The MUSE Harvest - Happy Fall, Y’all!

Pumpkin drinks, crunchy leaves, cooling weather, cute boots … these are typical associations with fall, at least for me. But, traditionally the fall season marked the time of harvest (not just improved fashion and seasonally-themed lattes). The transition signaled the gathering of ripe crops for enjoyment and sustenance through the winter months. Many civilizations celebrated (and still celebrate) this season with festivals, feasts and parties. 

In keeping with tradition, MUSE offers a variety of fall programs, ripe and ready for harvest! For example, the event in Newport Beach embodies a cornucopia (sorry, couldn’t resist) of topics most pertinent in healthcare IT.The menu includes:

• MEDITECH 5.66 Upgrade (both Client Server and Magic)

• Patient Portals

• Meaningful Use

• ICD-10

• CPOE

• Technology

You can check out this event here: Newport Beach Event. 

Webinars
Sometimes a forum discussion continues to grow and receive so much attention, that it develops into a presentation. That is the case with the October 29 webinar. This webinar, Unit Clerk Utilization with CPOE, describes Upper Chesapeake Health Systems’ unique checklist for unit secretaries during a CPOE go-live, and demos the role the unit secretary plays in alerting nursing for STAT CPOE orders and how they are responsible for “Managing the Transfer” of patients. 

You can register for this webinar here:  Unit Clerk Utilization with CPOE

Also, these topics were recently offered, but you can get access to the recordings to watch at your convenience:-

• The ARRA Journey – So, you thought you were through with Stage 1?
• MU Stage 2: The Transition from Quality Measurement to Informatics
• MEDITECH 5.66 – The Early Adopter Experience and Go-Live
• The ARRA Project – Quest to Attest Using Project Management Tools 

Many other webinars and Peer Group JAM sessions are in the works for the coming months; watch for announcements and website updates. And if you are looking for something you don’t see listed, just let me know.

                    Other Events

Additionally - a few fall offerings have already occurred, and if you did not attend, here’s what you missed (and what you can look forward to in the future): 

Ontario Shores Event
More than 20 MUSE attendees gathered on September 18 at Ontario Shores Centre for Mental Health Sciences and learned how the facility uses the MEDITECH 6.07 platform to support Inter-professional care delivery and achieve Stage 6 and Stage 7 of the HIMSS EMRAM model. 

This program, generously sponsored by Dell Services, offered tremendous value to attendees, as evidenced in feedback: 

“It was very valuable event; it was helpful to see how another facility is utilizing the system, especially 6.07.” 

“It was interesting to see the customization of menus and reports that Ontario Shores had to do - great value in this event.” 

“Good insight from Ontario Shores specifically regarding benefit and vision from the physician perspective. The adoption slides were very compelling as well.” 

“MUSE events like these are a valuable way to hear lessons learned from peer organizations. It makes sense to learn from each other vs. solving problems in a bubble.  These events encourage collaboration which we need to see more of in healthcare.” 

Thank you to Ontario Shores for offering this event and to Dell Services for your sponsorship! 

MAKIN IT Community Peer Group
The MAKIN IT Community Peer Group, comprised of Missouri, Arkansas, Kansas, Iowa and Nebraska hospitals, met for the second time in Clinton, Missouri on October 15 to discuss topics such as surveillance boards, patient portals, PCS rules writing, evidence-based order sets and more. 

Thanks to the generous sponsorship by Park Place International, more than 50 attendees were able to gather for this meeting free of charge! This vibrant group plans to continue meeting and promoting collaboration within the region. 

“This was awesome, great networking with other sites that are or have been through processes we are working on.” 

“Small meetings like this are great because it gives everyone the ability to speak to the problems or ask questions.” 

“Finding solutions from other locations was very helpful.” 

“Great opportunity to network with similar hospitals in our region.”

“Good ideas from other hospitals, especially hearing other problems/issues we haven't addressed yet.”

Thank you to the MAKIN It Leaders for working so hard to make this program happen: 

Alexa Thompson RN, Clinical Systems Analyst, Golden Valley Memorial Hospital

Kim Maples RN, Systems Analyst, Citizens Memorial Hospital 

Peer Group JAM Sessions
Have you tried an online Peer Group JAM session yet? These have become one of the most popular MUSE programs. Sponsored by Dell Services, these FREE sessions encourage open dialogue and discussion about pertinent topics.

The most recent ones offered set records in numbers of attendees!

• Magic 5.66 Multidisciplinary Discharge Routine
• Client Server 5.66 Multidisciplinary Discharge Routine
• UPT Utilization in 5.66 

So, take a break from raking your leaves and sipping your pumpkin spice drink, join your peers and participate in the “MUSE harvest” by attending the Newport Beach event or one of the upcoming webinars. 

Cheers!
Alicia

MEDITECH 5.66 Upgrade Journal Part 2

The Canary is Still Singing …

MEDITECH 5.66 Upgrade Journal - Part 2

Guest Poster:

Adnan Hamid, Director, IT Services

Henry Mayo Newhall Memorial Hospital, Valencia, CA

 

 

Last month, MUSE posted my C/S 5.66 Upgrade journal as part of the MUSE Matters blog.  Based on reader feedback, it was a hit … more like close to 1,500 hits to the blog. I also received emails from readers about the post and many follow-up questions regarding the upgrade.  So I thought I would consolidate the questions for this follow up article to the MUSE Matters blog.
 

Q:	Any other issues that you have seen since the journal blog was posted?
A:	Yes, we did have an issue with ORM reports not flowing into the EMR.  Based on MEDITECH’s review of the issue, HUB is attempting to grab the reports off the SCH HUB queue to bring the reports over to HUB so they can go to the EMR. It should be using the old numbering system to read the data, but the correct flags are not being set to do so. Thus, it's attempting to read in a "Holding" report when it should be reading an "Anesthesia" report. Since there's nothing entered for Holding reports in the OR parameters, it's crashing every time.  In order to determine the root cause, MEDITECH disabled the SCH OR EMR Midnight Run Queue.  MEDITECH is has submitted SCH DTS 13156 to help clean up the duplicate and mismatched reports in LIVE.  We are still awaiting the delivery of this DTS.   We also had an issue with the Hospital Central supply unable to produce a correct pick list. MEDITECH uploaded DTS CS MM 3389 which corrected this issue for another hospital. It was moved into our LIVE system on July 17th.  This DTS resolved the issue.   We have noticed that since the 5.66 upgrade on 6/18, all of our notification alerts from mtalert@henrymayo.com show a timestamp of 7 hour behind of the actual delivery.  MEDITECH is still investigating the issue.
Q:	Did you notice after your code overlay that when filing items in LIVE, you get a pop-up window that displays and disappears in a matter of a second or two?
A:	We did not notice any pop up window.  The user that submitted the question updated me stating that the pop up window occurred on clients that are 3-tier.  If the client is 2-tier, no issue.
Q:	How long did you allow for testing of the DTS?
A:	We had full day testing sessions to test out the major DTS for the upgrade.  We had three integrated testing sessions along with one parallel testing session for the upgrade.
Q:	What version were you on before the upgrade?
A:	We were on version 5.65 PP11.
Q:	Did you stop all build during the testing time?
A:	No.
Q:	Since the upgrade, have you noticed any issues with the new discharge routine?
A:	We are planning to utilize the new discharge routine as part of our PCM Phase 2 Go-Live in October 2013.  We’ve been having some issues, but MEDITECH has been pretty responsive in past 2-3 weeks getting us DTS fixes for them…a couple are still outstanding. Our continued meds, scripts, etc. are displaying in the routine and in the Patient Visit Summary appropriately.

 

Do you want to hear my upgrade experience live? I am presenting at the Newport Beach MUSE Event, November 11 -13. You can register to attend here: Newport Beach Event.

 

Stay tuned for Part 3 of my 5.66 Upgrade Journal … Issues and Challenges with the Discharge Routine. 

 

 

Adnan Hamid

Director, IT Services

Henry Mayo Newhall Memorial Hospital, Valencia, CA

What are Webinars Worth?

I was recently explaining to my grandmother how webinars work and why they’re such a valuable tool for business communication. She somewhat understands, but the generational and technological gaps still leave her a bit mystified.



 

 My grandmother and her young daughter (my mother) traveled several hours to visit her father and grandfather – apparently what folks did in the days before Skype and Facetime.

 

 

 

When she was my age, connecting with someone who did not live nearby meant planning a trip to physically meet with them, writing a letter that could take weeks to arrive or making a costly, static-laden telephone call. I live in an entirely different world where I text message, email and chat with my colleagues and co-workers in another country on a daily basis.



In 1952, Bell Telephone offered a “deal” of $1.10 per minute Dallas to Denver. That would be about $9.00 per minute today. Great deal, right?

 

 

So what is our communication technology, specifically the webinar, worth? Can it even be quantified?

Sort-of; it comes down to this:

1) Convenience

2) Immediacy

3) Affordability

Still with me? Good, because here’s the point of my post. As an organization that thrives on connection, my goal at MUSE is to provide you with the best way to “visit” your peers. The webinar earns a shiny star in this category; it’s the teacher’s pet in the connection classroom. Although I am certain that 98% of you are familiar with the functionality, for that 2% who are not I give you this: A webinar is a conference or presentation using a computer and a telephone to transmit and receive the information. You can even attend using just a smartphone, too!  It is no different in terms of the information and value gained from participation than from attending a conference. It certainly cannot replace face-to-face interaction, but it is darn close!

The webinar is in a league of its own when it comes to convenience. Eliminating travel for education is … you know, I don’t even need to finish that; it speaks for itself.

 

“But, I really enjoy spending time in airport lines,” said no one ever!

And by eliminating travel, you factor in the added convenience of the “anywhere, anytime” mindset. While most MUSE webinar attendees are at their offices, it is possible to attend from any location. Seriously, I have hosted many a webinar wearing … well, I am not going to divulge that. But, let’s just say not business attire – all while sitting in my own home office (or while travelling, or on vacation, etc.). And I am sure some of you have participated in webinars clad in less than your best as well.

 

Casual Friday has a whole new meaning with webinars!

And then there’s the timeliness benefit. Do you like to learn about someone’s upgrade experience as soon as it happens, or long after it occurred? Ok, that’s rhetorical, but it makes the point. Webinars allow for instant sharing of experiences and information. While it’s great to offer sessions at live events and such, it’s even better to be able to relay the details while they’re fresh.

But, what about the affordability? While it’s not exactly apples to apples, the average cost to attend a two-day conference could range between $400 and $2,000 (depending on travel expenses). Studies show that most conference-goers are looking for information on one specific topic, so essentially one presentation is the purpose. A MUSE webinar is $100, and many people can attend if you utilize a projector and speakerphone. Although if you have a webinar subscription the per webinar cost is much lower. MUSE offered 30 webinars in 2012, so with a typical subscription, about $43 per webinar (for as many attendees as you want). And sometimes webinars are free.

So if you have not experienced the immediate and affordable convenience of a MUSE webinar yet, now is the time.

While new webinars are always being added to the schedule, the current upcoming topics are:

• The ARRA Project: The Quest to Attest Utilizing Project Management Tools
• Physician Engagement
• The Patient Experience: An Integrated Process for Complaints/Grievances
• Project Management Methodology
• Oncology JAM Session
• OM/EMR for 6.x JAM Session

And be sure to check out the subscription option for your organization that allows an unlimited number of people to attend an unlimited number of webinars.

All webinar information can be accessed here: MUSE Webinars.

I hope you will take advantage of the webinar program, one of your most valuable resources as a MUSE member. But, if you have questions, or still want more information I look forward to hearing from you.

What do you think of webinars? You can post your answer in the comments.

 

Take care friends,

 

 

Subscribe to the MUSE Matters Blog and head on back for the next post … The 5.66 Upgrade, After the Go-Live – in real time from Henry Mayo Newhall Memorial Hospital.

 

The 5.66 Go-Live - the Canary in the Coalmine

Henry Mayo Newhall Memorial Hospital

MEDITECH 5.66 Upgrade Journal

 

 

Guest Poster:

Adnan Hamid, Director, IT Services

Henry Mayo Newhall Memorial Hospital, Valencia, CA

 

 

 

At the International MUSE Conference, I facilitated an education session on my hospital’s experience as a C/S 5.66 early adopter.  With the delay of MU certification for 5.66, our go-live was scheduled after the session for Tuesday, June 18.  I promised the attendees in the session that I would chronicle our experiences with the upgrade and share via the MUSE website. In this article, you will find major upgrade activities along with approximate start times. I have also included any of the major issues we experienced during the upgrade.

We planned for a 12-hour downtime given our previous history with upgrades and the uncertainty of being the early adopter.  As early adopters, we requested to have MEDITECH staff onsite to assist with any issues.  MEDITECH sent us three staff members.  An Update Programmer Manager, Update Specialist Supervisor, and our HCIS Coordinator.  Their presence and ability to communicate with MEDITECH during the upgrade was a critical success factor. 

We delayed the start of the upgrade by two hours due to a full Emergency Room. We started the upgrade at 3:00 am PDT. MEDITECH completed the upgrade by 6:35 am.  At this point, our hospital validate team began reviewing each module for basic functionality and access.  We completed our validation at 8:00 am and planned to lift the downtime flags at 8:30 am allowing our Admission team to register the remaining patients that came through our doors during the downtime. 
 

Shortly after 8:30 am, we started getting calls from users that the system was extremely slow and in some cases would not allow to enter their login information.  We were able to replicate this issue in our command center and show to the MEDITECH staff onsite.  Quickly, the MEDITECH staff were on the phone with the Technical team at MEDITECH. They were able to diagnose the problem to the MIS server running two instances of the CSMagic.exe file. Once they were able to remove one instance, we began to see stability in the system. For caution sake, we decided to allow our users by departments to monitor system stability. This process took about two hours and by 12:30 pm, we were confident to allow all users back to the system. 

For the rest of the day, we did get calls from users about unusual menu freezes and not able to access certain routines.  In all cases, we were able to resolve the issue by uninstalling and reinstalling the MEDITECH Client on their workstation. We kept the command center open until 11:00 pm the same day. Towards the end, we did experience brief outages with FS applications (EMR, PCS, EDM) due to issues with HUB Proxy Server. We continue to see random outages since the upgrade. MEDITECH is well aware of the issue and working on installing code on the Proxy Server to fix the issue. 

Overall, the upgrade was a success!  This was truly a TEAM effort by hospital and MEDITECH team members. While we could not have predicted the duration of the outage and subsequent issues, the time spent on planning for support and preparing our users for downtime were the primary reasons for our success.  I hope that you find this article helpful in your planning efforts.  If you have any additional questions, please feel free to contact me at hamidae@henrymayo.com

 

DATE	TIME (PDT)	Upgrade  Activity	Comments
6/11	9:00 AM	Completed PP#2 Validation Testing; ensure testing in Citrix environment
6/11	3:30 PM	Go/No Go Decision
6/14	5:00 PM	Finalized Support Schedule for Upgrade	Expanded staff schedules to cover 12 hr shifts
6/17	8:53 AM	The UPT application reconciliation report and all worklist items	Even though MT asks to close UPT 3 business days in advance; waited until the day before to add RXM dTS
6/17	11 AM	MEDITECH Upgrade Status Meeting;	Meeting with Core Teams, Hospital Management to review timeline and open issues; final go/no-go for upgrade
6/17	11:50 AM	Received Go from Hospital Team
6/17	12:02	MEDITECH starts pre-Live process. MEDITECH move the code from TEST in a renamed status to the current LIVE ring, because the code is renamed it will not affect the LIVE ring. Once Pre-LIVE is complete, MEDITECH will NOT move changes to LIVE or translate code until after the update is complete. Do not retranslate custom reports, menus and rules. Do not refile the EDM Tracker/Access dictionaries in LIVE after the Pre-LIVE is complete, if they are refiled they will crash and cannot be corrected till after the Go Live is complete.
6/17	12:40	MEDITECH Pre-Live process is complete
6/17	3 PM	Completed client update for workstations in non-clinical areas	Utilize Citrix workstations in Nursing areas
6/17	3:30 PM	Finalized  downtime users	Still able to add downtime users even with downtime flag set
6/17	6 PM	Confirmed Downtime Binders are available on Nursing Units
6/17	11 PM	Open up Upgrade Command Center in IT Trailer #1
6/17	11:30 P	Validated Patient Census Reports
6/18	12 AM	Verified Medical Record number procedure in Place
6/18	12 AM	Printed out all downtime reports MAR Patient Census OR Schedules
6/18	12:09 AM	Called MEDITECH to postpone upgrade until 3 AM due to full Emergency Room
6/18	12:30 A	Completed full system back-up
6/18	3:00 A	Authorized MEDITECH to move forward with upgrade
6/18	3:00 A	MEDITECH Software Support Technician (SST) began the update
6/18	3:05 A	MT proceeded with the Go-LIVE process, FS is also now starting their side of the update as well.
6/18	3:24 A	The 5.66 FS services are now running and I confirmed EMR sign-on on HMA-PXL01. I will now work on setting up the rest of the CS side and updating the CSproxyservers.
6/18	3:53 A	The object code rename has finished, we are proceeding with the conversions and replays.
6/18	4:34 A	The CFSs are currently running
6/18	4:41 A	We have encountered an issue with the MIS CFSs. Programming is currently reviewing and we will update once we have more information
6/18	5:20 A	The MIS CFSs have been completed, we are now proceeding with the Replays
6/18	5:30 A	Hospital Validation team reports to the Command Center
6/18	5:34 A	The replays are currently running
6/18	5:43 A	The Replays have now finished, we are now proceeding with updating the LIVE bkgs and restarting LIVE jobs.
6/18	6:28 A	The HUB jobs are up and running and the CSproxy servers are up to date.
6/18	6:35 A	The LIVE update is complete and downtime users have been entered. We are now at restricted signon.
6/18	6:35A – 8:00 A	Hospital Validation team begins checking modules for access, functionality, parameters.  Initially, system very slow and unable to emulate. MEDITECH discovers the following: There were no parameters set to replay to LIVE for MIS The MIS CFS's are in a cancelled status. It may be related to the configuration issue reported earlier The MIS job XI MSG FILR: ERX.XI is running with minutes since; NMI is reviewing
6/18	8:00 A	Validation Team 1st Roll Call; all modules report functional; decide to lift downtime flags by 8:30 AM after last downtime patient entered into the system
6/18	8:30 A	Downtime Flags lifted
6/18	8:57 A	After lifting downflags, all applications are reporting slowness. Users are experiencing timeouts when trying to log into the system using single signon and then experience delays when trying to navigate the menus. After accessing the applications, all routines are displaying response issues.
6/18	10:42 A	There were two csmagic.exe running on the MIS server. This was terminated and performance has improved. Units are being asked to start using the system gradually and we are continuing to monitor response times. This issue may have been caused from refiling the permissions on HMA-FS1
6/18	10:45 – 12:30 P	Gradually allowing users onto the system starting
6/18	12:30 P	All users back onto the system; no slowness experienced
6/18	1:00 P	Downtime Status Meeting
6/18	1:30 P	Send out master list notification to users
6/18	8:30 P	The MEDITECH HUBSproxy-HMA55_L " service terminate unexpectedly	Caused outage for EMR, PCS,
6/18	8:45 P	Restarted Service
6/18	11:00 P	Close Command Center
6/19	12:00 A	The MEDITECH HUBSproxy-HMA55_L " service terminate unexpectedly	Caused outage for EMR, PCS,
6/19	12:15 a	Restarted Service
6/19	12:27 P	Data Repository Available	According to MEDITECH, Data Repository module and database will also experience a downtime but the timeframe is longer and will be down between 8 to 24 hours

Issues:

Module	Description	Status
TECH	TCP proxy for HUBS Proxy server	Contains a few minor corrections in addition to a new debugging feature that will allow MEDITECH to view any issues that may occur and better identify what those issues may be
PCM	Physician Rounds Report Format
EDM	Setting up default printers for controlled Medication Rx	Closed - users are unable to see the listing of printers and there is no default defined.
PHA	Multiple interface errors coming from your dispensing machines into PHA - Pyxis refills; Invalid Transaction Type errors that are displaying from the Process Interface Errors screen in PHA	CS PHA 10963 will correct this issue
BBK	The codabar units will not scan the expiration date, and the ISBT 128 units are giving a "Max # is 14 digits" message	Reload the system dictionaries in LIVE
SCA	Cannot Transfer scans in SCA from folder	MRM DTS 3175
NMI	Mass amount of ADT messages since 5.66 go LIVE	It looks like the ADT generator urns were reset to 6/14; needed to reset for current date

Good Luck!

Adnan Hamid

Director, IT Services

Henry Mayo Newhall Memorial Hospital, Valencia, CA

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