Our first webinar “Plexina for Allscripts Sunrise Acute Care: Helping You Manage Order Sets and Other Clinical Content Effectively” had a lot more questions from the attendees than anticipated.
Dawn and I were able to answer everything during the 15 minute question period, but didn’t get into full details on few topics. We’ve posted all of the questions below with the answers from the session, along with expanding on a few of the areas we didn’t have time to cover.
If you missed the webinar and want to view the recording you may access it at goo.gl/cCw7N2. If you have any additional questions we’d be happy to answer them. Send us an email. or ask us on Twitter @PlexinaHealth.
Have you ever been the bridge between Provation and SAC?
We have not had any request to integrate with Provation yet but we have read order sets from various sources coming in different formats, e.g. text, html, pdf, spreadsheet, SQL databases etc. We have a 20 minutes demo that shows how Plexina reads an order set coming from a different source in pdf format, maps the orders in the order set into SAC’s order catalog and transforms and designs it into SAC look and feel.
If you are building a net new order set and the item does not exist in SAC yet what do you do?
Plexina supports the concept of ‘placeholder items’. If an item does not exist in the order catalog but is required for an order set, the user (i.e. Clinical Analyst using Plexina Studio) can adopt a similar item and use it as a placeholder item and re-configure its fields and properties to represent the required item and continue through the review process of the order set. This item will remain marked as a ‘placeholder’ item until the Orders team includes the corresponding order in the order catalog. The user here will generate a ‘Specification Details Report’ that will work as the specifications/requirements for the new item to assist the Orders team build this order in the backend. With the use of this placeholder item Plexina allows design and review of an order set continue while the order gets built in the backend.
Do you incorporate any evidence based data?
Yes, Plexina allows you to link evidence sources directly to your order set or to an order within the order set. Moreover, when the source is updated, Plexina flags the order and the order set as ‘Review Pending’ to ensure the changes in the evidence source gets reviewed. Plexina’s analytical reporting also provides means to scan all your order sets to validate compliance against evidence based checklists.
How does our item catalog get into Plexina?
Plexina’s SAC Adapter runs a nightly job to extract the order catalog from your Development environment (it can be configured to extract from Test or any other environment as well). When the Clinical Analyst launches Plexina Studio in the morning, all changes to the order catalog get up-dated with dynamic changes applied automatically across all correspond-ing order sets.
What are the SAC version requirements?
We currently support all versions through SAC 5.0 to 15.1. With every new version of SAC, Plexina works with the client as well as Allscripts to en-sure a smooth upgrade of all content.
With Allscripts load, if you hit an error, you have to reload all, does Plexina work the same?
Depending on where the error is, yes. If the issue is with the form, you could re-generate the form BLK from Plexina, and then load this as a standalone. If you were loading a batch of order sets, and one of the order sets had an error, you could just load the order sets without errors, and then regenerate a BLK for the problem order set.
If you have multiple systems where do you run the compare?
Plexina allows you to compare a group of order sets (typically the ones that are candidates for a release) between any two environments. If you have for example, dev, test, support, train, staging and production environments, ideally during every release you would run Plexina’s Environment Compare reporting (on all of the order sets to be released) after load to each environment. In the case of the aforementioned environments you would run comparison between dev and test, then test and support, and so forth thus ensuring all your environments are 100% in sync.
In review function; in Order Sets do you compare grids details (widths,spans etc); in Order sets (mapped fields, items); in Order Items (all defaults)? How does your software compare the items? So many names are close, do you do 1 to 1? What about items (parents and child items): does it tell you if one system has x child items and the other doesn’t?
Plexina’s QA Reporting (Version Difference Reports and Environment Compare Reports) uses an intelligent algorithm to match and compare similar items across multiple environments or versions. Any difference (whether the difference is in field level or in item’s core property) in an item belonging to an order set between two environments gets identified and highlighted. For example, in comparing an order set between Dev and Test:
If Test has 2 orders that Dev does not have then the report will show them in ‘green’ denoting the target environment has 2 new items.
If Dev has 1 order that Test does not have then the report will show it in ‘red’ denoting the target environment is missing one item that the source environment has.
If an order’s property (e.g. Security) differs between Dev and Test then that item will be highlighted in ‘blue’ and the specific property (‘Security) of the item will also be highlighted with the differences expanded.
This allows the users to quickly verify if there is any difference in an order set between two environments and if so then what exactly are the differences.
For the downtime order sets, when you save it to the internet will it overwrite the existing order set or do you have delete it and then update with the new order set?
Downtime publishing of order sets represents a release. As a result the newly published order sets always overwrite the old ones. Plexina also provides means to expire an order set from the downtime library as part of a release.
Along with publishing the released order sets Plexina also captures relevant details about the release, e.g., the associated tickets or issues, publisher info, timestamp, revision number of each order set, release name or number.
What software system does the clinician require to perform the review process?
Plexina’s Review Board is typically deployed at the client’s internal network. Reviewers belonging to the organization only needs a web browser to access Review Board hosted on their internal network. Plexina supports Internet Explorer 9 and up and the latest two versions of Firefox, Safari, Chrome as web browsers.
Is this presentation available in order to present to the other analysts?
Yes – you can find it here: goo.gl/cCw7N2
Are all the fields from the html actually stored to an Allscripts DB or how does that mapping happen? If we changed the order set and the data that gets passed in the Sunrise translator(s) to radiology… can that still happen?
As Plexina has the updated catalog every day, this includes all of the specifications about each item, including all fields for the items. When the Clinical Analyst wants to add the mapping for the order items in the order set, Plexina consults the item catalog, stored in Plexina, to show which fields are possible to map. If the items are changed in SAC, the corresponding fields will be updated in Plexina if it is a dynamic change.
Is there any integration with updating existing MLMs and report versions?
Not at this time, as we haven’t had a client request this functionality, but Plexina has the capability to work with any content type.
In the review functionality and in the PDF version of order sets, is it possible to see what is in drop down menus?
All corresponding drop-down dictionary options are shown in the EHR view of the order set on Review Board.
Plexina allows the Clinical Analyst to indicate if any order’s detail should be expanded out in the downtime pdf form. The selected order details get printed in the downtime pdf forms accordingly.
What is “checked” when conducting the BLK validation?
Some examples include:
– Overlapping fields/grids/checkboxes, etc. on form
– Orphaned items in order set
– Child items that have had a non-dynamic change since last load
– Order Set name character limit
– Referenced set constraints
– Linked order set rules
– Mapped field mismatches
– Many rules such as character limits, alpha versus numeric values, formatting of dates, etc.