Enterprisse Application Integration

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1 Different Systems, Common Purpose How an occupational health management system can fit in with the rest of your information management systems. by Peter Singer The members of an organization will inevitably reach a point where they determine that the combination of three-ring binders, spreadsheets, word processing documents, and Fred's homegrown Microsoft Access program isn't the most efficient way to manage occupational health, safety, and environmental (OHS&E) information. There are several options for selecting, purchasing and implementing such a system. As we focus on the many considerations for implementing such a system, I will illustrate a lot of the concepts through a case study. So you've selected the right software, obtained budget approval, purchased the software, and installed it. Congratulations! You're done, right? WRONG! Getting to this point was the easy part. Typically, there is much more involved in fully implementing such a system regardless of whether it's off-the-shelf or developed from scratch. Enterprisse Application Integration Of course the software industry requires a new buzzword for every new methodology, even though a lot of what's discussed below has been done in one way or another for years. In this case, the buzzword is Enterprise Application Integration (EAI), which is the process of intelligently routing and translating information between different software systems. Usually there are demographic, organizational, and industry-specific data that need to be entered into any new system-but no one wants to manually enter all that information. After all, computers are supposed to make our lives easier, not harder. Perhaps your demographic information is in PeopleSoft or some other human resource system. You may have your organizational codes, which define your location and related information, in a mainframe database. Maybe your ICD-9 diagnostic codes are on a CD-ROM in a proprietary format. So, how do you get all this information in to your new system? The answer is, "It depends." Departments Usually there are demographic, organizational, and industry-specific data that need to be entered into any new system--but no one wants to manually enter all that information. Ideally, you could just tell the new application to get its HR or other data directly from the original source. Hey, the vendor said their software is PeopleSoft-compatible, so it's just a matter of plugging it in, right? Unfortunately, although it may be possible in certain circumstances, it is typically not that simple. The HR people may not want you to have direct access to their data, but they're willing

2 typically not that simple. The HR people may not want you to have direct access to their data, but they're willing to make a copy for you every week or month so that you can put new and changed HR information into your system. Some HR systems may not be able to tell when information was added or changed in their database, which means that all the data needs to be transferred every time. This is not the most efficient manner to extract data, but it may be the only option in certain circumstances. At least you now have something with which to work. The next hurdle: different systems generally don't store the same pieces of information. Although hat size, for example, might be a vital statistic for one organization, chances are good that it isn't vital for every other organization. Furthermore, the types of information that are the same may not match. Did you ever think you'd need more than 14 characters to hold a phone number? Maybe that limit didn't come up until your organization merged with Euro Inc. Data In, Data Out Somewhere some "massaging" needs to take place. It may be in the source application, in the target application (assuming it has the ability to "talk" to other data sources and the power to do some massaging) or in some external program with the sole purpose of extracting and massaging the data. The massaging portion reads the source data, re-formats it, validates it, and generates a log file to let someone know about any problems that need to be fixed. It is often at this point that people realize how poorly their source data was organized. Internal, non-validated codes in plain text fields can be a real problem if the code is now going in to a validated field in the new system. You'll need to populate the appropriate reference table first. You'd be surprised how much cleaning up typically needs to be done when taking data from one system and putting it in to another. A term sometimes used is "GIGO," which stands for "garbage in, garbage out." Unfortunately, if the proper controls and checks aren't in place when people enter information into a system, nothing is going to make it any better (and chances are, may worsen them) when they try to take it out for use in another system. Something to take in to consideration is whether any sort of data feed will be a one-time occurrence or a recurring one. You may be more inclined to use a down-and-dirty approach, forgoing helpful log files if it's a one-time feed as opposed to a recurring one. If it is a recurring event, consider how errors should be handled. If the routine will be set up to run at 2:00 every morning when the network and servers are being least used, you probably don't want dialog boxes popping up asking user questions; there might not be anyone there to respond to them. Getting data into a new OHS&E system is typically one part of the equation. The other part is getting data out of it for use in other systems. Perhaps the software may do a lot of typical occupational health-related functions, but its strength is not in processing claims. There may be a company that you've worked with in the past that does claims quite well. How can you get your OHS&E system to get the appropriate information to the claims company as transparently as possible? Ideally, the OHS&E software has the ability to define "triggers." These may happen whenever someone adds an injury/illness record that meets certain criteria, or they may be based on other business rules. What the trigger does depends, in part, on the OHS&E software capabilities and how automated you'd like everything to work. The trigger may be as simple as popping up a dialog box telling the user that this new record needs to be sent to Claims. It may be as automated as generating an that is sent to the claims company with all the appropriate information in a format that allows them to directly import the data into their claims processing system. The latter approach is completely hands-off and doesn't require one to think about taking another manual step. Case Study Unfortunately, if the proper controls and checks aren't in place when people enter information into a system, nothing is going to make it any better. Although hat size, for example, might be a vital statistic for one organization, chances are good that it isn't vital for every other organization.

3 Perhaps the best way to illustrate this information is with a case study at the safety and medical services department of a large midwestern city government. In the past, when any of 4,000 full- and part-time city employees were injured or developed an illness on the job, they would report the fact to their supervisorsometimes. The supervisor would fill in the state's First Report of Injury form. At that point, the report may have sat on the supervisor's desk for a month, sometimes up to two months. If the employee was seriously injured, he or she couldn't get treatment at the medical clinic because it didn't have a copy of the First Report form. Approvals for referrals couldn't be made, because the necessary information was not readily available. Workers' compensation processing took longer than it should have, as the appropriate information wasn't available in a timely manner. The city would sometimes receive bills from referred medical providers before the original injury report from the supervisor was available. Also, employees would start receiving bills, because the providers hadn't been paid by the city in a timely manner. Typical turnaround time from an injury or illness report payment by the city was between one and two months. After a careful analysis and selection process using the help of a consulting firm, the city came up with a new method for managing their safety and medical services. Now, when an injury or illness occurs, any of 4,000 employees call a toll-free number to a company that provides workers' compensation and disability management services. The company takes the first report information from the employee and, within five to ten minutes, the information is automatically transferred electronically to the city's medical department as an attachment. A software routine continuously checks for the existence of such attachments, processes the information and automatically enters the appropriate information into the integrated OHS&E system. If the injured party was someone in the fire department the information gets automatically sent to the fire department system. Additionally, if the injury was workers' comp-related, the information is electronically forwarded to the city's internal workers' comp so ftware system. If the injury warrants a visit to the medical clinic, the first report information is readily available on-line before the employee even walks through the door. There is no more waiting for a supervisor to get the first report sheet to the clinic. The city has the necessary information right away, so their employees can get treatment right away. After treatment, someone in the clinic determines if the case is OSHA-recordable. Information is then entered into the OHS&E's Clinic Visits module in order to track what services were provided. If it is determined that the case is workers' comp-related, the appropriate information is entered into the Medical Progress Notes module in the OHS&E system. Part of the process of entering the information triggers an automatic that sends the information to the city's workers' comp system. If the employee was referred to a medical provider, the appropriate information is entered into the Referrals module in the OHS&E system, which also generates an e- mail to the workers' compensation system. If a referred doctor wants to treat an employee, he or she would call the workers' comp department, who already has the necessary information. The referred doctor performs the necessary services, and sends a bill to the city. The city reviews the bill, and sends it to a health plan organization that does a detailed review and sends it, along with the amount to pay back, to the city. The city then writes the checks. Outsourcing these two functions has been a cost-saver for the city. In addition to the processes discussed above there are other automatic procedures that occur. In fact, there are a total of seven interfaces between the city, four different vendors and some internal city systems. The interfaces are as follows: City demographic data sent to OHS&E software and call center automatically every night and to claims management system automatically every month (this is to ensure that each system has accurate, up-to-date employee information) First report, incident, medical triage, and other information read by OHS&E system automatically when received

4 Fire Department-specific information on case automatically sent to Fire Department system when received Twice daily automatic exchange of information between OHS&E system and claims management system Medical testing lab data sent to city via every day Weekly medical review and invoice information to health plan organization Medical instrument data read after test is administered Significant Progress Since implementation, the city has seen about a 30 percent reduction in medical clinic and claims management costs. In addition to direct cost savings, employees are much happier because the process of reporting has become much easier. They don't get bills from the medical providers, and, if they need immediate medical attention, they can get it without having to wait for paperwork. A process that used to take over a month has been streamlined to one to two days. Generally, authorizations are completed the same afternoon that the injury or illness was first reported. There are additional phases to the project that are currently being worked on. Data from medical instruments will be read directly from spirometry and other instruments, saving the nurses from manually entering the information in the OHS&E system. Analytical lab data will be provided in electronic format so that it can be automatically read and stored in the OHS&E system. Finally, OSHA 200 logs will be generated after this year since the necessary information will be in the OHS&E system. How easily an occupational health management system can fit in with the rest of your information management systems can vary enormously. The more you think about the different possible ways to communicate across systems, the better your chances are of dealing with new situations as they arise and the more you can automate the process. Peter Singer is VP - Product Development at Knorr Associates Inc., a New Jersey-based firm specializing in occupational health, safety and environmental information management systems. He can be reached at petes@knorrassociates.com. Copyright 1998, 1999 Stevens Publishing Corporation 5151 Beltline Rd. 10th Floor Dallas, Texas 75240

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8 Employee reports injury or illness (24x7) Call Center First Report Call Management System Medical Testing Lab Encrypted case information sent to city within 5-10 minutes of phone call Health Plan Organization Results ed daily Internet Review & billing sent automatically once a week Case Review & Billing System City Medical & Safety Departments OHS&E Management System City Firewall Direct read of medical instrument Fire Dept.-specific information on case Fire Department System Twice daily exchange of information Nightly feed of demographic information Human Resource System Claims Management System 2000, Knorr Associates Inc.