1. M.U.S.E. 2007 Tuesday Training Intro to Clinical Rule Writing Presented by: Jason Medeiros

2. Rules Course Agenda Overview Basic Rule Syntax Using Data fields, queries IF Statements Use of Local Variables How to apply rules in your application Different types of rules Output Where are rules attached? Important data fields in each application

3. Functions of Clinical Rules Rules allow you to evaluate criteria and perform a response Restrict ordering of medications/tests Send notifications to staff via MOX Calculate LAB values for RPh review Change a field value Generate notification of NUR intervention

7. Rule Syntax Basic Guidelines All rules must end with a semi-colon Every line within the Rule editor must end in a comma or semi-colon Each line of programming code is limited to the visual space provided in the Rule editor. “This is my warning message to the Meditech user"^MSG, IF{[f pt sex]="M" [f rx msg](MSG); [f rx ok]};

8. Accessing/Utilizing Data Fields: Data Fields reference Permanent and/or Temporary information. Data fields may perform action or Calculations Access: Use the “get” key (F4 on PC) Then “F” space and your lookup key You may ‘seed the lookup’ to quickly find fields

10. Data Fields – Permanent data Always available in Rules pt admit dr 30 Patient's admitting provider's name pt admit dr mne 10 Patient's admitting provider pt los 3 Discharged patient's length of stay pt name 30 Patient's name pt nok 30 Patient's next of kin pt oe wt kg 6 Patient's oe weight in kg pt sex 1 Patient's sex

11. Data Fields – Temporary data Data may or may not be entered yet lord col date 8 Lab order collection date lord col day 3 Lab order collection day of wk rx ord type 10 Rx's order type rx order site 10 Rx's order site rx sig 20 Rx's sig ord ser dt 8 Service date ord ser tm 4 Service time

12. Data Fields - Calculated day of week 3 Current day of week days old 4 # Days before today() lord lab test 1 Lab order lab test() lord lab today 1 Lab test already ordered today() lord get pt age3 Patient age today 8 Today's date

13. Data Fields – Perform Action rx msg 60 Rx message() rx set billing code 60 Rx set billing procedure code to() rx set charge type 60 Rx set charge type to() rx set rx comment 60 Rx set rx comment to() ord err msg60 Order error message() ord msg 60 Order message() ord reject 0 Order REJECT ord yes/no 60 Order ask yes/no()

14. Using Query Values in Rules You may pull Customer Defined Query values into Rules to be evaluated. Access: Use the “get” key (F4 on PC) “Q” space and your lookup key You may ‘seed the lookup’ to quickly find queries

15. Using Query Values in Rules - Issues Queries may not have a value when the particular rule is running If your value does not work as designed, try this trick: Example: [f rx msg](“Allergy1: “_[q OE.ALL1]); This syntax will display the value of OE.ALL1 in a yellow box. You will then be able to determine if the rule is getting the query value properly.

16. What is an Argument? Definition: An argument is a value that is passed into the data field to be used by that data field. An Argument may be: Text message Another Rule Mnemonic (CALC Rule) Local Variable

17. Argument Required – Parentheses in lookup

18. Some data fields require an argument If parentheses appears in the lookup for the data field then an argument is required You will receive an ERROR message from the syntax checker if an argument is not utilized If there is a comma in the lookup, then two arguments are required

19. What should my argument be? There is no easy way to tell what the argument of a data field should be, although it is usually possible to discern this from the field name/description Consult the Meditech L list Other expert sources?

20. Local Variables Used for the temporary storage of information during the processing of the rule Used to: Store information for future processing, such as calculated values Store large strings into smaller names in order to conserve space in the Rule Text Editor Your local variables are created and available only during the processing of the current rule

21. Local Variables – How to create Example: "This is my warning message to the Meditech User."^MSG, IF{[f pt sex]="M" [f rx msg](MSG); [f rx ok]}; Use local variable MSG to store the message Refer to MSG in the IF/THEN statement

22. Local Variables- Naming Conventions Use Capital-Alpha-Numeric characters Use at least 3 characters Use short, descriptive, meaningful names Example: MSG CREAT NAME LNAME AGE

23. Local Variables – what NOT to use Meditech uses its own local variables while the screen is functioning. You should take care not to overwrite the following local variables in your code: XANSRS ABC Can you think of others?

24. The Assignment Operator (  ) Shift-6 on your keyboard Used to: 1. Assign a value to a variable 2. Display a value on the screen 3. Erase a value Example: “Please change inventory to MAIN”^MSG, We read this as “Message text goes to local variable MSG.”

25. Relational Operators Used to compare values to determine a TRUE/FALSE relationship MAGIC Relational Operators: OperatorExplanation 'Not =Equal to ‘=Not Equal to >Greater Than <Less Than ‘>Not Greater Than (less than or equal to) ‘<Not Less Than (greater than or equal to)

26. Relational Operators - Example "Please obtain parental consent.“^MSG, IF{[f pt cur age]<18 [f lord msg](MSG); [f lord ok]}; Store the display text in MSG Check pt current age and if less than 18, display the message to user

27. Relational Operators – Nil vs. Non-nil In Magic, each operation will maintain a value If the evaluation is true, the value on the LEFT side becomes the value of the operation 5>4 ……………TRUE ………..…..5 is the value If the evaluation is false, nil becomes the value of the operation 4>5 …………….FALSE ………… “” is the value

28. Relational Operators - Examples OperationEvaluationValue 5>2True “ABC”=“ABD”False 3’>1False LOC=“3S”? “”=“”Initially – True Ultimately – False “” When creating operations, you should always be careful to not set something = to nil. Even if the value is nil, the final value of the operation will become nil and will ultimately be evaluated as false.

29. IF/THEN/ELSE Statements -Syntax IF/THEN: IF{condition response1;response2} Example: IF{[f pt sex]="M" [f rx yes/no](“Drug is male-specific. Order anyway?"); [f rx ok]};  There is a space between the condition and response. The space represents the “THEN" portion of the IF/THEN statement.  The semi-colon represents the separation between the first condition/response pair. The semi-colon is the "ELSE" portion of the IF/THEN/ELSE statement.

30. Multiple Condition Statements IF{condition1 response1; condition2 response2; response3} Each condition will be evaluated moving from left to right If condition 1 is true, then response 1 will be performed and no other conditions will be evaluated. If condition 1 is false, then condition 2 will be evaluated. If condition 2 is true, response 2 is performed. If both conditions 1 and 2 are false, then response 3 is performed.

31. IF/THEN/ELSE Statements –Syntax (ctd) Example: IF{[f pt facility]="A" [f lord use billcode]("A1234"); [f pt facility]="B" [f lord use billcode]("B1234"); [f pt facility]="C" [f lord use billcode]("C1234"); [f lord ok]}; Note: Indentation of the conditions – proper formatting

32. Boolean Operators Compare using AND and OR relationships. For example: Display a message if the patient is male AND older than 65. Notify user to order test as STAT if the patient is in the location of ICU OR CCU.

33. Boolean Operators (ctd) OperatorBoolean Equivalent !OR &AND

34. Boolean Operators - Examples "Ask for date of LMP.“^MSG, IF{[f pt sex]="F"&([f pt cur age]>15) [f lord msg](MSG); [f lord ok]}; If both conditions are TRUE, display message "Cannot order test.“^MSG, IF{[f pt sex]="M"!([f pt cur age]<10) [f lord msg)(MSG); [f lord ok]}; If either condition is TRUE, display message Note: Parentheses used in the expression!

35. Application Specifics – Similarities OE/LAB/PHA share some common characteristics: Data fields– In all apps, there are data fields which will perform a function such as display a message to a user: [f lord msg](“Please call LAB regarding this test!”)

36. Application Specifics – Similarities Certain fields will allow the user to file or reject the order. In general, a rule will allow filing if its FINAL VALUE is a non-nil value. If the final value is nil, the user is stopped. [f ord ok] – Order is ok, allow filing. [f ord reject] – Order is not ok, do not allow filing. [f rx err msg](“Patient is Male. You may not place this order.”) Error message- Do not allow filing.

37. Application Specifics – Similarities Prompt user to continue “Current time is after hours. Order anyway?”^MSG, IF{(0700>[f now])!(1500<[f now]) [f lord yes/no](MSG); [f lord ok]}; If user answers “Y”, then allow filing. If user answers “N”, then do not allow filing. Prompt User

38. Application Specifics - PHA

39. Types of Rules RX Rules Calc Rules Bill Rules Purge Rules Adj Rules – seldom used DUE Rules – seldom used

40. PHA – RX Rules Evaluate at

41. MED - When the medication is identified DOSE - When the dose is specified FILE - When the Rx is filed TXN - During the billing compile before Rx is sent to B/AR REFILL – When Refill List is run or Check Refill Rules routine is run STOP - When you enter a Stop Date and file the order

42. PHA – POM Enabled

43. PHA- POM Enabled (ctd) POM MED – Identify the MED in POM POM DOSE- Enter a DOSE in POM POM FILE – Enter a stop date for an order in POM

44. PHA – Page 2

45. PHA- Page 3

46. PHA – Page 4

47. PHA Rule View

48. PHA RX Rules– Where to attach? Global Rules – Attached in Customer Defined Parameters – Page 4 Evaluated for ALL orders Drug Specific Rules – Attached in the PHA Drug Dictionary – Page 4 Evaluated only for this drug

49. PHA – Global RX and Purge Rules

50. PHA- Print Profile routine

51. PHA- CALC Rules Referenced by RX rule using [f rx calc]

52. PHA – BILL Rule Charge Type Dictionary

53. PHA - Important Data Fields Field:[f rx reject] Description: Returns a nil value. This field is used to return “” as a result of a condition specified in the rule. User may NOT continue with the order. *Seldom used.

54. PHA - Important Data Fields Field:[f rx set billing code] Syntax:[f rx set billing code](X) Argument: X is the billing procedure code you intend to set. Description: Use this field to modify the billing code for an Rx based on a condition. This billing code must exist in B/AR database.

55. PHA - Important Data Fields Field:[f rx set charge type] Syntax:[f rx set charge type](X) Argument: X is the charge type you would like to default for this Rx. Description: This field will set the charge type for this Rx. The charge type must be valid in the Charge Type Dictionary.

56. PHA - Important Data Fields Field:[f txn qry resp] Syntax:[f txn qry resp](X,Y) Arguments: There are two arguments required for this field. X is the value you are sending. Y is the MIS query mnemonic you have setup to store the value you are sending. This query is used on the B/AR side and is attached to a CDS of type: BAR TXNS Description: This field is used to send additional query information to B/AR in an Rx rule evaluated at the TXN level.

57. PHA - Important Data Fields Field:[refill rule msg]() Syntax:[refill rule msg](X) Argument: X message to display on the Refill List Description: Will print on the Refill List printout if the rule fails and generates a message

58. PHA - Important Data Fields Field:[f rx last ver result] Syntax:[f rx last ver result](X) Argument: X is the lab test mnemonic that you are querying. Description: Returns the last verified result stored in LAB for this patient and test.

59. PHA - Important Data Fields [f rx nth ver Res-COL](“PSA",1) Returns result, collection date and collection time of the most recent PSA TEST. A argument: LAB TEST Mnemonic/print number B argument: Which LAB result to retrieve. 1 is most recent, 2 is next recent, 3 is third most recent

60. PHA - Important Data Fields [f rx nth ver Res-RES](“PSA",1) Returns result, result date and result time of the most recent PSA TEST. A argument: LAB TEST Mnemonic/print number B argument: Which LAB result to retrieve. 1 is most recent, 2 is next recent, 3 is third most recent

61. PHA - Important Data Fields You can parse out the data from these keywords Use String Extraction Example: TEST#"0,"^RES RESULT TEST#"1,"^DATE DATE TEST#"2,"^TIME TIME

62. PHA - Important Data Fields Field:[f pur do purge] Syntax:[f pur do purge] Description: This field is used to return “” as a result of a condition specified in the rule. Use this field to purge the record.

63. PHA - Important Data Fields Field:[f pur do not purge] Syntax:[f pur do not purge] Description: This field is used to return 1 as a result of a condition specified in the rule. Use this field to prevent the purge of the record.

64. PHA – Custom Keywords Meditech allows PHA users to create your own Custom Keywords. Use this feature to: Access fields not available in lookup Call custom NPR macros to: Search pt profile for a Generic Send a MOX message Perform complex calculations

65. PHA – Custom Keywords

66. Custom Keywords in other Apps The E/E Custom Keywords routine is ONLY available in PHA For OE/LAB/SCH, you may request custom keywords from Meditech. When doing so, BE SPECIFIC in your request.

67. Application Specifics – LAB

68. Application Specifics - LAB Rule Types BBUNIT# - Check format of BBK Unit numbers. Assigned in the BBK Source/Destination Dictionary BBASSN – BBK Assignment/Issue rules may allow or disallow the assign/issue of blood units. BCCHK – Check bar code formats CHG – Add miscellaneous charges to certain tests

69. Application Specifics - LAB Rule Types ORD – Order rules restrict ordering of LAB Tests BSP/LSP/MSP/PSP – Control the selection of specimens that use Selection Profiles LBCAST – Control download of specs to analyzers PQL – Customize Pathology Questionnaire Logic

70. Application Specifics - LAB Rule Types PTID – Verify PT ID formats for external LABS PURGE – Control purging of LAB records REFLEX – Control reflex ordering of tests SITE – Assign LAB Site to a requisition VERIFY – Control results notification

71. POM Enabled?

72. POM Enabled? – Provide user options Online help

73. LAB Rules – Where to Attach? Test Dictionary – ORD/CHG/Site Rules BBK Test/Product/Source/Destination Dictionary – All BBK Rules Micro- Procedure, Organism dictionary

74. LAB Rules – Where to Attach? Order Group Dictionary – RFLX Rules Pathology Questionnaire Dictionary – PQL Rules Analyzer Dictionary – LBCAST Rule LIS Client Dictionary – PT ID Rule

75. Attach multiple rules per TEST New!

76. LAB – Important data fields Field:[f lord lab test] Syntax:[f lord lab test](X) Argument: X is the LAB Test Mnemonic you are checking for Description: Returns a (Y)es if the Lab test has been ordered during the same requisitioning session.

77. LAB – Important data fields Field:[f lord lab today] Syntax:[f lord lab today](X) Argument: X is the LAB Test Mnemonic you are checking for Description: Returns a (Y)es if the Lab test has been ordered today.

78. LAB – Important data fields Field:[f lsp last ver result] Syntax:[f lsp last ver result](X) Argument: X is the LAB Test Mnemonic you are checking for Description: Will return the last verified test result for the test mnemonic in the argument.

79. LAB – Important data fields Field:[f lord gen info] Syntax:[f lord gen info](X) Argument: X is the Generic drug you are checking for Description: Returns the status of an RX that contains the generic - AC/UNV/DC You may also check for drug mnemonics using: [lord drug info]

80. LAB – Important data fields Field:[f psp view rel find] Syntax:[f psp view rel find] Description: This field will display the Related Findings screen in Pathology. This would typically be used with a POST rule.

81. LAB – Important data fields Field:[f ppr set response] Syntax:[f ppr set response](Mnemonic,Text) Arguments: Mnemonic of the prompt you want to set, TEXT to default into the prompt Description: This field will set the response for another prompt response within the questionnaire. This field will typically be used with a POST rule.

82. Application Specifics - OE

83. Types of Rules ORD – Evaluated when user FILES order OUTPUT– Control printing of reqs PTDATA – Evaluates entry of Patient Data in E/E Administrative Data routine. *seldom used

84. POM Enabled?

85. POM – Provide options to user

86. OE Rules – Where to attach? ORD- Attached Page 1 Procedure Dictionary. OUTPUT – Attached Page 2 Procedure Dictionary PTDATA - Linked via a query attached in the OE Parameters

87. Attach multiple rules New!

88. OE– Important data fields Field:[f do not print] Syntax:[f do not print] Description: This data field will suppress the printing of a requisition when used as the last value of a rule.

89. OE– Important data fields Field:[f do print] Syntax:[f do print] Description: This data field will allow the printing of a requisition when used as the last value of a rule.

90. OE – Output Rules Do Not print REQ if on a Weekend

91. Output Rule – Attach to Procedure

92. Application Specifics – NUR Generate Clinical Alerts when Interventions are documented Attached in Intervention Dictionary New!

93. NUR – Intervention dictionary

94. NUR Rule – Old school dictionary MIS Notification Mnemonic, Level, Detail

95. NUR– Important data field Field:[f pt notification](ca,lev,det) Syntax:[f pt notification](“ALERT”,”Med”,MSG) Description: This field generate an MIS Clinical notification, as specified in the MIS Notification dictionary. Arguments: “ALERT” – MIS Notification mnemonic “Med” – Level MSG – Detail to include on notification

96. For more information….. Our I-Online Learning courses are a great way to present this material to your entire staff simultaneously – for a fraction of the cost of On-site training. See our website for our Fall/Winter Course Schedule! Iatric Systems www.iatric.com 978 805 4100