1. Moving Beyond Standard BMV Reports Using Data Repository Session 373 Presented by: Ian Proffer

2. Session Agenda  Review eMAR and BMV benchmarking reports in MEDITECH applications and the Data Repository  Report development and deployment strategies  Example DR-based BMV scan rate and warning reports  Questions, answers, & discussion

3. Areas of Interest  Rx administration summary Doses administered, doses scanned Administered with or without warnings  BMV scan rates, looking for improvements By location and user By department and user?  BMV warnings analysis By location, drug, ordering provider, user, etc.

4. Our Development Strategy 1. Review standard reports available in MEDITECH (MAGIC 5.61) 2. Identify corresponding data within MEDITECH Data Repository 3. Create reports and structures to present the same data in a more user friendly and meaningful way 4. Validate results against MEDITECH application reports 5. Look for additional methods to relate eMAR and BMV data to glean additional knowledge into success of BMV / eMAR effort

5. MEDITECH eMAR and BMV Reports  eMAR Measuring & Monitor Detail This report allows users to specify and filter data by location, ordering provider, admin user, drug type, drug, and warning type. It then summarizes medication dose administrations, scan rates, warnings, and patient verifications.

6. MEDITECH Report Sample User-supplied criteria Summary Stats Warning Counts Administration Warnings By Location and User

7. Where We Get eMAR & BMV Data  MEDITECH Data Repository Versions 5.61  Most Pharmacy data became available in DR in version 5.5 Includes all NPR DPMs / segments as well as dictionaries  Can be easily linked to data in other MEDITECH applications

8. Data Repository in SQL Management Studio 6000+ tables containing most data from most MEDITECH applications SQL Server 2005 (or 2000) Relational Database Management System with MEDITECH Application Data

9. eMAR and BMV Information in the DR NPR DPM = PHA.RX SEGMENT = admin NPR DPM = PHA.RX SEGMENT = dose.warnings NPR DPM = PHA.STATS SEGMENT = emar.daily.admin.stats Information about dose administration eMAR Compiled Statistics Dose Warning Detail NPR DPM = PHA.RX SEGMENT = scanned.med.x BMV scan activity

10. A Closer Look at MEDITECH’s Total Statistics Totals for doses administered, scanned, administered with and without warnings, doses not administered, patients verified (by wrist band scanning) and total warnings. Two categories: 1)Doses Administered 2)Doses Not Administered

11. Data Repository-Driven Version User-supplied criteria includes date range, but can also include Location, Ordering Provider, etc. Totals provide same information as MEDITECH report and can show or hide detail data Charts are easily incorporated to add visual impact – this example highlights improving scan rates

12. Report Development & Delivery Strategies  SQL Server 2005 stored procedures to extract detail and summary eMAR and BMV data from DR tables  SQL Server 2005 Reporting Services to summarize and sort data, provide interactivity and drill-through to related reports, and deliver reports via intranet, email, file share, or printer  SQL Server 2005 Analysis Services to perform multi-dimensional analysis

13. More MEDITECH Reports Scan Rates by User, by Location

14. SSRS Report Designer Visual Studio 2005 VS provides a graphical design environment to simplify report development “Under the hood” complex coding takes place – dedicated IT developers can leverage powerful programming features

15. SQL Reporting Services (SSRS) Report Manager Web-based administration Organize into Folders Security Profiles Subscriptions Snapshots Uses local intranet (Microsoft ISS) to host reports and deliver to users

16. Reporting Services Versions Reports can be exported in a variety of formats, or printed directly from your browser Dates can easily be changed and the report re-run with one mouse click Conditional formatting allows you to highlight values based on your own metrics

17. Scan Rate by Department With Drill-down to Employee Very useful for clinical managers: location and department are two different things! DR reports allow cross-module analysis, in this case PHA and PP

18. SSRS Interactivity Remember This Report? Click on the date… …and the date is passed to run this report. Report Manager allows you to view and navigate reports just like a web page – very simple for staff to use.

19. MEDITECH Measuring and Monitoring Detail Report - Patient Statistics? This is really a breakdown of Warnings by Location and Admin User

20. Acmeware Version Using Drill-Down “+” Allows drill-down to totals by user and warning Totals By Location Totals By User

21. MEDITECH Measuring and Monitoring Detail Report - Warning Summary Warnings issued over a date range broken by medications administered and not administered Warnings percent is based on total warnings from Total Statistics Report Admin Percent of Total

22. Acmeware Warning Summary Report Filtering criteria can be changed immediately and the page refreshed Dropdown Box allows one, multiple or selection (SQL 2005) Percentages based on Total Warnings

23. SQL Server 2005 Analysis Services Cubes are Multidimensional Databases that allow data to be easily analyzed, sorted, filtered, and manipulated to look for trends, outliers, and other information hidden within the data.

24. What’s In a Cube?  Fact Tables define events occurring over time (e.g., patient visits, medication administrations, warnings, lab tests, etc.)  Measures are numeric computations of facts (e.g., count number of visits, total number of administration warnings, etc.)  Dimensions are the ways you might want to analyze the measures. Examples include items from MEDITECH dictionaries (e.g. providers, drugs, locations) as well as regular time increments (days, months, years).

25. BMV Warning Summary Measures Dimensions Facts

26. Warning Analysis by Administered Location Dimensions can be arranged to show logical groupings; subtotals are automatically updated. Dimension data can be hidden, but used to filter summary data.

27. Warnings by Location With Chart Chart can be displayed side-by-side with detail data, or on its own.

28. Warnings by User Chart

29. More Chart Analysis Options With a Few Clicks… …for these nurses only. Chart type is quickly changed to show total warnings by month for Jan-April…

30. Differences Between Reporting Services and Analysis Services  SSRS reports: run and done User may or may not supply criteria Typically designed and maintained by IT staff Reports are designed to present specific, detailed information  SSAS data: dynamic and open User decides what to see and how to see it Finished “report” is designed by user (within constraints of your software) Allow immediate analysis of a variety of information – great of revealing trends using summary data

31. Looking Ahead: Using DR Data to Measure Successful BMV/eMAR Use  Look for additional methods to correlate eMAR and BMV data Associate warnings with medication administration  Analyze effect on adverse events  Measure improvement in patient outcomes  Other indirect influences of BMV and eMAR

32. Thank you!