Lawson and Epic/Optim

Leslie,
We will be going live with our first OPTime site in the next week or so...and, yes, we will be doing pretty much exactly what you are talking about (though 20K items is a bit less than our total build out). We actually started this process in our Picis application(s) through a modified IC527 interface. I can go into pretty decent detail about the Lawson->Picis interface process. I am little less certain about how we are going to this same process in OPTime, because the use of the common "SUP" file is a bit of a different paradigm (as compared to the location-focused set up in Picis).

As a by the way, I do not endorse this process, per se: it runs counter to my "Master Data Management" indoctrination. But we could not come up with a better way to tie the EAP (CDM) code to the Lawson item.

Not sure that this helps,
Red

It seems like a lot of work/maintenance, especially when it comes to contracts and pricing. I wonder is there a way to build the items in Optime without building them in Lawson? We currently have an Epic workqueue that notifies Purchasing when a new item is used so that it can be built with a charge code, then added to Epic. I was hoping that if they built the items in Optime the OR staff could select the implant and then use the normal workqueue process for us to build in Lawson. What they are proposing sounds like buidling the entire phone book on the off chance that someone may come in to our facility and we'd need to have the number loaded. My concern is also with the chargemaster and maintaining correct charge codes. How many items are you building and do you have a plan for maintenance?

Thanks for anything you can help with!

Plan?!? We don't need no...

Anyway, you are correct, we are building items on the basis that they "might" need any one component at any moment in time. (Did I mention that I do not endorse this plan?) There were several thoughts as to the "why" of this... First, there are significant economies of scale when building 3K, 5K, or 7K similar items from a single manufacture. Especially when compared to getting peppered with 200 - 500 requests throughout the year because the items are not built. Second, there is an inherent expertise in the building of the items (different than the specific use-knowledge of the items) that makes my team more efficient at the item building process. Third, from a different efficiency perspective, we do not want our nursing or billing staff to spend time building items. I was going to lead into that point by saying that it is cheaper to have my team build the items, but I think that point is really debatable. Hour-to-hour, we are absolutely less expensive than the OR folks, but this is outweighed by the sheer number of person hours spent building the full catalogs (including some temp staff that I was able to utlize as well). The fourth issue is that there is a set window of time for billing a patient, and waiting for an ad hoc item to be built and interfaced to the Epic was seen as taking too long.

So, speaking of phone books, the stats that I have at hand are... We have a total of over 33K component items now built out, with about 2,300 more to go. Not all of these were built specifically as a part of this project (about 35% were previously built in just the normal operations). Of 13 identified suppliers, we have completed 8 catalogs, and have two more to complete in the short-term (three are currently on hold for external reasons).

Other thoughts... This is only Total Joints (primary and revision). This does not include Spine, Trauma, or Cardiac Rhythm Management, which look suspiciously similar, from a use-case perspective.

Other thoughts, part 2... Our EAP codes are based on a matrix of general item classificaitions/groupings and acquisition costs. So, six EAP codes may cover literally thousands of different items. On a periodic basis, our Revenue Cycle folks review the EAP to Lawson Item assignments to validate or update the values.

People think I am crazy when I say that I have an Item Master of over 300K items. They are probably right...
Red

Hmm. Sounds like we might be stuck with building everything. The EAP codes which are grouped is something I had not thought of. I'm not sure how much the revenue team is involved in this process. We just kind of had it dumped on us. The Purchasing Manager and I are trying to get a feel for what other companies are doing. Our item master is currently around 76,000 items (including inactive ones), and I really hate the thought of chunking it up with a lot of useless things we will never order. We have a streamlined item add process, but it is still a LOT of items. Synthes alone looks like around 15,000 give or take.

We went live with Optime 2 years ago.  OR management brought in consultants to help them through the operational decisions of the project and one of the decisions made was that every item they could anticipate using needed to be preset up in Lawson to interface with Optime ahead of time.  We argued against it but lost that fight.

Our line in the sand was that we would not add entire catalogs for them - items that are used have to be preapproved by our OR Value Analysis Committee and so we have not gone the route of adding entire catalogs for them.  Even so, we have thousands of items that they never use.

If the item is not in there, OR staff can add it as a one time use item in Epic at the time of the case. We have reportst that are supposed to tell us if this happens.

In Lawson, we created IC12 records (non inventory tracked of course) so we could tie a source vendor to the item. Our location for all of these items is simply OPTME.  If it is there - the interface knows to send it to EPIC. Implant item in the OPTME location are also marked on IC11 with the item major class IMPL and a minor class coding to assist EPIC with categorizing them.

Charge codes are kept solely in the EPIC OPTIME balance records. Everything in OPTME is added automatically to our main OR's balance records.  Any of our other locations that need an balance record created  are done manually by the our inhouse EPIC support (we have two surgicenters, a digestive health area, labor and delivery area and a regional hospital that we merged with all using OPTIME),

The one major problem with including charge master numbers on Lawson item numbers is that not all departments use the same charge master number for the same item. If you're only using this for surgery then that should work, but if you need to account for additional departments (and they don't all use the same charge master number) then your best bet may be an external table that billing can maintain (per department, per item) and interface that to Epic.

You can still create a Lawson interface for new items (only) to this external table and include a notification to billing so they can review to see if a charge number needs to be created.

David brings up a good point, and I should have clarified... As we have been rolling out the EPIC application, it has been established that the acute care facilities utilize a common chargemaster (EAP). There are some variances in how the individual EAP code is charged by facility (primarily based on geograph/environmental issues), but that is well outside my ken (I am lucky that I can parrot the terms).

Still, it seems like you would be able to use the PC10 screen to house the EAP information and handle the different codes at different locations that way. Going a little deeper into our process, we house the EAP code in one of the Item Master User Fields. When an affiliate goes live on Epic, they then participate in a synch program that cascades the information a specific User Field on the Item Location. This last step is done for two reasons. The first is that it was where we housed the CDM information for a legacy (MS Access) patient-charge label program. Second, as we are midway through the Epic rollout, some facilities are still using their own CDM numbers while others use the common EAP code. Once we have completed the rollout, I am imagine we point the Lawson->OPTime interface directly to the Item Master.

Red

We actually use our Lawson # as our charge (CDM) number, so that is not a problem. All the locations use the same EAP info.

So, here's an idea we had -- let me roll it past you all: We have most of the vendor catalogs in Excel format. What if we pre-assigned block of Lawson numbers (we don't use autonumber - not my decision) for those items and had them loaded to the EAP with zero dollars. Then when the item was used we would actually BUILD it through in Lawson and assign dollar value then. Our turnaround on charge codes currently is 24 hours once it hits our Epic workqueue, so that would not interfere with the billing process.

Thoughts?

We went a similar route to Red's - we started with PICIS and have since switched to Epic Optime. We built an itemmaster item for the ortho screws in the trays. Yes, it was around 20-25 thousand skus for the ortho trays alone.

Our stance is that if the item drops off the contract for the tray, it's being inactivated. So we can match the consignment/tray spreadsheet to a PO25.6 and if it's on PO25.6 but not the sheet - it gets inactivated. If it's on the sheet and not the PO25.6 it gets an itemmaster item.

The problem with your zero charge plan will be that you are still maintaining it in the itemmaster - how would you prevent it from being added to a PO or req?

We would not build it in Lawson at all; only in the EAP with a pre-assigned Lawson #. That way the nursing staff could choose it off the list for documentation purposes and we would add the pricing with our current workqueue process. Once the Purchasing staff was notified that the item was used, we would build the pre-assigned number all the way through in Lawson.

Who builds your EAPs? We've been told that they would need a Lawson number to add to Epic EAP.

We would "pre-assign" a Lawson number on an Excel spreadsheet with description, UOM, etc., for them to build in the EAP, with a zero dollar charge, but we would not actually build it in the Lawson item master until they used it in the OR. The Epic team still has the same amount of work, but we don't have to build entire catalogs in Lawson and maintain the pricing in PO25. That would keep our file maintenance down to what they have used. Of course it would mean numbers that are not in necessarily sequence in the item master, but we are not using autonumbering anyway, and it would have the advantage of readily identifying the implants.

Kat,
That sounds more like a process requirement rather than an application requirement. In our system, our Revenue Cycle team builds out the EAP codes. This can be triggered by a new Lawson item (we have Item X and need an EAP for it), but if an existing EAP meets the criteria then the relationship between Item and EAP merely needs to be validated by the Revenue Cycle team. An alternate model, as I believe was mentioned above, would be that the Lawson number is serving as the EAP code (or any other enforced one-to-one relationship), could explain the Lawson Item requirement.
Red

We are interested in using an Epic generated workqueue with Lawson process flow (via Cloverleaf?) to build 'one-time' items from OpTime into Lawson, various IC12 locations. Anyone using process flow to achieve this?  Our current process requires our billing team to key data into an Excel spreadsheet to send to Lawson MDM team for new item adds.

We've actually resisted this and will continue to do so. The information that nursing puts into EPIC in order to charge is not sufficient for our standardized descriptions, part numbers (vendor vs manufacturer), pricing, etc in Lawson. We use the spreadsheet method to have them give us what they want and then we cleanse the data before uploading it into Lawson.

We have about 10,000 items we've added to Lawson because of EPIC (we have both OPTIME and CUPID products) but they go in when we are sure the data meets our standards.

Michelle

And another thought....if it is truly one-time items, do you really even want them in Lawson? If they are going to continue to use the product, absolutely, but if it is never coming back again the billers can do a one time charge in EPIC without you having to setup the item in Lawson. Just my two cents.

Michelle

To Michelle's last point, we ran into a similar issue when it came to building out X-type special items. Our threshold was if usage was expected to be more than twelve orders per year, then we were to build it out as a system item (I- or N-type). The problem came in that one facility may only order the item once or twice a year, but across our system we could see dozens of orders (a prime example would be ICD coding books). To go back to Michelle's comment; one-time in one OR, one-time in another, etc, and soon enough it adds up to real demand...and sometimes it doesn't.

Red

To clarify, implant items brought in by sales rep not already in OpTime's inventory system are used in surgery, we must assign them a Lawson item # to charge and bill. If they are not built in OpTime, circulator has to key in several pieces of information, which is later sent to Lawson MDM to add IC11 and IC12, for PO creation and charging. We are looking to streamline this process. 

Thanks.

I agree with Michelle and Red. It was my first thought when I read the post that we don't add items with infrequent purchases to Lawson. Another thought was that nursing may not find the item they're looking for in Optime when it really is there which might create duplicate records. Here, before surgery items are added to Lawson they have to be approved by the OR VAT so in a perfect world any items that are charged to patients should be in Lawson before they're used in the OR.

Folks,
I did have an operational question related to the general process described above (build in Lawson and interface to Epic). How do you deal with 'inactive' items in the Lawson system?

Here is general situation A. Content Management receives notification that a manufacturer is discontinuing an item. There may be a suggested replacement, or not. We go through our standard validations and find no open orders and no stock-on-hand, so we inactivate the item throughout the system. Due to Par processes, the item is physically on the shelves but is nowhere in the system. Lo and behold, the OR now wants to bill for the item but cannot because it shows as inactive in Epic, thanks to the interface. On a one-off basis, we can reactivate, wait a day or two and then re-inactivate.

But here is general situation B. Contractually, we are moving from Item A to Item B. We go through our standard validations and find no open orders and no stock-on-hand, so we inactivate Item A throughout the system. Again, due to Par processes, Item A is physically on the shelves but is nowhere in the system. Again, the OR wants to bill for Item A but cannot because it shows as inactive in Epic. Here we run into a problem, because keeping Item A active for any length of time runs the risk of someone putting in an order for the Item (causing a number of downstream issues).

Hoping for a silver bullet,
Red

We also have items going through ORVAT for approval (in theory) before they are used. We haven't found that perfect world yet and so we have a number that show up as carried in for cases that we have to create POs for. However, if they aren't in Lawson, the buyer creates a special order PO for it; we don't require the Lawson setup before we can pay or charge for it. We give the billers the information they need and they bill it in EPIC if it doesn't yet exist in Lawson.

To Red's question about discontinued items - for scenario A - we inactivate it in Lawson and remove it from the interface. We do not send inactivations through the interface so it is still technically available to charge in EPIC.

For scenario B - if the item is substantially and clinically the same we can reuse the same item number (a glove is a glove is a glove) but if it is used for a different purpose or is determined by VAT to be very different we inactivate item A and create item B. Again, we don't send inactivations so the OR can still charge for the item A as needed though we do ask them to globally replace item A with Item B on any preference cards.

If we use the same Lawson item number, we have all mfg # iterations going into an alternate ID field in EPIC. This allows them to match whichever version of item A they are needing to charge for.

Michelle

We gave the Optime "Flex" report to the managers with our upload sheet and asked them to map it. That ended the discussion of us trying to pull the information from Optime. The one-offs are just that. They use a flex code for either special things brought in for a patient or for items that are inactive and being used up.

I added ALL the ortho screws, I get to take them out as they go off the market. Basic rule of thumb for us is if I can't get valid reorder information/contract pricing for the item, it is a flex code.

Red -

Your scenario B - the conversions. They are treated very similar to product discontinuations. All users are notified when the conversion is "live" and the old numbers have a description change: "L# VOID USE [New L#]" - if it's a stock item, they have until month end to get the stock off their shelves and then we inactivate it.