Meditech 6.0 Diary Part 6 — Building Towards an Uncertain Future

In this month’s blog, training sessions are in full swing. Also meetings with outside consultants have started, and they are starting to supplement the gaps in the Meditech program.

Patient Care Services (PCS) has had their training, and here are some of the notes the consultant has identified for us to keep in mind:

• You have to be aware of where annotated imaging comes into PCS (available in EDM).
• Repeatable: Ask Meditech to explain this function fully; examples include wound type, scrolling boxes, and how subsequent documentation would be made and viewed. Repeatable Headers stay active until completed.
• Nursing Standards for specialty units — populate in Detox, Rehab, and OB are also based on age and gender.
• Documenting of charges — documentation drives charges for some current processes. Documentation, for instance, in respiratory therapy, and newborn hearing tests will be lots easier in 6.0. Also, will have elapsed time charging and response-based charging. They will have to be built in 6.0 though, and it will be something to stress training on.
• Med Reconciliation: Have them load in standard Med Rec Reports. Home Med lists live in EMR which feeds into Order Management, translates to pharmacy, reports generated. New process much easier and better. Biggest complaint — workflow can be cumbersome.
• Pharmacy:  It is important to ask many questions while in training. For instance; Outpatient is on Lipitor (non-formulary), we only uses Crestor (formulary) — how will this play out in the Med Rec discharge report — will Crestor show up as current med on discharge, rather than the Lipitor that the patient takes at home?
• Demo Recall rules have changed dramatically.

Other items of note:

• Order Management: The staff was surprised at the increased functionality. A gotcha is that the training is a webex session and, when held onsite, the staff can experience lots of interruptions. For webex training, it is recommended they go to a formal classroom or offsite location.
• Another change in order entry is that in 6.0 it is done in the Imaging and therapeutics module. This is something key, as if you have a separate RIS which some sites do (for instance, if you have an integrated PACS/RIS product) you still have to install the imaging module.
• In order management, it is key that the various sub-teams you may have working on different modules coordinate, as the dictionary seldom has enough information and specifics for all to easily understand how they will function under different scenarios. This is also true for the charge master and insurance master as they are one of the first dictionaries that feed others and can have a significant impact on other builds.
• A good general note is that it will take longer than anticipated to get through all the webex sessions. It is important not to get hung up on some of the Meditech questions in the webex session and lose track of functionality or process. It is easy to get bogged down in detail questions, especially since the staff doing the dictionary builds may have not done one before or be familiar with the current dictionaries.

Ok, so now a bit more discussion on some of the other modules. An interesting point is around archiving of data. You really need to ask how much data to bring across into the new system as live versus archived data. At times, you don’t have a choice, but you do need to really review this process. The core reason is that when you run a report, it will only pull from the live data. So to get at any archived data you need to go through the repository and report functions embedded into that. This could mean having to run two reports, then do a manual merge of them later, especially if looking at long-term trend data. You will find that in BAR, most of the changes are cosmetic but, again, you need to give a lot of thought to how many old accounts you bring over versus how many you close out and archive.

This pattern of thinking is also very critical for the materials module. For instance, you need to figure out how to deal with unpaid POs since all POs (including outstanding ones) and open invoices go to the archive and become part of the history repository. It should be noted it is our understanding that in 6.0 you will be starting with PO number 1, whether you want to or not. Also, to do 1099s, you must run in both the old and new system due to possible archiving scenarios.

Another interesting issue for us was around the HR module. Since we are not up on any Magic HR modules, it was a clean build, but your staff has to fully understand both the current processes you have and how you want them to be in 6.0 (even though they may have not seen them yet). We suggest printing off the HR screens and using them as a build/process reengineering guide as you go.

Basically the challenge is trying to determine how to streamline processes without fully understanding future (6.0) system data flows and coding behind it. We did make a determination not to go with the staff scheduling that is part of the HR module. Our reasoning was we have Kronos and felt that time would be better invested in expanding its functionality and moving towards true workforce analytics than implementing Meditech staff scheduling as sort of a Band-Aid approach.

Another module that warrants some discussion is the scanning and archiving module (basically document imaging). While I have heard from a couple of CIOs that they are struggling with this post go-live, our independent consultant felt Meditech had done a pretty good job on this product, and that we could do a lot with it, especially by thinking “outside the box.” Again, we are hearing that there are database issues, for instance; registration documents for a male patient having metafile data attached that indicate the patient was registered in mammography. We are not far enough along to validate this, but I will comment more once we reach that stage of the project.

We had the Billing Accounts Receivable (BAR) training, and it went well. One of the items identified as an opportunity for us was, since we have to rebuild the insurance master dictionary, that we update the structure to accommodate better reporting due to the changes in the insurance industry and service offerings since our original Meditech Magic install. This has turned out to be a little lengthier of a project than anticipated due to numerous considerations, including the downstream impact on registration and other clinical areas. Also, in some cases, this needs to be completed before other areas can complete or get into their dictionary builds due to the cause and effect throughout the overall dictionary structures.

One item that is problematic — and we understand Meditech is addressing (although not in time for our build) — is how the physician and staff dictionaries are built. They basically merge into a “Person” dictionary. The problem is that you now have every physician the organization has ever had in the system (over 6,000 in our case) mixed in with staff. So when you try to bring up someone by name from the drop down search boxes, they are now all mixed together and you are searching 7,000 plus names instead of 700 actual employees and active physicians.

Not surprisingly, we have continued to have project management issues. One such challenge was around a hardware issue where Meditech could not see two of our servers through their VPN device. Instead of going to Dell, who owns the VPN device support, they opened customer tasks. We went around and around with them on whose problem this is and wasted well over a week, only to have our technical staff instruct them they had to refresh their DNS services (we did nothing on this end) which fixed their problem.

Another issue is that there are tasks which we cannot edit in the Meditech project site due to the tasks being joint or Meditech issues which do not always get completed in a timely manner. Don’t get me wrong, some of our staff was just as guilty of not updating the tasks, even though they were completed, which delayed the software installation as well. Adding to this was also that when jointly working on a problem or issue, Meditech staff would occasionally tell our staff that they would close out the task, although they did not do so. The short lesson learned is that your internal project manager must continuously stay on top of open tasks and ensure everyone is closing them as soon as completed.

While the delayed load is not expected to delay our ultimate go live, it does have a negative impact on PCS training. Any one of the sites that have already been through PCS training know how difficult it is to juggle nursing shifts so they can attend training. We are no different and, with a small pool to pull from, these types of delays have huge internal impacts.

Another surprise was a need to upgrade OS and firmware loads to be compliant with the Meditech ARRA version. We followed all the Meditech guidance on versions regarding the OS side, only to be surprised by having to then install additional upgrades. These were simply added to the project plan and added to the delay of the software loads. One should also note that the normal Meditech timeline to load the software is approximately 30 days. While we were able to negotiate an accelerated load, it will still take several weeks. Now color me jaded; but it would seem if they sent someone onsite to do this, it could be done in a couple of days. Having come from a best-of-breed environment, I have never run into a vendor requiring weeks to load their software.

One of the things going well is the engagement with our external Meditech advisory consultant. Most of the dictionary reviews have been completed, and we are awaiting a consolidated report. The largest challenge with this phase of the project is not the dictionary education but our staff having questions that exceed the dictionary scope of the project. While we have put some hours into the project for this, the need seems to be growing faster than the budgeted amount. We are not sure if this is because the staff is more comfortable working with the consultants or that they are not getting the level of guidance or answers they need from Meditech. We will be examining this challenge further and attempting to determine how best to address it.

Next month, I will report on the dictionary assessments and how the training is going. Our HR staff and finance teams will have completed their training by then