On FOCUS

by Mike DeVoe

Regardless of the mysteries under the hood of the new FOCUS client, we’ll always be able to control it from a script.  In a nutshell, scripting is nothing more than reading screens and sending keystrokes.  In the MEDITECH MAGIC days of terminal emulation we could write our own emulation to send keystrokes and manage the screens ourselves.   Later, MEDITECH was kind enough to give us a “script DLL” widget so we could read their screens and send keystrokes through the workstation application.

In FOCUS, the client is not a terminal emulator and even if it were, we probably couldn’t figure it out.  MEDITECH no longer provides a scripting DLL widget so it seems we’re on our own.  As far as the scripting basics of “screens and keystrokes,” we’ve got keystrokes figured out.  If you’ve done much Windows programming, you know sending keystrokes and simulating mouse clicks are fairly straightforward tasks.  Reading screens, however, is a whole different story.  In a Windows application, by the time text hits the screen, it is no longer text.  Instead, it is a collection of pixels that represent the text.  Much like closing the barn door after the horse has run off, by the time text hits the screen, we’ve missed it.

The trick to reading text is to read it before it gets to the screen.  Windows applications don’t get to talk directly to hardware such as screens and keyboards.  Instead, when an application wants to draw text on the screen, it has to ask the Windows operating system to do the drawing.  If a scripting tool can wedge itself between the FOCUS client and the Windows operating system, we can watch FOCUS ask the OS to draw text.  If we can watch this happen, we don’t need to read the screen.  We’ll know what is on the screen as it is being written.

In fact, we can watch the FOCUS client ask Windows to do all kinds of stuff so we can know exactly what it is up to at all times.  As Fleetwood Mac suggested in their 1987 single, we can also choose to tell “sweet little lies” if it suits us.  A scripting tool might benefit from watching the FOCUS client ask Windows how big the screen is and then tamper with the answer.  If FOCUS thinks it’s always running on an 800×600 display, it will draw screens at the exact same size, which helps us write more portable and consistent scripts.

As long as MEDITECH runs on Windows we’ll always be able to control it from a script.  Instead of trying to figure out what the FOCUS client is thinking, we can just watch it interact with the outside world to know what its doing.   Short of MEDITECH abandoning the Microsoft platform, scripting is here to stay and will continue to work just fine in FOCUS.

Check out the video below to see a script running on the 6.x platform:

by Ed Bishop
With the release of the 5.6 version of their Client/Server applications, MEDITECH took the first step toward creating an integrated hybrid of Client/Server and FOCUS (or Advanced Technology) applications. The user interface in 5.6 is much more modern looking than prior versions. With its rounded corners, expansion of the color palette beyond battleship gray, and the use of buttons rather than tabs, the screens look much more like the FS (EMR, PCS) and Advanced Technology applications.

In fact, they’ve done such a good job that as an end user it’s difficult to tell whether you are in a C/S application or an Advanced Technology one. Take a look at the two screens below and notice some of the subtle differences that you can use as clues.

The biggest difference you’ll notice is that on the C/S screen (from PHA) you’ll notice rounded corners on the main body, while on the Advanced Technology screen (from PCS), the corners are square. Also look at the small “i” on the left side of the header. On the C/S screen, it’s in an octagon and there’s a light vertical line between it and the rest of the header. On the FOCUS screen, it’s in a circle and the vertical line is not there. The right side menu is usually bigger in C/S, although in FOCUS it’s variably sized based on what displays. The five buttons in the lower right section of the screen are bigger in C/S.

C/S PHA Edit Patient Data

Click to enlarge.

Click to enlarge.

As an end user, it’s nice to have a product that looks the same no matter where you are. But sometimes, as a programmer or report writer, it’s helpful to know whether you are in NPR or Advanced Technology, in case you want to know where to find data displayed on the screen. In 6.0, you just have to look a little harder to figure it out!

by Frank Fortner

Timing is an amazing thing.  In almost “perfect storm” fashion, MEDITECH hospitals are currently operating in what looks to be the most transitional time in  health care information technology history – certainly in the two decades I’ve been working in this industry.  The convergence of the push to migrate to Client/Server 6.x and HITECH’s drive to meet Meaningful Use criteria through certified systems over the next few years is a tall order to place on many hospital IT staffs, even the larger ones.  In recent days, many hospitals have been forced to rethink (or create for the first time in some cases) their 3-5 year IT strategic plan to meet the demands that the new legislation requires by 2015.  In keeping with the blog theme, just where does MEDITECH’s new platform (6.x / FOCUS / Advanced Technology) fit into all of this?

There doesn’t seem to be a single correct answer to that question as it will depend on whom you ask.  For some, this “perfect storm” is ironically quite timely and fortuitous, meaning yes, it’s a lot to bite off, but they would have been looking to upgrade from MAGIC to something else anyway, mainly in the hope of securing provider adoption.  The new Advanced Technology platform gives these hospitals a viable option that comes from their current vendor of choice.  As a colleague of mine has been known to say, “sometimes the devil you know is better than the one you don’t.”  The only challenge here may be one’s place in the queue and the bandwidth of MEDITECH to convert these systems well before 2015.

Others, even some long-time MEDITECH customers, have simply chosen a different HIS vendor, perhaps looking to capitalize on a more mature platform than 6.x, which currently lacks the basic tools for writing reports to mix data from C/S and AT applications for example.  Those will certainly come in time, but for now it highlights the freshman nature of 6.x.

Another response has been, “we’re staying put on MAGIC.”  This translates to, “yes, it may look like DOS (according to many physicians) but we’ve invested years in getting it to fit our environment.  It’s mature and robust and there are modern 3^rd party tools out there to help meet Meaningful Use criteria and allow us to gain provider adoption.”

What does your hospital’s road map to 2015 look like?  This could be the most important discussion for many of us in our IT careers, so please feel free to comment and contribute your thoughts.

by Michelle Schneider

My number one goal for 2010 is to become an expert on Meaningful Use.  In keeping with this goal, I have immersed myself in the masses of information about the proposed ruling for Meaningful Use which was voted on in late December.  Needless to say, I’m like a deer in the headlights!  The more I learn, the more overwhelmed I feel.  Is it possible for hospitals to meet these requirements in such a short time?  So far, it’s similar to a Joint Commission regulatory roll out where there is so much room for interpretation and so little direction that it will be difficult for hospital groups to agree on and develop precise processes in the allotted time.

The bigger problem seems to be that the ruling will not be final until late spring, 2010.  To qualify for the bonus bucks, the hospital must meet the requirements for 90 consecutive days in fiscal year 2010 which ends on September 30, 2010.  If you’re doing the math along with me here, that means that all of the processes must be in place and active by the beginning of July 2010.  If the ruling is final in late spring and the processes must be in place by July, it would be quite a stretch for any health care IT vendor to enhance its product, test the changes for quality control, roll it out to customers and move it live to meet these requirements for this fiscal year.  If it can’t be done with your current system, look to 2011 as your first year for reimbursement.  The good news is you still have the potential to earn the same amount of bonus bucks if you start in 2011.  The money will just start coming in a little later.

I have worked with the MEDITECH HIS for almost 20 years.  This includes the $T, MAGIC, Client/Server and now 6.X platforms.  Any of these platforms would serve me well in taking on this new challenge.  The MAGIC platform shines in that it’s pliable.  We can evaluate user responses in all applications and trigger screens and reports to pop out of nowhere.  This makes it a good choice to quickly respond to changes in the ruling.  The Client/Server platform offers a more palatable computerized physician order entry (CPOE) process than its MAGIC counterpart and it relies more heavily on point and click, improving the physician experience.  When we consider the implications of the ruling and the ability to react quickly to changes, there is less room for creativity. However, with physicians on board and the fundamental requirements in place, success is within reach.  While the 6.x platform may be closer to meeting the Meaningful Use requirements, there is much less room for user modification to respond quickly when regulations are amended.  Also, MEDITECH’s website says they were expecting to have ten sites live by the end of 2009.  With the hundreds of MEDITECH sites out there and their suggested 9-11 month 6.x migration time line, waiting for 6.x to implement the meaningful use requirements just may not be realistic.  Once you’ve upgraded to the latest MAGIC or C/S version, you may be quite pleased to find that you’ve got all the tools in place to achieve these goals.  Perhaps we’re not so powerless after all.

How do you think your site will handle these challenges?

by Joe Cocuzzo

A note on terminology. MEDITECH is now calling their new platform 6.0, but the term FOCUS has already been established. In this post, I’ll use the term 6.0/FOCUS.

The new 6.0/FOCUS platform has a new database design and it is append-only. The database therefore contains its own complete audit trail. Only changes are stored, so to create the current state of the data of an order, registration, assessment, and so on, the data retrieval has to go through all transactions. We have done some very preliminary comparisons of report efficiency between NPR MAGIC, NPR C/S and 6.0/FOCUS and we noticed that 6.0/FOCUS reports can be much slower. You do not see this with well-indexed reports processing only a relatively few transactions, but the difference is dramatic if you write a report that processes many thousands of records.

In our tour, we need to deal with a change in terminology:

Applications are still called applications in 6.0/FOCUS, but…

DPMs are now called 0bjects and Segments are now called Records.

Use of the term Record for something that contains many records is unfortunate. Using “table” or sticking with the old term “segment” would have been better.

There isn’t much documentation available on the new Report Designer. If you go to MEDITECH for training, you get a seminar manual consisting mostly of screen shots. If you are hoping for online documentation, for now:

has been replaced by:

Let’s write an ADM (errr… REG) report that is a bit more complex than the example on the MEDITECH tour. We’ll include insurance information, sorted by the insurance order.

To create a report you can type the title into the Mnemonic field and the report writer will convert it into something MEDITECH calls Hungarian notation. Basically, strip any spaces, and your mixed case cannot contain more than one capital letter in a row or certain punctuation. No more dots in report names!

You’ll notice that MEDITECH provides Basic and Advanced report writing modes. In Basic Mode, you cannot write RULES and you cannot add multiple applications to a report:

For our example report we’ll select the Admissions (REG – Registration) application, the RegAcct object (think DPM), and the Main and InsuranceOrder records (think Segments).

You can only flag one segment as the detail on the main page.

Stay tuned for the next article in this series, “Why can’t I delete or edit the field that is highlighted????!!!!”