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Informatics Innovation via Available Resources. Shawn Toy, RPh April 21, 2010. The fundamental economic problem. Unlimited wants with finite resources Limited hardware availability Limited software availability Limited knowledge of informatics systems Limited FTEE
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Informatics InnovationviaAvailable Resources Shawn Toy, RPh April 21, 2010
The fundamental economic problem • Unlimited wants with finite resources • Limited hardware availability • Limited software availability • Limited knowledge of informatics systems • Limited FTEE • Including ancillary duties of assigned FTEE • Separation of OIT and VHA • Economic pressures and solutions may be separate between the two groups
Living within your means • Building a revised clinical informatics system requires new, and adaptable, attitudes • Class-III cannot impede system standardization • Requests for new functionalities must be categorized, stratified and placed into their appropriate position • Immediate attention is virtually impossible because the system scope exists well beyond the local level • We need to, “make due with what we got” • Which, is actually a lot
So, what’s in the bag • A dynamic data analysis and reporting solution • VHA FileManager (FileMan) • Data analysis andprogramming platform • Microsoft Excel • Data warehousing and analysis solutions (Databases) • Microsoft SQL Server • Microsoft SQL Server Express • Microsoft Access • National data marts via OLAP • MDX can be used by both ProClarity and MS Excel
A few words about Excel and Access • Microsoft Excel • Is not a statistical program • Is not a database • Is a full-featured programming platform under the hood • User familiarity helps promote Excel based solutions • Microsoft Access • Is limited in size • JET does not directly permit procedural programming • Has myriad security issues vs. SQL server • Is also a full-featured programming platform
A few words about FileMan • It is not evil incarnate • Is more than a means to an end • FileMan can be: • Programmed • Dynamic • Interactive • A one-stop-shop reporting tool • Weekly DVT prophylaxis reports • All patients prescribed a medication (user input) • Formatted text directly to a printer
Three steps is enough • Through Practice: • Most users lose interest after a process has 2-3 steps • Those that deal with data regularly have no problem • Try to delegate a multi-step process and… • Solution: • Create single step FileMan templates as Menu Options • Use a GUI based stream reader to import data • 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
Tool #1 VHA FileMan • FileMan templates can be programmed into one-step solutions via a VistA menu option • No programmer access required • FileMan supports variables, branching, iteration • The scope of variables permits cross-record information transfer • FileMan can actually be programmed via templates • Current single-option solutions include:
Tool #2 Microsoft Excel • The Excel platform allows for advanced programming • Processes can be recorded and replayed (macros) • Processes and functions can be directly coded via VBA • Add-ins can be produced and easily exported/imported
Tool #3 Databases • My preference: SQL Server • Allows for procedural code • Works on a separate server • Is very secure via Active Directory setup • Views and stored procedures enhance security • Use ODBC to directly link MS Office programs • Single click data updates • Efficiency of querying data outside the production system • Local warehouses may not be necessary in the near future • Coding SQL is easy vs. FileMan
Tool #4 OLAP • Bonus: the data is ready for analysis immediately • MultiDimensional Expressions (MDX) • Can be coded in ProClarity or Excel • Allow for dynamic reports • No need for user to update anything • Just click and voilà
Where do we go from here? • 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