1. Shawn Toy, RPh April 21, 2010

2. 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 2

3. 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 3

4. A dynamic data analysis and reporting solution VHA FileManager (FileMan) Data analysis and programming 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 4

5. 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 5

6. 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 6

7. 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: 1. Create single step FileMan templates as Menu Options 2. Use a GUI based stream reader to import data 3. 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 7

8. 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: 8 DVT Prophylaxis ReportDrug Recall Report † Complete Medication Entry Report † Patients prescribed medication(s) Concurrent Medications ReportProvider Extension Report (formatted) Medication Reconciliation Report † Non-Formulary Results Report † † Use a semi-automated Excel process to import, analyze and format data

9. 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 9

10. 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 10

11. 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 11

12. 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 12

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