Readmit After A11

[Victor Ligenza]

Has anyone encoutered this issue with an interface to MIDAS?

If we send an Cancel (A11) to MIDAS, the account is canceled and removed from the data base.  If a subsequent A08 or P01 is sent for whatever reason, Midas will recreate the account.  The problem then becomes the created account will never get a Discharge message so length of stay will continue to grow.

The vendor says they do not have a way to set a flag to only create an account when an Admit (A01) or Reg (A04) transaction is received.

The only way I can see correcting this is to added a cancel flag to the messages as the HIS system generates them, and then filter them in the engine.  This seems like overkill for one ADT feed.

Can anyone offer any words of wisdom on this?

Topic

[David Barr]

We’ve put in filters before to block messages for systems like this if the message type is not A03 and the discharge date (PV1 45) is not NULL.

[Nick Stainback]

I have had to do the same thing for a Lab system that would re-admit discharged patients that were updated in he HIS Billing software after discharge, but never to canceled visits

I don’t know that the Canceled date and time is sent in the A08 or anything that would indicate that the visit has been canceled.

Do you not always send the A11 to the downstream systems as well when the visit is canceled?  This would remove it there and prevent them from ever sending the A08 or anything for that matter.

[Shibu Mathew]

Victor,

If the A08 is for an already discharged patient, it will be indicated in the  message. I believe it will be in the PV1.41_Account Status field (or PV1.36 Discharge disposition). You can use the value in this field to stop the A08 from going to the external system.

Thanks,

[Robert Milfajt]

So the Cancel the admission (A11), which deletes the account in MIDAS, and then a few extraneous A08/P01’s come across which create the account back.

I do not see anyway, short of storing data on the cancelled accounts in Cloverleaf of how to tell which messages to send and which not to send.  If you cannot control your inbound registration system, you are in a predicament.

What if you changed A11 to something else, which would deactivate, but not delete the account in MIDAS, if MIDAS had such a capability.  At least then you would be updating something that should be ignored, instead of creating something people end up reviewing.

Hope this helps,

Robert Milfajt
Northwestern Medicine
Chicago, IL

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