentChildParentLaboratoryChildParentHematologyUrinalysisChildCBCParentUA DipstickPrimitive LevelWBCRBCHgbBilirubinUrineDipstick POCBloodUrineDipstick POCGlucoseUrineDipstick POCChildEvent CodesWBCRBCHgbBilirubinUrine DipstickPOCBloodUrine DipstickPOCGlucoseUrine DipstickPOCThis slide depicts many of the concepts we have discussed related to event sets:The ESH is a sequence of parent/child relationships until the lowest level of the hierarchy is reached. At this level, there must be a connection to an event code for results view to occur for that event.The event set hierarchy allows for results to be organized into logical grouper event sets.The lowest level of the hierarchy defines the primitive event sets.
82 Flowsheet – Grouper and Primitive Event Sets Vital Signs would be considered a Grouper Event Set while Temperature Tympanic, Respiratory Rate etc. are Primitive Event Sets. Vital Signs is the Parent of these primitive event setsThe Event Code of Respiratory Rate is tied to the Event Set Respiratory RateThere are no Event Codes tied to Grouper Event SetsSo, event sets are what you can see. In this screen shot, the dark and light bars, whether they are green or blue, are event sets.
83 “All Results” Organization Analogy Event Codes = Paper(Results of WBC, RBC, Hgb are written on different sheets of paper)Grouper Event Sets = Sections & DrawersWBC, RBC & Hgb are filed into CBC. CBC goes to “Hematology” Divider in the “Laboratory” Drawer.Primitive Event Sets = FilesAll WBC, RBC & Hgb papers are filed into separate WBC, RBC, & Hbg filesAll papers, files, dividers, and drawers are logically organized and sequenced in appropriate SIDE of the “All Results” cabinet.
84 “All Results” Organization Analogy All OCF EventsGrouperEvent SetsAll Result SectionsFILE CabinetAll Service SectionsSide of the FILE CabinetLaboratoryDRAWERHematologyUrinalysisSECTIONSCBCUA DipstickSECTIONPrimitive LevelWBCRBCHgbBilirubinUrineDipstick POCBloodUrineDipstick POCGlucoseUrineDipstick POCFILESEvent CodesPAPERWBCRBCHgbBilirubinUrine DipstickPOCBloodUrine DipstickPOCGlucoseUrine DipstickPOCThis slide depicts many of the concepts we have discussed related to event sets:Let’s compare this slide to our file cabinet analogy.