HPF 61 Principles of Operations

Horizon

Horizon Patient Folder and Horizon Business Folder

Horizon Patient Folder Workstation Principles of Operations Manual

Release 6.1 August 2003 Document ID HPFXXPO0406101

Copyright notice Copyright © 2003 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved. Use of this documentation and related software is governed by a license agreement. This documentation and related software contains confidential, proprietary and trade secret information of McKesson Information Solutions and is protected under United States and international copyright and other intellectual property laws. Use, disclosure, reproduction, modification, distribution, or storage in a retrieval system in any form or by any means is prohibited without the prior express written permission of McKesson Information Solutions. This documentation and related software is subject to change without notice. United States Government Restricted Rights: This documentation and the related software are provided with Restricted Rights. Use, duplication or disclosure is subject to restrictions as set forth in contract subdivision (c)(1)(ii) of The Rights in Technical Data and Computer Software clause at DFARS 252.2277013 or subparagraphs (a) through (d) of the Commercial Computer Software Restricted Rights clause at 48 CFR 52.227-14, as applicable, in addition to the limitations set forth in the license agreement governing this software. Manufacturer is listed below. Unpublished rights are reserved under the copyright laws of the United States. The software described in this documentation cannot substitute for the knowledge, skill and experience of the competent medical personnel who are its intended users. Its use as such a substitute is prohibited.

Publication date Original Release: August 2003

Product and version Horizon Patient Folder 6.1

Publication number HPFXXPO0406101

Reader comments Any comments or suggestions regarding this publication are welcomed and should be forwarded to the attention of: Enterprise Imaging Documentation Team McKesson Information Solutions Mail Stop ATHQ-2304 5995 Windward Parkway Alpharetta, GA 30005-4184

Trademarks and Horizon Patient Folderare Horizon Business Folder

trademarks of McKesson Information

Solutions LLC. All other trademarks are the property of their respective owners.

Patents U.S. Pat. No. 5,319,543

McKesson

Contents About This Manual................................................................................................................................. iii Chapter 1: Product Information ................................................... ..................................................... .1–1

Introduction............................................................................................................................................ .1–1 HPF Workstation ................................................................................................................................1–1 How HPF Workstation Works................................................................................................................1–3 Open Technology................................................................................................................................1–3 SQL Engine Independence .................................................................................................................1–3 Device Independence..........................................................................................................................1–4 Wide Area Implementation.................................................................................................................1–4 Horizon Patient Folder System Components..........................................................................................1–5 Server Components.............................................................................................................................1–5 Client Workstation Components.........................................................................................................1–6 System Administration Components ..................................................................................................1–6 Chapter 2: Horizon Patient Folder Functional Overview .................................................. ..............2–1

Introduction............................................................................................................................................ .2–1 Functional Areas.................................................................................................................................2–1 Input Functions .......................................................................................................................................2–3 Document Capture/QC Index Workstation.........................................................................................2–4 COLD Agent.......................................................................................................................................2–4 Fax Input Server..................................................................................................................................2–5 Transaction Agent...............................................................................................................................2–5 Report Agent.......................................................................................................................................2–6 Batch Compiler...................................................................................................................................2–6 Release/Upload Functions ......................................................................................................................2–7 Release Components...........................................................................................................................2–8 Archive Agent.....................................................................................................................................2–8 Index Upload.......................................................................................................................................2–8 Index Correction Utility (ICU) ...........................................................................................................2–8 Storage/Retrieval Functions....................................................................................................................2–9 HPF Database Server........................................................................................................................2–10 Object Storage Servers......................................................................................................................2–10 Advanced Image Server....................................................................................................................2–10 HPF Storage Server ..........................................................................................................................2–10 Schedule Agent.................................................................................................................................2–11 User/System Functions .........................................................................................................................2–12 Workflow Agent ...............................................................................................................................2–13 HPF Workstation ..............................................................................................................................2–13 Signature Server................................................................................................................................2–13

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Text Editing Server .......................................................................................................................... 2–13 Web Server....................................................................................................................................... 2–14 Output Server ................................................................................................................................... 2–14 Purge Utility..................................................................................................................................... 2–15 Outbound Agent............................................................................................................................... 2–15 System Administration Functions........................................................................................................ 2–16 Image Engine System Administration Workstation......................................................................... 2–17 Workflow Manager .......................................................................................................................... 2–17 COLD Manager................................................................................................................................ 2–17 Schedule Manager............................................................................................................................ 2–17 Transaction Manager........................................................................................................................ 2–17 HPF Console .................................................................................................................................... 2–18 AIS Object Manager ........................................................................................................................ 2–18 OSS Administrator........................................................................................................................... 2–18 Chapter 3: Flow of Information............................................................................................. ............. 3–1

Introduction............................................................................................................................................ 3–1 Information Input ................................................................................................................................... 3–2 ADT Input.......................................................................................................................................... 3–2 ANSI X12N Input .............................................................................................................................. 3–3 Document Input.................................................................................................................................. 3–4 Magnetic Release ............................................................................................................................... 3–7 Chart Completion............................................................................................................................. 3–10 Archiving ......................................................................................................................................... 3–12 Retrieving and Displaying Documents ............................................................................................ 3–15 Printing and Faxing.......................................................................................................................... 3–17 Chapter 4: Horizon Patient Folder Workflow ............................................ ...................................... 4–1 Introduction............................................................................................................................................ 4–1 Work Objects ......................................................................................................................................... 4–2 Workflow Programs........................................................................................................................... 4–2 Assignments and Tables..................................................................................................................... 4–3 Chapter 5: Horizon Patient Folder Workstation COLD.................................................................. 5–1

Introduction............................................................................................................................................ 5–1 Computer Output to Laser Disk ............................................................................................................. 5–2 Indexing ............................................................................................................................................. 5–2 COLD Components............................................................................................................................ 5–2 Release ............................................................................................................................................... 5–4 COLD Process Flow .............................................................................................................................. 5–5 Appendix A: Monitoring the Web Server and Text Editing Server .............................................. .A–1

Introduction........................................................................................................................................... .A–1 Monitoring the Web Server................................................................................................................A–1 Monitoring the Text Editing Server...................................................................................................A–1 Index ..................................................... ....................................................... ................................. ..Index–1

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About This Manual ATTENTION! This document is effective with the Horizon Patient Folder and Horizon Business Folder products except where specifically noted. For easier reading, this document may cite only ‘Horizon Patient Folder’ or ‘HPF’ when referring to system components, and readers should assume the information is applicable to either product. For stand-alone Horizon Business Folder applications:In this manual, sections addressing Release of Information (ROI) and deficiency processing (or chart completion) do not apply. They are used in the Horizon Patient Folder environment for clinical information only.

Purpose

This manual provides an in-depth functional description of each of the components of the Horizon Patient Folder Workstation (HPF Workstation) product and how they interact with each other and with Image Engine functions. Audience

This manual is intended for management personnel who are responsible for evaluating and selecting information management solutions. This document assumes you are familiar with Microsoft Windows user interface principles and terms. Organization

This document is organized into the following chapters: 

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Chapter 1: Product Informationdescribes the Horizon Patient Folder product suite and its components. Chapter 2: HPF Workstation Functional Overviewdescribes the system components that comprise HPF Workstation and groups them into functional areas to present the interaction among these components. Chapter 3: Flow of Informationdescribes how information is entered into HPF Workstation, initially released, moved from temporary (magnetic) storage to permanent (optical) storage for archival, retrieved (depending upon whether it is in cache), and routed to print and fax queues for printing and faxing. Chapter 4: Horizon Patient Folder Workflowdescribes how the workflow process operates within the HPF Workstation application Chapter 5: Horizon Patient Folder COLD (HPF COLD)explains COLD processing, COLD components, Release components, and COLD process flow. Appendix A: Monitoring the Web Server and Text Editing Serverprovides information about the flow of Web-based transactions through the system. Horizon Patient Folder Workstation Principles of Operations Release 6.1

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Related Documentation

This manual is part of a documentation set developed for the HPF Workstation product. In addition, the HPF Workstation product is used in conjunction with McKesson’s Image Engine and Workflow Engine. You should receive a documentation set for each product you purchase. Contact your Customer Service representative if you do not have appropriate product documentation. Publication Number

HPFXXPO0406101 Contacting Support

If you have questions about this software, do not hesitate to phone your support organization. Contact the McKesson Enterprise Imaging Group Support Center at 800.711.7284, option 4, option 4. In addition, McKesson Information Solutions maintains a For Customers website at https://mckesson.com. A valid user account is required to access this Web site. The site offers executive messages, company news, product documentation, detailed product support information, product education course offerings, and resources such as white papers and release overviews and guides.

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Chapter 1: Product Information

Chapter 1: Product Information Introduction The McKesson Horizon Patient Folder Workstation (HPF Workstation) product is one component of the McKesson Horizon Patient Folder Release 6.0 series product suite. The McKesson Horizon Patient Folder is an enterprise document management imaging solution. Horizon Patient Folder helps organizations overcome the barriers of physical documents and manual processes by consolidating patient chart and record information within a healthcare enterprise. Horizon Patient Folder provides an information management solution by integrating current and historical data with existing information management systems. Horizon Patient Folder complements existing clinical and financial Healthcare Information Systems by extending their range to include historical patient information and business operations data. Horizon Patient Folder modules and foundation components capture, store, and retrieve computer-generated or scanned documents electronically, while structuring the flow of information to increase productivity. Horizon Patient Folder is comprised of these products: 

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Image Engine (a foundation component) Workflow Engine (a foundation component) Horizon Patient Folder Workstation TM (HPF Workstation)

HPF Workstation HPF Workstation integrates patient Healthcare Information System (HIS) data, ancillary system reports, and images of paper-based documents into a consolidated electronic patient record for the Medical Records Department and for patient-centric documents in the Business Office. It provides the functional tools for managing the patient’s medical record and financial information in a paperless environment. Healthcare application functions supported by the HPF Workstation include: 

Chart creation and completion

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Chart deficiency management

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Physician electronic signatures and annotation

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Patient record archival on optical disk Workflow management

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Direct user access and query of electronic patient record information

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User security management

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System audit trails

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System administration


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How HPF Workstation Works Open Technology HPF Workstation is a Microsoft Windows-based application developed in the client/server model. In addition to a user interface, Windows serves as the operating environment used by the application to access network resources. HPF Workstation software operates with network-based servers and the Windows 2000 operating system. HPF Workstation employs the entire Horizon Patient Folder suite of services: integration tools: Computer Output to Laser Disk (COLD) Agent, Transaction Manager, Image Engine, and Workflow Engine.

SQL Engine Independence Application software is insulated from the vendor specifics of SQL implementation by using a software layer. The SQL database server contains the following five databases: 

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HIS (Hospital Information System) database. Patient data is the core of the patient’s record. The minimum data set required by HPF Workstation is patient demographic and encounter data that identifies the patient and the encounter history. This data typically srcinates from the institution’s Admission, Discharge, and Transfer (ADT) system. AUDIT database. The AUDIT database contains a log of encounter-based activities. This area of the database is dynamic and can become quite large. The audit trail is maintained in this separate database to maintain optimum system performance and scalability. CABINET database. This database contains document-related information pertaining to all encounters and the operating parameters for the Transaction Manager. In addition, it contains workflow rules, status tables and COLD processing parameter tables. The Transaction Manager’s parameters map each ADT transaction’s HL-7 formatted fields ‘into’ the various tables and fields of the HIS database. WFE (Workflow Engine) database. The Workflow Engine database contains attributes and components used to process queues and assignments. EIWDATA (Image Engine) database. The Image Engine database is an extended, distributed database that contains: user indexing information and location tables to associate external indexing information with internal document location information. It also contains system-level definitions of subsystem entities, system usage, and utility processes. HBF (Horizon Business Folder) database. The HBF database stores ANSI 835 and 837 data. Transaction Manager reads the data and populates the HBF database tables. Horizon Patient Folder Workstation Principles of Operations Release 6.1

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Device Independence HPF Workstation uses peripheral devices that are available with a Windows driver, such as client PCs, monitors, laser printers, magnetic disk arrays, and network interface cards. Note: Other devices used with HPF Workstation, such as scanners and optical storage media, must be configured for device compatibility.

Wide Area Implementation HPF Workstation can be accessed from multiple locations by extending the local area network (LAN) into the wide area network (WAN) environment. This is accomplished by normal networking without additional integration effort by the HPF Workstation application. The patient’s chart can be accessed using HPF Workstation anywhere on the WAN. This functionality is subject to minimum throughput requirements as discussed with your technical integration team.

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Horizon Patient Folder System Components Horizon Patient Folder includes a series of components that are configured to manage the patient’s medical record and financial folder information in a paperless environment. HPF Workstation integrates information from HIS systems, ancillary systems (such as laboratory or transcription systems), and scanned paper documents into a consolidated patient record. This section contains a list of system components in HPF Workstation and Image Engine. For more information about the functionality of these components, refer to Chapter 2: HPF Workstation Functional Overview .

Server Components The following are the server-based components of Horizon Patient Folder. A server is an Horizon Patient Folder component that runs in an unattended mode and supports a single function or provides a dedicated service.

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ADT Interface Engine (Transaction Agent)

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Advanced Image Server (AIS)

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Archive Agent Server

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Archive Release Server

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Batch Compiler

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COLD Agent

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Fax Input Server

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HPF Database Server (includes Image Engine and HPF Workstation databases)

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HPF Storage Server

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Index Upload Server

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Magnetic Release Server

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Object Storage Server (OSS), optical media

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Outbound Agent

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Output Server (print, outbound fax, e-mail)

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Purge Utility

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Report Agent

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Schedule Agent

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Signature Server

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Text Editing Server

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Web Server

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Workflow Agent


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Client Workstation Components The following are the HPF Workstation and Image Engine client workstation components. Client refers to a PC workstation that requires frequent or constant human interaction to perform the function. 

Document Capture (DCS) workstation

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HPF Workstation

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ICU (Index Correction Utility)

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Quality Control/Index (QCI) workstation

System Administration Components Following are the Horizon Patient Folder system administration components:

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AIS Object Manager

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COLD Manager

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HPF Console (EPRS Console)

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Image Engine System Administration Workstation

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Object Manager

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OSS Administrator

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Schedule Manager

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Transaction Manager

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Workflow Manager module


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Chapter 2: Horizon Patient Folder Functional Overview

Chapter 2: Horizon Patient Folder Functional Overview Introduction This chapter identifies the system components that make up Horizon Patient Folder and groups them into functional areas to present the interaction among these components.

Functional Areas The following table lists each functional area and the components that it includes: Function

Input

Component

ADT Interface Engine (Transaction Agent) Batch Compiler COLD Agent Document Capture Workstation Fax Input Server Report Agent

Release/Upload

Magnetic Release Server Archive Release Server Archive Agent ICU (Index Correction Utility) Index Upload

Storage/Retrieval

HPF Database Server (includes IE and HPF Workstation databases) Object Storage Server (OSS) Advanced Image Server (AIS) HPF Storage Server Schedule Agent

User/System

HPF Workstation Workflow Agent Output Server (print, outbound fax, e-mail) Signature Server Text Editing Server Web Server Purge Utility Outbound Agent

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Input Functions

Function

System Administration

Component

IE System Administration Workstation application Workflow Manager HPF Console (EPRS Console) COLD Manager Schedule Manager Transaction Manager AIS Object Manager OSS Administrator

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Input Functions Information enters Horizon Patient Folder through components that support Input functions. These components include the following: 

Document Capture workstation (DCS); attached to a scanner

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Quality Control/Index workstation (QCI); not attached to a scanner

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COLD Agent Fax Input Server

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Batch Compiler

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Report Agent

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Transaction Agent

The following diagram illustrates the components in their functional areas.

Input Functions

Scanner Quality Control/Index

Document Capture

Workstation

Workstation

COLD Agent Report Agent

Batch Compiler

Fax Input Server

Transaction Agent Host - ADT

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Input Functions

These components are discussed in this section.

Document Capture/QC Index Workstation Documents are scanned at Document Capture/QC Index (DCS/QCI) workstations, which can be one workstation or several, depending upon the volume of capture. With high volume capture, it is more efficient to separate the scanning function from the indexing function. With a medium/high speed paper scanner attached, the DCS workstation offers the following: Color scanning 

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Variable scanning resolutions and densities Single (simplex) or double-sided (duplex) scanning (depending on scanner capabilities)

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Barcode recognition for automated document indexing

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Automatic deletion of blank sides/pages

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Automatic detection of document splitting through barcode recognition

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Automated writing, reading, and sending batches to designated queues

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Automatic splitting of multi-patient Explanation of Benefits (EOB) statements when DCS/QCI is used in the Business Office.

Documents are scanned, digitized, and enhanced using image processing techniques. They are then converted to TIFF images and stored in compressed form on magnetic or optical media. The QCI workstation includes features such as image rotation, page navigation, and data entry for document indexing. The indexing process identifies a document for subsequent retrieval. Document information, such as Document Name, Facility, and Encounter Number, is entered in fields on the QCI window either manually or automatically.

COLD Agent The Computer Output to Laser Disk (COLD) Agent accepts computer-generated report-formatted documents (for example, Facesheets, Lab Reports, Transcription) from the ADT and ancillary systems. It then adds them automatically to the patient’s electronic record. COLD Agent reads the srcinal ancillary system output (in ASCII or PostScript) and performs the following functions: 

Identifies the patient (encounter) account number/document type/facility


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Identifies any signature deficiency processing needed. Creates work queue entries for assignments. Provides Index Upload with the information to route the document to the physician’s signature queue, if necessary; if no user ID is available, Index Upload creates an unlinked deficiency and a corresponding assignment Based on COLD template rules, identifies whether to append, replace, or insert a document if a prior version exists Formats the index information to be processed by Release Server

Refer to Chapter 5: Horizon Patient Folder COLDfor additional information.

Fax Input Server Horizon Patient Folder provides the ability to import faxes. The Fax Input Server is a dedicated server that manages the inbound fax function. A fax received by the Fax Input Server is placed into a queue for manual quality assurance and indexing into the patient chart at the QCI workstation. From the QCI workstation, it is released as if it were scanned at the DCS workstation.

Transaction Agent Another method of introducing data into Horizon Patient Folder is through the interface provided by the Transaction Agent. The Transaction Agent updates the HPF databases based on HL-7, X12N (ANSI 835 and 837 data for HPF 6.1 and above), or proprietary transactions received from an interface engine. Translation tables defined in Transaction Manager (Transman) enable Transaction Agent to map incoming data into corresponding fields in the various databases. Source transactions are identified and the data is defined in terms of Type of Transaction, Field Name(s), Type of Field, and Size. The source transaction is cross-referenced to the SQL Database identifying the target table, location in the table, and transaction type. Additionally, Transman can be used to configure special HL7 transactions (embedded HL7) to extract COLD files. These extracted files can be processed by COLD Agent. The following diagram shows the interface:

TCP/IP Feed

Transaction Agent

Databases

COLD Agent

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Input Functions

Report Agent Report Agent allows you to generate Patient Remittance (835) Explanation of Benefits (EOB) reports using predefined formats. You can preview or print the report, or export it to a text file for processing by COLD Agent. During processing, COLD Agent is able to index and produce an image file of the report. The image is then stored in the individual patient folder. Report Agent also processes 837 data.

Batch Compiler Batch Compiler creates batches from ASCII or TIFF images using IERL script information. During the batch creation process, Batch Compiler creates dcs_data files (temporary storage in EIW_STORE) and doc_set files (all index information). Release Server then copies the files from dcs_data temporary storage to permanent magnetic or optical storage.


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Release/Upload Functions The release/upload functions support the release and upload of electronic objects to magnetic and optical media. This is accomplished through database object location tables and application-specific indexing information. Release/Upload components include the following: 


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Archive Agent

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Index Upload

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ICU (Index Correction Utility)


Archive Agent

Index Upload Archive Release Server

Index Correction Utility

Release/Upload Functions

These components are discussed on the following pages.

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Release/Upload Functions

Release Components The Release components support the transfer of images from temporary storage on a file server to the appropriate permanent storage media. This includes updating the index values that are used by Index Upload when updating the CABINET database. The Release component writes images to magnetic and/or optical media. There are two release components: 

Magnetic Release Server. The Magnetic Release Server moves images from the QCI workstation to magnetic storage for immediate viewing. Functions supported include writing images to a magnetic server, creating and updating document index and location data, and making application index data available for upload.

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Archive Release Server. The Archive Release Server stores magnetic images on permanent optical media. This agent allows the enterprise to mirror information on several optical platters at the same time. It also allows patient records to be grouped together on the same optical platters through the use of volume allocation rules. The Archive Release Server processes batches created by Archive Agent.

Archive Agent The Archive Agent creates batches of completed patient charts and prepares the batches for archiving by the Archive Release Server. A user or an automated workflow process initiates archiving.

Index Upload

Index Upload populates the CABINET database with document index information (for example, encounter, document, page). Logical pointers to the document are created by the Magnetic Release Server or Archive Release Server. Index Upload links these logical pointers to the index information for the associated object. When a chart is archived to optical from magnetic storage, Index Upload marks the magnetic document for deletion and inserts the optical pointers into the CABINET database.

Index Correction Utility (ICU) The Index Correction Utility (ICU) allows you to repair error documents identified by Index Upload. The ICU displays a subset of QC/Index application fields and permits you to correct missing or invalid indexing information. Within ICU you can view either all pending errored documents or only expired pending documents.


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Storage/Retrieval Functions The storage/retrieval functions support the storage and retrieval of electronic objects on magnetic and optical media. The Horizon Patient Folder hierarchical information management techniques stage this information from long-term retention media to magnetic media for optimum response time. Storage and retrieval components include the following: 

Object Storage Server (OSS)

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HPF Database Server (includes Image Engine and HPF Workstation databases)

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Advanced Image Server (AIS)

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HPF Storage Server

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Schedule Agent

OSS

Optical Jukebox

Advanced Image Server

HPF Database Server

HPF Storage Server Schedule Agent

Storage/Retrieval Functions

These components are discussed on the following pages.

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Storage/Retrieval Functions

HPF Database Server The HPF Database Server includes the Image Engine (IE) and the HPF Workstation databases. Tables in these databases are managed by a Microsoft SQL Server database. HPF Database Server - Image Engine Functions

The Image Engine (EIWDATA) storage and retrieval functions of the HPF Database Server, manage the AIS cache tables. The AIS cache tables store information about images temporarily staged magnetic servers tothe quickly service retrieval requeststhat for are active documents. Thison information includes physical location of the image files and attributes that determine how long the files remain on magnetic storage before being purged. HPF Database Server - HPF Workstation Functions

The HPF Workstation functions manage HPF Workstation application data. The HPF Workstation functions store patient demographics, information objects associated with the patient’s encounter, and work queue assignments.

Object Storage Servers The Object Storage Servers (OSS) store and retrieve document images to and from optical media. To efficiently service subsequent requests for the same document, the compressed image is stored in AIS cache. The OSS: receives requests from AIS, retrieves an image, places the image in AIS cache, and notifies AIS of the image location. The OSS also includes cache management of images using a Least Recently Used algorithm.

Advanced Image Server The Advanced Image Server (AIS) prefetches information objects from devices, such as optical jukeboxes, and caches them on high-speed magnetic arrays for immediate user access. The AIS retrieves image path information from the OSS and sends the path to the calling application (such as, HPF Workstation, Archive Agent).

HPF Storage Server The HPF Storage Server (HPFSTORE) provides temporary magnetic storage for images scanned during document capture and prior to release to archive. The HPF Storage Server also provides configuration files. This magnetic storage accommodates scanners, inbound faxes, and incoming COLD data feeds from ancillary systems.


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Schedule Agent Schedule Agent receives transactions from the scheduling system that identify which records will be needed based on the admission of patients to the facility. Schedule Agent uses AIS to prefetch these records and stages them on fast-access magnetic cache.

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User/System Functions

User/System Functions The user/system functions support the delivery of information to the client workstations and the output of information objects. The user functions include the application user interface and all presentation, display, or viewing functions. System output encompasses both print and fax functions. User and system components include the following: 

Workflow Agent

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HPF Workstation

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Signature Server

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Text Editing Server

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Web Server

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Output Server (print, outbound fax)

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Purge Utility

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Outbound Agent

Use r/ S st em Fun ct io ns

Output Server HPF Workstation

Workflow Agent Text Editing Server

Signature Server

Web Server

Purge Utility


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These components are described in this section.

Workflow Agent Horizon Patient Folder Workflow is activated by the Workflow Agent. Workflow Agent polls for changes in queue status and routes workflow objects from one user or work queue to subsequent queues. Its primary function is routing of electronic patient record information for action by users. Workflow Agent uses rules that are defined in Workflow Manager.

HPF Workstation The HPF Workstation allows users to query the database for patient records, to retrieve relevant information (for example, documents), and to complete chart deficiencies. It is integrated with the workflow module to allow users to access assigned cases and to forward cases to other users or workflow queues. HPF Workstation Administration Functions

The HPF Workstation administration functions define operational rules and security policies within HPF Workstation. They also control access to user functions through system security. Users require administrative permissions to access these functions. The administration functions support: 

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System-wide control parameters such as the Document Master List, Record Views, and fax numbers. Dynamic maintenance of the master document file, which applies revisions to document characteristics across the entire chart library. For example, if the order of the document in the chart is changed, that change is applied across all existing charts. Chart assembly order defined by the institution. Various levels of detail maintained and reported within the audit trail defined by the institution.

Signature Server The Signature Server is a background process that allows the system to flag signature deficiencies as complete following physician review. The physician reviews documents in the system and is prompted to sign all pages with deficiencies that have been displayed. Signature Server modifies all appropriate document images with the correct signature authentication string.

Text Editing Server Text editing is a process that allows the physician to add, update, or delete text when completing a signature deficiency on an ASCII text COLD document in HPF Workstation.

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User/System Functions

When a document is text edited, the physician completes the deficiency and the system creates a new image with the added text. The Text Editing Server creates a batch that re-releases the text edited document into the system. The document is processed through the Text Editing Server, Release Server, Index Upload, and Signature Server (to raster the signature text). About Text Edited Versions

The enterprise can elect to retain prior versions of text edited documents or replace the srcinal (and any other predecessor versions). Version creation and control is an Index Upload function.

Web Server The Web Server handles all http requests for Web-based chart completion activities in HPF Workstation. The Web Server can exist as its own stand-alone machine or run with other applications.

Output Server The Output Server handles print and fax requests submitted by client workstations. Output requests are typically initiated by client applications through the Object Broker. An output request, also referred to as a job, is composed of one or more pages. Each item in the job can reference either a multi-page document through the 64-byte document unique ID (Duid) or a single page through a 22-byte DocID. The job is created on one of the print/fax queues and is usually associated with an IERL script that controls the format of the output. As a print server, it can handle one or more printers and it services only those print queues to which it has permissions. Print queues are administered through the System Administration Workstation application. The server sends print jobs either to a default printer or to a specific printer (if multiple printers are mapped at the workstation). Each printer can be mapped to a specific print queue. All jobs on that queue will be sent to the assigned printer. As a fax server, it services only those fax queues to which it has permissions. It currently uses RightFax® to fax documents to the appropriate destinations. Typically, an Output Server is configured to route faxes to a specific phone line (channel) on a RightFax server. However, multiple fax channels may be set up at each Output Server and each channel configured to route faxes to a specific channel on one of the RightFax servers.


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The Output Server selects print and fax jobs from the database that are in a ready status. Each job may contain one or more job items. The server then sends commands to the AIS to get the physical location of the images referenced by the 64-byte document unique ID (Duid). After all the images in the job have been located or the paths have been determined using AIS, the job is ready for output. The server interprets an associated IERL script and acts upon the keywords contained in the script. The server then fetches each image, decompresses it and prepares it for output. This may involve converting COLD files to bitmaps, merging text, scaling, and so forth. After the image has been prepared, it is sent to the appropriate print or fax device.

Purge Utility The Purge Utility is used to physically delete images from magnetic media. Images can be flagged for deletion: 

After a copy is archived to optical for permanent storage.



During image replacement (by Index Upload).



Resulting from an Adjust Document Indexes transaction.



Resulting from an Index Correction Utility (ICU) transaction.

Using the Purge Utility in an Optical Archive Scenario

When a chart is archived to optical from magnetic, Index Upload creates a new entry for the location of the optical image. The entry for the magnetic image is then marked for deletion. At this point, HPF Workstation has access to the optical pointer. The enterprise configures Purge Utility to wait number of days before deleting the magnetic image and pointer database entry.

Outbound Agent Index Upload creates entries for Outbound Agent to send HL7 transactions back to the host system. Pointers to the page and document ID allows the host system to fetch images and be image enabled.

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System Administration Functions

System Administration Functions The system administration functions support the management of information objects within HPF Workstation and Image Engine. System administration components include the following: 

COLD Manager



HPF (EPRS) Console





IE System Administration Workstation Schedule Manager



Transaction Manager



Workflow Manager

IE System Administration Workstation

HPF Console

Transaction Manager

COLD Manager

Workflow Manager

Schedule Manager

System Administration Functions These components are discussed on the following pages. The following background components in System administration are not included in the above illustration, but are also described in this section: 

AIS Object Manager



OSS Administrator


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Image Engine System Administration Workstation The IE System Administration Workstation application defines operational rules and security policies in Image Engine. It also controls access to user functions through system security. The IE System Administration Workstation application allows you to maintain: 









Resources such as: users, scanning and indexing queues, volumes, units, and servers relating to optical storage and mirroring. Queue management: print/fax, upload. The indexing form that specifies the index set and attributes to use, as well as the document processing rules to use. You can: create customized forms, copy or rename forms and indexes, and specify index-to-form field mapping. Security, including: user permissions, DCS/QCI queue permissions, and SQL Server permissions. Volume allocation and mirroring rules.

Workflow Manager The Workflow Manager module is the administrative tool that allows the enterprise to automate its business processes using a graphical approach. Workflow Manager provides a library of 14 Workflow objects to develop unique automated workflow rules that Workflow Agent uses to route the electronic medical record. Each Workflow object has its own icon and performs a specific type of work. Workflow Manager supports: 



Electronic work queues. These ‘to do’ lists can be accessed from within the HPF Workstation application. Rules for populating work queues by: interface transactions from third party systems, entry of documents into the system, database query, Workflow rules, or manual entry of items.

COLD Manager COLD Manager is used to create the templates and rules used by COLD Agent to process document files.

Schedule Manager Allows you to configure Schedule Agent parameters, including intervals for retrieving documents, Workflow queues, and default facilities.

Transaction Manager Allows you to configure the Inbound and Outbound agents and specify layout preferences for output.

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System Administration Functions

HPF Console Provides a graphical user interface that allows you to view log files for Schedule Agent, Outbound Transaction Agent, Inbound Transaction Agent.

AIS Object Manager Allows you to control AIS cache by purging cache files as needed.

OSS Administrator Allows you to view log files for OSS and manage volumes by loading and unloading platters in the jukebox.


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Chapter 3: Flow of Information

Chapter 3: Flow of Information Introduction This chapter describes how information enters HPF Workstation, is initially released, moved from temporary (magnetic) storage to permanent (typically optical) storage for archival, retrieved (depending upon whether it is in cache), and routed to print and fax queues for printing and faxing. Workflow processes, COLD input and output, and system administration functions are described in later chapters. IMPORTANT!

The HPF Database Server includes both Image Engine and the HPF Workstation databases.

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Information Input

Information Input Information is entered into HPF Workstation from ADT or from document input including scanning, fax input, magnetic release, and COLD. Data can also be entered directly into HPF Workstation by functions such as ROI (Release of Information.)

ADT Input This information is most commonly sent in an ADT feed from the healthcare provider’s host application (HIS). The HIS transmits information to HPF Transaction Agent, which defines and reformats the HL7 data transactions and updates the HIS database. The data is defined in terms of type of transaction, field name, type of field and size, and is cross-referenced to the associated tables in the CABINET database. This cross-reference identifies the target table, location in the table, and transaction type. The information in the HIS database is also used by the EPFQCI Extension when it makes standard SQL queries into the database to check field validation. Transaction Agent uses the rules created in Transaction Manager to populate the database. The following diagram represents the flow of information from ADT input.


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Host - ADT

Transaction Agent

HPF Database Server

QCI Workstation with EPF Extension lookup

ADT Input ANSI X12N Input ANSI X12N input is similar to the ADT feed, except the input format is X12N. The data is typically placed in the HBF database. The rules used to process the transactions are defined in Transaction Manager. X12N input includes ANSI 835 and 837 data; for HPF 6.1 and above.

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Information Input

Document Input Document input occurs through: 

Scanning



Fax input



COLD feed



Batch Compiler

DCS Input

Documents are scanned into Image Engine using a Document Capture (DCS) workstation. The DCS workstation offers scanning through flatbed, manual, or ADF options, variable scanning and scanning resolutions and densities, and single- or double-sided scanning. It also offers bar code recognition (optional), immediate or deferred display during document capture, and system workflow operations such as writing, reading, and sending batches. When DCS/QCI is used in the Business Office, the application has the ability to take the multi-patient Explanation of Benefits (EOB) paper statements and create individual patient statements, which can include simple headers and footers. Fax Input

External sources can fax documents directly to the Image Engine. The Fax Input Server places the faxed documents into a queue for manual quality assurance and indexing into the patient chart, which occurs at the QCI workstation. COLD Input

COLD input is made up of ASCII or PostScript files, such as computer-generated report-formatted documents (for example, Facesheets or Lab Reports) from the ADT and Ancillary systems. Based on rules created in COLD Manager, COLD Agent receives indexing information (Encounter number, Facility, and Document Type) from the document. It parses the file into individual pages and creates a batch to be released into the system (relmagq). Batch Compiler

COLD input is made up of ASCII or PostScript files, such as computer-generated report-formatted documents (for example, Facesheets or Lab Reports) from the ADT and Ancillary systems. A COLD Forms Layout window accepts field names such as Encounter, Facility, and Document Type that identify a document.


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Temporary Storage

All the input functions temporarily store images before releasing them to magnetic storage. Input functions write batch information for images to queues located in the EIWDATA database using the same batch format. Batch information consists of the: 

Generated BatchID



User-supplied batch label



Complete path to the SetInfo file Total number of documents in the batch



Total number of pages in the batch



Name of the user who created the batch



Batch Creation

The DCS workstation places batch information in the qcindexq, the Fax Input Server places batch information in faxinq, and the COLD Agent places batch information in relmagq. This batch information causes the following fields to be initialized in the new input queue table record: 

Queue name. This is set to a name that has been predefined in the queue table.



Queue status. This is initialized to a ‘ready’ status (2).



Queue ID. This contains the batch ID and batch directory path.



Queue message. This contains a note entered by the indexer before writing the batch.

Release Process

Batch information for COLD input is sent to the Magnetic Release Server (relmagq) for release. Batches initiated by DCS workstation and Fax Input Server are created for QCI in the qcindexq or the faxinq. A QCI operator logs into the QCI workstation to look at the specific queue into which the batch was delivered. When the QCI operator reads a batch, the input queue table record is modified so that the status is set to ‘inprogress.’ This prevents another user from reading this batch while it is in use. After the batch is indexed, QCI releases it to the relmagq. Batch information for the Fax Input function is sent to the faxinq. Batch information for the Batch Compiler function is sent to the relmagq to be released.

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Information Input

The following flow diagram shows the information being input into IE and the images moving to temporary storage on the HPF Storage Server, the input queue table being updated, and the images indexed and ready for release. Upon completion of QCI, the entire batch is ready for release of the images and index information.

HPF Storage Server

Scanner

COLD Agent

Document Capture Workstation

Fax Input Server

relmagq qcindexq

faxinq

HPF Database Server (Image Engine) EIWDATA

relmagq qcindexq faxinq

Batch Compiler QCI Workstation

Document Input and EPFQCI Extension


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Magnetic Release The batch must be released to make its contents available for general retrieval and display. The batch is first stored on magnetic media until all of the components of the chart are completed and released. The basic objectives of the release process are: 

Select the proper magnetic storage for each document



Commit document images to magnetic disk



Update document location data in the CABINET database



Create application index data and location data for each document available for processing in Workflow

The release server polls the relmagq in the HPF Database Server for batches that are ready for magnetic release. If it finds a batch, it marks the batch entry in relmagq as ‘in progress’ to prevent other Magnetic Release Servers from processing the same batch. For each document, the server selects the proper magnetic storage to store the document based on the volume allocation rules, releases the images to magnetic, and creates an index file containing document index information. Index Upload then creates a corresponding 22-byte ID (page level) and 64-byte unique document ID (Duid). The index file is located in a configurable directory on the HPF Storage Server. The Magnetic Release Server then makes an entry for the batch in the uploadq indicating that the batch is ready for uploading index data to the CABINET database. Index Upload periodically queries the database for batches. Index Upload checks the uploadq for batches and, for each batch, returns the batch label, batch ID, total number of documents, total number of pages, total number of documents released, and the path to the index file. Index Upload polls the uploadq for batches to upload. Index Upload opens the index file, reads the index information, and updates the CABINET database with the new 22-byte ID (page level) and 64-byte unique document ID (Duid), if needed.

Index Upload also performs one of the following actions, depending on the configuration of the COLD template rules, EPF Options in DCS, the Document Type properties, including Document Succession, in HPF Workstation: 





Appends the new document to the existing document. Replaces the existing document with the new document. (The existing document is marked for deletion by the Purge Utility.) Inserts the new document into the existing document.

After the upload process, HPF has the necessary document type, key indexes, and image address information needed to relate each image to its corresponding document name, Encounter Number, and Facility record.

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Information Input

The following also occurs: 





The system creates an entry into the Audit table for the action. Index Upload creates a linked or unlinked signature deficiency as specified in the Document Type rules. Index Upload creates a work queue entry as specified in the Document Type rules.


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The following illustration shows the magnetic release process of images and the uploading of index information.

Magnetic Release

images, index information

Magnetic Release Server uploadq

HPF Storage Server

relmagq

HPF Database Server (Image Engine)

Index Upload Agent

HPF Database Server

HPF Workstation

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Information Input

Chart Completion The next step is chart completion. The chart is completed after all the documents associated with an encounter have been released to HPF Workstation and all deficiencies have been satisfied. The completion process places the encounter record in the archive object as the last step of a Workflow thread. The archive object places an entry in the Archiving table in the CABINET database. Archive Agent queries the Archiving table in the CABINET database to find all the documents associated with that encounter. It then uses Object Broker to create a batch of completed patient charts and puts the batch on the relarcq in the input queue table. Here, relarcq is the configurable name for the release queue dedicated for batches containing documents to be archived. Images are stored on the HPF Storage Server. The Archive Release Server is configured to poll the relarcq in the EIWDATA database to check if there are batches ready for optical storage.


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The following illustration shows the chart completion process starting with an archive object through the Archive Release Server waiting to release the batch to optical or permanent media.

Chart Completion

Archive Object

Workflow Process

HPF Workstation Database

encounter

HPF Database Server (Image Engine) relarcq

Archive Agent

Archive Release Server HPF Storage Server

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Information Input

Archiving After completion, the chart is archived. This procedure, also called the release process, transfers files from temporary magnetic storage to permanent storage on optical disk or other media. The Object Storage Server (OSS) stores and retrieves document images to and from the optical disk and manages the platter volumes and devices within the jukebox. The release process includes two important features: Volume Allocation and Volume Mirroring, both of which involve writing images to multiple volumes. Volume Allocation

Volume Allocation allows different patient records to be grouped together on the same optical platters. This is done by applying a set of rules based on certain document index criteria. The rules are defined in Image Engine System Administration Workstation. Volume Mirroring

Volume Mirroring is the process of writing records simultaneously to multiple volumes as part of a disaster-recovery backup scheme. Records then exist on a primary volume as well as one or more other volumes. The OSS maintains a database table that correlates the volumes, enabling retrieval of images from backup volumes if the primary volume is unavailable. Volume mirroring can also be used to establish alternate paths to stored images to improve system performance and load balancing for caching. Release Process

The Archive Release Server polls the relarcq for batches that are ready for archiving. If it finds a batch, it marks the batch in the uploadq as ‘in progress’ (3) to prevent other Archive Release Servers from working on the same batch. It then goes through each document in the batch, selects the proper optical storage to store the document based on the volume allocation rules, and releases the images to the OSS. The Archive Release Server then creates an index file containing document index information. The name of the upload index file is the same as the batch name. The index file is located in a configurable directory on the HPF Storage Server. The Archive Release Server then deletes the entry in the relarcq and creates an entry for the batch in the uploadq indicating that the batch is ready for Index Upload.


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Index Upload periodically queries the EIWDATA database for batches. Index Upload checks the uploadq for ready batches and, for each batch, returns the batch label, batch ID, total number of documents, total number of pages, total number of documents released, and the path to the index file. Index Upload polls the uploadq for batches to upload. Index Upload opens the index file, reads the index information, and updates the Page table in the CABINET database with the new 64-byte document ID (Duid). After the indexes have been successfully loaded to the CABINET database, Index Upload marks the images to be deleted. The Purge Utility is run to delete the images. After these steps are completed, HPF Workstation has the necessary document type, key indexes, and image address information needed to relate each image to its corresponding Document Name (Doc Type), Encounter Number, and Facility record.

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Information Input

The following illustration shows the flow of information for archiving documents, which changes the 22-byte magnetic DocID to a 22-byte optical DocID. The frame number is the physical location on the optical platter.

Archive frame #

images


OSS 1

Optical Jukebox 1

OSS 2

Optical Jukebox 2

images

frame # uploadq

images

delete batch

Index Upload HPF Storage Server

HPF Database Server (Image Engine)

HPF Database Server (HPF Workstation)


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Retrieving and Displaying Documents The retrieval process depends upon whether the requested page already exists in cache. A 22-byte DocID references each page of a document in the Page table of the CABINET database. This ID is used to determine the physical location of the page. To display a page, the HPF Workstation issues a request to Object Broker to fetch the page using the 22-byte DocID. It also passes a file path for the Object Broker to copy the page then sends an image fetch request to the AIS for the page needed. Retrieval/Display from AIS Cache

Using the object ID, the AIS first checks the Cache table. If the image has already been cached internally, the AIS returns the complete path to the cached file as a Universal Naming Convention (UNC) path. (For example, \\server\volume\pathname.) Using this UNC path, the Object Broker copies the file from the AIS cache to the location that HPF Workstation had requested.

HPF Workstation path

HPF Database Server

path build

AIS and cache

Retrieve from Cache HPF Storage Server

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Information Input

Retrieval/Display Not In AIS Cache

If the AIS does not find the requested image in cache, it examines the CABINET database tables and obtains the name of the optical platter containing the image and the OSS where the platter is mounted. It then instructs the OSS to copy the image from the optical platter to the AIS cache. Once the image is placed in cache, the image location is returned to the requesting HPF Workstation. The HPF Workstation then retrieves the file directly from cache as described in the previous section.

HPF Workstation path

HPF Database Server path build

image

AIS and cache

path

image

HPF Storage Server

OSS

Optical Jukebox

Retrieval/Display Not in Cache


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Printing and Faxing An output (print/fax/e-mail) request is initiated by the user or workflow object through the print options available in the HPF Workstation. Each output request consists of one or more documents and is directed to one of the output queues defined in the EIWDATA database. The request includes data such as the object type, priority, date and time of request, and userID of the user making the request. This data is entered into the EIWDATA database queue tables by the workstation’s local Object Broker. The EIWDATA database queue table entries require a database login into the Image Engine database. Output occurs at either a printer or a fax machine or by e-mail. The Output Servers (Print, Fax, E-mail) on the LAN are configured to poll the print, fax, and e-mail queues periodically for any print, fax, or e-mail requests. A local print option is also available that requires a default network printer defined for the workstation. Print Server

The Print Server reads print requests from the EIWDATA database according to request priority. The highest priority is 1 and the lowest priority is 99. The priority applies across all queues for a server. All high priority requests across all queues are serviced before any lower priority requests. The Print Server expands each print job into its components and issues requests to the AIS to fetch all the pages into the AIS cache. After all the pages of the request have been cached, the Print Server queues the images to the Windows print driver. After the request has been processed, the server marks the corresponding output queue entry in the database as ‘done.’ Jobs can be deleted upon completion. If any errors were encountered either during image fetching or printing, the output queue entry is marked as ‘error’ (0). The Print Server continues processing other requests in a similar manner until a configured number of requests have been output. This number is referred to as the output-cycle-depth. The Print Server then reads more requests from the queues and performs prefetch processing as described above. The Print Server also enables the administrator to map print queues to specific printers to direct all the jobs on a print queue to its assigned printer.

E-mail Horizon Patient Folder supports MAPI (Microsoft Messaging API) compliant secure e-mail. The e-mail function is a form of output that is part of the Print Server feature of Output Server.

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Information Input

The e-mail request is submitted to third-party software (MAPI) along with the e-mail address and other details. The selected images are copied, the banner page and images are encrypted, then zipped and compressed. The resulting files are included as an attachment to the e-mail. The system sends e-mails to a host system, MAPIcompliant, e-mail service. Fax Server

Like the Print Server, the Fax Server reads output requests from fax queues to which it has permissions and faxes them to the appropriate destinations. The Fax Server is used with multiple supported fax boards. The Fax Server issues a request through AIS to the appropriate OSS to place all requested images in AIS cache. The server then retrieves each image from the AIS and expands it to a disk file. The request is submitted to third-party software along with the telephone number and other details. At some configurable interval of time, the Fax Server queries the fax software to check whether the fax transmission is complete. The following illustration shows the interaction between the components of HPF Workstation to print, fax, and e-mail documents.

HPF Workstation print/fax request

Output Server HPF Database Server

E-mail

Fax

Print

Print/Fax/E-mail


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Chapter 4: Horizon Patient Folder Workflow

Chapter 4: Horizon Patient Folder Workflow Introduction Workflow is a means of automating business processes within an organization. The Workflow module within Horizon Patient Folder allows you to define the relationship between various procedures, rules, workflows, and business goals. These relationships, depicted by graphic workflow icons, are translated into a visual workflow thatwithin is converted into the computer workflow map process Horizon Patient Folder. instructions that direct the

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Work Objects

Work Objects Horizon Patient Folder Workflow provides a library of work objects that perform specific tasks. An icon represents each work object. Work objects can be linked as required to form logical processes that are called workthreads. The Horizon Patient Folder Workflow module supports: 

Electronic Work queues (electronic ‘to do’ lists)



Multiple users accessing work assigned to a queue



Security controlling user access to queues



Work queue population by interface transactions from third-party systems, scanning documents into the system, Workflow Rules, or manual entry

Workflow Programs The following programs are required to implement Workflow: 



Workflow Manager. This program allows an administrator to define work objects and graphically link them into workthreads. Workflow Agent. This program executes all assignments for work items not processed by users.

Workflow Manager

Workflow Manager allows users to design and maintain a Workflow map using graphical work objects to form workthreads. This program allows the system administrator to create workflow threads by defining, modifying, and deleting work objects and linking work object icons in a logical sequence. Workflow Manager uses SQL logic to automate business rules. A SQL fragment is a descriptive reference that points to a specific SQL syntax (usually the syntax associated with the WHERE clause). The SQL fragment extends the power of workflow by allowing workthreads to use captured data that is not required by Horizon Patient Folder. SQL fragments control the following Workflow Agent processes:

4–2



Routing items to specific work queues



Performing database queries


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Chapter 4: Horizon Patient Folder Workflow

Workflow Agent

The Workflow Agent systematically processes workflow threads in the production environment. It tracks workflow queues and tasks. It checks for changes in queue status and routes work from one queue to another based on the defined workflow process. It processes objects defined in the workflow threads (except for the Work Queue Object) in a predetermined order based on the type of object. Workflow Agent recognizes new encounter records and initiates required activities. It runs continuously. Workflow Agent processes are controlled by work object parameter settings. Assignments are created or routed to designated work object queues. Once all Workflow Agent assignments are processed, Workflow Agent begins again and processes in a continuous loop. The Workflow Agent uses specific patient database values. These values determine where a Calculation and Decision Object sends an assignment.

Assignments and Tables An assignment is a representation of a work task to be processed in Workflow. It is one unit of work assigned to a Workflow object. Workflow assignments and how they are processed are directly related to certain CABINET database tables. For example, work is performed for the patients listed in the Patients and Encounter tables in the HIS database. These same tables are also accessed when using SQL statements from the SQL Query Object to create assignments and from the Decision and Calculation Object when a rules-based routing decision is needed. The WFE database contains tables that define Intelligent Business Components (IBC). These components allow the user to create logical definitions of Workflow objects that build on their physical definitions in the CABINET and HIS databases. Workflow tables in the CABINET database contain the Workflow rules. As Workflow is being defined, the following tables are updated in temporary storage: 

WQ_Definition (provides attributes of the objects)



WQ_Linkage (provides SQL fragment information used to connect/link objects)



WQ_Users (defined in HPF Workstation, Workflow Activities/Group)

When the Workflow process is finalized, these tables are copied into production. The tables in temporary storage are emptied. An individual assignment is defined by its entry in the CABINET database, Assignments table. SQL fragments store the SQL logic used by decision and database query objects. Auditing of work assignments processed by users is captured in the AUDIT database.

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Chapter 5: Horizon Patient Folder COLD

Chapter 5: Horizon Patient Folder Workstation COLD Introduction This chapter provides information on Computer Output to Laser Disk (COLD) and explains COLD processing, COLD components, Release components, and COLD process flow.

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Computer Output to Laser Disk Horizon Patient Folder stores Computer Output to Laser Disk (COLD) data in ASCII text format. Because COLD information is captured and stored as ASCII data, storage requirements are significantly less than for bitmap images. ASCII text does not retain formatting such as font face/size, bolding, or italics. A typical ASCII text COLD document requires 5 kilobytes of storage space versus 60 kilobytes for a document image. The contents of COLD files are often merged with a bitmap overlay at the time of output (display/print/fax). This bitmap is called the COLD Overlay Form. A COLD file has a proprietary header that contains information such as font name, font size, inter-character spacing, line spacing, and the ID of the COLD Overlay Form. The COLD data and formatting information are merged on output. When a user requests a COLD document from the HPF Workstation, the document displays/prints/faxes just like any other document image; therefore, the COLD process is transparent to the imaging system users. The COLD Agent can also accept PostScript files. COLD PostScript files are converted to TIFF images before they are put into a batch and sent to the Release Server. (PostScript files retain formatting such as font face/size, bolding, or italics, and are almost as large as scanned images. In other words, they require the same storage space.) Note: Elan software from Elan Technologies, Inc. is required to convert PostScript to TIFF.

Indexing The COLD process allows document data to be captured and indexed automatically. The input to a COLD process is typically an ASCII text file. Index fields are automatically extracted from the ASCII text file and stored in the HPF Workstation database. At a minimum, the patient Encounter Number, Facility, and Document Type index fields are required for document identification. Therefore, no manual document indexing process is required.

COLD Components COLD processing has two modules: the COLD Manager and the COLD Agent.

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COLD Manager

The COLD Manager allows you to specify index definitions, data repository location, font size, and image overlays of the COLD documents. The COLD Manager also allows the system administrator to configure document attributes for each document type, including: 

Document code set.



PostScript or ASCII.













The beginning of a document, the end of a document, and page breaks. How to file the document (Insert, Replace, Append). Location of the document identifier in the ASCII or PostScript file (row, column) if searching by text, or in which directory to find a particular document type if searching by directory. (The document identifier is a unique string in the file that, when matched to the template, provides the document type.) Location of other document indexing information (row, column) in the ASCII or PostScript file. Definition of the underlying template (COLD Overlay Form). Definition of the COLD ASCII overlay parameters: font file, font rotation, number of lines per page.



Print properties.



Where to find the physician codes (row, column) for automatic signature deficiency assignment.

COLD Manager stores all the template information in the CABINET database. COLD Agent

COLD Agent sends document information to Image Engine through the Object Broker. Processing is described in the following text. The COLD Agent creates batches of COLD documents from ASCII or PostScript data files stored in a predefined configurable directory. The COLD Agent periodically polls data repository locations for available work. When it finds new ASCII/PostScript files in these locations, it processes each data file as a batch. The processing involves parsing the data file for documents, pages, and index information.

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While processing the data file, the COLD Agent uses template information stored by the COLD Manager in the CABINET database. This information contains markers, which may include end-of-page, end-of-document, and locations of the various index fields. The COLD Agent processes each ASCII or PostScript data file and creates a batch of documents similar to the output of a Document Capture Workstation. While creating each document the COLD Agent checks the CABINET database and the HIS database to verify the presence of the document type and the encounter and whether the document type is included in the document code set for the facility. COLD Agent then creates the batch in the DCS_DATA directory area and makes an entry for it in the relmagq. If the COLD process fails, the agent writes the ASCII/PostScript data file to a configurable error directory. The COLD Agent can set flags for Index Upload to create signature deficiencies for COLD documents for those physicians in the physicians cross-reference table. This table is updated manually by the system administrator. If a signature reference is not valid, the COLD Agent has the ability to send the document to a Workflow queue for manual assignment of the physician signature deficiency. Index Upload adds assignments and creates unlinked deficiencies. The following system actions also occur during COLD processing: 

Places copies of the processed COLD files (successful and error) in the Done directory identified by COLD Manager.



Copies the errored COLD files to the Error directory defined in COLD Manager.



COLD Agent creates a log of all documents processed.

Release A COLD batch appears to the release process as a batch created from a Document Capture (DCS) workstation. The release process picks up the COLD batch from the relmagq and does the following: 

Releases the COLD files to the appropriate media according to the rules of volume allocation, typically magnetic storage (set_info file).



Creates an ASCII file containing the index information for each document.



Creates an entry in the uploadq.

Index Upload subsequently uploads the index file.

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COLD Process Flow The COLD process consists of a well-defined sequence of steps. The steps are illustrated in the following diagram:

Raw Data File

COLD Manager

releaseq

COLD Agent

uploadq

COLD Database Table

deletes files if successful

DCS Data Release Server AIS and OSS

Index Upload

Cabinet Database Table

Magnetic Volume

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COLD Process Flow


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McKesson

Appendix A: Monitoring the Web Server and Text Editing Server

Appendix A: Monitoring the Web Server and Text Editing Server Introduction This appendix provides information about monitoring the processing flow of transactions through the Web Server and Text Editing Server used by the HPF system. Figure 1: Web Application Server and Text Editing Serverin this appendix illustrates the high-level interaction of Web-based components and how to locate errored transactions. Error files/directories and event logs are indicated in red.

Monitoring the Web Server Web Server errors can be monitored in two places: the browser and the Web Application Server itself. The browser writes errors to the Java Console Log. This contains viewer errors only. The Web Application Server writes errors to: 

Pim.log



Server.log

To monitor errors in these files, capture the log files and make a copy of the error message. Send these to the EIG Support organization. In the pim.log file, you should search for Java ‘exception’ errors. Note: Purging of the pim.log file (based on size) is set in the pim.properties file. The file is purged automatically based on the pim.properties file setting. (If the setting is too high for the volume of work at your site, the disk may fill quickly.) You can also specify how many logs are to be retained.

Monitoring the Text Editing Server The Text Editing Server has two associated files that can be checked for errors:

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

Text Editing Server log file



IEDK event log (for IEDK errors)

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The Text Editing Server log file is automatically purged based on the following settings in the pim.properties file: 



Log.maxfilesize. Maximum size of each log file in kilobytes. Log.backupcount . When the log file reaches the maximum size specified, a new file is created and the current file is backed up. This parameter specifies the number of back-ups to keep.

Since the log file is purged based on these settings, you need only back up a log file manually when youschedule.) find a problem. (If you do not, it will be purged automatically based on the above Troubleshooting the Text Editing Server

To troubleshoot errors on the Text Editing Server, it is important to understand the flow of edited documents through the system. Stage 1: When the physician edits text on a document with a signature deficiency, the Application Web Server creates an object of all pages and indexes for the changed document. Stage 2: This object is then passed to the Text Editing Server. The Text Editing Server saves the object to the local drive based on the textediting.localpagepath parameter in pim.properties. Stage 3: During processing, the Text Editing Server saves the edited pages from the

object. Stage 4: After processing the edited pages, the Text Editing Server deletes all pages (if the deleted flag in pim.properties is set to 1) and moves or deletes the saved object, based on whether the object was processed successfully. It saves the footer lines with new page numbers, if configured in HPF Workstation. If the srcinal document has…

And after text editing it has…

The directory structure after text editing is…

Page 1

Page 1

\batch\p1.txt

Page 2

Page 2

\batch\p2.txt

Page 3

\batch\p3.txt

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Text Editing Server Directories to Monitor

Under the directory structure for the Text Editing Server you will find the following directories: 

\In_progress



\Ready



\Error

As part of daily maintenance, the Error directory entries should be reviewed based on the following steps: 1. Determine if the entry is legitimate. For example, if you are running test transactions, they can be deleted. 2. If the entry is legitimate, attempt to resolve the problem. For example, if the AIS is not running, restart the AIS. 3. When the problem is resolved, move the files from the Error directory to the Ready directory. The background processor (explained below) will then process these files. Note: It is important to move these files rather than copying them. This clears the Error directory.

The In_progress directory often contains many files. This is merely a back-log that will be picked up by the foreground processor. If your site wants faster processing, you can increase the number of threads in the pim.properties file (textediting.foregroundmaxthread parameter). One or two threads should be adequate. The foreground processor thread count should be larger than the background processor thread count. Text Editing Server Processors

During processing, the Text Editing Server uses the following two processors: 



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Foreground processor: monitors the In_progress directory. If an error occurs during this stage of the text editing process, errored files are moved to the Error directory. This serves to save the text the physician entered on the document. Background processor: monitors the Ready directory and moves files to the next processing step.

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A–3

rs o s s e c o r P r e rv e S g n it i d E t x

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n o i b t e a c il Wp p A

err v e S g n it i d E t x e T d n a re v re S b e W e h t g n ir to io n M : A x i d n e p p A

re v re S g n it i d E t x e T d n a re v er S n o it a ci l p p A b e W : 1 er u ig F

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IS A

L A D

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t n g e o v l e

-4 A

McKesson

Index

Index A

F

Adjust Document Indexes, 2–15 Advanced Image Server, 2–10 administration functions, for HPF, 2–13 ADT input, 3–2 ADT interface, 2–5 ANSI 835 and 837 data, 2–5, 3–2 Archive Agent, 2–8

Fax Input, 3–4 Fax Input Server, 2–3, 2–5 Fax Server, 3–18 foreground processor, A–3

Archive Release Server, 2–7, 3–11 archiving, 3–12 arcrelq, 3–8, 3–10 ASCII, 2–6 AUDIT database, 1–3 Audit table, 3–8

graphical user interface, 1–1

B background processor, A–3 Batch Compiler, 2–3, 2–6, 3–4 Business Office, 3–4 Business Office functions, 2–4

G

H HBF database, 1–3 HIS data, 1–1 HL7 data, 2–5 Hospital Information System, 1–3 Horizon Patient Folder, 1–1 HPF Workstation administration functions, 2–13 HPF Workstation Database Server, 2–10 HPF Workstation, 2–13

I C CABINET database, 1–3, 3–7, 3–13 chart completion, 3–10 client, 1–6 client workstation components, 1–6 COLD Agent, 2–3, 2–4, 5–2, 5–3 COLD components, 5–2 COLD data objects, 5–2 COLD feed, 3–4 COLD Manager, 2–17, 5–3 COLD Overlay Form,5–3 COLD process flow, 5–5 COLD template rules,3–7 components, HPF Workstation, 1–5 Computer Output to Laser Disk (COLD), 2–4, 5–1

IEDK event log, A–1 IE System Administration Workstation, 2–17 Image Engine database, 1–3 Image Engine Database Server, 2–10 Index Correction Utility (ICU), 2–8, 2–15 Index Upload, 2–8 indexing, 5–2 input functions, 2–3 input queue table, 3–5

J Java Console Log, A–1, A–4

K

D

L

Document Capture Workstation, 2–3 Document Capture/QC Index, 2–4 document input, 3–4

logbackupcount, A–2 logmaxfilesize, A–2

M

E EIWDATA database, 1–3, 3–5 EIW Storage Server, 2–8 Electronic Work queues, 4–2 e-mail, 3–17 EPFQCI Extension, 3–2 Explanation of Benefits (EOB) reports, 2–4, 2–5, 3–4

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magnetic release, 3–7 Magnetic Release Server, 2–8 MAPI (Microsoft Messaging API), 3–17


N

Index 1

McKesson

Index O

T

Object Storage Server, 2–10 operating systems used, 1–3 Outbound Transaction Agent, 2–18 output (print/fax) request, 3–17 Output Server, 2–14, 2–15

P Patient Remittance (835), 2–5 pim.log file, A–1 pim.properties file, A–2 Print Server, 3–17

Text Editing Server, 2–14, A–1 Text Editing Server log file, A–1, A–2 TIFF, 2–6 troubleshooting, A–2 Transaction Agent, 2–3, 2–5 Transaction Manager, 2–17 Transman, 2–5

U uploadq, 3–7, 3–12, 3–13 user/system services, 2–12

Purge Utility, 2–15, 3–7

V Q

Quality Control/Index Workstation, 2–3 queue ID, 3–5 queue message, 3–5 queue name, 3–5 queue status, 3–5

R relarcq, 3–12 related documentation, iii Release components, 2–8 release of COLD files, 5–4 release process, 3–12 Release/Upload components, 2–7 release/upload services, 2–7 releaseq, 5–4, 3–7 Report Agent, 2–6 RightFax®, 2–14

Volume Allocation, 3–12 Volume Mirroring, 3–12

W WAN, 1–4 Web Server, 2–14, A–1 WFE (Workflow Engine) database, 1–3 Work objects, 4–2 Workflow, 4–1 module, 4–2 programs, 4–2 Rules, 4–2 Workflow Agent, 2–13, 4–2 Workflow Manager module, 2–17, 4–2

X X12N data, 2–5, 3–2

Y-Z

S scanning, 3–4 Schedule Agent, 2–11 Schedule Manager, 2–17 server, 1–5 server-based components, 1–5 servers used with Horizon Patient Folder, 1–5 Signature Server, 2–10, 2–13 SQL fragment, 4–2 storage/retrieval services, 2–9 support organization, iv system administration, 2–16 system administration components, 1–6

Index 2


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HPF 61 Principles of Operations

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