The abc’s of tiu uploading plus, Filing errors

The ABC’s of TIU UPLOADING

• Plus, Filing errors

• Missing field errors

Enter Upload Utility Parameters

• Option to use is:

• TPM2 Modify Upload Parameters

• This option is located:

• TIU Menu for Medical Records Option
• TMM - TIU Maintenance Menu Option (required key TIUZMGR)
• TPM – TIU Parameters Menu Option

Settings at Red Lake, MN

• Select INSTITUTION: RED LAKE HOSPITAL BEMIDJI RED LAKE 01 MN IHS 497

• ASCII UPLOAD SOURCE: host file server//

• UPLOAD HEADER FORMAT: captioned//

• RECORD HEADER SIGNAL: $HDR//

• BEGIN REPORT TEXT SIGNAL: $TXT//

• END OF MESSAGE SIGNAL: $END//

• RUN UPLOAD FILER IN FOREGROUND: NO//

• Now Select upload error alert recipients:

• Select ALERT RECIPIENT: LASLEY,KARRIE//

• IHS UPLOAD PARAMETERS

• UPLOAD FILE DIRECTORY: f:\pub\mxtiu\//

• ARCHIVE FILE DIRECTORY: f:\pub\mxarch\//

• UPLOAD FILE NAME: tiufile.txt//

Setup for Progress Notes Document Class

• Now edit the DOCUMENT DEFINITION file:

• DOCUMENT DEFINITION: PROGRESS NOTES CLASS

• ABBREVIATION: PN//

• LAYGO ALLOWED: YES//

• UPLOAD TARGET FILE: TIU DOCUMENT//

• Select TARGET TEXT FIELD: REPORT TEXT//

• UPLOAD LOOK-UP METHOD: D LOOKUP^TIUPUTPN//

• UPLOAD POST-FILING CODE: D FOLLOWUP^TIUPUTPN(TIUREC("#"))

• Replace

• UPLOAD FILING ERROR CODE: D PNFIX^TIUPNFIX//

• Select CAPTION: CLINIC CODE// ?

• Answer with UPLOAD CAPTIONED ASCII HEADER, or ITEM NAME, or

• FIELD NUMBER, or LOOKUP LOCAL VARIABLE NAME

• Choose from:

• CLINIC CODE

• DICTATED BY

• DICTATION DATE

• EXPECTED COSIGNER

• HRCN

• TITLE

• TRANSCRIPTIONIST

• URGENCY

IHS UPLOAD PARAMETERS

• These parameters allow you to automatically upload files to the TIU Document file.

• You will need a ftp-file-transfer type software application to check for completed files at the location defined in field, Upload File Directory.

• Combines all completed files into one file with an ending $END.

• Names it to the file name you have defined in the field, Upload File Name. Therefore, for Red Lake it is named tiufile.txt

• When it has uploaded, file is moved to the location defined in field, Archive File Directory.

• The file name is changed to append the date, ex: tiu3050502.txt.
• If there is more than one file for the same date it appends a time.

• The archive directory saves the file should you need to upload the file again due to problems.

Tasked job for the IHS Parameters

• Option Name: BTIU UPLOAD DOCUMENTS QUEUED

• Menu Text: Upload Documents (Queued) TASK ID: 270439

• _____________________________________________________________

• QUEUED TO RUN AT WHAT TIME: MAY 10,2005@09:45
• DEVICE FOR QUEUED JOB OUTPUT:
• QUEUED TO RUN ON VOLUME SET: RDL
• RESCHEDULING FREQUENCY: 900S
• TASK PARAMETERS:
• SPECIAL QUEUEING:

• ______________________________________________________________

Clinic Set Up Create Visit at Check-In? YES

Progress Notes Class Caption fields

• CAPTION: HRCN ITEM NAME: HRCN

• FIELD NUMBER: .02 LOOKUP LOCAL VARIABLE NAME: TIUSSN
• EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-")

• CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE

• FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT
• EXAMPLE ENTRY: 06/28/04 CLINICIAN MUST DICTATE: NO
• REQUIRED FIELD?: YES

• CAPTION: DICTATED BY ITEM NAME: DICTATED BY

• FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH
• EXAMPLE ENTRY: DOOGIE HOWSER CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

• CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER

• FIELD NUMBER: 1208 EXAMPLE ENTRY: MARCUS WELBY
• CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

• CAPTION: VISIT DATE ITEM NAME: VISIT DATE

• FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUVDT
• EXAMPLE ENTRY: 042805 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

Progress Notes captioned fields continued

• CAPTION: URGENCY ITEM NAME: URGENCY

• FIELD NUMBER: .09 EXAMPLE ENTRY: ROUTINE
• CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

• CAPTION: TITLE ITEM NAME: TITLE

• FIELD NUMBER: .01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE
• EXAMPLE ENTRY: PEDIATRIC ENCOUNTER CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

• CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST

• FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX
• CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

• CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE

• FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC
• EXAMPLE ENTRY: 08 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

About two of the fields…

• Required fields

• If a field that is required is missing, it will attempt to file the document but will generate a Missing Field Error Alert

• Clinician Must Dictate

• This will determine what fields are shown should the option, Help for Upload Utility, which is not used.
• Some fields the clinician does not normally need to dictate:
• Dictation Date – Normally this date in stored when dictated in most Transcription Companies software applications.
• Transcriptionist – Would be entered by the transcriptionist that types the document

Additional facts…

• Clinic Code is sufficient and works better than expecting the transcription company to type the exact clinic name.

• The only time you would have a problem with clinic code – if the patient has two same clinic codes for the same visit date
• You would then receive a Filing Error Alert and have to manually link to the correct visit.

• Expected Co-signer is normally left blank but it should be defined if ever you have students that dictate so they may designate their expected co-signer.

• Someone with programmer access will need to define these two fields:

• Lookup Local Variable Name
• Transform Code

Discharge Summary field settings set on the Title

• CAPTION: HRCN ITEM NAME: HRCN

• FIELD NUMBER: .02 LOOKUP LOCAL VARIABLE NAME: TIUSSN
• EXAMPLE ENTRY: 123456 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES
• TRANSFORM CODE: S:X["-" X=+$$STRIP^XLFSTR(X,"-") S X=+X

• CAPTION: DATE OF ADMISSION ITEM NAME: ADMISSION DATE

• FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUADT
• EXAMPLE ENTRY: 03/30/93 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

• CAPTION: DICTATED BY ITEM NAME: DICTATING PROVIDER

• FIELD NUMBER: 1202 EXAMPLE ENTRY: DOOGEY P. HOWSER, M.D.
• CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES
• TRANSFORM CODE: S X=$$INAME^TIULS(X)

• CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE

• FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDICDT
• EXAMPLE ENTRY: 04/03/93 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: NO

Discharge Summary cont…

• CAPTION: ATTENDING PHYSICIAN ITEM NAME: ATTENDING PHYSICIAN

• FIELD NUMBER: 1209 EXAMPLE ENTRY: MARCUS WELBY
• CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES
• TRANSFORM CODE: S X=$$INAME^TIULS(X)

• CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST ID

• FIELD NUMBER: 1302 EXAMPLE ENTRY: T1212
• CLINICIAN MUST DICTATE: NO

• CAPTION: URGENCY ITEM NAME: STAT OR ROUTINE

• FIELD NUMBER: .09 EXAMPLE ENTRY: ROUTINE
• CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: NO

Discharge Summary additional facts

• If the dictated by and attending physician are the same their name has to be entered in the header in both fields

• Note that Discharge Summary caption field settings are done at the title level not class.

• The reason is that only one record is allowed per admission

Consults field setting done at the Document Class level

• CAPTION: TITLE ITEM NAME: TITLE

• FIELD NUMBER: .01 LOOKUP LOCAL VARIABLE NAME: TIUTITLE
• EXAMPLE ENTRY: SURGERY CONSULT CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

• CAPTION: VISIT DATE ITEM NAME: VISIT DATE

• FIELD NUMBER: .07 LOOKUP LOCAL VARIABLE NAME: TIUVDT
• EXAMPLE ENTRY: 04/15/05@1300 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

• CAPTION: DICTATED BY ITEM NAME: DICTATED BY

• FIELD NUMBER: 1202 LOOKUP LOCAL VARIABLE NAME: TIUAUTH
• EXAMPLE ENTRY: MARCUS WELBY CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES TRANSFORM CODE: S X=$$INAME^TIULS(X)

• CAPTION: DICTATION DATE ITEM NAME: DICTATION DATE

• FIELD NUMBER: 1307 LOOKUP LOCAL VARIABLE NAME: TIUDDT
• EXAMPLE ENTRY: 04/28/05 CLINICIAN MUST DICTATE: NO
• REQUIRED FIELD?: YES

• CAPTION: EXPECTED COSIGNER ITEM NAME: EXPECTED COSIGNER

• FIELD NUMBER: 1208 EXAMPLE ENTRY: DOOGIE HOWSER
• CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

Consult fields cont…

• CAPTION: CONSULT NUMBER ITEM NAME: CONSULT NUMBER

• FIELD NUMBER: 1405 LOOKUP LOCAL VARIABLE NAME: TIUCNNBR
• EXAMPLE ENTRY: 1234 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES TRANSFORM CODE: S X="C."_X

• CAPTION: HRCN FIELD NUMBER: .02

• LOOKUP LOCAL VARIABLE NAME: TIUSSN EXAMPLE ENTRY: 123456
• CLINICIAN MUST DICTATE: YES REQUIRED FIELD?: YES
• TRANSFORM CODE: S X=+$$STRIP^XLFSTR(X,"-")

• CAPTION: CLINIC CODE ITEM NAME: CLINIC CODE

• FIELD NUMBER: 1203 LOOKUP LOCAL VARIABLE NAME: TIUCLNC
• EXAMPLE ENTRY: 23 CLINICIAN MUST DICTATE: YES
• REQUIRED FIELD?: YES

• CAPTION: TRANSCRIPTIONIST ITEM NAME: TRANSCRIPTIONIST

• FIELD NUMBER: 1302 EXAMPLE ENTRY: SECURE,MX
• CLINICIAN MUST DICTATE: NO REQUIRED FIELD?: NO

Example of a Progress Note Upload Document

• $HDR: PROGRESS NOTES

• HRCN: 3475

• DICTATION DATE: 04/20/05

• DICTATED BY: MICHAEL BORROMEO

• EXPECTED COSIGNER:

• VISIT DATE: 04/20/05

• TITLE: LETTER

• CLINIC CODE: 06

• TRANSCRIPTIONIST: SECURE, MX

• $TXT

• Progress Note dictation is typed here.

• $END

Example of a Discharge Summary upload document

• $HDR: DISCHARGE SUMMARY

• HRCN: 2101

• DATE OF ADMISSION: 04/15/05

• DICTATED BY: MICHAEL BORROMEO

• DICTATION DATE: 4/18/05

• ATTENDING PHYSICIAN: MICHAEL BORROMEO

• TRANSCRIPTIONIST: SECURE,MX

• URGENCY: ROUTINE

• $TXT

• Discharge Summary dictation is done here

• $END

Example of a Consults upload document

• $HDR: CONSULTS

• TITLE: SURGERY CONSULT

• VISIT DATE: 04/15/05@1300

• DICTATED BY: MARCUS WELBY

• DICTATION DATE: 04/28/05

• EXPECTED COSIGNER: DOOGIE HOWSER

• CONSULT NUMBER: 12

• HRCN: 123456

• CLINIC CODE: 23

• TRANSCRIPTIONIST: SECURE,MX

• $TXT

• CONSULTS Text

• $END

TIU Upload Menu Option

• UPL1 Upload Documents

• This option enables the user to upload transcribed ASCII documents in batch mode, either from remote microcomputers, using ASCII or KERMIT protocol upload, or from Host Files (i.e., DOS or VMS ASCII files) on the host system.
• This is the manual option to upload documents if you are not using the IHS Parameters

• UPL2 Help for Upload Utility

• Displays information on the formats of headers for dictated documents that are transcribed off-line and uploaded into DHCP.
• Displays "blank“ character, major delimiter and end of message signal as defined by your site.

• UPL3 Display Upload Status

• UPL4 Reset Upload to Restart

UPL3 Display Upload Status

• Displays last file uploaded and last attempt to find file for uploading.

• Can also show if upload stopped for a known reason.

• Example:
• **STATUS OF TIU UPLOAD**
• LAST FILE UPLOADED INTO RPMS: NO FILES UPLOADED
• **STATUS OF TIU UPLOAD**
• LAST FILE UPLOADED INTO RPMS: Monday May 09, 2005@22:15:06
• LAST SCAN FOR NEW TIU FILE: Tuesday May 10, 2005@09:15:02

UPL4 Reset Upload to Restart

• Used if "Upload Running?" field still has date AND problem has been solved.

• If the Status option displays similar to this and you are sure an upload is not currently happening then you should use the Reset option:

• **STATUS OF TIU UPLOAD**
•  
• LAST FILE UPLOADED INTO RPMS:   NO FILES UPLOADED
•  
• LAST SCAN FOR NEW TIU FILE:     Thursday Sep 09, 2004@14:52
•  
• UPLOAD STILL RUNNING; CHECK END OF FILE MARKERS
• UPLOAD STARTED ON SEP 09, 2004@14:52

Blank Character String

• This string of characters is used by the transcriptionist to represent a "blank" when a word or phrase in the dictation cannot be understood for inclusion in the transcription.

• Clinicians will not be able to sign their note if the blank character string exist in the note. They must edit all blank character strings with the appropriate text before they can sign the note.

• Option to define the Blank Character string:

• Select TIU Parameters Menu Option: Basic TIU Parameters

• Field to set:

• BLANK CHARACTER STRING: @@@

• IHS is recommending using three @@@

Now what?

• Once you have all of your fields defined for uploading using the option:

• TPM2 Modify Upload Parameters

• You are now ready to do an upload

• Are all uploads successful?

• No – That is why you have defined Medical Records staff to do the Missing field and Filing error alerts

Error Alerts…now what?

• Your Medical Records staff that are defined in the field:

• Select ALERT RECIPIENT

• Will get alerts when a record could not file

• Missing Field alerts
• Field marked required was missing in the header
• Filing Error alert
• Example: The Health Record number was wrong and it did not match any patient record on your system
• Example: Visit Date could not be identified due patient not having an appointment for that date with the defined clinic code in the headers.

Handling of these alerts need to be done in RPMS

• When you sign on to RPMS it will show the following:

• You have 2 PENDING ALERTS
• Enter "VA to jump to VIEW ALERTS option

• Select IHS Core Option: "VA

• 1 FILING ERROR: HRCN: 5391 GENERAL Record could not be found or created
• 2. FILING ERROR: HRCN: Letter Record could not be found or created.
• Select from 1 to 2
• or enter ?, A, F, S, P, M, R, or ^ to exit:

• At this point you can either select a number or choose A for All.

Handling of alerts by Medical Records

• After choosing the VA alert

• You will be asked if you wish to inquire into the patient record
• If you say No
• This will result into taking you into the actual upload document and allows you to modify the actual upload header. When you exit it will then ask you if you want to upload the file and you can say Yes.
• Make sure that you are using Screen Editor as your preferred editor
• Line Editor will cause problems
• You change this by going to TBOX User’s Toolbox
• Choose Edit User Characteristics
• PREFERRED EDITOR: SCREEN EDITOR - VA FILEMAN
• If you say Yes to inquire into the patient record
• It will ask you the missing items for the patient field by field.
• Saying No initially may be better as you can verify the actual information and see all of the upload file.

Alerts additional facts…

• It is not unusual should you say No initially and then after saying Yes to re-upload the document that you get a second filing or missing field alert.

• Suggest that the second time you say Yes to inquire into the patient record and complete the needed field

Dictation guide for clinicians

• Specify at the beginning of dictation the header:

• Progress Notes
• Discharge Summary
• Consults

Progress Notes fields to be dictated at the beginning of the dictation

• Health Record Number

• Dictated By

• Expected Cosigner (optional)

• Visit Date and Time

• Title

• Clinic Code

Discharge Summary fields to be dictated at the beginning of the dictation

• Health Record Number

• Dictated By

• Attending Physician (your name or a different name)

• Date of Admission

• Urgency

• Priority or Routine

Consults fields to be dictated at the beginning of the dictation

• Health Record Number

• Dictated By

• Expected Cosigner (optional)

• Visit Date and Time

• Title

• Clinic Code

• Consult Number

How to setup the auto printing of notes rather than using the batch print option

• Select TIU Parameters Menu Option: tpm3  Document Parameter Edit               

• First edit Institution-wide parameters:                                        

•                                                                                

• Select DOCUMENT DEFINITION: PROGRESS NOTES       CLASS     CLASS                

•          ...OK? Yes//   (Yes)                                                  

•                                                                                

• DOCUMENT DEFINITION: PROGRESS NOTES//                                          

• REQUIRE RELEASE: NO//                                                          

• REQUIRE MAS VERIFICATION: NO//                                                 

• REQUIRE AUTHOR TO SIGN: YES//                                                  

• ROUTINE PRINT EVENT(S):                                                        

• STAT PRINT EVENT(S):                                                           

• MANUAL PRINT AFTER ENTRY: NO//                                                

• ALLOW CHART PRINT OUTSIDE MAS: YES//                                           

• ALLOW >1 RECORDS PER VISIT: YES//                                              

• ENABLE IRT INTERFACE:                                                          

• SUPPRESS DX/CPT ON ENTRY:                                                       

• FORCE RESPONSE TO EXPOSURES:                                                   

• ASK DX/CPT ON ALL OPT VISITS:                                                  

• SEND ALERTS ON ADDENDA: YES//                                                   

• ORDER ID ENTRIES BY TITLE: NO//                                                

• SEND ALERTS ON NEW ID ENTRY: NO//                                              

• SEND COSIGNATURE ALERT: After Author has SIGNED//                               

• EDITOR SET-UP CODE:              

• If document is to be uploaded, specify Filing Alert Recipients:                

•                                                                                

• Select FILING ERROR ALERT RECIPIENTS:                                          

•                                                                                

• Now enter the USER CLASSES for which cosignature will be required:             

•                                                                                 

• Select USERS REQUIRING COSIGNATURE: STUDENT//                                  

•                                                                                

• Now enter the DIVISIONAL parameters:                                           

•                                                                                

• Select DIVISION: RED LAKE HOSPITAL//                                           

•   CHART COPY PRINTER: MEDICAL RECORDS//                                        

•   STAT CHART COPY PRINTER: MEDICAL RECORDS//                                   

• Select DIVISION:                                                               

QUESTIONS??