Requested CCMDB changes for the next version

see the Development Documentation Category for other development logs

Bug Fixes

Tasks not being sent

• Occasionally Medicine TASK items don't get sent to the task.mdb. Need a way to flag this. Ttenbergen 15:53, 2 July 2010 (CDT)

• • How frequent of a problem is this, has it recurred since this was documented? Ttenbergen 11:09, 20 October 2010 (CDT)

No initials in settings file causes error on sending

• If no initials are entered in the settings file sending will crash when it tries to look them up. Ttenbergen 15:24, 14 October 2010 (CDT)

Functional Improvements

Tasks

For a long time now there have been requests to make the Tasks more of a drop-down, similar to the ADLs, or a checklist like the greensheets used to be. This is a mess to implement, since it doesn't correspond to the data structure this is stored in. An alternative might be to automatically enter the five tasks as "blanks" for every new medicine patient. I would make 5 new tasks etries that would sort before each of the 5 existing options. This would be similar to a checklist in that the records are already there, and only would need to be edited. Template:Discussion I can not think of any data or process drawbacks of doing this... can anyone else? Ttenbergen 11:09, 20 October 2010 (CDT)

Patient List For Medical Records

• for improvements request for this go to Patient List for Dicussions.--TOstryzniuk 12:26, 22 September 2010 (CDT)

1. Create a query in Access for patient lists that can filter to columns of data required by a collector to be used for Medical records list.
2. to be able to printout or email to Medical records (MR) patient list. (not sure if MR would accept email with patient ID's. This process save time creating a hand written list for MR.

• Items required on the list:
• Record column filter: MR
  • site and location
  • FN
  • LN
  • chart #
  • DOB
  • admit date/time
  • discharge date/time

• suggestions for this?--TOstryzniuk 12:45, 22 September 2010 (CDT)
• any other types of patients list you want Access to sort by?--TOstryzniuk 12:17, 27 September 2010 (CDT)
• discussed this with Stephanie yesetrday and she said that a field for room numbers would be helpful at the Grace as well.

Patient Listing Report

Make a report that prints patients who meet a specific criteria, e.g. Record field = "MR"

Template:Discussion Printing to order Medical Records is one thing this would be useful for, but there might be purposes for which collectors currently manually transcribe lists of patients onto paper. If so I might as well make the report in a way that is multi-functional.

• Are there other subsets of patients currently being manually transcribed to paper?Ttenbergen 11:09, 20 October 2010 (CDT)

Template:Discussion This report request was brought on by the following: "Could chart numbers be on patient list? Makes it easier to order charts…" If we generate a complete report for this, is there still a point in having the chart number on the patient list? Ttenbergen 11:09, 20 October 2010 (CDT)

get rid of old buttons

Unless I hear that there is still use for this button, I will remove both the "Edit Patients" button and the filter button from CCMDB.mdb in the next round of changes. Speak now or forever hold your peace if you think there would be a problem with this. Note: Sending_Patients#Historical:Filtering_for_complete_patients needs to be fixed after this change.

• We use these buttons before sending files here at HSC otherwise we are unable to edit patients and filter completes.--CMarks 08:08, 18 October 2010 (CDT)
  • We use them at STB also it is handy to filter the completes especially when you are sending many profiles. --LKolesar 11:55, 18 October 2010 (CDT)

Template:Discussion When we had the PDAs, we needed to check the complete patients only at sending time since the PDAs could not do it as you go along. Now that we are collecting in Access all along, we no longer need to wait and batch this check for send day. Is there any reason to not set a patient to "final checked" when you are finished collecting them? When final-check is clicked a bunch of tests run, so doing this when you still have the chart in front of you would save a trip back later. Checking patient over at send time seems like an extra step that doesn't add any value any longer. Should we continue to do this? Trish, this probably requires input from you. Ttenbergen 11:09, 20 October 2010 (CDT)

Changing the local data structure automatically

Need a wayto make changes to data that is stored in \ccmdb_data\ccmdb.mdb, such as adding room numbers. By Access design, \ccmdb_program\ccmdb.mdb can not touch a linked table's structure. Will need to copy down new data structure and transfer existing data into that. This gives the opportunity to rename the data version into something less ambiguous. If it is renamed, I'll also need to change news and backup file.

Misc

• increase fonts on Dx Chooser Ttenbergen 10:31, 24 September 2010 (CDT)
• also open the output data upon sending. apparently collectors have been instructed to do this manually, doing it auto will save a few steps. Ttenbergen 17:40, 26 August 2010 (CDT)

• How about going back to the previously opened category once you have entered a co-morb. ie:CVS to CVS.--CMarks 13:59, 13 October 2010 (CDT)
  • Tina explained more tabbing to me, I had missed a step but thanks anyway Laura.--CMarks 14:01, 13 October 2010 (CDT)

Viewer

Full Apache Score

• add full apache score
  • That one would need thorough testing to make sure I got the score right, e.g. enter 10 patients and check if their apache scores in ccmdb are what you would have calculated. Any volunteers for the testing? If it won't be validated I'd rather not add this to confuse anyone. Ttenbergen 11:05, 9 June 2010 (CDT)
    • Marie Laporte offered to help with this. I will let her know once I have implemented this. Ttenbergen 16:01, 2 July 2010 (CDT)

Counting Date Tracker

As per email from Marie Laporte: "Thought I would email some thoughts re: moving away from paper collection. Each time I have to type in "last counted EKg @ 0000 hrs on date" and have to do the same for pharm, CXR and labs and date reviewed; I think... it would be very convenient and user friendly to have this available from a drop down list/or permanent field adjacent to our notes field. If it was set up like DOB or admit date/time fields we could easily enter date and time of the last counted item-and everyone would have the same format. Example:

• LAST COUNTED LABS: DATE TIME
• LAST COUNTED EKG: DATE TIME
• LAST COUNTED CXR: DATE TIME
• LAST COUNTED PHARM DATE TIME
• CHART REVIEWED: DATE TIME

• • I sent an email to Trish to clarify something. Pending response I might implement this. Ttenbergen 15:10, 21 May 2010 (CDT)
    • I might use this but I put ticks in the chart so I know which labs I have counted.--MWaschuk 17:43, 9 June 2010 (CDT)
      • We would not use this at STB because we utilize electronic chart to count labs at the end of a patient stay. --LKolesar 14:56, 10 June 2010 (CDT)

Data changes

• why is the DOB defaulted to today?
• add a field for room number to list
• store the ABG calculation table locally

Final Check into drop-down

Make final check into a drop down to comply with requirement for stating the status within the process of data once we store data on U of M. Ttenbergen 13:25, 8 December 2009 (CST)

• change can not be made via ccmdb.mdb since table structure for linked tables (as used by laptops) can not be manipulated externally.
  • option: Have ccmdb.mdb automatically generate a new .mdb based on the changes, and then change linking to that new .mdb
• still required: change every spot that deals with finalcheck to deal with record_status instead. Easiest might be to make it a function finalcheck = (record_status = "CollectComplete")

sL_AaDO2 values

At this point sL_AaDO2 is stored in the program section of ccmdb.mdb, not the data section. This means two things:

• Values are not being deleted at this point when "their" patient is deleted. This is no big deal since the table gets overwritten every time there is a new version is rolled out.
• values are not preserved when a new version of the program is rolled out

This table should be added to the data section instead.

Bugs that need replicating

In order to troubleshoot a bug we need to know a way to "make it happen". This section contains bugs that have been reported but can not be demonstrated on demand.

WBC = 0 does not uncheck apache box

As per email from Pagasa, and confirmed by Tina, 28 jan 2010 Ttenbergen 14:32, 28 January 2010 (CST)

There may also still be a problem with sending very low numbers. Lois apparently thought she entered and sent WBC with a value of 0.02, which CCMDB.mdb should accept, but may not send properly. Ttenbergen 12:58, 29 January 2010 (CST)

How to demonstrate this bug

• Anyone?Ttenbergen 12:25, 12 April 2010 (CDT)
  • HSC-MICU-Batch 22 sent June 2.10. See Pagasa Email sent June 3.10. Will double check if it is the uploader program. If value 0.02. --TOstryzniuk 17:27, 8 June 2010 (CDT)
    • Trish, have you been able to find out if this goes wrong in the uploader? Ttenbergen 16:19, 2 July 2010 (CDT)

Infection without pathogen subcode was sent to csv

Oaks - Patient coded for Cystitis Bladder Infection but no sub code? Admit date Jan 25/10-Jan. 30/10. Pagasa Torres.

Patient coded for Cystitis Bladder Infection but no sub code; Admit date Jan 25/10-Jan. 30/10.

Asked Wendy if there was any extraordinary edits for this pt, and she replied "Nope and I too am surprised as it has always been caught if I miss it in the Edit Patients pane??? I just simply forgot as I was awaiting the results...have no idea how it got sent???"

How to demonstrate this bug

• Anyone? Ttenbergen 16:59, 9 February 2010 (CST)

Changes Under Discussion

These requested changes can not be processed until the questions about them have been answered. Wherever possible the discussion should conclude in the home article of the topic. If a topic has no home article, it can be listed here.

Facilitating diagnosis entries

I have had various requests to make it faster or easier to enter diagnoses. A lot of those requests would be addressed with more training on the various ways diagnoses can be entered. I have added a fair bit of functionality, but there may not have been enough training on this yet. Trish, before I add much functionality here, could you put me on the next meeting agenda for 15 minutes to show/tell/discuss diagnoses entries. Template:Discussion

I discussed with Fran and Con that, if there were groups of diagnoses that often go together, it might be possible to combine them somehow. I could add a limited number of buttons to e.g. put in "cardiovascular- Hypertension, MI, hypercholesterol, etc." as requested by Con. Could collectors provide a list of dx groups for which this would be useful?

• (button name?): cardiovascular- Hypertension, MI, hypercholesterol,

batch file checks

• make sure the "News and backup" batch file complains noisily if it does not have a server connection. Ttenbergen 09:47, 18 December 2009 (CST)
  • actually, if it were to complain if there is no network connection, then it will complain every time there is a backup done off the network, which is not the intent. Will have to think of a better error scenario, e.g. if a backup to network has not been done in one week. Might be best to have that error come up to Trish rather than a collector, that way we'd catch two birds with one stone: make sure process works, and make sure process is followed. Suggested course of action: Tina will make batch file for Trish that runs by scheduled task and alerts if there is no data file in a given directory with a time stamp within the last week. Trish would know if there is a good reason and ignore the error accordingly. If there is no reason, Trish would contact the collector to find out if they have backed up to network. If so, Trish or collector would contact Tina for tech support. Plan? Ttenbergen Template:Discussion

extra "pathogens"

--MWaschuk 17:46, 9 June 2010 (CDT) As part of an effort to reduce relying on paper notes during collection, Marie brought up the possibility to put "waiting for tests" and "review" as options into the pathogen dropdown and to conditional-format the field in orange if they are chosen. Of course, choosing them would also disable checking DX complete.

• Would anyone else find this useful? Should it be included in the Master DB? Ttenbergen 17:34, 9 February 2010 (CST)
  • Yes, I would find this useful
    • I usually put unknown pathogen in my pathogen slot if waiting for results, then when rechecking the profile upon discharge, I re-check on the EPR for results again. If still no results, I generally do not hold the profile longer. I wonder what our policy should be on this. How long should we hold a profile for possible results? This could back up our flow of profiles quite a bit. What does everyone think?--LKolesar 15:08, 10 June 2010 (CDT)

Changes to the ccmdb.mdb to reduce reliance on paper

The "extra pathogens" entry above makes me wonder: are there other features collectors can think of that would suddenly make it more desirable to enter data electronically in the first place rather than on paper? This question really only applies to the access program (e.g. to laptop users) since we are phasing out the PDAs and I am not going to make any modifications to them because they cause cascading problems.

• Any thoughts? Ttenbergen 17:34, 9 February 2010 (CST)

QA Functionality

Facilitate exchange of patient discharge times

DCs have to know the discharge times for patients arriving at their wards from another collected ward. We should automate that rather than have them exchange manually. Might be an extension of the status file for Julie...Ttenbergen 16:05, 3 February 2009 (CST)

• moved a note into Admit, Transfer and Discharge date and time, as this is unrelated to updates to the program. Ttenbergen 09:27, 11 February 2009 (CST)

Logging errors in the CCMDB.mdb

Add a table to the CCMDB that records every time an error is generated with the following details:

• Date/time of error
• patient ID (Hosp Loc Serial)
• Field Identifier
• error descriptor (text)
• erroneous value

Make that table sync to a central repository on send.

After-Laptop changes

Improve Data Entry for Tasks

make tasks easier to enter, e.g. a checklist

Limited Labs List

We are gearing towards changing the lab lists, see new lab list at S AllLabsTable Ver2. Template:Discussion Trish, is to be implemented once possible, or do we need a discussion with collectors and a go-ahead from you? Ttenbergen 15:44, 2 July 2010 (CDT)

Make a better labs entry system

Once reduction of number of labs collected is official and down to as many as can be, I will make it so the labs are entered in a pre-populated list. Ttenbergen 15:16, 2 July 2010 (CDT)

• I was under the impression that we could collect the reduced number of labs. Why should this be delayed? It is just more work for no benefit. --LKolesar 13:57, 1 October 2010 (CDT)

Implement mean BP calculation tool on laptop

It would be beneficial to put in a mean BP helper (like the ABG helper) so that we could enter our systolic and diastolic BP's and it would automatically calculate the mean BP and perhaps even indicate the higher apache score and then we could pick the worst one. This would make apache scores more accurate.

Clean up pharm list

Make spelling consistent, get rid of weird duplicates. Also, make Propofol regular sort before bolus for better defaulting. Ttenbergen 15:16, 2 July 2010 (CDT)

Default specific drugs to the most common dosage

Amiodarone infusion: 300 Amiodarone tab 200 ASA tabs 81 Atorovastatin 80mg Cefotaxime IV 1G Ceftazidime 1G Ceftrioxime: 1G Cefuroxime: 1G Ciprofloxacin IV: 750mg Ciprofloxacin tabs: 500mg Clindamycin 450 mg Dobutamine 500 mg Dopamine: 400 mg Enalapril tabs 2.5 mg Fosinopril tabs 2.5 mg Heparin SQ: 5000 U Imipenem 250mg (not really used anymore) Lasix tabs: 40 mg. Lisinopril: 5 mg Metoprolol tabs 25 mg. Milrinone inf: 10mg Nitropatch 1 Norepinephrine: 16 mg Phenylephrine: 50 mg. Pravastatin: 10 mg Propofol inf: 1000 mg Ramipril tabs: 2.5 mg Simvastatin tabs 10 mg

I would like to see these meds default to the above listed option. Some are already defaulted correctly. (ie when you start typing it in that dose comes up first), however if this could be implemented it would speed up our data collection process.

Previous requests that were not addressed (with reasons)

Cancel for Settings

change the settings form to have a save and a cancel button...

No can do. There are is a sb-form in settings form that would not be cancelled, so having a cancel would be misleading.

Off-line copy of wiki for laptop

We found a way to do this, but it would add overhead work to the collectors' job and it would deter from using the wiki as a tool owned and updated by all, so Trish and Tina decided not to pursue this further. Ttenbergen 15:01, 16 April 2010 (CDT)

• look into possibility of automatically downloading WIKI guide to laptop each day that it is synch'd. (portable version of guideline)--TOstryzniuk 20:11, 4 April 2009 (CDT)

• As moved from Diagnosis Coding:

A suggestion has been put forth to Tina is to find a away to allow a downloaded copy of the WIKI guide on laptops, the collection tool we are moving to soon. I think this would be an excellent solution if she can do this. Collectors would then be able to search for info no matter where they are in the collection field and each time they synch there laptop, they would get updated WIKI items. That is the plan............but waiting to here from IT support.

It is challenge right now in that the guideline information is not easily and quickly accessible while you are doing your work in the unit or in medical records. Most collectors must run back to their office or find a free computer to log in and look up guide info.

Keep in mind, guide information changes regularily, so what you print out one day is outdated the next for a number of articles. TOstryzniuk 11:25, 29 April 2009 (CDT)

• April 2010 - Trish and Tina reviewed the apparent option to have a COPY of wiki on laptop. Problem if implemented:

1. if collectors will not have the most update the copy on laptop because changes and updates are happening daily on the MAIN copy here, and thus changes to instruction will get missed.
2. 2. Don't want multiple copies of instruction and information on multiple laptops that are not up to date.
3. Collector questions and contribution to the Wiki cannot be added to copy of Wiki on laptop. Questions and contribution must be made centrally not locally so that information is in ONE PLACE and the same for everyone.--TOstryzniuk 19:11, 20 April 2010 (CDT)

APACHE lab value limit change request

• Apache upper limit for creatinine is 2968, which is based on the highest APACHE that was ever in database. STB has one pt with a creat of 3000 and has requested to change upper limit. Laura K. --TOstryzniuk 12:12, 6 July 2010 (CDT)
  • Decided to leave limits be and have collectors enter limit values and email Pagasa with real values when extreme values are encountered. Contacted Pagasa to let us know if such emails become too frequent. Ttenbergen 08:53, 12 July 2010 (CDT)