1- Cash Withdrawals

 Cash Withdrawals Reasons

1 – Cash Withdrawals Reasons

2 –  Cash Withdrawals Reasons

3 - Cash Withdrawals Reasons

Total Amount ————————-

Cash Withdrawals Techniques

1 – Cash Withdrawals Technique

2 –  Cash Withdrawals Technique

3 -  Cash Withdrawals Technique

Total Amount ————————-

Grand Totals

         Cash Withdrawals Reasons —————————–

Cash Withdrawals Techniques ————————–

Transactional data of the reasons and techniques was stored in 2 different table and Cash withdrawal stored the Cash Withdrawal master information like Main Cash Withdrawal Id and Person Associated with the Cash Withdrawal.

Report was created by making a union view of   Cash Withdrawals Reasons and Cash Withdrawals Technique and linked to the Main Withdrawal Table.  Totalization of Cash Withdrawals Reasons and Cash Withdrawals Technique were accomplished via using Manual Running Total because these 2 total can be summarized by simply using summary option in Crystal Reports.

Indexing is on of the several techniques for faster processing of the Reports. According to Sap Crystal Reports Userguide 2011

“Creating indexes for database tables can increase the speed of data access and reduce the time it takes for the program to evaluate data. Some DBMS applications automatically index your database tables, while others require that you create an index yourself. For the best report generation performance, make sure each of your database tables has a corresponding index.

The information in this table is organized according to the Order# field.

This is fine anytime you want to look up information in the table based on order numbers. However, what if you want to look up information specific to a certain customer?

Instead, Say you want to look up all orders made by Sierra Bicycle Group. The database engine must begin by looking at the first order number in the list and checking to see if the customer name matches the request. If not, it goes to the second order number, and checks that customer name. When an order number is reached that contains the correct customer name, the database engine retrieves the information, then continues to the next order number.

Using this technique, both the Order# field and the Customer field must be read for every single record in the table. This takes a long time and a large amount of computer processing effort for examining extensive database tables with thousands, or even millions of records. Instead, you can create an index for the table based on the Customer field. Such as

In this index, information is organized by customers, not order numbers. Also, notice that the second column actually contains pointers to specific order numbers in the original table. By using this index, the database engine can search just the information in the Customer column until it finds the customer you are interested in, Sierra Bicycle Group.

For each correct customer entry the database engine finds in the index, it looks up the matching order in the table according to the pointer in the second column of the index. Only the orders for the correct customer are read. Finally, since information in the index is organized according to the customer names, the database engine does not need to continue searching through the index or the table as soon as it finds an index entry that does not match the requested customer.

The advantage of this highly organized search through a database table according to an index is speed. Using indexes speeds up data retrieval and report generation, important factors when reporting on large database files.”

Reference:

Sap Crstal Reports Users Guide 2011 page 505 – 506.

There are several options to tackle this issue 1 may be to create a manual cross tab. We experimented with 2 cross tab overlapping each other. In 1 cross tab the same data in the two internal columns was multiplied by -1 and last column i.e. sale amount was multiplied by +1 and hence we can achieve the objective in total for the rowHowever if users don’t want to the negative signs with amounts and also we have to add up the respective columns at bottom, then it may seem that we cannot achieve this Crystal Reports cross tab object.

But fortunately we achieved this by adding another cross tab on top of the first cross tab report with same data source. In the first cross tab two internal columns were suppressed whereas last column was shown.

In the second cross tab we showed the 2 internal columns and moreover no column in the second cross tab was multiplied with -1, lastly the total column in second sub report was suppressed, in other words cross tab were showing the internal columns from the second cross tab and sales amount total column from first cross tab.

The data presented perfectly, though it needs some alignment and of column sizes etc. The purpose of writing this post was to show just an example how flexible and mature isCrystalreports in tackling infinite issues of database reporting.

By eReporting.net

Recently I was working on Multilevel report which has a main transaction and child transaction. The child transaction further have 1 level down two different types of transaction and lastly these each of the two different types of transactions have two further different types associated parties involved with the transactions. Reporting on such scenario would definitely invoke the thought of using Sub-Reports at each level i.e 1 for child transaction sub report linked to Main transaction then two more Sub-report linked to child transaction containing two different type of transactions and so on.

I recently read that Microsoft SSRS supports sub-reports and it does it to 20 levels deep and Crystal reports supports only upto 1 level. Being a reporting analyst I have always discouraged the use of Sub-Report even at a single level though sometime we need Sub-Report because of bad database design or not leveraging the power of SQL language.

Mostly when we use the sub report we basically ignore the power of data grouping in Reporting tools and unlimited flexibility of SQL Language and when I read about 20 levels deep sub-report support by SSRS, I immediately though of what scenario would need this functionality and have also read that the biggest complaint about sub-reports with Crystal Reports is that they only allow one level of nesting.

I would say Crystal Reports is the smartest tool for reporting and that’s why it has only 1 level and I created several multilevel reports including the one scenerio I mentioned in the beginning using Crystal report by efficient use of grouping functionality and unlimited power of SQL Language.

Readable formatting

To complete the formatting:
- uncheck the “Show Cell Margins” option.
- select the field then go Format field Select Border tab and then go to back ground
and in the formula option enter the following formula you can select different colors try to change color codes.

For the Row Label

whileprintingrecords;numbervar d;d := iif(d=255,153,255);color(200,200,d);

For the Inner Fields of the row

whileprintingrecords;numbervar c;c := iif(c=153,255,153);color(200,200,c);

The foromatting used the two buit in functions

Mian Kaleem is Crystal Reports Consultant and have experience of Crystal reports consultancy services to many medium to large size comapnies. View complet profile

Report Abstract

This paper provides a high level overview of the healthcare data integration and its effect on agility of healthcare organizations. It explains why data integration is not an option, but a critical component of healthcare information technology. It introduces the basic knowledge of data integration and addresses the key business factors for demand of data integration. It also highlights data integration industry, vendors and solutions.

The report is intended to enhance the knowledge of healthcare data integration for healthcare organizations, government agencies as well healthcare users. It is not intended to serve as the only source of information for a data integration understanding, vendor selection or strategy development process.

Even though of field of medicine is characterized by new discoveries and breakthroughs, but the healthcare data which is a key for medical advancements is disintegrated, costly and stored in data silos. It has resulted in vulnerable agility of Healthcare organizations, frustrated patients, high operating costs and constraints in medical research.

This report also shows that data integration is on the critical path to bridging islands of information and attaining the goal of Agile Healthcare organizations. Healthcare data especially the biological data is very sensitive and therefore without the data integration valuable time is wasted on compilation of data, hence meaning full use and agility of healthcare organizations. Data integration should be a mandatory factor in Healthcare information technology. Data integration is not a luxury but a necessity in the well being of patients which are the center of Healthcare.

Manual systems and data silos practices should be eradicated at any cost. If end users need data in their required formats i.e. word or spread sheet, they should be able to import the data sets from centralized integrated database. In fact this option is available with most of database vendors in user friendly way.
Data governance is very critical to ensure what kinds of data can be shared and under what circumstances it can be shared, in addition, to breaking the data silos and connecting doctors, patients, researchers and insurers.

(EHR) a main driving force behind the data integration should be utilized at its full potential and not used as a simple patient data storage system. Data integration in (EHR) should be taken very seriously for the agility of organizations and meaning full use and making evidenced based decisions. In view of Canada health Infoway’s interoperable infrastructure efforts and initiatives, this is the responsibility of Healthcare organizations to upgrade their systems meeting integration criteria and resulting in enhanced organizational agility and meaning full use of healthcare information technology.

In this respect vendors should work as catalysts i.e. creating integrated Healthcare software’s which meets the spirit of integrated (EHR) in compliance with Canada Health Infoway documentation EHRs Blue Print.
Although, there are challenges in Healthcare data integration, however its implementation should be taken on priority. Its benefits are in the shape of best patient care, savings of governmental expenses on healthcare and cost saving at organizational level. Most importantly data integration has promising effects on medical breakthroughs and medical research.

Healthcare data integration improves communication and information sharing among Healthcare organizations. Physicians can have an overall health history of patient and hence enable them to make evidence based decision and timely consumption of patient data. One major concern due to data silos, a torture of redundant tests, procedures and repetitive filling of medical forms will be taken care of by implementing data integration. Reduce costs for staff labor, reduce paper work and may strengthen the strategic bonds between hospitals and community physicians.

In view of the major vendors in data integration they have different products and services for examples Microsoft Amalga offer centralized database system to improve operational systems, Novo Innovation claims to be the only the technology i.e. Novo Grid to connect all healthcare stakeholders for community-wide health information exchange and ensure that Physicians have 360° view of their patient’s health.
Lawson’s Cloverleaf is an enterprise-caliber healthcare data integration engine that facilitates the movement of data through disparate systems within and outside your enterprise. Mobile MD and Bluegate works as internet based application service providers (ASP).

Data Integration is not only about software and technologies, but a mindset of how to utilize technologies to enhance the agility of the organization. Healthcare Data integration is about patient care, Healthcare organizations operational efficiency and scientific breakthroughs, by timely utilization of accurate and relevant information.

1) – Introduction: Integration for agile healthcare organizations

Objective of this research paper is to discuss data integration and its relation with agility of a healthcare organization. Data Integration refers to the organization’s inventory of data and information assets as well as the tools, strategies and philosophies by which fragmented data assets are aligned to support business goals. [1]

The word agile according to Dictionary.com is “Marked by an ability to think quickly; mentally acute or aware” so an agile healthcare organization must have the characteristics of ability to think quickly and be aware of the state of healthcare organization and continuously improves healthcare organization by enhancing patient care, lowering costs and utilizing technologies for new researches and scientific breakthrough.

A revolution based on integrated healthcare information has enormous potential to redefine the healthcare technology, economics and medical discoveries. Businesses in general and Healthcare organizations in particular need agility in highly competitive business environment.

In order to add the first hand knowledge of disintegration and its effect on the agility, I talked To Dr Farah pathologist at Wayne State University about how they get the required information to complete the work, “Dr Farah stated that, they have to look for patient information in two different databases namely Laboratory Information systems and Hospital information system”. (T. Farah, personal communication, February 3, 2011)

Laboratory information system stores only the patient test, whereas hospital information system stores patient medicine history and then compiles it through manual process. A lot of efforts are required to reconcile the figures, correcting errors and so on In many healthcare organizations, a question can sometimes require a compilation of data from several different systems, or a patient record by patient record search. Data analysts often must pull the data from the systems, analyze and normalize it, compile it in a usable format, and return it to the original requestor—a process that can take weeks and hence sever the agility of a healthcare organization(See-Figure 1).
Figure -1 [8]

According to John Dineen, President and CEO, GE Healthcare and contributor to 2009 Forum Challenge: “Moving beyond the Limitations of the Traditional Healthcare System”.
“The potential gains from fully integrating IT as the backbone of any healthcare system are enormous, but appropriate deployment is challenging [16].”

In this perspective it will be worth presenting an article printed in Washington post March 4, 2005 under the heading “Innovation comes from within’ In 2005, the folks at the Washington Hospital Center have discovered is that most of the makings of an electronic medical record are already available in digital form at most hospitals.

By investing a relatively small amount of time and money, they’ve collected it all in one database and designed an easy-to-use interface that allows nurses, doctors, medical researchers and finance staff to organize it in almost any way they want and hence enhanced agility of healthcare organization. It’s called Azyxxi (don’t ask), and it’s one of the most advanced systems for managing patient care in the country.
Azyxxi, created at MedStar Health’s Washington Hospital, was acquired by Microsoft in 2006 and enhanced for use by other healthcare organizations. [14].

The above article shows that how an healthcare organizations are hindered by the disintegrated digital data and smart organization find the way to overcome.

2- Need for integrated healthcare information

To date, most IT applications and infrastructures have been deployed in isolation, suffering from interoperability challenges and making systematic evaluation and enhancement of healthcare problematic. Fortunately, we can learn from early adopters who have integrated IT into their entire care process and are able to show that medical care improves while costs go down. – [16]

Following are few of critical reasons for greater need of healthcare at present times;
 An explosion of emerging laboratory biotechnologies has created unprecedented complexity and scale of data for research organizations.
 The ability to converge, explore, infer meaning from, and share data across disciplines is hindered by a current gap in computational systems, which makes it difficult to manage enormous volumes of complex data.
 Biological data is extremely dynamic, and its interpretation is sensitive to experimental context.
 The quickly changing needs of investigators and other decision makers require smart, adaptable, and extensible systems.
 Healthcare organizations have to comply with continuously changing requirements for governing healthcare data standards and increasing number of data formats and sources.
 Data is locked inside hundreds of different information systems and special-purpose databases used by individual disciplines, and is stored and represented differently according to the specific science. Releasing, organizing, and reconciling data from those systems is typically a manual and time-consuming process.

3- Forms of data integration

Data integration is basically timely sharing of relevant information to make evidence based decisions, meaning full use of healthcare information technology and enhancing the agility of healthcare organizations. Data integration begins within the healthcare organization and then expands through interoperable networks to other healthcare organizations at local, regional and national levels.
Data integration can pursue several strategies, including single, federated or virtual compilations of data for a given business purpose. Increasingly, businesses are striving to deliver consistent data views through master data management [1]. (MDM)—creating a single, unified view of an organization—is growing in importance and which is meant to deliver a near real-time, hub-based and synchronized presentation of information to any seat or point of view in the organization [17]-(See figure – 2)[18].

Figure -2
4- Effects of disintegrated data on patients

Adverse effects of disintegrated data are huge, how ever at basic level negativity of disintegrated data includes patients filling out the same medical forms repeatedly at every healthcare organization. Frequently patients are asked to do same test several times and so on, this can be very distressing and is an avoidable financial Burdon on tax dollars.

The problem mentioned above is due to the fact that single patient commonly has more than one physician or caregiver and these healthcare organizations and Physicians are not connected due practices of using data silos/disintegrated data. Frequently physicians and hospitals treats the patient from scratch, exchanging information is exchanged via faxed notes or phone calls may results in serious human error. (See Figure – 3.)

Figure – 3[19]
In order to demonstrate how serious this data silo practice may result, let’s take an example of a female middle aged patient who suddenly experiences chest pain after dinner one night. She goes to the nearest emergency room and has a rapid and extensive evaluation. Let’s say the results did not point to a heart attack, but there were indeed some abnormalities on the ECG.

The patient ends up being discharged home with the emergency department (ED) physician writing gastroesopheageal reflux as a possible cause, and instructing the patient to follow up with a cardiologist and their primary care physician. The next morning the patient will call the cardiologist and show up in his office that afternoon. In their hand is…..nothing, but they do remember the abnormal ECG they had in the ED.
The patient has no records from the hospital’s ED and unfortunately does not have the PCP’s ECG from last year showing the same abnormality. The cardiologist gets a new ECG, and puts them on a beta blocker and aspirin. The next day the patient goes to their PCP carrying….nothing.

The PCP sees the pill bottles and assumes they must have had a heart attack and orders more labs and sends them for a cardiac CT. All this for a simple case of gastroesophageal reflux? It’s not unheard of. [3]
In fact we are all affected by disintegrated data in our everyday life, few examples are given below;
Many people in all over Canada receive telemarketing calls to purchase a product that they already own? They are offered a special upgrade discount for a product which they don’t own? They called a technical support line and answered the same questions over and over as their call is passed from one customer service agent to the next?

Everyone has experienced the frustration of dealing with companies that do not integrate their customer information. Despite great advancement in technology gadgets, high-tech autos and other great products the same companies are still lacking in data integration. The next sect will highlight the reasons for disintegrated data.

5- Barriers to Data integration

Why despite a great potential of data integration, agility of healthcare organizations, well being of patients, staff and stake holders of healthcare organizations data integration is still lacking and practices of data silos still continued?

a- Political/Organizational

Integration of data from multiple systems and sources can be expensive, especially for the provider Healthcare organizations which might want data integration with multiple community physicians. Depending on funding arrangements, physician groups may face similar cost concerns if they are seeking to share data with multiple hospitals and other organizations in the service area. [5] Data integration will enhance stronger relationship between Hospital and the physician community.

b- Manual Data systems and Data silos in financial and Clinical

As mentioned earlier data that could be used to analyze patient financial outcomes, such as excessive costs, length of stay, or utilization of services, are collected in different clinical or financial systems by different entities in the system and typically are not integrated across the healthcare organizations. Redundant data entry occurs when a number of different staff members enter essentially identical data into different systems. The problem is worsening by external requirements that the IDS maintain separate registries for various purposes e.g., transplant or birth registry .

Clinical data regarding a patient’s health history and risk factors, including whether the patient is a smoker, is overweight, or has a sedentary lifestyle, high cholesterol level, or a genetic predisposition toward specific types of health problems, may be collected only in physician offices or entered only into stand-alone hospital registry systems, such as a state birth registry, cardiac registry, trauma registry, or organ transplant registry.
Clinicians and administrators may know exactly what data are needed to analyze a given set of patient outcomes. But if the data are documented by hand and stored only as paper records, the labor-intensiveness of the effort required to access the data will impede data tracking, reporting, and analysis [6].

c- Nonstandard Data.

Nonstandard data typically result when essentially identical data are entered into different systems using slightly different formats or values. Even when an interface exists between these different systems, the lack of standard data formats and values will make it difficult or impossible to access all of the data related to a given identifier.

Canada Healthinfo way “Standards collaborative guide key resource for health information standards” is a great source and key component of the Canada health info way goal. Collaborative are the building blocks for the health information exchange that is essential for sharing clinically relevant information in real time across the continuum of care. [13]

d- Invalid Data.

If appropriate rules are not established to ensure data validity, invalid data may be captured. For example, a data entry person might misidentify an 84-year-old man as an obstetrics patient rather than an orthopedics patient. This type of error can be minimized by implementing “if-then” programming rules, whereby the computer would automatically alert the data entry person when a patient is placed in a category for which the patient does not meet certain basic criteria (e.g., all patients assigned to the patient class “obstetrics” must be female).

e- Technical challenges

Differing uptime performance between systems (i.e., hospitals run 24 x 7 x 365 but physician practices do not and their systems may operate at differing levels of reliability) and the lack of highly skilled technical data integration resources. [5]

6- How the challenges of data integration can be overcome

There is no magic wand which is once used and all the data is integrated, but it’s a mindset and critical thought process of working with a data set and viewing of data in the context of overall healthcare agility. It is also about organizational discipline in making use of healthcare data. The most critical factor is data governance, as control will not come without governance. It starts with higher level management’s commitment. Data integration is a continues improvement process of healthcare organization by using technologies and business process improvements. Data Integration Path –See Figure 4 [8]
Figure – 4

In Canadian perspective, Canada Health Infoway long-term plans on building interoperable (EHR) infrastructure will undoubtedly address the healthcare data integration. At provincial level Government of Ontario have taken right direction toward IT implementation, at present, government policy requires communities to fund all of their equipment costs, including information technology (IT) to address the following concerns on the principle that;

Hospital IT systems in Ontario should be interoperable across departments, as well as between hospitals and community providers. It would prevent duplication of tests, increase patient safety, and integrate patients‟ health information across a variety of providers. Sustained funding and coordinated planning should be major components of the provincial IT strategy.[11]

a- Not Just Technology – Governance is critical

Data governance ensures that data can be trusted and that people can be made accountable for any adverse event that happens because of low data quality. Not only do we need to break down silos to connect doctors, patients, researchers and insurers, we must specify what kinds of data they can share and under what circumstances they can do so.

Defining these policies is the number one job of data governance, and it’s more about organizational dynamics and rationalizing goals, objectives and expectations than it is about technologies involved in data management. With data governance, trust in data sharing is built and maintained. Without it, the underlying systems and technologies will still be inefficient. The worst outcome is that we spend scarce resources building more sophisticated silos, thereby driving the costs of health care up instead of down [7].

b- Integration and Interoperability

For the purpose of this paper it is also very important to explain difference between integration and interoperability as sometimes these are used interchangeably. Integration is the arrangement of an organization’s information systems in way that allows them to communicate efficiently and effectively and brings together related parts into a single system.

Interoperability is the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities. http://www.Himss.org

7- Advancements in healthcare data integration

a- EHRs a driving force behind the data integration

Although current Electronic Healthcare records applications are doing good job of replacing paperwork and storing information digitally but is that sufficient? The answer is absolutely not. This is a minimal application of highly capable technology. This is like buying a computer for writing letters only, is that best use of computer? Again answer is absolutely not.

EHR without integration will results in another data silo, and in most healthcare environment they are still not integrated and staff have to login to different hospital system to get the required information.
Healthcare is so far behind in basics like user interfaces and data integration that most of the money spent on electronic health records will have to be re-spent later when the technology actually catches up, according to a new report.

In United States nearly $20 billion in stimulus money will flow to Healthcare providers, primarily for Electronic Health Records (EHR). By late 2010 many more healthcare providers will evaluate their EHR efforts with mixed reactions. By 2011/2012 new technologies will emerge to support a better physician and patient experience. [12] Unfortunately most of the Electronic Health Records applications are not technologically smart enough to deliver true potential of (EHR). Additionally (EHR) are being implemented rapidly because of governmental incentives and adverse consequences of not having (EHR). Moreover in the light of current advancements in wireless and mobile Information technologies all of EMR applications have to be upgraded at heavy cost within next few years this research paper will highlight emerging trend in data integration.

Discussion of advancements in Healthcare data integration will be incomplete without writing about Canada health info way’s efforts to enabling Interoperable EHR Solutions because organizational data integration will be incomplete without that.

b- Canada Health infoway

In Canadian perspective, Canada Health infoway is dedicated to implement (EHR) all over Canada by insuring the best use of technology and successful project implementations. Canada health infoway is fully aware of the data sharing importance in (EHR). To meet clinical and future business needs and support (EHR) interoperability, these disparate health information systems must be able to share and synchronize patient health Information while maintaining the integrity and security of the information exchanged. [2]

As per Canada Health info way (EHR) Blue print, shared reference information source will be populated with clinically relevant data by the various Point of Service Systems (POS) systems. Other POS systems or viewers reference it, and pull needed data from it. This reference source will remain external to the system of each POS and does not directly touch the POS.

The above model (Figure 5 [2]) as per blue print 2006 will address the following concerns of data integration/interoperability; When full interoperability is achieved at the jurisdiction level using the principles of (EHR) blue prints then ability to find and access EMR data across country will be a reality. [2]

c- From National Interoperability to Organizational data integration

The above information was critical to cover the scope of this paper and now we know that infrastructure for data integration for healthcare organizations have been implemented or underway at governmental level i.e. data interoperability and now it is up to the organizations that how they model their internal information systems to reap the rewards of government support in technical and other incentives.

In the previous sections we also highlighted the data integration and its impact on Healthcare and how agile organizations overcame data integration challenges. We also covered the data integration and data interoperability and Canada health Infoway’s initiatives to this direction which are critical for achieving the organization data integration and resultantly agility of Healthcare organizations. In the next section we go through the technologies available in the market and there features which further enhance the understanding and help healthcare providers make informed technology.

8- Healthcare data integration Vendor Market

Healthcare integration software vendor in this paper are based on research on their product’s and services relevance with data integration topics and their effects on the agility of the healthcare organizations. Additionally these are ordered based on data integration products case studies and information on their websites.

Purpose of selected case studies in this research paper is also to have the in-depth knowledge of data integration topic in general and related vendor in particular.
 Microsoft Amalga
 Novo Innovations
 Mobilicity
 Health vision now Lawson
 Bluegate

a- Microsoft Amalga

As mentioned earlier Microsoft purchased Amalga in 2006, it was developed at MedStar Health’s Washington Hospital by Doctors under the name Azyxxi and that is one of the strongest point in Microsoft Amalga.
Microsoft Amalga brings historically disparate data together and makes it easy to identify and act on insights into clinical, financial, or operational performance.
Microsoft Amalga helps answer questions like these:

 How can we use one centralized system to improve operational performance across the enterprise?
 How can we get usable reports faster?
 How can we create a simpler process for managing CMS quality measures that helps minimize abstraction time and redundant reviews?
 How can we help ensure our organization is properly reimbursed for patients admitted from the Emergency Department?

Case study of Microsoft Amalga

At Washington Hospital Centre, physicians and residents use Amalga to easily search for and analyze patient data, in addition to retrieving information.
“We use Amalga to trend test results, which is especially important for patients with multiple hospital visits,” says Hong. “I can see prior laboratory values for particular tests extended over several visits and view a single test result in the context of the overall “We use Amalga as a teaching aid with all of our students … because it’s so flexible and dynamic.

It is a terrific educational tool.” Lisa M. Boyle, MD, Associate Chair, Department of Surgery, Associate Program Director, Surgical Residency Training Program, Washington Hospital Center In addition to retrieving information, physicians and residents use Amalga to easily search for and analyze patient data. “We use Amalga to trend test results, which are especially medical history of the patient. That’s very powerful [9].”

b- Novo Innovations (Now Medicity)

As per Novo innovations website, only the Novo Grid connects all healthcare stakeholders for community-wide health information exchange, on a flexible and adaptable platform, so that all parties involved in delivering care to a patient – including physician practices with and without EHRs – have the most up-to-date and accurate, 360° view of their patient’s health.

According to them their patented Grid technology forms a secure peer-to-peer network to distribute and exchange health information – including orders, results, transcribed reports, problems, medications, allergies and demographic data – across acute and ambulatory care settings.

The Novo Grid seamlessly integrates health information across the care continuum, while at the same time creating a “professional social network” among participating providers – such as primary care physicians, specialists and ancillary service providers – enabling them to more effectively communicate, collaborate and coordinate patient care. This unique Grid approach keeps patients at the center of the universe, with the care team collaborating around them in a coherent manner. http://www.Medicity.com

Case study of Novo grid

Atlanta Women’s Hospital implemented the Allscripts Professional EHR in 2002 and was able to establish electronic connectivity between their EHR and partners like Quest Diagnostics® Lab Information Systems, Genzyme Genetics, and LabCorp. However, they hadn’t established connectivity with Northside Hospital – their biggest trading partner, which continued to deliver information via fax and courier – because of the complexity of interfacing with multiple clinical systems within the hospital.

To reduce costs, save staff time, improve the timeliness and quality of information, and truly capitalize on their Allscripts investment, AWS needed an interface from Northside into their EHR.
Before integration via the Grid, AWS staff would receive reports and summaries by fax, scan the documents, save them in electronic format, and manually match each one to a patient in the EHR. The volume of information received often required several staff members each day to handle the processing load. However, with integration in place, patient information is delivered automatically and directly into the EHR within minutes
in a discrete data format without requiring involvement of staff members to manage the process. [10]

If Microsoft Amalga was developed by Doctors at Washington Health Centre, the Novo leadership’s background at McKesson provided ample experience in integrating complex and disparate technologies.

c- MobileMD

According to the Mobile MD website their 4DX Intelligence Engine Network is a scalable, cost-effective and practical answer to clinical data and information exchange. Clinical and administrative data e can be exchanged securely between all members of the healthcare community. Eliminates need for on-site connection software or hardware and Communicates in multiple formats, including HL7, XML and others. Also supports transmission of continuity of care records (CCR) and continuity of care documents (CCD). MobileMD operates as an Internet-based ASP and available 24x7x365.

http://www.Mobilemd.com

d- Health vision now Lawson acquired by Lawson on January 2010.
e- Cloverleaf Integration Suite
Market-Leading Integration Engine for Healthcare – Proven to Perform
Lawson Cloverleaf is an enterprise-caliber healthcare data integration engine that facilitates the movement of data through disparate systems within and outside your enterprise. As the cornerstone of your interoperability strategy, Lawson Cloverleaf Integration Suite can help streamline efficiencies to reduce administrative costs and save time – so you can focus on delivering quality care.

Lawson Cloverleaf Integration Suite is a proven, reliable integration technology platform that is at work in thousands of facilities around the globe: 40% of all large integrated delivery networks; 33% of all hospitals in North America. http://www.Lawson.com/

f- Bluegate

Like Mobile MD, Bluegate’s Link connects Hospitals, Medicaid, payers and Physicians through an Internet-based network with no software or hardware to purchase by using your existing fax machine and Internet connection.
Bluegate Link is an all-encompassing communication tool that electronically transfers protected health information between trusted healthcare parties.

All communications are time and date stamped with an audit trail, minimizing future denials. This web-based technology enables you to send and receive protected health information while meeting HIPAA privacy requirements and revenue cycle management is improved by streamlining the efficiency and accountability of healthcare.

Deployed using your existing fax machine and Internet access, Bluegate Link will seamlessly bring together electronic records and paperwork creating a single workflow process for communication, which can be securely accessed from any location with Internet connectivity. http://www.Bluegate.com/

g- Other vendors

Many of the large HIT vendors such as Allscripts, Cerner, Epic, Eclipsys, McKesson, Meditech, Medsphere, GE Centricity, Siemens SMS and so on, has unmet requirements for data integration. Each requires data integration in order to attain interoperability with existing local and remote electronic healthcare record (EHR) systems.

End-user enterprises (hospitals and physician practices) are considering purchasing applications like these with the hope of being financially reimbursed by demonstrating meaningful use under HITECH/ARRA. Like the ERP vendors of the late 1990s and early 2000s, these run-your-provider systems are at risk of proliferating the islands of information rather than eliminating them.[8]

9- Major Findings

Data integration in healthcare organization is now being implemented at governmental levels and these should be implemented at healthcare organizational levels and physician’s offices level. A critical point to remember is that data integration is not only technologies but mindset and data governance. Through data governance responsible personnel should be subject to consequences for any carelessness i.e. data silo practices, invalid data entry and not following data standards.

Although there are major vendors in the data integration market but there products should considered carefully with long term view. For example are there software is quick fixes? Or they aligned with organizational goals? This is also very common that organization may develop solutions in house, more efficiently and these solutions are frequently more practical than buying readymade software.

The electronic health records are key driving force for the increasing need of data integration. In Canada, Canada Health info way’s (EHRs) Blue print is great source of data integration information and should be an integral part of data integration at organizational levels. Canada Health infoway’s standard collaborative comprehensive resource guide can be used to overcome medical errors and reduction of paper work. Healthcare software vendors can consult this guide to offer standards-based products demonstrating a commitment to delivering high-quality interoperable solutions. According to the Canada Health Infoway EHRS Blueprint, when full interoperability is achieved at the jurisdiction levels, using the principles of the EHRS Blueprint, the ability to find and access EHR data anywhere in the country will be a reality. [2]

10- Conclusion

This paper reemphasizes that potentials of true healthcare data integration are enormous but it should pursued carefully to avoid costly mistakes. Appropriate participation of healthcare staff at all levels and patients must be taken into consideration. Top level managements initiative is very crucial and without data governance, even a highly sophisticated technology is useless. A phase by phase approach for the implementation of data integration in organizations is required. Electronic health records should be implemented in an integrated system, otherwise they are no more than other data silo. By integrating existing clinical findings and other documents, patients may be less exposed to unnecessary duplicate examinations and examination costs can be reduced. If the end users need data in specific formats such as in spreadsheets or word documents, data must be exported from centralized integrated database into spread sheets or word documents. Receiving the data from a centralized integrated source will be very effective in combating frauds in healthcare and overall significant betterment of Healthcare industry.

References

1- Information Management. (2005) – Data Integration Channel
Retrieved February 20, 2011, from http://www.information-management.com/channels/data_integration.html

2- Canada Health Infoway EHRS Blueprint (2006) Retrieved February 15, 2011, from https://www2.infoway-inforoute.ca/Documents/EHRS-Blueprint-Infosheet.pdf

3- Wodajo, F, MD. (March 02, 2010). The compelling results from their study with the
Cleveland Clinic, Retrieved January 31, 2011, from http://www.imedicalapps.com/2010/03/microsoft-healthvault-community-connect-cleveland-clini/

4- Wodajo, F., MD,. (2010, February 3). Compelling results
from their study with the Cleveland Clinic, Microsoft Health Vault Community
Connect Retrieved February 17,2011, from http://www.imedicalapps.com/2010/03/microsoft-healthvault-community-connect-cleveland-clini/

5- Impact Advisors, LLC. Healthcare Data Integration Market
Overview(2008, September 30). Healthcare Data Integration Market Overview.  Retrieved February 17, 2011, http://www.impactadvisors.com/UserFiles/file/IA%20Whitepaper%20-%20HC%20Data%20Integrator%20Market%20Overview%202008030.pdf

6- Merlo, J, Freundl M,. (June, 1999) Overcoming the barriers to cross-continuum
information integration. Healthcare Financial Management. Retrieved January 20,
2011, from http://findarticles.com/p/articles/mi_m3257/is_6_53/ai_54956134/?tag=content;col1

7- Fernandes L,. Moseley, M, (March 17, 2011) Improving
Health Care Data with MDM and Data Governance, Information Management.
Retrieved January 20, 2011, from http://www.information-management.com/infodirect/2011_195/data_governance_management_MDM_health_care-10019950-1.html?portal=data_integration

8- Agosta, L,  Ph.D, (June
1, 2010). Data Integration Delivers Healthcare Meaningful Use. Retrieved
January 31, 2011, from http://www.pervasiveintegration.com/dcontent/Collateral/PervasiveHITR.pdf

9- Microsoft case
Library. (March 2008).Teaching Hospital Uses Unified Intelligence

System, Improves Education and Patient Care, Retrieved October 30, 2001, from http://www.microsoft.com/amalga/library/default.mspx

10- Medicity Written case studies. (2006). Catholic Health Retrieved March 2snd, 2011, from Novo
InnovationsSystems now Medicity http://infosite.medicity.com/Images/PDFs/CaseStudy_CHS.pdf

11- Hospitals’ Roles, Relationships and Funding May 31, 2010. OMA Principles to Stimulate Discussion.
Retrieved March 5th, 2001, https://www.oma.org/Resources/Documents/HRFprinciples2010-05-31.pdf

12- Rob, T, (November 2010). Top HIT Trends for 2010-11 -
Innovation and Acquisitions Healthcare ITS, HIT Spotlight Issue Number One
(March, 2010) Retrieved January 31, 2011, from www.siteground135.com/…/spotlights/hit%20spotlight%201%20pdf.pdf

13- Standards Collaborative guide – Canada health info way (2006) Retrieved January 31, 2011, from https://www.infoway-inforoute.ca/flash/lang-en/scguide/docs/StandardsCatalogue_en.pdf

14- Pearlstein, S, (March 4, 2005). Innovation Comes from Within. WashingtonPost.   Retrieved January 31, 2011, from http://www.washingtonpost.com/wp-dyn/articles/A5780-2005Mar3.html

15- Steve S, (2009). “The Data Governance
Imperative”, IT Governance. (p. 38).

16- The National Bureau of Asian Research. (2009), Forum
Challenge: Moving beyond the Limitations of the Traditional Healthcare System Retrieved
October 30, 2001, http://www.nbr.org/publications/element.aspx?id=477

17- Fisher, T, (April 30, 2007). Demystifying Master Data Management, CIO.com, Retrieved January 31, 2011, from http://www.cio.com/article/106811/Demystifying_Master_Data_Management?page=2&taxonomyId=3006

18- Tackling the Tough One. (2009 December 23). Master Data Management for the Healthcare Enterprise Retrieved January, 30 2009 http://edgewatertech.wordpress.com/2009/12/23/tackling-the-tough-one-master-data-management-for-the-healthcare-enterprise/

19- Huber, H, (February 11, 2010). Healthcare Data Integration – Will EHR Adoption Widen the Gap? Retrieved February 27, 2011, from http://blog.gossergroup.com/2010/02/healthcare-data-integration-will-ehr-adoption-widen-the-gap-.html

A client wants see the customer orders list in the comma delimited format in crystal report view used in a custom application. Customer name and related orders are stored in 2 different tables.

Please figure 1 below report can be created by placing the customer names and related orders.

Client wants to see this in the following format please see figure 3 below

We only have the option of using Crystal report side to produce the above result by using formulas and data tables provided.

Solution;

Crystal reports Array function can very easily handle this request.

Create formulas – init

1- whileprintingrecords;
stringvar array relatedorders;
numbervar counter :=0;

Create a Group customer Name and place the above formula in group header Customer name.

2- Create formula – Cumm

whileprintingrecords;
stringvar array relatedorders;
numbervar counter;
counter :=counter+1;
redim preserve relatedorders[counter];
relatedorders[counter] :={Related_Orders.Order};

Place the above formula in detail section and suppress the detail section.

3- Create a formula Display and place it in the Customer group footer 1

WhilePrintingRecords;
stringVar array relatedorders;

Join(relatedorders, ‘, ‘);

Please figure below

Now run the report it should look like figure 3.

Figure 1: A table of contents, showing group names and page numbers

The technique that we will describe has the advantage of being very simple – only three short formulae are needed. But it also has two important limitations. First, the TOC must always appear at the end of the report, rather than at the start where most people would expect to see it. That’s because group names and page numbers are not available until all the groups have been printed.

Secondly, the technique is only suitable for relatively short TOCs – typically those containing up to 20 to 40 entries. If the total length of the entries exceeds 254 characters (the maximum length of a string in CR), the surplus characters will not appear.

If those limitations are too onerous for you, there is an alternative approach you could take, although this has drawbacks of its own. More about this later in the article.

First build the TOC …
To create the TOC, you first need a formula which collects the group names and their corresponding page numbers and stores them in a pair of global string variables. The formula, which is placed in the group header band, looks something like this:

global stringvar strTOC1;
global stringvar strTOC2;
local stringvar strTemp;

if not InRepeatedGroupHeader then
( strTemp := {customer.country} + chr(10) ;
if len(strTemp) + len(strToc1) <= 254 then
( strToc1 := StrToc1 + strTemp;
strToc2 := StrToc2 +
totext(PageNumber,0) + chr(10) ))
The formula declares two global strings variables. The first of these, strToc1, holds the group names (the country names in this example) separated by line-feed characters. The line-feeds ensure that each name will appear on a separate line within the table of contents. Before adding each new group name to this string, we check to see if it has reached the limit of 254 characters. If it has, no further names are added.

The second string, strToc2, holds the page numbers, converted to text. These too are separated by line-feed characters.

You might be wondering why we didn't choose to build a single string containing both the group names and the page numbers. This is a matter of alignment. Given that the group names vary in length, there would have been no way of getting the names and the numbers into two neatly aligned columns if they had been in the same string. Creating two separate strings solves that problem.

After you have added the above formula to the group header section, be sure to suppress it to avoid spurious output appearing in the group header.

... Then display it
To display the TOC, we need two further formulae, both of which are extremely simple. The first simply returns the contents of the group name string, like so:

whileprintingrecords;
global stringvar strTOC1;
strToc1
The other formula, which is almost identical to the first, returns the contents of the page number string:

whileprintingrecords;
global stringvar strTOC2;
strToc2Place these two formulae in the report footer section. Position them side by side, and line them up along their top edges. Be sure to enable the Can Grow option for both formulae (do this from the Common page of the format editor). To improve the alignment of the page numbers, right-justify the second of the two formulae. Finally, add a suitable text object (such as 'Table of Contents') to label the TOC.

And that's all there is to it. When you preview the report, you should see the finished table of contents, complete with group names and page numbers, all neatly lined up on the last page of the report.

An alternative approach
Earlier, we mentioned two drawbacks that might rule this technique out for your reports. There is an alternative method of creating a table of contents that doesn't have these disadvantages, although it is much more complicated than the technique we have described. It involves maintaining a special table in the database to hold the TOC, and updating this by means of SQL code within the report.

However, this method should be approached with caution. In general, it is not a good idea to write data to the database from a report, because a mistake could lead to invalid data and corrupted tables. You would also need to have the necessary permissions to create and update tables, permissions which database administrators might be reluctant to grant. Also, the ability to write SQL code to update a database was only added in Crystal Reports 9.0, so the technique would not work with earlier versions.

If, despite these difficulties, you would like to know more about this table-based approach, you can find full details at http://support.businessobjects.com/library/kbase/articles/c2011950.asp.

Summing up
If you can live with the drawbacks mentioned earlier, you should find the technique which we have described in this article to be a simple and effective way of creating a table of contents for your reports. We have often found it useful in our own reporting projects, and we hope you will find a use for it in yours.

Mike Lewis Consultants Ltd. January 2004.