TIU or NOT TIU IT MAY BE A BUSINESS RULE

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TIU or NOT TIU IT MAY BE A BUSINESS RULE!

• Class 132H

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FACULTY

• Boots Brinkman, RRT, MS
• Clinical Applications Coordinator
• VA Gulf Coast Veterans Health Care System
• Anne Rega
• Clinical Product Support
• Clinical 3 Team

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HOUSEKEEPING

• QUESTIONS??
• Please use 3 X 5 cards to write down all
  questions.
• Please hold all questions until end of session.
• Those not answered today will be on the VeHU
  website
• Please mute all cell phones, blackberries, etc.
• If you loose your place during the hands on
  session, please raise your hand high for a room
  assistant.

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Learning Objectives

• Review the basic Text Integration Utility (TIU)
  hierarchy.
• Describe the components of Authorization
  Subscription Utility (ASU).
• Learn how to create business rules.
• Recognize the impact of business rules.

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TEXT INTEGRATION UTILITY (TIU)

• TIU is a collection of software tools that manage
  clinical documents in a standardized way.
• In conjunction with ASU, they allow providers to
  enter, edit, sign and print different kinds of
  documents from a single program.

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TIU HIERARCHY
CLASS
DOCUMENT CLASS
TITLES
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AUTHORIZATION SUBSCRIPTION UTILITY (ASU)

• ASU originated in response to the Scope of
  Practice model.
• A Knowledge Base or table of Production Rules
  that can be developed in compliance with the
  sites local by-laws.

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A BUSINESS RULE

• An UNSIGNED (CLASS)CLINICAL DOCUMENT may be
  SIGNED by a PROVIDER who is an EXPECTED COSIGNER

• The parts
• STATUS (unsigned)
• DOCUMENT TYPE
• (clinical document)
• ACTION (signed)
• USER CLASS (provider)
• USER ROLE
• (expected cosigner)

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VISTA LOG-ON INSTRUCTIONS

• Each work station has their own unique VistA
  system.
• ACCESS CODE
• 55VEHU
• VERIFY CODE
• VEHU55

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PART 3 - TROUBLESHOOTING

• Four case studies will be presented, one at a
  time.
• FIRST..

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CASE 1

• The phone starts ringing off the hook No one
  seems to be able to sign their own Progress Note.
• Hmm The phones started right after you added a
  rule so clinical service chiefs can sign unsigned
  notes.

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• Getting started
• Sign onto CPRS as 10VEHU/VEHU10

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• Getting started
• Sign onto CPRS as 10VEHU/VEHU10
• Try to write and sign a note (esig VEHU10) you
  can use any patient and any title

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• Getting started
• Sign onto CPRS as 10VEHU/VEHU10
• Try to write and sign a note (esig VEHU10) you
  can use any patient and any title
• Try deleting

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• Getting started
• Sign onto CPRS as 10VEHU/VEHU10
• Try to write and sign a note (esig VEHU10) you
  can use any patient and any title
• Try deleting
• Go look at the Business Rules
• Clinical Documents
• Progress Notes

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• Getting started
• Sign onto CPRS as 10VEHU/VEHU10
• Try to write and sign a note (esig VEHU10) you
  can use any patient and any title
• Try deleting
• Go look at the Business Rules
• Clinical Documents
• Progress Notes
• Remember how the hierarchy is used in evaluating
  rules!

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• CAUSE The rule for signing progress notes by the
  clinical service chief was written at the
  progress note level. The rule for signing
  documents by the author/dictator is at the
  Clinical Document level.

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• SOLUTION

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CASE 1

• Case No one can sign their own progress note
  after a rule was added allowing clinical service
  chiefs to sign unsigned notes.
• SOLUTION
• Enter the following rule at the Progress Note
  level
• An UNSIGNED (CLASS) PROGRESS NOTE may BE SIGNED
  by an AUTHOR/DICTATOR.

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• Set-up this case on your system. The note title,
  Enter in Error has been created for you. Use
  VEHU,TWENTY in this exercise.
• Access Code 20VEHU
  
• Verify Code
  VEHU20

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• STEPS

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• STEPS
• Assign Medical Information Section user class to
  appropriate User. (For this class, Vehu, Twenty)

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• STEPS
• Assign Medical Information Section user class to
  appropriate class. (For this class, Vehu, Twenty)
• Create two business rules

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• STEPS
• Assign Medical Information Section user class to
  appropriate class. (For this class, Vehu, Twenty)
• Create two business rules
• An UNTRANSCRIBED (TITLE) ENTER IN ERROR may BE
  ENTERED by a MEDICAL INFORMATION SECTION

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CASE 2

• The site wants to have a note title called Enter
  in Error, but is should only be used by the
  Medical Information Section. Also, you dont
  want anyone else but MIS and the author to view
  the note.
• STEPS
• Assign Medical Information Section user class to
  appropriate class. (For this class, Vehu, Twenty)
• Create two business rules
• An UNTRANSCRIBED (TITLE) ENTER IN ERROR may BE
  ENTERED by a MEDICAL INFORMATION SECTION
• A COMPLETED (TITLE) ENTER IN ERROR may BE VIEWED
  BY A MEDICAL INFORMATION SECTION

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CASE 3

• CASE Your site has begun a new Respiratory
  Therapy training program. The only note that the
  students will require a cosignature on is the
  title, RESP TREATMENT NOTE.
• Start Be sure that they will have all the same
  abilities as the respiratory therapist user
  class.
• VEHU,THIRTY is a respiratory student.
• Access code 30VEHU
• Verify code VEHU30

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a cosignature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a co-signature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)
• STEPS
• Create a new user class - Respiratory Therapist
  Student

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a cosignature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)
• STEPS
• Create a new user class call Respiratory
  Therapist Student
• Add it as a subclass to Respiratory Therapist

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a cosignature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)
• STEPS
• Create a new user class call Respiratory
  Therapist Student
• Add it as a subclass to Respiratory Therapist
• Assign the new user class to the user Vehu,
  Thirty.

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a cosignature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)
• STEPS
• Create a new user class call Respiratory
  Therapist Student
• Add it as a subclass to Respiratory Therapist
• Assign the new user class to the user Vehu,
  Thirty.
• Using the TIU Parameters menu, Document Parameter
  Edit, RESP TREATMENT NOTE, assign the new user
  class to the Required Cosignature field.

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CASE 3

• CASE Your site began a Respiratory Therapy
  program. The only note that the students will
  require a cosignature on is the title, RESP
  TREATMENT NOTE. (The note title is in place.)
• STEPS
• Create a new user class call Respiratory
  Therapist Student
• Add it as a subclass to Respiratory Therapist
• Assign the new user class to the user Vehu,
  Thirty.
• Using the TIU Parameters menu, Document Parameter
  Edit, RESP TREATMENT NOTE, assign the new user
  class to the Required Cosignature field.
• Dont forget to populate all fields!

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• Start Fortyfive, Inpatient has an unsigned LTC
  discharge summary written by Vehu,Forty. To see
  that you cant delete, sign onto CPRS as
  40VEHU/VEHU40 and try to delete the unsigned
  discharge summary.

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• Steps
• Check the TIU hierarchy

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• Steps
• Check the TIU hierarchy
• Check the business rules

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• Steps
• Check the TIU hierarchy
• Check the business rules
• Notice on the Discharge Summaries DOCUMENT CLASS
  there is the following rule
• An UNSIGNED (DOCUMENT CLASS) DISCHARGE SUMMARY
  may BE DELETED by an AUTHOR/DICTATOR.

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• BUT

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• BUT
• The LTC Discharge Summary title is in a different
  document class.

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• BUT
• The LTC Discharge Summary title is in a different
  document class.
• SOLUTION

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• BUT
• The LTC Discharge Summary title is in a different
  document class.
• SOLUTION
• Move the existing rule up to the Discharge
  Class Level or

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CASE 4

• CASE A resident calls and complains he cant
  delete an unsigned discharge summary for his long
  term care patient, but he seems to have no
  problems with a general discharge summary.
• BUT
• The LTC Discharge Summary title is in a different
  document class.
• SOLUTION
• Move the existing rule up to the Discharge
  Class Level or
• Create the same rule but for the LTC Document
  Class.

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