INTERACTIVE VIEW (AUDITING AND ANALYSIS)
By Matthew Pedrotty
In the ever-changing healthcare world and the continuing push toward the electronic
medical record (EMR), utilizing direct charting via Cerner’s Interactive View (IView);
accuracy of data in the patient’s chart and strict adherence to timelines to implement
these initiatives are critical. Below are some auditing options that will help to ensure
both accuracy and timeliness with regards to implementation and maintenance of the Cerner
product in your organization.
Benefits of auditing
- Reducing the amount of time and effort put into assessing what is already in your domain
- Assuring accuracy as data is extracted directly from the domain
- Consistent/repeatable process that can be performed as necessary
- Can be extracted into easier to use formats (MS Excel) for editing and reviewing
- Can be formatted into pivot tables for easy reference, user friendly
Utilizing Content Manager to extract the entire content of domain (DTA, DTA Description,
DTA Type, Alpha Responses…), is recommended. This will be necessary to view all existing
content in one domain (Prod) and bounced off what is in another non-prod domain (via
MSAccess). This will ensure you are not duplicating efforts on existing data (leverage
through re-use).
All audits are run via CCL and can be imported into MS Excel for easier manipulation and
viewing of data. MSAccess is also utilized for further comparison and manipulation of
data. Audits to consider running and analyzing:
- PowerForm audit All powerforms, sections, dtas, and event codes
- Interactive View Audit what is currently on the Interactive View in the
domain (ex. View/Band, Section, Primitive Event Set, DTA, DTA Description, DTA Type,
Alpha Responses, Event Codes, Includes, and Excludes.
- DTA’s attached to grids
- PowerForms with grids audit (a more detailed description of this audit and
the processes are detailed below)
- DTA's that violate the 1:1:1 relationship (1Event Set:1Event Code:1DTA; a
further explanation of the logic and process of this audit is detailed below)
DTA's without 1:1:1 relationship
Ensure that there is a 1:1:1 relationship among DTA's:Event Codes: Primitive Event Sets.
- Ensure DTA’s are not duplicated across DTA activity types
- Check event codes that are attached to multiple DTA’s
- Check primitive event sets that have more than one event code associated
It is possible to have two DTA’s with the same name and same event code association if
their activity type is different. In this case, if the DTA’s mean the same, the following
steps should take place:
- Choose one DTA to keep
- “zzz” all instances of duplicate DTA’s
- Run update to remove event code association from “zzed” DTA’s
- Update into discrete_task_assay set event_cd = 0 where mnemonic = “XXXXXXX” go
- Commit go
- “XXXXXXX” is the mnemonic that has been “zzzed”
- Update PowerForm controls where “zzzed” DTA’s had been used with the DTA that is
being kept
If an event code is attached to multiple DTA’s:
- Consider consolidating DTA’s – If the DTA’s mean the same thing, is it necessary to
have more than one?
- If DTA’s have different meanings, then they need their own event code
- Create the new event code using the event code load/unload spreadsheet
- Associate new event code to DTA in DTA Wizard
- If some of the DTA’s that are attached are not being used or can be consolidated
- “zzz” all instances of the unused DTA’s
- Run update to remove event code association from “zzzed” DTA’s
- Update into discrete_task_assay set event_cd = 0 where mnemonic = “XXXXXXX” go
- Commit go
- “XXXXXXX” is the mnemonic that has been “zzzed”
If a primitive event set has more than one event code associated
- If an event code is being used, then it needs a new primitive event set
- If it is not being used, then it needs to be disassociated
- To disassociate
- Unload event codes
- Remove event set from the event set name column for all event codes that are not
being used
PowerForms with grids audit
This audit identifies the input type for the Grid on the PowerForm. The merge_id in this
audit is the event_cd for the grid. Column F (event_cd) if a value a row on in this column
the value is used to link the grid event code the event set hierarchy.
If you plan to remove the PowerGrid do not create and event for the PowerGrid.
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Purpose of audit:
Returns back active PowerForms, their sections,
and any grids that appear on each section.
Includes column of "I.INPUT_TYPE" which tells you which type of grid it is:
14 = discrete grid
17 = PowerGrid
19 = UltraGrid
- Also shows you the evcode_display (display of the event code associated to the
grid.)
- In general, it is OK to have the evcode_display be blank for a "14" grid.
- It is generally NOT OK to have evcode_display blank for a "17" grid - but it depends
on what level you have the grid set to.
- If you have it set to "detail" level, then you will not need a row or grid event
code.
- If you have it set to "row" level, then you will need a row event code.
- If you have it set to "grid" level, then you will need a grid event code.
- Both row and grid level event codes return to the same columns in this query. The
return of "DCP GENERIC CODE" to this column for a grid set to result at the row or grid
level is cause for concern. Ensure that the grid has an appropriate event code in this
case using the PowerForms tool.
- Discrete Grids are always viewed at the “discrete” level, so these DTA’s can easily
be shared between INET and PowerForms. They can be documented and viewed
consistently.
- UltraGrids MUST be charted at the “detail” level for the following reasons:
- The Interactive View cannot display grids charted at the “row” or “grid” level
- In order to use the same event code for documentation, the first step is to
ensure the UltraGrids are set to the “detail” level.
- PowerGrids are not integrated with the Interactive View at this time.
- Where possible, stop using PowerGrids.
- Example: Pain Assessment (Content team is working on a new method to capture
pain information)
- Example: Surgical History (Continue to chart via a PowerForm, NOT the
Interactive View)
It is recommended that once the data is formatted in a way you are comfortable, the
auditing process is run on a routine basis. You may choose to perform this daily, weekly,
or monthly; depending on the timeline. This will ensure any changes to the domain are
captured and can assist with change control procedures.