1. 1 The ABC’s of TIU UPLOADING Plus, Filing errors Missing field errors

2. 2 Enter Upload Utility Parameters Option to use is:  TPM2 Modify Upload Parameters This option is located:  TIU Menu for Medical Records Option TMM - TIU Maintenance Menu Option (required key TIUZMGR)  TPM – TIU Parameters Menu Option

3. 3 Settings at Red Lake, MN Select INSTITUTION: RED LAKE HOSPITAL BEMIDJI RED LAKE 01 MN IHS 497 ASCII UPLOAD SOURCE: host file server// UPLOAD HEADER FORMAT: captioned// RECORD HEADER SIGNAL: $HDR// BEGIN REPORT TEXT SIGNAL: $TXT// END OF MESSAGE SIGNAL: $END// RUN UPLOAD FILER IN FOREGROUND: NO// Now Select upload error alert recipients: Select ALERT RECIPIENT: LASLEY,KARRIE// IHS UPLOAD PARAMETERS UPLOAD FILE DIRECTORY: f:\pub\mxtiu\// ARCHIVE FILE DIRECTORY: f:\pub\mxarch\// UPLOAD FILE NAME: tiufile.txt// Define all of the users that will be filing all Missing Field and Filing Error alerts. If you want to automate the upload process you must define these three fields. If you are going to manually upload the files, these fields do not need to be defined plus these two fields would be set different: ASCII UPLOAD SOURCE: remote computer UPLOAD PROTOCOL: KERMIT

4. 4 Setup for Progress Notes Document Class Now edit the DOCUMENT DEFINITION file: DOCUMENT DEFINITION: PROGRESS NOTES CLASS ABBREVIATION: PN// LAYGO ALLOWED: YES// UPLOAD TARGET FILE: TIU DOCUMENT// Select TARGET TEXT FIELD: REPORT TEXT// UPLOAD LOOK-UP METHOD: D LOOKUP^TIUPUTPN// UPLOAD POST-FILING CODE: D FOLLOWUP^TIUPUTPN(TIUREC("#")) Replace UPLOAD FILING ERROR CODE: D PNFIX^TIUPNFIX// Select CAPTION: CLINIC CODE// ? Answer with UPLOAD CAPTIONED ASCII HEADER, or ITEM NAME, or FIELD NUMBER, or LOOKUP LOCAL VARIABLE NAME Choose from: CLINIC CODE DICTATED BY DICTATION DATE EXPECTED COSIGNER HRCN TITLE TRANSCRIPTIONIST URGENCY These fields are the ones defined at Red Lake. See the following slides for each upload document type and the settings for each caption field.

5. 5 IHS UPLOAD PARAMETERS These parameters allow you to automatically upload files to the TIU Document file. You will need a ftp-file-transfer type software application to check for completed files at the location defined in field, Upload File Directory. Combines all completed files into one file with an ending $END. Names it to the file name you have defined in the field, Upload File Name. Therefore, for Red Lake it is named tiufile.txt When it has uploaded, file is moved to the location defined in field, Archive File Directory.  The file name is changed to append the date, ex: tiu3050502.txt.  If there is more than one file for the same date it appends a time. The archive directory saves the file should you need to upload the file again due to problems.

6. 6 Tasked job for the IHS Parameters Option Name: BTIU UPLOAD DOCUMENTS QUEUED Menu Text: Upload Documents (Queued) TASK ID: 270439 _____________________________________________________________ QUEUED TO RUN AT WHAT TIME: MAY 10,2005@09:45 DEVICE FOR QUEUED JOB OUTPUT: QUEUED TO RUN ON VOLUME SET: RDL RESCHEDULING FREQUENCY: 900S TASK PARAMETERS: SPECIAL QUEUEING: ______________________________________________________________

7. 7 Clinic Set Up Create Visit at Check-In? YES 1.Using the Set Up a Clinic option, look at Page 4 of 4 2.Make sure that Create Visit at Check-In is set to YES 3.Make sure there is at least one default provider 4.TIU upload files to the entry in the VISIT file and not the appointment; therefore this ensures that a visit is created when the clerk checks-in the appointment.

8. 8 Progress Notes Class Caption fields CAPTION: HRCN ITEM NAME: HRCN FIELD NUMBER:.02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-") CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT EXAMPLE ENTRY: 06/28/04 CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: YES CAPTION: DICTATED BY ITEM NAME: DICTATED BY FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH EXAMPLE ENTRY: DOOGIE HOWSER CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X) CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER FIELD NUMBER: 1208 EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO CAPTION: VISIT DATE ITEM NAME: VISIT DATE FIELD NUMBER:.07 LOOKUP LOCAL VARIABLE NAME: TIUVDT EXAMPLE ENTRY: 042805 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

9. 9 Progress Notes captioned fields continued CAPTION: URGENCY ITEM NAME: URGENCY FIELD NUMBER:.09 EXAMPLE ENTRY: ROUTINE CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO CAPTION: TITLE ITEM NAME: TITLE FIELD NUMBER:.01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE EXAMPLE ENTRY: PEDIATRIC ENCOUNTER CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC EXAMPLE ENTRY: 08 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES

10. 10 About two of the fields… Required fields  If a field that is required is missing, it will attempt to file the document but will generate a Missing Field Error Alert Clinician Must Dictate  This will determine what fields are shown should the option, Help for Upload Utility, which is not used.  Some fields the clinician does not normally need to dictate: Dictation Date – Normally this date in stored when dictated in most Transcription Companies software applications. Transcriptionist – Would be entered by the transcriptionist that types the document

11. 11 Additional facts… Clinic Code is sufficient and works better than expecting the transcription company to type the exact clinic name.  The only time you would have a problem with clinic code – if the patient has two same clinic codes for the same visit date You would then receive a Filing Error Alert and have to manually link to the correct visit. Expected Co-signer is normally left blank but it should be defined if ever you have students that dictate so they may designate their expected co-signer. Someone with programmer access will need to define these two fields:  Lookup Local Variable Name  Transform Code

12. 12 Discharge Summary field settings set on the Title CAPTION: HRCN ITEM NAME: HRCN FIELD NUMBER:.02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S:X["-" X=+$$STRIP^XLFSTR(X,"-") S X=+X CAPTION: DATE OF ADMISSION ITEM NAME: ADMISSION DATE FIELD NUMBER:.07 LOOKUP LOCAL VARIABLE NAME: TIUADT EXAMPLE ENTRY: 03/30/93 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES CAPTION: DICTATED BY ITEM NAME: DICTATING PROVIDER FIELD NUMBER: 1202 EXAMPLE ENTRY: DOOGEY P. HOWSER, M.D. CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X) CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDICDT EXAMPLE ENTRY: 04/03/93 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: NO

13. 13 Discharge Summary cont… CAPTION: ATTENDING PHYSICIAN ITEM NAME: ATTENDING PHYSICIAN FIELD NUMBER: 1209 EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X) CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST ID FIELD NUMBER: 1302 EXAMPLE ENTRY: T1212 CLINICIAN MUST DICTATE: NO CAPTION: URGENCY ITEM NAME: STAT OR ROUTINE FIELD NUMBER:.09 EXAMPLE ENTRY: ROUTINE CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: NO

14. 14 Discharge Summary additional facts If the dictated by and attending physician are the same their name has to be entered in the header in both fields Note that Discharge Summary caption field settings are done at the title level not class.  The reason is that only one record is allowed per admission

15. 15 Consults field setting done at the Document Class level CAPTION: TITLE ITEM NAME: TITLE FIELD NUMBER:.01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE EXAMPLE ENTRY: SURGERY CONSULT CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES CAPTION: VISIT DATE ITEM NAME: VISIT DATE FIELD NUMBER:.07 LOOKUP LOCAL VARIABLE NAME: TIUVDT EXAMPLE ENTRY: 04/15/05@1300 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES CAPTION: DICTATED BY ITEM NAME: DICTATED BY FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X) CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT EXAMPLE ENTRY: 04/28/05 CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: YES CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER FIELD NUMBER: 1208 EXAMPLE ENTRY: DOOGIE HOWSER CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

16. 16 Consult fields cont… CAPTION: CONSULT NUMBER ITEM NAME: CONSULT NUMBER FIELD NUMBER: 1405 LOOKUP LOCAL VARIABLE NAME: TIUCNNBR EXAMPLE ENTRY: 1234 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X="C."_X CAPTION: HRCN FIELD NUMBER:.02 LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-") CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC EXAMPLE ENTRY: 23 CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

17. 17 Example of a Progress Note Upload Document $HDR: PROGRESS NOTES HRCN: 3475 DICTATION DATE: 04/20/05 DICTATED BY: MICHAEL BORROMEO EXPECTED COSIGNER: VISIT DATE: 04/20/05 TITLE: LETTER CLINIC CODE: 06 TRANSCRIPTIONIST: SECURE, MX $TXT Progress Note dictation is typed here. $END

18. 18 Example of a Discharge Summary upload document $HDR: DISCHARGE SUMMARY HRCN: 2101 DATE OF ADMISSION: 04/15/05 DICTATED BY: MICHAEL BORROMEO DICTATION DATE: 4/18/05 ATTENDING PHYSICIAN: MICHAEL BORROMEO TRANSCRIPTIONIST: SECURE,MX URGENCY: ROUTINE $TXT Discharge Summary dictation is done here $END

19. 19 Example of a Consults upload document $HDR: CONSULTS TITLE: SURGERY CONSULT VISIT DATE: 04/15/05@1300 DICTATED BY: MARCUS WELBY DICTATION DATE: 04/28/05 EXPECTED COSIGNER: DOOGIE HOWSER CONSULT NUMBER: 12 HRCN: 123456 CLINIC CODE: 23 TRANSCRIPTIONIST: SECURE,MX $TXT CONSULTS Text $END The consult number prints out on the consult request. It also may be viewed on the Consults tab of the EHR

20. 20 TIU Upload Menu Option UPL1 Upload Documents  This option enables the user to upload transcribed ASCII documents in batch mode, either from remote microcomputers, using ASCII or KERMIT protocol upload, or from Host Files (i.e., DOS or VMS ASCII files) on the host system.  This is the manual option to upload documents if you are not using the IHS Parameters UPL2 Help for Upload Utility  Displays information on the formats of headers for dictated documents that are transcribed off-line and uploaded into DHCP.  Displays "blank“ character, major delimiter and end of message signal as defined by your site. UPL3 Display Upload Status UPL4 Reset Upload to Restart

21. 21 UPL3 Display Upload Status Displays last file uploaded and last attempt to find file for uploading. Can also show if upload stopped for a known reason.  Example: **STATUS OF TIU UPLOAD** LAST FILE UPLOADED INTO RPMS: NO FILES UPLOADED **STATUS OF TIU UPLOAD** LAST FILE UPLOADED INTO RPMS: Monday May 09, 2005@22:15:06 LAST SCAN FOR NEW TIU FILE: Tuesday May 10, 2005@09:15:02

22. 22 UPL4 Reset Upload to Restart Used if "Upload Running?" field still has date AND problem has been solved. If the Status option displays similar to this and you are sure an upload is not currently happening then you should use the Reset option: **STATUS OF TIU UPLOAD** LAST FILE UPLOADED INTO RPMS: NO FILES UPLOADED LAST SCAN FOR NEW TIU FILE: Thursday Sep 09, 2004@14:52 UPLOAD STILL RUNNING; CHECK END OF FILE MARKERS UPLOAD STARTED ON SEP 09, 2004@14:52

23. 23 Blank Character String This string of characters is used by the transcriptionist to represent a "blank" when a word or phrase in the dictation cannot be understood for inclusion in the transcription. Clinicians will not be able to sign their note if the blank character string exist in the note. They must edit all blank character strings with the appropriate text before they can sign the note. Option to define the Blank Character string:  Select TIU Parameters Menu Option: Basic TIU Parameters Field to set:  BLANK CHARACTER STRING: @@@ IHS is recommending using three @@@

24. 24 Now what? Once you have all of your fields defined for uploading using the option:  TPM2 Modify Upload Parameters You are now ready to do an upload Are all uploads successful?  No – That is why you have defined Medical Records staff to do the Missing field and Filing error alerts

25. 25 Error Alerts…now what? Your Medical Records staff that are defined in the field:  Select ALERT RECIPIENT Will get alerts when a record could not file  Missing Field alerts Field marked required was missing in the header  Filing Error alert Example: The Health Record number was wrong and it did not match any patient record on your system Example: Visit Date could not be identified due patient not having an appointment for that date with the defined clinic code in the headers.

26. 26 Handling of these alerts need to be done in RPMS When you sign on to RPMS it will show the following: You have 2 PENDING ALERTS Enter "VA to jump to VIEW ALERTS option Select IHS Core Option: "VA 1 FILING ERROR: HRCN: 5391 GENERAL Record could not be found or created 2. FILING ERROR: HRCN: Letter Record could not be found or created. Select from 1 to 2 or enter ?, A, F, S, P, M, R, or ^ to exit: At this point you can either select a number or choose A for All.

27. 27 Handling of alerts by Medical Records After choosing the VA alert  You will be asked if you wish to inquire into the patient record  If you say No This will result into taking you into the actual upload document and allows you to modify the actual upload header. When you exit it will then ask you if you want to upload the file and you can say Yes. Make sure that you are using Screen Editor as your preferred editor  Line Editor will cause problems  You change this by going to TBOX User’s Toolbox  Choose Edit User Characteristics  PREFERRED EDITOR: SCREEN EDITOR - VA FILEMAN  If you say Yes to inquire into the patient record It will ask you the missing items for the patient field by field.  Saying No initially may be better as you can verify the actual information and see all of the upload file.

28. 28 Alerts additional facts… It is not unusual should you say No initially and then after saying Yes to re-upload the document that you get a second filing or missing field alert. Suggest that the second time you say Yes to inquire into the patient record and complete the needed field

29. 29 Dictation guide for clinicians Specify at the beginning of dictation the header:  Progress Notes  Discharge Summary  Consults

30. 30 Progress Notes fields to be dictated at the beginning of the dictation Health Record Number Dictated By Expected Cosigner (optional) Visit Date and Time Title Clinic Code

31. 31 Discharge Summary fields to be dictated at the beginning of the dictation Health Record Number Dictated By Attending Physician (your name or a different name) Date of Admission Urgency  Priority or Routine

32. 32 Consults fields to be dictated at the beginning of the dictation Health Record Number Dictated By Expected Cosigner (optional) Visit Date and Time Title Clinic Code Consult Number

33. 33 How to setup the auto printing of notes rather than using the batch print option Select TIU Parameters Menu Option: tpm3 Document Parameter Edit First edit Institution-wide parameters: Select DOCUMENT DEFINITION: PROGRESS NOTES CLASS CLASS...OK? Yes// (Yes) DOCUMENT DEFINITION: PROGRESS NOTES// REQUIRE RELEASE: NO// REQUIRE MAS VERIFICATION: NO// REQUIRE AUTHOR TO SIGN: YES// ROUTINE PRINT EVENT(S): STAT PRINT EVENT(S): MANUAL PRINT AFTER ENTRY: NO// ALLOW CHART PRINT OUTSIDE MAS: YES// ALLOW >1 RECORDS PER VISIT: YES// ENABLE IRT INTERFACE: SUPPRESS DX/CPT ON ENTRY: FORCE RESPONSE TO EXPOSURES: ASK DX/CPT ON ALL OPT VISITS: SEND ALERTS ON ADDENDA: YES// ORDER ID ENTRIES BY TITLE: NO// SEND ALERTS ON NEW ID ENTRY: NO// SEND COSIGNATURE ALERT: After Author has SIGNED// EDITOR SET-UP CODE: If document is to be uploaded, specify Filing Alert Recipients: Select FILING ERROR ALERT RECIPIENTS: Now enter the USER CLASSES for which cosignature will be required: Select USERS REQUIRING COSIGNATURE: STUDENT// Now enter the DIVISIONAL parameters: Select DIVISION: RED LAKE HOSPITAL// CHART COPY PRINTER: MEDICAL RECORDS// STAT CHART COPY PRINTER: MEDICAL RECORDS// Select DIVISION: Setup your division with your printer defined for these two fields. You may setup the PN Class such as this or individual titles if you want to use a different printer. Make sure manual print is set to NO otherwise they will not autoprint.

34. 34 QUESTIONS??