Finding the “Meaning” in Meani
MUSE International Session # 1176
Wednesday 5/30/2012 at 2:30PM
Glen R. D’Abate

Introduction
 Development of Data Repository (DR) for
“clinical analysis” at MEDITECH (1994)
 Genesis of Acmeware (1998)
 DR Auditor & 5.4 SR3 makes DR a viable
solution (2002)
 Diabetes, coronary arterial disease, and other
quality reporting with Affinity Health (2006)
 ARRA Meaningful Use – DR’s potential is finally
being realized (2010)

Session Overview
 Review of MEDITECH EHR and module certified recommended
data sources and workflow to achieve CMS Meaningful Use
(MU) Quality Measures (QM) attestation
 Look at the MEDITECH supplied Data Repository (DR) based
SQL scripts and how these can be modified and enhanced to
meet attestation requirements
 Examine the technologies employed and the required skill-set
of staff to produce these solutions
 Review MU quality measure data validation reports
 Demonstration of a sampling of custom MU analysis reports
 Emergency Department Turnaround By ED Provider
 Emergency Department Turnaround By Hour-of-Day
 VTE Prophylaxis Performance Rate Trend By Unit
 Core Measure Dashboard Report

MEDITECH Recommends DR for
ARRA Meaningful Use Solution

Why Data Repository
 Data retention in DR
 MEDITECH supplied Structured Query
Language (SQL) scripts
 Performance
 Ability to add indexes as needed
 SQL’s native dataset processing
 Separation of transaction processing (i.e.,
MEDITECH applications) from report processing
 Direct access to other vendor certified
quality data in via open standards
connections (OLE, ODBC)
 Wide array of report presentation options

What are MEDITECH Best Practices?
 MEDITECH Best Practices documents are available for
review and assessment from their web site at: (
http://www.meditech.com/bestpractices/...)
 An organization must determine what MEDITECH
applications and workflow are in place that meets the
Best Practices and where and how they deviate from
these practices
 This includes identifying where and how MU quality data
is being captured when other than the specified Best
Practice’s location (e.g., different CDS Queries, another
MT module, a certified third party product)
 The closer your workflow and practices parallel the
MEDITECH Best Practices, the less customization is
required to the MEDITECH DR MU QM scripts

MEDITECH ARRA Web Site
 MEDITECH ARRA Implementation Plan
 Best Practices Documentation
 MU Checklist
 List of NPR/DR DPMs/Table Impacted
 SQL Script Templates
 Much more…

MEDITECH DR SQL Scripts
Basic instruction on how to implement and customize scripts
Tables may need to add to this list based on your workflow
RxNorm code data is often not complete – verify with your
formulary vendor data
SQL Scripts to use as
a basis for compiling
and reporting MU
quality performance
measures
Stroke Scripts

CMS Guidelines on Modifying
MEDITECH Workflow & Scripts
CMS FAQ 10473
For the Medicare and Medicaid Electronic Health Record (EHR) Incentive
Programs, is an eligible professional or eligible hospital limited to
demonstrating meaningful use in the exact way that EHR technology was
tested and certified? For example, if a Complete EHR has been tested and
certified using a specific workflow, is an eligible professional or eligible
hospital required to use that specific workflow when it demonstrates
meaningful use? Similarly, if the EHR technology was tested and certified with
certain clinical decision support rules, are those the only clinical decision
support rules an eligible health care provider is permitted to use when
demonstrating meaningful use?
In most cases, an eligible professional or eligible hospital is not limited to
demonstrating meaningful use to the exact way in which the Complete EHR or
EHR Module was tested and certified. As long as an eligible professional or
eligible hospital uses the certified Complete EHR or certified EHR Module’s
capabilities and, where applicable, the associated standard(s) and
implementation specifications that correlate with the respective meaningful
use objective and measure, they can successfully demonstrate meaningful use
even if their exact method differs from the way in which the Complete EHR or
EHR Module was tested and certified.
certified

Examples of Workflow Modifications
 Use of a CDS Query Mnemonic that is based on a hospital’s
existing workflow (e.g., identifying patients on a Clinical
Trial)
 Identification of data in a method that differs from MT Best
Practices (e.g., check for VTE Diagnostic Testing by looking at
Ordered Procedures rather than a CDS Query)
 Identification of Emergency Department (ED) Decision to
Admit Date/Time directly from another certified other-vendor
ED system (rather than MEDITECH EDM)
 Modification of scripts to save detailed data about the
measure within a datamart for later analysis (note this data
cannot be used for producing numerator, denominator, or
exclusions values for CMS attestation!)

From MEDITECH Best Practices
“VTE1Q.1” is Best Practice Query Mnemonic
for Capturing Patients on a Clinical Trial

Script Code Change to Address
Clinical Trials Workflow
Original Script Code
Script mtzcus_VTE_1
Non Multiple Clinical
Queries Table Selected
Modified Script Code
Query Mnemonic Replaced

2nd Example of Workflow Modifications
 Use of a CDS Query Mnemonic that is based on a hospital’s
existing workflow (e.g., patients on a Clinical Trial)
 Identification of data in a method that differs from MT Best
Practices (e.g., check for VTE Diagnostic Testing by looking at
Ordered Procedures rather than a CDS Query)
 Identification of Emergency Department (ED) Decision to
Admit Date/Time directly from another certified other-vendor
ED system (rather than MEDITECH EDM)
 Modification of scripts to save detailed data about the
measure within a datamart for later analysis (note this data
cannot be used for producing numerator, denominator, or
exclusions values for CMS attestation!)

VTE Diagnostic Test Order Query
Best Practice recommends setting
up CDS with VTE test query

VTE Testing Identification
A client who had configured their Order Entry system such that
certain imaging procedures were only ordered for the specific
purpose of ruling out VTE. Therefore, rather than add a new
CDS Query and Response, the script exclusion logic was
modified to look for the presence of these procedures.
Original Script Code
VTE Diagnostic Test NOT Ordered No JOIN to OE Queries Use Ordered Procedure
to ID VTE Testing
Modified Script Code

3rd Examples of Workflow Modifications
 Use of a CDS Query Mnemonic that is based on a hospital’s
existing workflow (e.g., patients on a Clinical Trial)
 Identification of data in a method that differs from MT Best
Practices (e.g., check for VTE Diagnostic Testing by looking at
Ordered Procedures rather than a CDS Query)
 Identification of Emergency Department (ED) Decision to
Admit Date/Time directly from another certified vendor ED
system (rather than MEDITECH EDM)
 Modification of scripts to save detailed data about the
measure within a datamart for later analysis (note this data
cannot be used for producing numerator, denominator, or
exclusions values for CMS attestation!)

SQL Linked Server Provided the Solution
DR Server
Create a Linked Server from your
certified MEDITECH DR System
directly to your certified ED
vendor system
Original Script Code
Modified Script Code

Examples of Workflow Modifications
 Use of a CDS Query Mnemonic that is based on a hospital’s
existing workflow (e.g., patients on a Clinical Trial)
 Identification of data in a method that differs from MT Best
Practices (e.g., check for VTE Diagnostic Testing by looking at
Ordered Procedures rather than a CDS Query)
 Identification of Emergency Department (ED) Decision to
Admit Date/Time directly from another certified other-vendor
ED system (rather than MEDITECH EDM)
 Modification of scripts to save detailed data about the
measure within a datamart for later analysis (note this data
cannot be used for producing numerator, denominator, or
exclusions values for CMS attestation!)

Modify Script Output to Capture Details
Original Script Code
Add INSERT Statement
Modified Script Code

Technologies Required
 MEDITECH Data Repository (MAGIC, CS, M-AT)
 SQL Server 2005, 2008, 2008 R2 RDMS (on which
DR resides)
 Microsoft Management Studio (MMS) (for
generation, review, and modification of MEDITECH
transact-SQL stored procedure scripts)
 SQL Server Reporting Services (SSRS) 2008 R2
(report authoring and presentation)
 Internet Information Server (IIS) web server with
SSRS Report Manager installed or SharePoint
Services with SSRS in SharePoint Integrated Mode
 Browser to view reports on portal within the intranet

Developer(s) Aptitude Requirements
 Solid understanding of the ARRA Meaningful Use
Core Measures, Menu Set Measures, and Clinical
Quality Measures
 Basic knowledge of the MEDITECH application
modules involved in capturing MU measures
 High proficiency in understanding and identifying
where MEDITECH application data is stored within
the MEDITECH DR tables
 High proficiency in Microsoft Transact-SQL
 Proficiency in SQL Server Reporting Services report
authoring.

DR Script Data in SSRS for Attestation
Data derived directly from enhanced DR scripts can be presented in SSRS
in a table for easy transcription to CMS web site for attestation
Each number can provide a hyperlink to detailed patient data in a
non-certified datamart that you create for the purpose of valuation

Validating Patient Exclusions
VTE-2 (ICU Patient) Exclusions

About the Demonstrated Reports
 This represents a small sample of the
possibilities of data analysis and
presentation using ARRA MU data
 These sample reports have been
implemented at Acmeware client sites
 Most data presented is live data, though not
from site(s) where the report was originally
developed
 Identifiable information has been removed
or replaced

Analysis Question
We would like to look at our average
CQM ED performance measures
(i.e., arrive to depart time &
decision to depart time) by
Emergency Provider for the current
attestation period. We want to omit
providers if they have less than 5
ED patients.

Analysis Question
We are interested in knowing if there
are certain times of the day where
our ED measure performance
numbers are better or worse?

Analysis Question
We would like to view and analyze
how each unit (including ICU units)
in our hospital facility is complying
with regard to VTE prophylaxis
performance measures and we
would like to trend this over the
current full-year attestation period

Analysis Question
We would like to view an
instantaneous snapshot of the
performance of our Core Measures
in a format that will please our
organization’s executives?

Summary
 MEDITECH has developed comprehensive ARRA MU
Best Practices that do not always match your current
workflow practices
 You can and will need to modify the DR-based CQM,
CM, and MSM SQL scripts to function properly with
your environment and workflow
 Data used for attestation must come directly from the
modified scripts however, there is no reason you
cannot capture the details behind these measures at
the same time
 With a detailed MU datamart and a little knowledge of
SQL Server Reporting Services, you can create very
cool custom, purpose specific, MU analysis reports
 You can do this!

Discussion, Questions & Answers

Come see our other MUSE sessions!
Fri 6/1 3:30PM
 1140 - Simplify Downtime with Data Repository