MCO Pathways Care Manager

1. MCO Pathways Care Manager How Care Manager fits into patient Care at MCO An introduction / overview of the build of Care Manager, technical aspects and functionality The Department of Clinical Informatics, MCO Julie Christy-Givin, Churton Budd, Kathleen Barber

2. What is Care Manager • HBOC Product • Client / Server Application • The Server is an HP9000 in the DH computer room • The client operates under Win95, X-Windows or high end Mac running Virtual-PC • It will replace the IBM Patient Care System (PCS) • During phase-one of the HBOC project it will be primarily used for order entry and results reporting and the minimal goal is to simply duplicate functions of the PCS

3. Order Entry / Results Reporting • On a daily basis, clinical staff enter LAB, RAD and ancillary department physician orders into an order entry system • A Smart department has it’s own computer system • A Dumb department has a requisition print at a designated printer or simply reviews pending orders online.

4. Order entry / results for a “smart” department (LAB / RAD) • When the order is placed in Care Manger for our LAB or RAD departments • a unique order is sent to the ancillary computer system where it is processed, a requisition or “to do” list is generated by that system • An order can also be entered in the RAD or LAB system and communicated back to Care Manager to show up there • The ancillary department gets to the patient and performs the test / study, draws the blood, etc. • The ancillary department sends the results back to Care Manager • The ancillary computer sends a charge transaction to STAR • The clinical staff views the results online

5. Order entry / results for a “dumb” department • When an order is placed in Care Manager for a department without an interfaced system • The order remains on Care Manager and a printed requisition is sent to a printer in that ancillary department • The ancillary department does whatever they need to do to complete the test / study • Results of the study are recorded on paper and placed in the patients paper chart record • The ancillary department manually enters a charge into STAR • The clinical staff view the results in the patients paper medical record

6. Results view

7. Reports currently built on Care Manager • Care Manager users can print eight reports

8. Charting in Care Manager • Presently the only charting being done in Care Manager is for Height / weight / allergies / precautions • When these are charted, they appear on every requisition to communicate this info to the ancillary departments

9. “The Making of Care Manager”

10. The Link Between STAR and Care Manager • Star is the ADT, charges and financial system • STAR was built first and is the foundation of the HBOC enterprise products at MCO • It contains the data that populates tables on Care Manager STAR Care Manager • SIM / FIM Order Item Master • Employee File Staff Table • Physician Master Staff Table

11. PCM holds no charge info at this time • Electronic charges are almost real time • Manual charges are entered into STAR usually at the end of the day or next day • Ancillary systems send a charge transaction back to STAR which uses the financials module to generate a bill

12. SIM / FIM • Service Item Master / Financial Item Master • Everything that can be ordered, done to or charged to a patient at MCO • About 15,000 items • each item has 10 pages worth of info in the database • Presently it mirrors our PCS “Charge Master”

13. SIM / FIM Download to PCM • Some of the SIM / FIM info was electronically transferred from the SIM table to the “Order Item” table in Care Manager • As each item comes across to Care Manager, it must be “edited” to include other info relevant to the Order Entry Process • About 6000 items are in Care Manager • Orderable departments

14. Order Item Master “tweaking an item on the Care Manager side” • Alias • Prompts • “method of transportation”, “Clinical Information”, “specimen source”, etc. • Security (orderable or not) • Define when and where the requisition will print

15. Security on Care Manager • 0 to 99 • Items • Item level & group level • Staff • Staff level & group level • Menu dropdowns, buttons and access to functions can be controlled • 50 or higher in order to order an item

16. Tables and system access • Telnet to the system and execute UNIX commands • Access to ORACLE tables via RUNFORM command • These oracle tables hold all the info in Care Manager • Can execute SQL commands to get data out of the tables in Care Manager

17. Major Pitfalls and User Traps

18. TTY ID • The client for Care Manager uses a “TTYID” which identifies each connecting client to the server • the TTYID is defined in an oracle table and based on this the device can • Be assigned to a physical location / floor / room • Be assigned to a printer • along with security settings, limit what the user can access in the system

19. Passwords and User ID’s • Case Sensitive • User ID’s are built in caps, but if the user sets their password in lower case, they may have difficulty logging on • No expiration capability • users initials and last four digits of SS# • Attending physicians it’s their MD # (Ohio MD license number ??)

20. Order Item Maintenance • When an item is edited in STAR, it is re-sent across the interface to Care Manager • Every Item needs to be edited after this send • New items must be built before they are seen by users (prompts, aliases, etc.) • Ongoing / daily function

21. Any Questions ????