Wanda_MediAR

Coexisting Real Time andCoexisting Real Time and
Batch Charge ServiceBatch Charge Service
InterfacesInterfaces
Chrystelle Ayerhart &Chrystelle Ayerhart &
Wanda TaylorWanda Taylor
Grey Bruce Health ServicesGrey Bruce Health Services
Achieving Excellence:Achieving Excellence:
Bridging Healthcare & TechnologyBridging Healthcare & Technology
Cerner Canadian RUG 2010, Prince Edward Island, CanadaCerner Canadian RUG 2010, Prince Edward Island, Canada

Grey Bruce InformationGrey Bruce Information
Network (GBIN)Network (GBIN)
 ApproximatelyApproximately
9000 sq. km (3,4759000 sq. km (3,475
sq. miles)sq. miles)
 3 corporations3 corporations
 11 hospital sites11 hospital sites
 1 outpatient clinic1 outpatient clinic
sitesite

Strategic Goals (Technology)Strategic Goals (Technology)
 Grey Bruce Health Services will utilizeGrey Bruce Health Services will utilize
technology as it becomes available if ittechnology as it becomes available if it
improves efficiency and safety, and enhancesimproves efficiency and safety, and enhances
our serviceour service
 We will create mechanisms to share informationWe will create mechanisms to share information
to support a seamless care experience for theto support a seamless care experience for the
patient and to improve system efficiencypatient and to improve system efficiency

Operational GoalsOperational Goals
 Reduce paperReduce paper
 Enter data once, reduce the effortEnter data once, reduce the effort
 Reduce labourReduce labour
 User friendly applicationsUser friendly applications
 EfficienciesEfficiencies
 Fewer steps for staffFewer steps for staff

Previous $tate IPrevious $tate I
 Our billing system is not a realOur billing system is not a real
time system:time system:
 Patients would present to thePatients would present to the
Finance Department to pay for anFinance Department to pay for an
item they had just purchased…item they had just purchased…

Previous $tatePrevious $tate
 The finance clerk would look up the bill codeThe finance clerk would look up the bill code
and the price of that item from a list kept atand the price of that item from a list kept at
the deskthe desk
 The patient was given the cost of the itemThe patient was given the cost of the item
 The patient record would be located in theThe patient record would be located in the
billing systembilling system
 The item’s bill code would be entered intoThe item’s bill code would be entered into
the billing system….the billing system….

Previous $tatePrevious $tate
 IfIf the charge came over from thethe charge came over from the
Cerner system and it matched whatCerner system and it matched what
was entered no invoice would bewas entered no invoice would be
created…created…

Project Specific ObjectivesProject Specific Objectives
 Streamline process to eliminateStreamline process to eliminate
duplication of workduplication of work
 Promote payment while patient stillPromote payment while patient still
herehere
 Reduce paper trail required forReduce paper trail required for
billing purposesbilling purposes
 Take advantage of real timeTake advantage of real time
abilitiesabilities

Design ApproachDesign Approach
 Who has already built real timeWho has already built real time
charges?charges?
 Look to the Cerner communityLook to the Cerner community
 Look to the MediAR communityLook to the MediAR community
 What did we already have in place?What did we already have in place?

Build Steps – CernerBuild Steps – Cerner
 First step was messing with theFirst step was messing with the
Tiering LogicTiering Logic
 With the code level that we were on,With the code level that we were on,
created an edit version of thecreated an edit version of the
cstiermaint.exe.cstiermaint.exe.
 In CSDBtools.exe, opened theIn CSDBtools.exe, opened the
miscellaneous tab to create a real timemiscellaneous tab to create a real time
interface fileinterface file
 Added a row to the tiering logicAdded a row to the tiering logic

Build Steps – Interface AnalystBuild Steps – Interface Analyst
 Needed to generate DFT messagesNeeded to generate DFT messages
 Turn on P03 trigger in eso_init_outbound,Turn on P03 trigger in eso_init_outbound,
under Financial Managementunder Financial Management
 Alias 13028 – Charge Type CodeAlias 13028 – Charge Type Code
 Used current comclients, redirectedUsed current comclients, redirected
to new script if P03to new script if P03
 Adjusted route scriptAdjusted route script

Build Notes – Interface AnalystBuild Notes – Interface Analyst
 Messages actually use the ADT libraryMessages actually use the ADT library
(OEOCF23ADTADT)(OEOCF23ADTADT)
 Took advantage of existing ADT scriptsTook advantage of existing ADT scripts
 Reduced development timeReduced development time
 Pre-testedPre-tested
 Didn’t get fast response from MediARDidn’t get fast response from MediAR
or Cerneror Cerner
 so tried sending through first messagesso tried sending through first messages
using existing structures – and itusing existing structures – and it
worked!!!worked!!!

Testing, Testing, TestingTesting, Testing, Testing
 1st round – Application Specialist,1st round – Application Specialist,
Interface Analyst and Senior FinanceInterface Analyst and Senior Finance
ClerkClerk
 Found some data that just needed to beFound some data that just needed to be
moved around in the messagemoved around in the message
 2nd round2nd round
 Turned test environments over to FinanceTurned test environments over to Finance

ImplementationImplementation
 Owen Sound is the pilot siteOwen Sound is the pilot site
 Our rural sites will implement this nextOur rural sites will implement this next
 Because we used existing structures, noBecause we used existing structures, no
adjustment was needed at the interface leveladjustment was needed at the interface level
 Very simple go-live procedureVery simple go-live procedure
 Tiering logic was most difficult partTiering logic was most difficult part
 Built a report in PowerVision to give a reportBuilt a report in PowerVision to give a report
of what ‘should’ have hit the billing systemof what ‘should’ have hit the billing system

TimelineTimeline
 Initial request was receivedInitial request was received
 Nov. 2007Nov. 2007
 Conflicts with other projectsConflicts with other projects
 Code Level IssuesCode Level Issues
 ““No one has ever done that!”No one has ever done that!”
 Request was linked to another projectRequest was linked to another project
 Mar. 2009Mar. 2009
 Go-live March 2010Go-live March 2010

Current ProcessCurrent Process
 Initial Material Management order inInitial Material Management order in
Powerchart triggers P03 messagePowerchart triggers P03 message
 Routed to MediAR comclientsRouted to MediAR comclients
 Posts in real time to MediARPosts in real time to MediAR
 No extra invoicing is required, orders areNo extra invoicing is required, orders are
available when patient presents at theavailable when patient presents at the
Business officeBusiness office

Lessons LearnedLessons Learned
 Building on a proven foundation (ADTBuilding on a proven foundation (ADT
to MediAR) eliminated many potentialto MediAR) eliminated many potential
customizationscustomizations
 Tiering Logic was manageableTiering Logic was manageable
 We are innovative!!We are innovative!!

Next StepsNext Steps
 Roll out to other sitesRoll out to other sites
 Works too well—now there areWorks too well—now there are
requests for additional billings to comerequests for additional billings to come
overover
 MargaritasMargaritas

Questions?Questions?
 Grey Bruce Health ServicesGrey Bruce Health Services
 519-376-2121519-376-2121
 Chrystelle AyerhartChrystelle Ayerhart
 Interface Systems AnalystInterface Systems Analyst
 Ext. 2198Ext. 2198
 cayerhart@gbhs.on.cacayerhart@gbhs.on.ca
 Wanda TaylorWanda Taylor
 Project CoordinatorProject Coordinator
 Ext. 2519Ext. 2519
 wtaylor@gbhs.on.cawtaylor@gbhs.on.ca

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