Activity: Meet the Client

Why was Cerner Millennium chosen by Saddlebag’s CIO, Mattie Earp?

What are some of the organizations within Saddlebag Health System?

How long will the installation of Cerner Millennium at Saddlebag take? Why?

What’s involved in Phase I? How long will it take?

What type of system is Tumbleweed currently using to register patients?

Will they continue using this system during Phase I?

Activity: Data Model Review

Answer the questions below, referring to the Cerner Data Model.

What is the primary key on the person_alias table?

What is the foreign key on the encounter table?

You have the Medical Record number of a patient, MRN = TA13974. List the command or commands that would be required to view the person’s name.

You have a person's name, Sarah O’Neil. List the command or commands that would be required to determine all of the Person Aliases.

You have the financial number of a patient, FIN = 87629. No other information has been provided. List the command or commands that would be required to view the patient’s name.

Activity: CCL Review

Answer the following questions referring to both the Cerner Data Model and an active session of CCL.

Look at the entire person table. Write down the command you would use to do this.

Look up Elijah Blodgett on the person table. (Hint: search for Elijah Blodgett using the name_last_key field). Write down the command you used.

Write down Elijah’s person_id.

What table would you look at to determine whether someone has been a patient in a hospital before?

Using Elijah’s person_id, determine how many times Elijah has been a patient in the hospital (or, in other words, how many encounters he has). Write down the encounter_id for ONE of the encounters.

People have many numbers or names used to identify themselves. Looking at your data model, what table would you look at to determine those other names?

Find out what Elijah’s aliases are. Write the commands you would use, and then record the actual aliases.

Activity: Define Organization Types

When completing this exercise, please use the information that is specifically stated in the descriptions below.

Org Description / Facility?
(Y/N) / Other Org Types (Client,Hospital,Employer,Insurance Company, Physician Office, Reference Lab, Home Health, School, Donor Group, Destruction Svc.)
Saddlebag Corporate Offices. There are some people employed by the corporate offices, in particular those who work in the data center, located in the offices. There is no patient care performed here.
Tumbleweed MedicalCenter. TMC has inpatients and receives reports from other organizations via RRD. Also, receives bills from other orgs, especially the reference lab, for work done at those orgs.
Millennium Psychiatric Research Institute is a for-profit entity that participates in psychiatric drug clinical trials using paid participants. There are no beds in this institution.
The Earp Clinic is a physician office building. If overnight stays are needed by patients, patients are sent to Tumbleweed hospital for admission. The organization is not using RRD, although it has an interface with Tumbleweed's ADT system, not Cerner Millennium.
Ford County Blood Center is a blood donor center that provides blood products to the region including Saddlebag. People come in to give blood, but never stay for more than an hour or so. They have no interfaces and no RRD.
Apache Central Reference Lab is a commercial reference lab providing services to hospitals, clinics, and doctor's offices. Patients are registered to a location within the Millennium system and Apache will use Charge Services.
Stagecoach hospital is an inpatient hospital that houses both sub-acute care and pediatric patients. It will be receiving reports via RRD, and will be sending patient information into Cerner Millennium via an interface.
LongbranchPsychiatric Hospital is an inpatient psychiatric hospital that will use Charge Services. However, it has no interfaces and will not be using RRD.
OK Medical Corral is a 90 bed community hospital serving the Dry Gulch area. It will be receiving reports via RRD, and will be sending patient information via an interface to Cerner Millennium.
Dalton Brothers Surgery Center is an ambulatory surgery center. Patients are assigned to a room and bed during surgery. Any patients that may require overnight care are transferred to OK Medical corral. They are not using RRD and have no interfaces to Cerner Millennium
Shawnee Nursing Home has 50 beds available for long term care. It has a physician who makes rounds, and sends specimens to the reference lab.
Blue Cross/Blue Shield of Kansas is a large insurance company within SalidaCounty. This organization is a major claims processor for the tri-county area and has over 500 associates working at this location.
Spico Food Processing is the SalidaCounty's largest employer. There are over 750 employees working multiple shifts to provide food products for shipment.
Prime Health is a insurance provider based in Mobile, Alabama. Several of the local businesses have decided to utilize this organization as their offering for employee insurance coverage.
K Mart is the city of Salida's oldest business. This organization employees over 50 employees.

Owner: KnowledgeWorks Client InstructionMillennium Fundamentals: MVP Participant Materials

Effective date: January 14, 2009 Version 01 Document #: 25TRGEXT014727

Content extracted from Document #: 25TRGEXT012359

Activity: Define Patient Care Locations

Location Data Collection Worksheet

Facility / Building / Location / Room / Bed

Owner: KnowledgeWorks Client InstructionMillennium Fundamentals: MVP Participant Materials

Effective date: January 14, 2009 Version 01 Document #: 25TRGEXT014727

Content extracted from Document #: 25TRGEXT012359

Activity: Design Code Sets

Code Set Data Collection Worksheet

Code Set / Display / Contributor_Source / Alias

Owner: KnowledgeWorks Client InstructionMillennium Fundamentals: MVP Participant Materials

Effective date: January 14, 2009 Version 01 Document #: 25TRGEXT014727

Content extracted from Document #: 25TRGEXT012359

Activity: Use the Data Model

On which table would you find the aliases for marital status?

On which table would you find the display values for the marital status you built?

What CCL queries would return only the aliases you built for Single? (Hint: You need the data you recorded above.)

What CCL queries would return only the aliases you built for Yuma? (Hint: You will need to write two queries to obtain this information.)

Activity: Translate Incoming Data

In answering the following questions, refer to the incoming PID segment shown on your computer screen,as well as the “PID Segment – Patient Identification” section of the ADT Universal Specifications document.

What is the field number that contains the value for marital status in the UI Specs document?

What is the value sent for marital status in the PID Segment displayed?

According to your code value alias data collection worksheet, what would be displayed in the PowerChart applications for marital status?

The remaining questions refer to the HL7 message displayed on your computer screen.

Name one of the segments in the message.

What is the | character used for?

Why are there some places in the message with several | characters in a row?

What is the ^ character used for?

Find the patient’s name. In which segment did you find the name?

Now that you know which segment the name can be found in, determine the number of the field containing the name. (For example, is it the first field in the segment? The second?)

What kind of information has been sent in the OBX segments?

Why are there multiple OBX segments?

Activity: Person Identifiers

Part 1

(Please be sure to complete the second part of this worksheet found on the following page.)

When are alias pools used?

What is the purpose of using alias pools?

What are the two steps to person identification?

What two things must be true of a primary identifier?

During what step or steps of person identification are primary identifiers used? Give an example for each.

What is the purpose of using secondary identifiers?

Why are driver’s license and SSN not used as a primary identifier?

Why is it possible to uncombine persons?

Part 2

Match the person descriptions to the person examples. Write the corresponding person description number to the right of the correct person example. Some of the descriptions may not be used or may be used multiple times.

Person Identification Descriptions
1. / Unauthenticated
2. / Contributor System
3. / FIN
4. / Driver’s License Number
5. / Secondary Identifier
6. / MRN
7. / Authenticated
8. / SSN
9. / Code Set
Person Identifier Examples / Person Description Number
A. / An Example Primary Person Identifier
B. / An Example Primary Encounter Identifier
C. / A Shared Alias Pool
D. / Last Name
E. / First Name
F. / DOB
G. / Sex
H. / SSN
I. / An ADT feed is an _____type of feed

Activity: Identify Person Identifiers and Alias Pools

Note: Detailed instructions for this activity can be found within the online course site.

Part D: Interface Information

There is one master patient registration system (IDX) that also sends ADT data to Cerner’s Classic PathNet system. The lab will send results to Cerner Millennium.

Tumbleweed Medical Center

Some of the information sent from IDX in a patient admit transaction includes:

IDX medical record number / Zip code
Financial number / Home phone number / Alias Pool? / Shared?
Last name / Marital status
First name / Social Security number
Middle name / Patient class
Date of birth / Nursing unit
Sex / Room
Race / Bed
Religion / Patient type
Street address / Admitting physician
City / Referring physician
State

There are also result interfaces coming from an ADAC radiology system, a Lanier transcription interface, and an Emtek nursing documentation system (this is basically an electronic keypad system where nurses record vital signs).

OK Medical Corral

OKMC uses an SMS patient management system (sends ADT data into system). Medical record numbers are assigned through the SMS system. Some of the information sent in an admit transaction includes:

SMS medical record number / Zip code
Financial number / Home phone number / Alias Pool? / Shared?
Last name / Marital status
First name / Social Security number
Middle name / Patient class
Date of birth / Nursing unit
Sex / Room
Race / Bed
Religion / Patient type
Street address / Admitting physician
City / Referring physician
State

Result interfaces include a Sunquest Lab system, Classic RadNet, and a SoftMed transcription interface.

StagecoachHospital

There is a single point of registration for both buildings. An HBOC patient management system is used. Some of the information sent in an admit transaction includes:

HBOC medical record number / Zip code
Financial number / Home phone number / Alias Pool? / Shared?
Last name / Marital status
First name / Social Security number
Middle name / Patient class
Date of birth / Nursing unit
Sex / Room
Race / Bed
Religion / Patient type
Street address / Admitting physician
City / Referring physician
State

A Lanier transcription interface is in place. Currently, laboratory and radiology are both manual. They will be converting to Cerner MillenniumPathNet and RadNet in a later phase of the implementation.

Activity: Registration

Steps Two and Four: Query Tables in CCL to Complete Worksheets

After both patients have been registered (see Step One), use Discern Explorer (CCL) to complete the Person Activity Worksheet below. After Step Three has been completed, update the worksheet as necessary.

Person Activity Worksheet

Patient #1 – Person ID
PERSON_ALIAS_ID / ALIAS / ACTIVE_IND / PERSON_ALIAS_TYPE_CD / ALIAS_POOL_CD / PERSON ALIAS TYPE*
Example: 37821 / 1234 / 1 / 2 / 1234 / CMRN -
Community Medical Record Number
Patient #2 – Person ID
PERSON_ALIAS_ID / ALIAS / ACTIVE_IND / PERSON_ALIAS_TYPE_CD / ALIAS_POOL_CD / PERSON ALIAS TYPE *
Example: 37821 / 1234 / 1 / 2 / 1234 / CMRN -
Community Medical Record Number

* For all tables, use the Person Alias Type column to record the code value display for the person_alias_type_cd.

Activity: Process the Incoming Data (Part E)

Match and Reconcile Worksheets

Person Table
Person_ID / Active_Ind / Name_Full_Formatted / Sex_CD / Name_Last_Key / Name_First_Key / Birth_DT_TM
Person Alias Table
Person_Alias_ID / Person_ID / Active_Ind / Alias_Pool_CD / Alias
Encounter Table
Encounter_ID / Person_ID / Active_Ind
Encounter Alias Table
Encounter_Alias_ID / Encounter_ID / Active_Ind / Alias_Pool_CD / Alias

Activity: Process the Incoming Data (Part F)

Match and Reconcile Worksheets

Activity: Process the Incoming Data (Optional Practice)

Match and Reconcile Worksheets

Activity: Review Common Order Management Terminology

Define the term Order Catalog.

List the three different synonym types and identify where each synonym can be seen within Cerner Millennium.

Define the term catalog type.

Define the term activity type.

Saddlebag Activity: Review the Order Catalog

Open DCPTools.exe, then expand the Order Management plus sign and select the Order Catalog tool.
You will see three radio buttons at the top of the tool. Select the Modify Orderable option and review the following orderables:

Physical Therapy Evaluation
US Biopsy Liver
Urine Culture

Complete the table below.

Orderable Description / Catalog Type / Activity Type / Order Format / Synonym / Synonym Type

Activity: Design Catalog Types

The Saddlebag project team is designing and building the Order Catalog. Unfortunately, the departments cannot seem to agree on how to build the orders. Nursing wants to order something by one name, while lab wants to order it by another name. For the orderable below, determine the appropriate catalog type and identify whether any synonyms should be built into the order catalog.

A CBC (complete blood count) is a laboratory test that measures white blood cell count, red blood cell count, and several other things related to the patient’s blood. A high white blood cell count can indicate infection, where as a low red blood cell count can indicate anemia. The hospital-wide accepted name as endorsed by the Standards Committee is Complete Blood Count. The nursing and laboratory departments, however, have never used this term and are quite resistant to doing so.

J. Cates, lab manager:“We’ve always called it a CBC, and we’re not going to change now!”

Nurse Ramsey: “All the nurses are used to ordering this procedure under the name of Hemogram. If we try to make them call it a CBC, they will not be happy!”

Catalog type:

Synonyms (include the type):

Saddlebag Activity: Identify Systems

Note: Detailed instructions for this activity can be found within the online course site.

Consider the following information as you fill out the Event Code / Event Set Worksheet:

Contributor Source column:

As discussed during the Interfaces section, information can be received from many sources. When Cerner Millennium receives this information, it needs to be translated; therefore the first step is to determine the source of the information.
In this column, indicate the contributor course for each alias being sent.

Alias column:

Just as code value aliases are used to represent code values, aliases are also sent to represent event codes.
In this column, indicate the value being sent to represent the corresponding result.

Primitive Event Set column:

This column often coincides with the New Display column. This is the lowest viewable level in the Event Set Hierarchy, and must be defined in order to display the results.
This column should match Saddlebag's agreed upon display values.

Event Set column:

Event sets are a way of grouping information together to be displayed on the Flowsheet. As mentioned previously (in the Project Status and also in Project Information Part G), Saddlebag has decided to use the event sets Chemistry and Nursing.
In this column, enter the appropriate event set and grouping for the information being sent.

Event Code / Event Set Data Collection Worksheet
Contributor Source / Alias / Primitive Event Set Name / Event Set Name

Saddlebag Activity: Review an Event Set Hierarchy

Using the Event Code and Event Set spreadsheet, complete the designed event set hierarchy below based on client needs and the rules for an event set hierarchy.

Saddlebag Activity: Identify Users (Security Questions)

Based on the information in the security presentation, answer these questions:

What does Cerner recommend positions be based on? Where are they built within the system?

Define the term application group.

In addition to application groups, name three ways in which users are restricted from accessing patient information.

How would you use the Content Manager and the HNA User tool?

Describe encounter/organization security and confidentiality and how they relate to each other.