We have used proximity badges in conjunction with a terminal server to
accomplish what is needed.  A nurse goes into a room the proximity badge
logs on to the pc and starts a terminal server session.  Here a user can
access Meditech from the terminal server.  If they are called out the
proximity badge logs them out of the pc and locks the terminal server
session.  If the user goes to a different pc that has the same terminal
server / proximity card settings the user is logged onto the pc and rejoins
the terminal server session where they were last at in Meditech.  We did not
like the particular proximity card we were using so we ended up not staying
with it but imagine there have been improvements since we checked.  I cannot
speak for many of the inconsistencies that I am sure exist with the little
Meditech bugs.

Shane

-----Original Message-----
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[EMAIL PROTECTED]
Sent: Thursday, June 21, 2007 7:16 AM
To: meditech-l@MTUsers.com
Subject: meditech-l Digest, Vol 32, Issue 33

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Today's Topics:

   1. RE: Access to eMAR (Stewart, Donald)
   2. RE: Buggy Meditech programming of DTS's (Jay Gilmore)
   3. RE: Buggy Meditech programming of DTS's (Lehl, Jim)
   4. RE: {Spam?} (Elizabeth A. Nye)


----------------------------------------------------------------------

Message: 1
Date: Wed, 20 Jun 2007 09:05:37 -0400
From: "Stewart, Donald" <[EMAIL PROTECTED]>
Subject: RE: [MEDITECH-L] Access to eMAR
To: "Davis Daniel - Southern Hills" <[EMAIL PROTECTED]>,
        "Kenny Whiteside" <[EMAIL PROTECTED]>,
        <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>,
        <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>,
        <meditech-l@MTUsers.com>
Message-ID:
        <[EMAIL PROTECTED]>
Content-Type: text/plain;       charset="us-ascii"

What a problem for Windows PCs! It doesn't sound like as much of a
problem for *nix PCs, however. You would actually be logging into your
own session on a server, locking it, and then coming back to it. Don't
think Meditech works with the *nix systems yet, though.

Donald F. Stewart


-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf
Of Davis Daniel - Southern Hills
Sent: Tuesday, June 19, 2007 2:01 PM
To: Kenny Whiteside; [EMAIL PROTECTED];
[EMAIL PROTECTED]; [EMAIL PROTECTED];
[EMAIL PROTECTED]; meditech-l@MTUsers.com
Subject: RE: [MEDITECH-L] Access to eMAR

Now that's a neat trick if you can do it!  Think of the logistics
involved with grabbing the complete state of everything on a PC and then
recreating that on a different PC anywhere on the network.  That would
nearly require that the PC reboot for each user, and all of that data
would have to be transmitted across the network to that new PC (that is
if you could even figure out a way to store it in the first place).
Wow!  What a problem.

Daniel Davis

-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf
Of Kenny Whiteside
Sent: Tuesday, June 19, 2007 9:57 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED];
[EMAIL PROTECTED]; [EMAIL PROTECTED]; meditech-l@MTUsers.com
Subject: RE: [MEDITECH-L] Access to eMAR

Perhaps!  I'm not an IT person... but my understanding of proximity
cards is that they simply lock the computer or automatically log the
user off.  That might help prevent the need for additional
authentication once logged in if no one else can access that computer
until the logged in user returns.  But that creates additional problems.

And the second part of what I believe nurses need is to be able to walk
up to ANY other computer and the session that they are logged into is
"brought" to that computer for them exactly where they were rather than
having to start back at the beginning of the log-in process.  You see,
the problem is that the process of "logging in" that we use was designed
for an office environment.  Healthcare is migratory in nature!  And that
is especially true for nursing!

Thanks,
Kenny Whiteside

>>> "Saira Somani-Mendelin" <[EMAIL PROTECTED]> 06/19/07 10:36
AM >>>
Would proximity cards not be helpful in the situations you describe?

-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf
Of Kenny Whiteside
Sent: Tuesday, June 19, 2007 8:16 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED];
[EMAIL PROTECTED]; meditech-l@MTUsers.com
Subject: RE: [MEDITECH-L] Access to eMAR

I can see the need for the additional authentication (although as a
nurse I would prefer that this not be necessary!)  The difference in
paper versus electronic documentation is that on paper, you have an
opportunity to examine handwriting to determine whether the
documentation was forged by another person.  Not true with electronic
documentation.

Image a computer at the bedside of a computer savy patient.  The nurse
is documenting the physical assessment when there is a code blue two
doors down.  Do you think she will log-out before responding?  It would
be bad if the patient viewed HIPPA protected information.  But it could
be a patient safety issue if they documented that meds were given that
were not!  And there would be no way in the record to determine that it
was NOT the nurse who documented this information!

Until the healthcare environment has reliable technology to
automatically disable the nurse's session when she walks away from a
computer and then return that session to any computer that she walks up
to.... this will continue to be a problem.  I look forward to the day
that there is a good solution to this.

My humble opinion!

Thanks,
Kenny Whiteside

>>> "Kimberly Frick" <[EMAIL PROTECTED]> 06/18/07 10:21 AM >>>
I thought that an additional level of authentication was unnecessary
too, but our State Pharmacy Board requires it. This level of security
doesn't exist in the paper MAR world, so why is it so restrictive in the
electronic version?  
Our State Board of Pharmacy requires us to enter our pin last, so we did
not have a choice for that either. The only advantage I can see of
entering it last is that you can access the e-mar to view the MAR, run
MAR reports or do anything else except document without entering your
pin. The "enter pin" prompt only comes up when you document something.

 
Kim Frick, RN
Project Coordinator
Licking Memorial Health Systems
Phone: 740-348-4114
Fax: 740-348-4769
[EMAIL PROTECTED]
www.LMHealth.org
 


-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] Behalf Of
Sharon LaDuke
Sent: Monday, June 18, 2007 7:36 AM
To: Kenny Whiteside; Deborah L O'Briant; meditech-l@MTUsers.com
Subject: RE: [MEDITECH-L] Access to eMAR


I recently worked for a multi-facility organization which did not
require anything additional for eMAR access. No problems that I ever
heard of. Sharon

-----Original Message-----
From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf
Of Kenny Whiteside
Sent: Friday, June 15, 2007 2:42 PM
To: Deborah L O'Briant; meditech-l@MTUsers.com
Subject: Re: [MEDITECH-L] Access to eMAR

Deborah,

We just had this discussion this afternoon also!  If your nurses ALWAYS
log off when they walk away from their computers.... I would say that
the redundancy would be insane.  But I also know that in the fast-paced,
pulled in every direction at once world of hospital nursing... that's
not likely to happen.  For this reason, we chose to require the user's
password when entering the eMAR from the Status Board.

But who knows, maybe someday we will decide that this is not necessary!

Have a good weekend,
Kenny Whiteside

>>> "O'Briant, Deborah L" <[EMAIL PROTECTED]> 06/11/2007 11:38
PM >>>
Hello All, 
 
I am trying to gauge how the majority of sites live with the eMAR set up
their password/pin options in MIS. We are currently using the NUR Status
Board and the Project lead for nursing wants to take out any additional
requirement to authenticate the user signing on to the eMAR.
The thought is that the original request for a user mnemonic/password to
log onto Meditech is sufficient and asking for the password again if
accessing the eMAR, once in the Status Board, is redundant (we've set it
up so all inpatient nurses get the Status Board upon successful
sign-in). 
 
Our State Board of Pharmacy does not currently have any specific
guidelines (yet) for us to follow. 
 
Has anyone experienced problems (ie, diversion) with the eMar and what
security was in place at the time? I am trying to think of every
scenario where having no additional requirement to access the eMAR might
get us into trouble. 
 
I greatly appreciate anyone taking a minute to answer this posting! 
Thanks in advance!
 
Deborah O'Briant
Sr. Project Manager
IT Applications
Arkansas Children's Hospital
(501) 364-3643
[EMAIL PROTECTED] 

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Message: 2
Date: Wed, 20 Jun 2007 10:13:51 -0400
From: "Jay Gilmore" <[EMAIL PROTECTED]>
Subject: RE: [MEDITECH-L] Buggy Meditech programming of DTS's
To: "'Charlie Downs'" <[EMAIL PROTECTED]>,      "MEDITECH-L"
        <MEDITECH-L@mtusers.com>
Message-ID: <[EMAIL PROTECTED]>
Content-Type: text/plain; charset="us-ascii"

Hi Charlie,

 

I am in agreement with you 100%.  There was a BAR issue that was opened
several months ago that was supposed to fix an issue that was happening when
screening a claim.  When they moved the changes in to "fix" this problem,
users noticed that when they went to edit or view a claim, they were getting
kicked out of the system.  I notified MEDITECH by a phone call AND opening a
ticket, asking them to get this fixed ASAP, because our internal auditor had
a deadline she needed to meet by the end of the day, and she needed to be
able to view some claims.  It was not fixed until the next day.

 

Not only that, but we have also purchased their Scanning & Archiving
solution and are in the middle of setting this up.  We just had to cancel
the Apps visit, because we had 17 tasks open with them relating to problems
that I have found so far while setting this up.  There was no point in
having Apps training when their product is not functioning correctly in
TEST.  Also, the archiving functionality was described differently when they
were selling the product as opposed to when we went to dictionary training.
I have also discovered "functionality" that was mentioned in the demo
training is not working correctly.  I opened a task about it.to summarize,
when he told me that it would not work, I told him what we said to our CFO
at the demo visit regarding this issue, because she was the one asking
questions about it.  In the end, the specialist said that he had spoken with
development, who said that this functionality was not available, and that he
was incorrect of his understanding of the functionality.

 

Every time I take 2 steps forward, I get knocked 3 steps back.  I go to set
up one part of the product, and I find that something is not working
correctly.  I open a task to get the problem corrected.  And the cycle
repeats itself.

 

They definitely oversold this "unfinished" product.  They told us things
that would happen that are not going to happen.  Our HIS director is peeved.
Her department is in desperate need of this product, because they are
running out of space keeping up with medical records.  She realizes that we
are not the problem, but that MEDITECH is the problem, and she is VERY
unhappy with them.

 

I could go on and on about things I am displeased with concerning this
product, other issues, and with MEDITECH, but I could be here all day
typing, and you could be here all day reading.

 

I will mention one more thing.I get very annoyed when I have to reset the
modems for MEDITECH to dial in and fix something, because other people who
dialed in previously did not log out correctly!!

 

Jay Gilmore

 

Systems Analyst

Crisp Regional Hospital

(229) 276-3173

[EMAIL PROTECTED]

 

 

  _____  

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Charlie Downs
Sent: Wednesday, June 20, 2007 8:44 AM
To: MEDITECH-L@MTUSERS.COM
Subject: [MEDITECH-L] Buggy Meditech programming of DTS's

 

I don't know about everyone else, but I feel that was as Meditech users,
really need to get Meditech to improve on their programming accuracy. I've
run into more and more programming problems that have totally unintended
consequences unrelated to the problems that they were supposed to fix. Below
is an e-mail that I sent to our VP of IT this morning. I would like to see
some discussion on the L as to how to go about getting Meditech to change.

Thanks, Charlie

   

     We had a huge problem which we discovered last week, but only realized
the

consequences this weekend from a DTS which Meditech moved to Live on
Thursday. Pharmacy

Issue #5294828 was a problem that one had to give a reason when
re-processing a billing

error when we should have not been prompted for a reason. For some reason,
this tied to the

drug dictionary where one had to give a reason when updating it. This was
totally unrelated

to billing, yet when they moved this to live, it not only caused Pyxis
billing to stop, but

each time an item was removed, it credited a previously removed item. When I
called on

Thursday, Meditech denied that this was what was causing my problem. I've
pasted what they

found was the problem below:

Rebhan,Maria (MEDITECH) - Jun 18, 2007 - 0948 EDT:  Brian, there is a
problemwith the DTS

we delivered.   It was patched correctly but, the code from it iswrong.
I've fixed this

Inhouse and will just need change control for TEST.  Tx

   If this issue would have been a billing issue, I would have tested it
thoroughly before

having them move it to live, but it was not a billing issue. I am seeing
more and more of

this that when Meditech moves a DTS to test or live, it has uninteded
consequences that are

often not noticed until we are live with it, because no amount of testing
will pick up an

unintended change entirely unrelated to the DTS. Another example is Pharmacy
Issue

#5237726. It was supposed to fix a problem with a field not defaulting from
the formulary

service when adding a new drug (FirstDataBank). After this was moved to
live, I noticed

that we could not look up drugs as we had before and instead had to use
extra keystrokes

for look-ups.

    The hours to correct all of the billing problems is huge. I strongly
feel that Meditech

needs to be held accountable for what I see as increasingly sloppy
programming. I would

like to see us file a formal complaint with Meditech over this issue since
this is one of

many times that I have seen this happen in pharmacy and cause huge problems.
Meditech does

not even have a Pyxis machine to test out the Pyxis fixes, and instead is
relying on the

users to test the fixes. In addition, they need to thorougly test other
programming changes

more thoroughly instead of using their customers as basically alpha test
sites.

Unfortunately, sometimes we only find out about these programming errors
after the fact,

which is not right.

    Hopefully, by filing a formal complaint, we can get their attention, but
I would hold

my breath. We had an interesting discussion at MUSE about how to get
Meditech to change

their business practices, and short of a large group of users agreeing to
withhold

maintenance payments, I don't see them changing. Perhaps it is time for
Meditech users to

band together and consider such action.

 

 

Charles Downs PharmD

Washington County Hospital

251 E. Antietam Street

Hagerstown, MD, 21740

301-790-8904

 

 


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Message: 3
Date: Wed, 20 Jun 2007 09:23:23 -0500
From: "Lehl, Jim" <[EMAIL PROTECTED]>
Subject: RE: [MEDITECH-L] Buggy Meditech programming of DTS's
To: "Charlie Downs" <[EMAIL PROTECTED]>, MEDITECH-L@MTUSERS.COM
Message-ID:
        
<[EMAIL PROTECTED]
alth.net>
        
Content-Type: text/plain; charset="us-ascii"

Charlie:
 
I would like to think that Meditech is as conscious about quality as any
corporation in this business, but obviously there is room to speculate.

 
Interesting that the issue you site is related to Pharmacy.  I have been
absolutely amazed over the past 4 years of the number problems we have
experienced with this module.  I also get the impression that over the
past 5 years Meditech has had difficulty retaining programmers for this
module and the dedicated programmers they do have get spread thin with
coding for integrated applications like POM, RXM, eMAR, etc.  I know how
important employee retention is when it comes to supporting complicated
systems like pharmacy and laboratory, but I imagine retention takes on a
new meaning of importance when it comes to programming for these
applications.  
 
One challenge we seem to face at home is how to articulate and convince
our local leadership why it is so important to resource and retain
dedicated and talented people to support these applications in light of
the growing complexity of these systems and growing problems as a
consequence of poor quality coming out of Meditech.  I guess I'm not too
optimistic that there will be an overnight change in the quality of
programming coming out of Meditech, not because of the programmers, but
more because of the response by Meditech's management.  I honestly
appreciate the dedicated programmers at Meditech who stay in the
trenches to grind out the problems they face.  I think we owe them much
gratitude for what they do, and perhaps more important, we owe them our
support to work with them as a member of a team by doing things like
thoroughly testing DTS, frequently auditing data integrity, and
accurately diagnosing and documenting problems when they are discovered.
 
I'm not about to suggest quality measures for Meditech themselves;
however it would seem to me that one possible and accessible measure of
quality we could use locally would be the quantity of correction DTS
Meditech has to code to fix what is broken in any module, or perhaps a
ratio of correction DTS and enhancement DTS.  This could give us a
measurable indication of quality over time, with limitations, that may
be useful when communicating to our local leadership the need for local
support as well as volume control for their booming voices as they speak
out to Meditech.  The risk we face when we venture down these paths is
assuming that the grass must be greener with another vendor.  I'm not so
sure that it is even though their sales people might make it sound like
it is or we into the conclusion that their systems are better just
because they "look" better on the surface.  Its hard to compare Meditech
to other vendors when it comes to the "quality" of programming without
some universal measure -- it this exists, I'm not aware of it.
 
One thing I hope will not be lost out of this dialogue you've initiated
on the L is respect for the hard working people at Meditech -- we need
them!  Too often we, the L, fall into griping about Meditech in ways
that just don't make any difference and serves more to pull us all down
into a spear chucking contest rather than lifting up anyone to make a
real difference.
 
Should be fun seeing the responses ;~}
 
Jim
 
 

        -----Original Message-----
        From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Charlie Downs
        Sent: Wednesday, June 20, 2007 7:44 AM
        To: MEDITECH-L@MTUSERS.COM
        Subject: [MEDITECH-L] Buggy Meditech programming of DTS's
        
        

        I don't know about everyone else, but I feel that was as
Meditech users, really need to get Meditech to improve on their
programming accuracy. I've run into more and more programming problems
that have totally unintended consequences unrelated to the problems that
they were supposed to fix. Below is an e-mail that I sent to our VP of
IT this morning. I would like to see some discussion on the L as to how
to go about getting Meditech to change.

        Thanks, Charlie

           

             We had a huge problem which we discovered last week, but
only realized the

        consequences this weekend from a DTS which Meditech moved to
Live on Thursday. Pharmacy

        Issue #5294828 was a problem that one had to give a reason when
re-processing a billing

        error when we should have not been prompted for a reason. For
some reason, this tied to the

        drug dictionary where one had to give a reason when updating it.
This was totally unrelated

        to billing, yet when they moved this to live, it not only caused
Pyxis billing to stop, but

        each time an item was removed, it credited a previously removed
item. When I called on

        Thursday, Meditech denied that this was what was causing my
problem. I've pasted what they

        found was the problem below:

        Rebhan,Maria (MEDITECH) - Jun 18, 2007 - 0948 EDT:  Brian, there
is a problemwith the DTS

        we delivered.   It was patched correctly but, the code from it
iswrong.   I've fixed this

        Inhouse and will just need change control for TEST.  Tx

           If this issue would have been a billing issue, I would have
tested it thoroughly before

        having them move it to live, but it was not a billing issue. I
am seeing more and more of

        this that when Meditech moves a DTS to test or live, it has
uninteded consequences that are

        often not noticed until we are live with it, because no amount
of testing will pick up an

        unintended change entirely unrelated to the DTS. Another example
is Pharmacy Issue

        #5237726. It was supposed to fix a problem with a field not
defaulting from the formulary

        service when adding a new drug (FirstDataBank). After this was
moved to live, I noticed

        that we could not look up drugs as we had before and instead had
to use extra keystrokes

        for look-ups.

            The hours to correct all of the billing problems is huge. I
strongly feel that Meditech

        needs to be held accountable for what I see as increasingly
sloppy programming. I would

        like to see us file a formal complaint with Meditech over this
issue since this is one of

        many times that I have seen this happen in pharmacy and cause
huge problems. Meditech does

        not even have a Pyxis machine to test out the Pyxis fixes, and
instead is relying on the

        users to test the fixes. In addition, they need to thorougly
test other programming changes

        more thoroughly instead of using their customers as basically
alpha test sites.

        Unfortunately, sometimes we only find out about these
programming errors after the fact,

        which is not right.

            Hopefully, by filing a formal complaint, we can get their
attention, but I would hold

        my breath. We had an interesting discussion at MUSE about how to
get Meditech to change

        their business practices, and short of a large group of users
agreeing to withhold

        maintenance payments, I don't see them changing. Perhaps it is
time for Meditech users to

        band together and consider such action.

         

         

        Charles Downs PharmD

        Washington County Hospital

        251 E. Antietam Street

        Hagerstown, MD, 21740

        301-790-8904

         

         


        ***** CONFIDENTIALITY NOTICE ***** This message contains
confidential information and is intended only for the individual named.
If you are not the named addressee you should not disseminate,
distribute or copy this e-mail. Please notify the sender immediately by
e-mail if you have received this e-mail by mistake and delete this
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Message: 4
Date: Wed, 20 Jun 2007 13:35:54 -0400
From: "Elizabeth A. Nye" <[EMAIL PROTECTED]>
Subject: RE: [MEDITECH-L] {Spam?}
To: "Lawrence, Mitchell" <[EMAIL PROTECTED]>,
        <[EMAIL PROTECTED]>, <meditech-l@mtusers.com>
Message-ID:
        <[EMAIL PROTECTED]>
Content-Type: text/plain; charset="us-ascii"

I don't know if this is possible but when I did a search for Berkshire
Medical Center it is in Pittsfield Massachusettes. Can that possibly be
true in the same state that Meditech is based in?!
 
Liz 
 

________________________________

From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lawrence, Mitchell
Sent: Wednesday, June 20, 2007 1:09 PM
To: [EMAIL PROTECTED]; meditech-l@mtusers.com
Subject: Re: [MEDITECH-L] {Spam?}



1.      Meditech should assist you in meeting your state's requirements.

2.      Your state should join the rest of us in the 21st century. 

 

From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Wednesday, June 20, 2007 11:53 AM
To: meditech-l@mtusers.com
Subject: [MEDITECH-L] {Spam?}

 

We are a CS 5.5.2 site. As we continue to move forward with the advanced
clinicals, (PCS,eMAR,EDM, PCM, RXM etc.) Medical records is finding it
increasingly difficult to produce a printed copy of the record upon
discharge. Our state does not currently recoginize the electronic record
as the legal medical record. This leaves medical records printing the
chart upon discharge. First, there is no one place that MR can go to
print the entire record, leaving them to go to the individual modules
which is quite time consuming. Second the quality of the printed record,
organization, font size etc just does not lend itself to readability.
Are there solutions out there that people are using that allows for one
stop printing of the record in a readable, easy to follow and readable
format? 

Thanks for any help you can give with this issue.

Danielle J. Peppard RN
Clinical Systems Consultant
For Berkshire Medical Center

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End of meditech-l Digest, Vol 32, Issue 33
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