Iatric Systems M'U'S'E' 2006 International Tuesday Training Intro to Clinical Rule Writing

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Iatric SystemsM.U.S.E. 2006 InternationalTuesday
TrainingIntro to Clinical Rule Writing

• Presented by
• Jason Medeiros
• Iatric Systems

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Rules Course Agenda

• Basic Rule Syntax
• Using Data fields, queries
• IF Statements
• Use of Local Variables
• How to apply rules in your application
• Different types of rules
• Output
• Where are rules attached?
• Important data fields in each application

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Functions of Clinical Rules

• Rules allow you to evaluate criteria and perform
  a response
• Restrict ordering of medications/tests
• Send notifications to staff via MOX
• Calculate LAB values for RPh review
• Change a field value
• Generate notification of NUR intervention

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Rule Syntax

• Basic Guidelines
• All rules must end with a semi-colon
• Every line within the Rule editor must end in a
  comma or semi-colon
• Each line of programming code is limited to the
  visual space provided in the Rule editor.
• This is my warning message to the Meditech
  user"MSG,
• IFf pt sex"M" f rx msg(MSG)
• f rx ok

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Accessing/Utilizing Data Fields

• Data Fields reference Permanent and/or Temporary
  information.
• Data fields may perform action or Calculations
• Access
• Use the get key (F4 on PC)
• Then F space and your lookup key
• You may seed the lookup to quickly find fields

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Data Fields Permanent data

• Always available in Rules
• pt admit dr 30 Patient's admitting
  provider's name
• pt admit dr mne 10 Patient's admitting
  provider
• pt los 3 Discharged patient's
  length of stay
• pt name 30 Patient's name
• pt nok 30 Patient's next of kin
• pt oe wt kg 6 Patient's oe weight
  in kg
• pt sex 1 Patient's sex

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Data Fields Temporary data

• Data may or may not be entered yet
• lord col date 8 Lab order collection
  date
• lord col day 3 Lab order collection
  day of wk
• rx ord type 10 Rx's order type
• rx order site 10 Rx's order site
• rx sig 20 Rx's sig
• ord ser dt 8 Service date
• ord ser tm 4 Service time

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Data Fields - Calculated

• day of week 3 Current day of week
• days old 4 Days before today()
• lord lab test 1 Lab order lab test()
• lord lab today 1 Lab test already ordered
  today()
• lord get pt age 3 Patient age
• today 8 Today's date

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Data Fields Perform Action

• rx msg 60 Rx message()
• rx set billing code 60 Rx set billing
  procedure code to()
• rx set charge type 60 Rx set charge type
  to()
• rx set rx comment 60 Rx set rx comment to()
• ord err msg 60 Order error message()
• ord msg 60 Order message()
• ord reject 0 Order REJECT
• ord yes/no 60 Order ask yes/no()

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Using Query Values in Rules

• You may pull Customer Defined Query values into
  Rules to be evaluated.
• Access
• Use the get key (F4 on PC)
• Q space and your lookup key
• You may seed the lookup to quickly find queries

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Using Query Values in Rules - Issues

• Queries may not have a value when the particular
  rule is running
• If your value does not work as designed, try this
  trick
• Example
• f rx msg(Allergy1 _q OE.ALL1)
• This syntax will display the value of OE.ALL1 in
  a yellow box. You will then be able to determine
  if the rule is getting the query value properly.

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What is an Argument?

• Definition An argument is a value that is passed
  into the data field to be used by that data
  field.
• An Argument may be
• Text message
• Another Rule Mnemonic (CALC Rule)
• Local Variable

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Argument Required Parentheses in lookup
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Some data fields require an argument

• If parentheses appears in the lookup for the data
  field then an argument is required
• You will receive an ERROR message from the syntax
  checker if an argument is not utilized
• If there is a comma in the lookup, then two
  arguments are required

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What should my argument be?

• There is no easy way to tell what the argument of
  a data field should be, although it is usually
  possible to discern this from the field
  name/description
• Consult the Meditech L list
• Other expert sources?

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Local Variables

• Used for the temporary storage of information
  during the processing of the rule
• Used to
• Store information for future processing, such as
  calculated values
• Store large strings into smaller names in order
  to conserve space in the Rule Text Editor
• Your local variables are created and available
  only during the processing of the current rule

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Local Variables How to create

• Example
• "This is my warning message to the Meditech
  User."MSG,
• IFf pt sex"M" f rx msg(MSG)
• f rx ok
• Use local variable MSG to store the message
• Refer to MSG in the IF/THEN statement

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Local Variables- Naming Conventions

• Use Capital-Alpha-Numeric characters
• Use at least 3 characters
• Use short, descriptive, meaningful names
• Example
• MSG
• CREAT
• NAME
• LNAME
• FNAME

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Local Variables what NOT to use

• Meditech uses its own local variables while the
  screen is functioning. You should take care not
  to overwrite the following local variables in
  your code
• X ANS R S
• A B C
• Can you think of others?

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The Assignment Operator (?)

• Shift-6 on your keyboard
• Used to
• Assign a value to a variable
• Display a value on the screen
• Erase a value
• Example
• Please change inventory to MAINMSG,
• We read this as Message text goes to local
  variable MSG.
•  

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Relational Operators

• Used to compare values to determine a TRUE/FALSE
  relationship
• MAGIC Relational Operators
• Operator Explanation
• ' Not
• Equal to
• Not Equal to
• gt Greater Than
• lt Less Than
• gt Not Greater Than (less than or equal to)
• lt Not Less Than (greater than or equal to)

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Relational Operators - Example

• "Please obtain parental consent.MSG,
• IFf pt cur agelt18 f lord msg(MSG)
• f lord ok
• Store the display text in MSG
• Check pt current age and if less than 18, display
  the message to user

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Relational Operators Nil vs. Non-nil

• In Magic, each operation will maintain a value
• If the evaluation is true, the value on the LEFT
  side becomes the value of the operation
• 5gt4 TRUE ....5 is the value
• If the evaluation is false, nil becomes the value
  of the operation
• 4gt5 .FALSE is the value

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Relational Operators - Examples

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IF/THEN/ELSE Statements -Syntax

• IF/THEN
• IFcondition response1response2
• Example
• IFf pt sex"M" f rx yes/no(Drug is
  male-specific. Order anyway?")
• f rx ok
• There is a space between the condition and
  response. The space represents the THEN"
  portion of the IF/THEN statement.
• The semi-colon represents the separation between
  the first condition/response pair. The
  semi-colon is the "ELSE" portion of the
  IF/THEN/ELSE statement.

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Multiple Condition Statements

• IFcondition1 response1
• condition2 response2
• response3
• Each condition will be evaluated moving from left
  to right
• If condition 1 is true, then response 1 will be
  performed and no other conditions will be
  evaluated.
• If condition 1 is false, then condition 2 will be
  evaluated. If condition 2 is true, response 2 is
  performed.
• If both conditions 1 and 2 are false, then
  response 3 is performed.

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IF/THEN/ELSE Statements Syntax (ctd)

• Example
• IFf pt facility"A" f lord use
  billcode("A1234")
• f pt facility"B" f lord use
  billcode("B1234")
• f pt facility"C" f lord use
  billcode("C1234")
• f lord ok
•  Note
• Indentation of the conditions proper
  formatting

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Boolean Operators

• Compare using AND and OR relationships.
• For example
• Display a message if the patient is male AND
  older than 65.
• Notify user to order test as STAT if the patient
  is in the location of ICU OR CCU.

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Boolean Operators (ctd)

• Operator Boolean Equivalent
• ! OR
• AND

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Boolean Operators - Examples

• "Ask for date of LMP.MSG,
• IFf pt sex"F"(f pt cur agegt15) f lord
  msg(MSG)
• f lord ok
• If both conditions are TRUE, display message
• "Cannot order test.MSG,
• IFf pt sex"M"!(f pt cur agelt10) f lord
  msg)(MSG)
• f lord ok
• If either condition is TRUE, display message
• Note Parentheses used in the expression!

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Application Specifics Similarities

• OE/LAB/PHA share some common characteristics
• Data fields In all apps, there are data fields
  which will perform a function such as display a
  message to a user
• f lord msg(Please call LAB regarding this
  test!)

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Application Specifics Similarities

• Certain fields will allow the user to file or
  reject the order.
• In general, a rule will allow filing if its FINAL
  VALUE is a non-nil value. If the final value is
  nil, the user is stopped.
• f ord ok Order is ok, allow filing.
• f ord reject Order is not ok, do not allow
  filing.
• f rx err msg(Patient is Male. You may not
  place this order.)
• Error message- Do not allow filing.

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Application Specifics Similarities

• Prompt user to continue
• Current time is after hours. Order
  anyway?MSG,
• IF(0700gtf now)!(1500ltf now) f lord
  yes/no(MSG)
• f lord ok
• If user answers Y, then allow filing. If user
  answers N, then do not allow filing.

Prompt User
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Application Specifics - PHA
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Application Specifics - PHA

• Types of Rules
• RX Rules
• Calc Rules
• Bill Rules
• Purge Rules
• Adj Rules seldom used
• DUE Rules seldom used

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PHA RX Rules Evaluate at
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PHA RX Rules Evaluate at

• MED - When the medication is identified
• DOSE - When the dose is specified
• FILE - When the Rx is filed
• TXN - During the billing compile before Rx is
  sent to B/AR
• REFILL When Refill List is run or Check Refill
  Rules routine is run
• STOP - When you enter a Stop Date and file the
  order

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PHA POM Enabled
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PHA- POM Enabled (ctd)

• POM MED Identify the MED in POM
• POM DOSE- Enter a DOSE in POM
• POM FILE Enter a stop date for an order in POM

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PHA Page 2
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PHA- Page 3
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PHA Page 4
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PHA Rule View
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PHA RX Rules Where to attach?

• Global Rules Attached in Customer Defined
  Parameters Page 4
• Evaluated for ALL orders
• Drug Specific Rules Attached in the PHA Drug
  Dictionary Page 4
• Evaluated only for this drug

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PHA Global RX and Purge Rules
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PHA- Print Profile routine
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PHA- CALC Rules

• Referenced by RX rule using f rx calc

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PHA BILL Rule

• Charge Type Dictionary

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PHA - Important Data Fields

• Field f rx reject
• Description Returns a nil value. This field is
  used to return as a result of a condition
  specified in the rule. User may NOT continue
  with the order. Seldom used.

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PHA - Important Data Fields

• Field f rx set billing code
• Syntax f rx set billing code(X)
• Argument X is the billing procedure code you
  intend to set.
• Description Use this field to modify the billing
  code for an Rx based on a condition. This
  billing code must exist in B/AR database.

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PHA - Important Data Fields

• Field f rx set charge type
• Syntax f rx set charge type(X)
• Argument X is the charge type you would like to
  default for this Rx.
• Description This field will set the charge type
  for this Rx. The charge type must be valid in
  the Charge Type Dictionary.

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PHA - Important Data Fields

• Field f txn qry resp
• Syntax f txn qry resp(X,Y)
• Arguments There are two arguments required for
  this field. X is the value you are sending. Y
  is the MIS query mnemonic you have setup to store
  the value you are sending. This query is used on
  the B/AR side and is attached to a CDS of type
  BAR TXNS
• Description This field is used to send
  additional query information to B/AR in an Rx
  rule evaluated at the TXN level.

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PHA - Important Data Fields

• Field refill rule msg()
• Syntax refill rule msg(X)
• Argument X message to display on the Refill List
• Description Will print on the Refill List
  printout if the rule fails and generates a
  message

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PHA - Important Data Fields

• Field f rx last ver result
• Syntax f rx last ver result(X)
• Argument X is the lab test mnemonic that you are
  querying.
• Description Returns the last verified result
  stored in LAB for this patient and test.

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PHA - Important Data Fields

• f rx nth ver Res-COL(PSA",1)
• Returns result, collection date and collection
  time of the most recent PSA TEST.
• A argument LAB TEST Mnemonic/print number
• B argument Which LAB result to retrieve. 1 is
  most recent, 2 is next recent, 3 is third most
  recent

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PHA - Important Data Fields

• f rx nth ver Res-RES(PSA",1)
• Returns result, result date and result time of
  the most recent PSA TEST.
• A argument LAB TEST Mnemonic/print number
• B argument Which LAB result to retrieve. 1 is
  most recent, 2 is next recent, 3 is third most
  recent

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PHA - Important Data Fields

• You can parse out the data from these keywords
• Use String Extraction
• Example
• TEST"0,"RES RESULT
• TEST"1,"DATE DATE
• TEST"2,"TIME TIME

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PHA - Important Data Fields

• Field f pur do purge
• Syntax f pur do purge
• Description This field is used to return as a
  result of a condition specified in the rule. Use
  this field to purge the record.

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PHA - Important Data Fields

• Field f pur do not purge
• Syntax f pur do not purge
• Description This field is used to return 1 as a
  result of a condition specified in the rule. Use
  this field to prevent the purge of the record.
•  

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PHA Custom Keywords

• Meditech allows PHA users to create your own
  Custom Keywords. Use this feature to
• Access fields not available in lookup
• Call custom NPR macros to
• Search pt profile for a Generic
• Send a MOX message
• Perform complex calculations

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PHA Custom Keywords
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Custom Keywords in other Apps

• The E/E Custom Keywords routine is ONLY available
  in PHA
• For OE/LAB/SCH, you may request custom keywords
  from Meditech.
• When doing so, BE SPECIFIC in your request.

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Application Specifics LAB
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Application Specifics - LAB Rule Types

• BBUNIT - Check format of BBK Unit numbers.
  Assigned in the BBK Source/Destination Dictionary
• BBASSN BBK Assignment/Issue rules may allow or
  disallow the assign/issue of blood units.
• BCCHK Check bar code formats
• CHG Add miscellaneous charges to certain tests

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Application Specifics - LAB Rule Types

• ORD Order rules restrict ordering of LAB Tests
• BSP/LSP/MSP/PSP Control the selection of
  specimens that use Selection Profiles
• LBCAST Control download of specs to analyzers
• PQL Customize Pathology Questionnaire Logic

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Application Specifics - LAB Rule Types

• PTID Verify PT ID formats for external LABS
• PURGE Control purging of LAB records
• REFLEX Control reflex ordering of tests
• SITE Assign LAB Site to a requisition
• VERIFY Control results notification

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POM Enabled?
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POM Enabled? Provide user options
Online help
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LAB Rules Where to Attach?

• Test Dictionary ORD/CHG/Site Rules
• BBK Test/Product/Source/Destination Dictionary
  All BBK Rules
• Micro- Procedure, Organism dictionary

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LAB Rules Where to Attach?

• Order Group Dictionary RFLX Rules
• Pathology Questionnaire Dictionary PQL Rules
• Analyzer Dictionary LBCAST Rule
• LIS Client Dictionary PT ID Rule

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Attach multiple rules per TEST
New!
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LAB Important data fields

• Field f lord lab test
• Syntax f lord lab test(X)
• Argument X is the LAB Test Mnemonic you are
  checking for
• Description Returns a (Y)es if the Lab test has
  been ordered during the same
  requisitioning session.

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LAB Important data fields

• Field f lord lab today
• Syntax f lord lab today(X)
• Argument X is the LAB Test Mnemonic you are
  checking for
• Description Returns a (Y)es if the Lab test has
  been ordered today.

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LAB Important data fields

• Field f lsp last ver result
• Syntax f lsp last ver result(X)
• Argument X is the LAB Test Mnemonic you are
  checking for
• Description Will return the last verified test
  result for the test mnemonic in the argument.

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LAB Important data fields

• Field f lord gen info
• Syntax f lord gen info(X)
• Argument X is the Generic drug you are
  checking for
• Description Returns the status of an RX that
  contains the generic - AC/UNV/DC
• You may also check for drug mnemonics using
• lord drug info

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LAB Important data fields

• Field f psp view rel find
• Syntax f psp view rel find
• Description This field will display the Related
  Findings screen in Pathology. This would
  typically be used with a POST rule.

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LAB Important data fields

• Field f ppr set response
• Syntax f ppr set response(Mnemonic,Text)
• Arguments Mnemonic of the prompt you want to
  set, TEXT to default into the prompt
• Description This field will set the response for
  another prompt response within the questionnaire.
  This field will typically be used with a POST
  rule.

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Application Specifics - OE
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Application Specifics - OE

• Types of Rules
• ORD Evaluated when user FILES order
• OUTPUT Control printing of reqs
• PTDATA Evaluates entry of Patient Data in E/E
  Administrative Data routine. seldom used

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POM Enabled?
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POM Provide options to user
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OE Rules Where to attach?

• ORD- Attached Page 1 Procedure Dictionary.
• OUTPUT Attached Page 2 Procedure Dictionary
• PTDATA - Linked via a query attached in the OE
  Parameters

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Attach multiple rules
New!
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OE Important data fields

• Field f do not print
• Syntax f do not print
• Description This data field will suppress the
  printing of a requisition when used as the last
  value of a rule.

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OE Important data fields

• Field f do print
• Syntax f do print
• Description This data field will allow the
  printing of a requisition when used as the last
  value of a rule.

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OE Output Rules

• Do Not print REQ if on a Weekend

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Output Rule Attach to Procedure
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Application Specifics NUR
New!

• Generate Clinical Alerts when Interventions are
  documented
• Attached in Intervention Dictionary

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NUR Intervention dictionary
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NUR Rule Old school dictionary
MIS Notification Mnemonic, Level, Detail
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NUR Important data field

• Field f pt notification(ca,lev,det)
• Syntax f pt notification(ALERT,Med,MSG)
• Description This field generate an MIS Clinical
  notification, as specified in the MIS
  Notification dictionary.
• Arguments
• ALERT MIS Notification mnemonic
• Med Level
• MSG Detail to include on notification

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For more information..

• Our I-Online Learning courses are a great way to
  present this
• material to your entire staff simultaneously
  for a fraction of
• the cost of On-site training.
• See our website for our Summer Course Schedule!
• Iatric Systems
• www.iatric.com
• 978 805 4100
• Enjoy the Conference!