System Review CORE Concepts

1. King Saud University Hospitals System ReviewCORE Concepts Ilham Hobba

2. 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.

3. What is Core? • Organizations • Security • Locations • Alias Pools • Code Sets • Event Codes/Event Sets

4. Core Services Organizations

5. Organizations in Millennium • Organization: Any business entity that is affiliated with the health system. • Organization Types • Organizations are classified into different Organization Types • Each type drives functionality within the Solutions • Examples of Organization Types: • Client Facility • Employer Insurance Company • Hospital Physician Offices • Multiple Organization Types can be used to define an organization. • Example: Cerner Hospital can be a Facility, Client, Hospital, and Employer

6. Facility Organizations Organizations Hospital Employer Ins. Company Client

7. Organization Types • Possible “Employment/Billing” Organizations: • Employers • Insurance companies • Clients (e.g. Industrial accounts) • Employer: An organization that may be given as a place of work or health plan sponsor • Insurance Company: An organization with one or many health plans associated underneath it.

8. Organization Types • Client: 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 billing • Destination for Clinical Reporting

9. What are Core Organizations? • Possible “Patient Care” Organizations: • Hospital • Physician Office/Clinic • Home Health • Hospice • Facility • Physician 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.

10. Core Organization Types • Facility • An organization at which patient care activity takes place. • Organization is a facility if: • Patient care takes place • Patient registration occurs • Identifiable patient population (Charting, Security) • ProFit billing entity (one tax id) • Facilities can contain: • One Pharmacy formulary • One Order Catalog • One Charge Description Master (CDM)

11. Core Services Security

12. Security Design • Security Risks in Healthcare • Unauthorized disclosure of patient information • Unauthorized disclosure of sensitive information • Substance abuse treatment, abortion, mental health, HIV/AIDS, genetics • Unauthorized disclosure of intellectual property • Security is not… • An add-on to your solutions • Built after workflow is designed • Software that protects the configuration • Recommended to be set up at an user-level

13. 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?

14. Positions Defined • Role based access to Cerner Applications • Should be based on the role the user has within scope of Cerner Solutions • Not based on job title • Position determines authorization within Cerner • NOT the same as a job class or employee title

15. Position Collection • Positions will be collected on Core Systems Positions DCW • Start positions are outlined on the deliverable • This deliverable is assigned to the Core team to complete two weeks prior to Design Review • Solution teams will be required to assist the client in designing their positions based on Start content • This is to be completed on weekly calls between System Review and Design Review • Address position integration points between solutions as they arise • The completion of this deliverable will ensure the successful design of position based security at Design Review

16. Encounter/Organization Security • Broad Level of Security • Limits what Patient visits (encounters) each User can view, based on what organization the visit occurs at. • Users are “tied” to Organizations • Users may view information from Patient visit, if the visit occurs at an Organization they are associated with • Users can be associated to one or many Organizations • Will 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.

17. Encounter Organization Security • Information Available across all encounters/visits: • Allergies • Problems • PowerNote • Clincal Notes • Procedures • Form Browser (results) • Histories (past medical, family, social) • Immunizations • Medication List (prescriptions and administrations) • Encounter/visit-specific information: • PowerOrders • Diagnoses • Provider Relationships

18. User has access to view patient encounter Confidentiality Code Security If And User associated to Facility AND User assigned a Confid. Level Patient encounter occurs at Facility AND Encounter assigned a Confid. Level And 1 2 User’sConfid. Level Meets or exceeds EncounterConfid. Level Then > 2 1

19. Encounter/Organization Security Dr. B Dr. A Dr. C Cerner Clinic Cerner Hospital C.H. Psych Unit Encounter 3 Encounter 1 Encounter 2

20. Confidentiality Levels • Prerequisite - Encounter Organization Security • Compare user and patient encounter codes to determine access • Levels are client defined

21. Examples of Levels: Users Encounter Psych 7 Security 5 Sensitive 3 Routine Clinical 1 7 Psych users 5 Partial Restricted/Regular Users 3 Clinical Staff 1 PMLocator Users (patient directory) User with a Confid. Level of 5 can view any Encounters with a level 5, 3, or 1 Maximum of 4 levels recommended due to maintenance considerations

22. Within ERM:

23. Without Cerner ERM • Confidentiality Codes can be sent from ADT (Registration System) • Sent in HL7 Message- PV2:22

24. After Encounter Org/Confid Level:

25. Positions Defined • Role based access to Cerner Applications • Should be based on the role the user has within scope of Cerner Solutions • Not based on job title • Position determines authorization within Cerner • NOT the same as a job class or employee title

26. Core Services Locations

27. Locations • Generic 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.

28. Location Hierarchy Facility (type of organization) Cerner Hospital Buildings West Pavilion Nurse Unit 2 South Room 202 Bed A

29. Facility (type of organization) Buildings Nurse Unit Room Bed Buildings • Buildings Defined • A physical structure on hospital property • “Houses” registration locations • Drives no product functionality (security, billing, etc.)

30. Facility (type of organization) Buildings Nurse Unit Room Bed Nurse/Ambulatory Unit, Rooms, and Beds • Core Units Defined • Nursing Unit • Ambulatory Unit • Rooms and Beds • Represents physical Rooms and Beds • Hierarchy format allows for multiple Rooms and Beds with the same name

31. LOCATION HIERARCHY INPATIENT Facility Building Nurse Unit Room and Beds

32. LOCATION HIEARCHY DAY REHAB & OUTPATIENT Facility Building Ambulatory Loc

33. Two Sides Service Resources Institutions Departments Sections Subsections Exam Rooms Core Locations Facilities Buildings Nurse units Rooms Beds

34. What solutions use Core Locations? • Registration • Scheduling • PowerChart • CareNet • INet • Charge Services • PharmNet • ProFile • ProFit • FirstNet • Clinical Reporting • PathNet AP

35. Encounter/Organization Security Controls access to patient information by organization. Confidentiality Level Security Additional function available with Encounter Org Security that can be set per facility What solutions use Core Locations?

36. What solutions use Core Locations? • Registration • Patients registered to Facilities • If an inter-facility transfer needs to occur, the alias pools for those two orgs must be set up exactly the same • Registration can filter out patients by facility • PMLocator (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 bed • Certain code sets can be filtered by facility • Patient Type • Medical Service • Accommodation Code • Discharge Disposition • Discharge Location

37. What solutions use Core Locations? Registration

38. What solutions use Core Locations? Person Search Window Search by location or facility Customize encounter results window with location hierarchy fields.

39. What solutions use Core Locations? • Scheduling • Patients 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

40. What solutions use Core Locations? • PowerChart • Encounter 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 organization • Locations (nurse units/ambulatory) can be used to specifically lock down patient lists on individual computers • Set up with a default location list • Location patient lists can also be used to help organize work

41. What solutions use Core Locations? PowerChart Organize Patients by Location

42. What solutions use Core Locations? • CareNet Orders • Locations used for routing and printing • Orders requisitions • Consent forms • Reports • Printed charts • Patient location and ordering location can be used to flex order entry formats. • Orderables can be virtualized to specific facilities • Ordering is then controlled depending on whether patient is registered at that facility.

43. What solutions use Core Locations? Inet can flex views based on the patient’s location • Patient on the left is located in the adult ICU • Patient on the right is located in the NICU

44. What solutions use Core Locations? • Charge Services • Any 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 fields • Patient location • Performing location • Facility

45. What solutions use Core Locations? • PharmNet • Formulary 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? • ProFile • HIM 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? • ProFit • Revenue can be reported by: • Patient location • Performing location

48. What solutions use Core Locations? • FirstNet • Any area where an emergency patient needs to be tracked (beds, hallways, waiting room, etc) will need to built as a location within the emergency department • Lab label printing can be routed to different printers in the ED based on location, if necessary • Tracking List tabs can be organized based on location Only displaying patients in Fast Track area

49. What solutions use Core Locations? • Clinical Reporting • Chart 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 lab • AP uses the functions of Charge Services and Profit to charge based on patient location • AP uses Registration and Patient search functions • Service resources are used to route internal orders to work lists and work queues • Processing orders are added to work queues based upon routing • Worklists and Labels are printed based on routing • Reports are sent to review queues based on routing • Calendars 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.