Shawn Toy, RPh

April 21, 2010

Informatics Innovationvia

Available Resources

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Unlimited wants with finite resourcesLimited hardware availability Limited software availabilityLimited knowledge of informatics systemsLimited FTEE

Including ancillary duties of assigned FTEESeparation of OIT and VHA

Economic pressures and solutions may be separate between the two groups

The fundamental economic problem

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Building a revised clinical informatics system requires new, and adaptable, attitudesClass-III cannot impede system standardizationRequests for new functionalities must be categorized,

stratified and placed into their appropriate positionImmediate attention is virtually impossible because the

system scope exists well beyond the local levelWe need to, “make due with what we got”

Which, is actually a lot

Living within your means

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A dynamic data analysis and reporting solutionVHA FileManager (FileMan)

Data analysis and programming platformMicrosoft Excel

Data warehousing and analysis solutions (Databases)Microsoft SQL ServerMicrosoft SQL Server ExpressMicrosoft Access

National data marts via OLAPMDX can be used by both ProClarity and MS Excel

So, what’s in the bag

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Microsoft ExcelIs not a statistical programIs not a databaseIs a full-featured programming platform under the hoodUser familiarity helps promote Excel based solutions

Microsoft AccessIs limited in sizeJET does not directly permit procedural programmingHas myriad security issues vs. SQL serverIs also a full-featured programming platform

A few words about Excel and Access

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It is not evil incarnateIs more than a means to an endFileMan can be:

ProgrammedDynamicInteractiveA one-stop-shop reporting tool

Weekly DVT prophylaxis reportsAll patients prescribed a medication (user input)Formatted text directly to a printer

A few words about FileMan

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Through Practice:Most users lose interest after a process has 2-3 steps

Those that deal with data regularly have no problemTry to delegate a multi-step process and…

Solution:1. Create single step FileMan templates as Menu Options2. Use a GUI based stream reader to import data3. Use macros, or actual programming integrated into the

stream reader process, to render formatted reports Use it and “burn” it mentality promotes data security

The process must be easy and efficient

Three steps is enough

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FileMan templates can be programmed into one-step solutions via a VistA menu optionNo programmer access requiredFileMan supports variables, branching, iteration

The scope of variables permits cross-record information transferFileMan can actually be programmed via templates

Current single-option solutions include:

Tool #1 VHA FileMan

DVT Prophylaxis Report Drug Recall Report†

Complete Medication Entry Report† Patients prescribed medication(s)

Concurrent Medications Report Provider Extension Report (formatted)

Medication Reconciliation Report† Non-Formulary Results Report†

† Use a semi-automated Excel process to import, analyze and format data

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The Excel platform allows for advanced programmingProcesses can be recorded and replayed (macros)Processes and functions can be directly coded via VBAAdd-ins can be produced and easily exported/imported

Tool #2 Microsoft Excel

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My preference: SQL ServerAllows for procedural codeWorks on a separate serverIs very secure via Active Directory setup

Views and stored procedures enhance security

Use ODBC to directly link MS Office programsSingle click data updates

Efficiency of querying data outside the production systemLocal warehouses may not be necessary in the near future

Coding SQL is easy vs. FileMan

Tool #3 Databases

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Bonus: the data is ready for analysis immediatelyMultiDimensional Expressions (MDX)

Can be coded in ProClarity or ExcelAllow for dynamic reports

No need for user to update anythingJust click and voilà

Tool #4 OLAP

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We have the basic tools needed for informatics excellence“We can’t” needs to be eliminated from our vernacular

Everyone has FileMan, Access, Excel and ProClarity

Where do we go from here?

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Questions