David Hallberg

Chart Inconsistencies Create Confusion

In my years of looking for performance issues in Millennium® environments – from Millennium 5.2 to 2007.18 – I typically have been called on to do the evaluations no one else wants to do. So I might look at the VMS or AIX nodes to verify that their performance settings are the same and, if they’re not, what needs to be done to synchronize the nodes. In the past few months, however, I have had the opportunity to review half a dozen sites – both self-hosted and those hosted by a third party – with a broader scope. The outcome was a little perplexing.

I had assumed that the application side of Millennium had tools, automated or not, to look for chart consistency issues. It appears I had a very erroneous assumption. In each of the sites I reviewed, I discovered that abbreviations varied from one chart to the next for such things as abnormal results or corrected results. For example, symbols for abnormal results might be A or * or blank. Symbols for critical results might be C or c or * or blank. I can only imagine the confusion the clinicians have when they see one chart where C means corrected and another chart in the same facility where C means critical. The potential for negative clinical delivery outcomes is very real.

To avoid any confusion, I recommend you find and fix any chart formatting inconsistencies at your facility. To find the discrepancies, you can run the following command from CCL or from SQL*Plus and put the results into a spreadsheet:

select * from chart_format where active_ind = ‘1’

Any inconsistencies should quickly become apparent. They also should be fairly straightforward to fix, at least on the technical side. You can use Millennium build tools or direct update statements to change the symbols being used so that they are consistent from chart to chart. I do understand that at least one quality person or an entire committee will probably have to oversee any changes. That will slow down the process, but it’s worth the hassle to ensure that the charts use abbreviations in a consistent manner.

Prognosis: Eliminating chart formatting inconsistencies will prevent confusion among clinicians concerning results reporting.