"The Bridge - MediSoft"
Medisoft Clinical & LytecMD Bridge 5/25/2010 Medisoft and Lytec Bridge Patient Records and Medisoft Clinical / LytecMD There are four distinct components to Clinical and MD: the EHR, the HL7 interface for the EHR (PPConnect), the PM, and the HL7 interface for the PM (Communications Manager). Let’s start by discussing the EHR side of Clinical and MD, then we’ll discuss PPConnect, Communications Manager and we’ll finish with Medisoft and Lytec. The only difference in the EHR program functionality between Practice Partner Patient Records, Medisoft Clinical and Lytec MD are the brand names and logos/icons. Medisoft runs on a database called Advantage Database Server (ADS) and the Patient Records install is always done on a Ctree Server Database (CTS). Lytec runs on SQL Server so the Patient Records side of Lytec MD is always installed on a SQL server instance (separate from the PM’s server instance). 1 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 The Bridge (HL7 Interface) Purpose Because Medisoft and Lytec use their own separate databases apart from Patient Records they need to communicate with each other. The purpose of the HL7 interface is to push patient and appointment data from the PM to the EHR and billing data from the EHR to the PM. The diagram above demonstrates that there are two sides to every interface; a sending side and a receiving side. Both sides of the interface must be running at all times for transactions to get where they need to go. Bridges can run in a file-based mode or a TCP/IP based mode. File-based interfaces are much easier to troubleshoot. Clinical and MD use a file-based interface setup. The bridge should always be ran from the server, ideally where PPart is located. 2 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Setting up PPconnect for Clinical and MD Although a PPConnect CD may have been shipped with early versions of Clinical and MD, the disk didn’t need to be used because PPConnect is preinstalled when Clinical or MD is installed. There are always two instances of PPConnect that must be running at all times – Inbound “DemSched” and Outbound “BillCode”. Except for Medisoft Clinical 16, there is still some painful manual setup needed in order for PPConnect to work. Those steps are outlined next and then we’ll talk about what’s different in MCL 16. Most Important First Step – Input Providers into the EHR (and hopefully give each provider the same code as in Medisoft or Lytec) then complete the cross-reference files. DemSch_Pvid.ref is located in P:ppart\Interface\BillingBridge\DemSch\CrossRef. BillCode_Pvid.ref is located in P:ppart\Interface\BillingBridge\BillCode\CrossRef. These files are blank after the initial install and must be completed. If these are forgotten, patients and appointments will dump into the EHR and they won’t be associated with any provider in the EHR nor will appointments appear in any dashboard. The format of the files is always: CODE space PIPE space CODE No space should follow the last code. If provider codes are the same in Patient Records as Medisoft/Lytec, there is no need to remember which order the codes are to be entered in the files and the contents of one file may be copied into the other. If the provider codes are different, it’s critical to put the codes in the correct order, based on the inbound or outbound direction: Bill Code – PR | PM DemSched – PM | PR 3 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 4 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Once these are cross-reference files are setup and saved, we’re ready for the configuration files. P:\ppart\Interface\BillingBridge\BillCode\BillCodeSnd.ini P:\ppart\Interface\BillingBridge\DemSch\DemSchRcv.ini DemSchRcv.ini should be opened in notepad first and modified. The top of the file should look like this: [Interface] Type=inbound OutDelay=00,00,00,00,00 InDelay=00,00,00,02,00 And should be changed to this: [Interface] Type=inbound OutDelay=00,00,00,00,00 InDelay=00,00,00,00,00 Otherwise, a very large Medisoft or Lytec practice’s patient data could take weeks to transfer. The desktop shortcuts for PPConnect need to be sent to the Server’s desktop and pointed to these files by modifying the shortcuts’ properties. This is a slightly complex process, but I’ll do my best to explain the easiest way: Starting in P:\ppart\Interface\BillingBridge\DemSch\ find the Connect.exe application, right click and Send To – Desktop (as shortcut) 5 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Rename the shortcut “Inbound DemSched”. Then right-click on it and click Properties: In the Target field, you’ll find: P:\ppart\Interface\BillingBridge\DemSch\Connect.exe You’ll need to change the target to this: P:\ppart\Interface\BillingBridge\DemSch\Connect.exe P:\ppart\Interface\BillingBridge\DemSch\DemSchRcv.ini 6 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 That entire line needs to be in the target. There’s a space between the “…Connect.exe” and the “P:\ppart..” that space is critical. Now, go to P:\ppart\Interface\BillingBridge\BillCode\ and send that Connect.exe shortcut to the desktop. Go into the shortcut properties and change its target from: P:\ppart\Interface\BillingBridge\BillCode\Connect.exe To: P:\ppart\Interface\BillingBridge\BillCode\Connect.exe P:\ppart\Interface\BillingBridge\BillCode\BillCodeSnd.ini Now PPConnect is all setup and ready to be launched. Both BillCode and DemSched Connect applications need to be running at all times. This means that a user must remain logged into the server at all times. The user can lock the server but cannot log out. Medisoft Clinical v16 maps the cross-reference and configuration files automatically during installation. None of the above steps are necessary; however it is still best practice to check these files before launching PPConnect, especially due to the next important caveat. Important Caveat Most long time Medisoft and Lytec users who have upgraded from previous versions will have the same provider in Medisoft or Lytec twice or even multiple times. They set up their providers this way so that they could bill various insurance companies differently. This is not necessary in our latest versions, but that doesn’t mean that the providers won’t still be in there. Only one of each provider should be mapped in the cross-reference files, otherwise it will be very confusing to the practice and the provider will need to constantly switch providers and dashboard schedule views. 7 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Starting Communications Manager Communications Manager is configured and works the same in Medisoft and Lytec, same buttons and options, but they are launched from different places. Once configured Communications Manager starts automatically on Windows startup and it should always be left running. It usually runs minimized in the task bar and looks like this: If you hover your mouse over the icon, it should say “Communications Messenger”. If the icon isn’t running and you need to launch it, your user will need to log into Medisoft or Lytec to do this. In Medisoft, click Tools (from the Task Bar) , Communications Manager. It will start up and look like this: 8 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 In Lytec 2009, click Settings, Communications Manager. In Lytec 2010, click Admin, Communications Manager.. it will look like this: Click Connections to verify that Communications Manager has been setup properly and registered for Clinical/MD. It should look just like this or it might say Medisoft Clinical: 9 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 To launch it, click on the Configuration button up top, then check the box that says “Enable Communications Messenger on this machine”. You may notice that the box doesn’t check immediately – that is typical but the program should launch then go to the taskbar. Once launched and running in the taskbar, you can close the window above. Configuring Communications Manager If you launch Communications Manager, click Connections and it’s blank, you’ll need to configure it for MD/Clinical. This is very simple. Click Add… 10 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 The Connection Name can be anything, but it should be called LytecMD or Medisoft Clinical. Type that in and then select either Lytec MD or Medisoft Clinical from the Connection Type drop-down box. Then click OK. Click the Enable button and if registration is required, a registration screen will appear. If the customer needs assistance registering Communications Manager, they should contact support. Once the status says Enabled, you’re ready to click on the Configuration button up top and launch it. 11 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 By default, Communications manager transmits every two minutes. It is not recommended to modify this, but it can be modified by clicking Edit (see screen shot above). Important Regarding Multiple Practices The bridge setup described above is for a single practice. Communications Manager is currently only able to manage one practice at a time. This makes multiple practice bridge setups very complex, but you should know that it is possible. DemSched into Patient Records As soon as Communications Manager is initially launched and both PPconnects are running, patient demographics and appointments should flow over to the EHR. Because patients only flow from Medisoft or Lytec into Patient Records and never the other way, users should never schedule appointments or add patients in Patient Records. You can maximize the DemSched icon from the taskbar to confirm: 12 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Nothing else is needed to view appointments except perhaps to refresh any dashboard that is up. BillCode into Medisoft or Lytec EEFs marked complete in Patient Records will flow through PPConnect BillCode into Lytec or Medisoft. Once transmitted, the charges will appear in Lytec in Billing/Pending Transactions or in Medisoft in Activities/Unprocessed Transactions/Unprocessed EMR Charges where they can be saved as new charges. If the chart number, patient name, CPT or ICD9 is not in the Medisoft or Lytec database an error will display. 13 Rex Lloyd McKesson Corp. Medisoft Clinical & LytecMD Bridge 5/25/2010 Appointment Statuses With Medisoft 16 Clinical, additional appointment status messaging was introduced. This means that users can right click on an appointment in Office Hours (the Medisoft scheduler) and check in or out patients, and then the check-in status will update in Patient Records. The check-in status in Patient records also writes back to Medisoft, so clicking the Timing button in Patient Records will update Office-Hours. Below is a graphical representation of what exists for Medisoft Clinical 16 and what is proposed for Lytec 2011. 14 Rex Lloyd McKesson Corp.