Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

As you’ve seen occasionally here on our blog, we like to highlight some features from Allscripts Enterprise^TM EHR. We’ve focused this approach so far on several versions with 11.2.  I found a new little feature in some release notes that users may find appealing.

In version 11.2.2, a new .Net General preference was added that allows users to hide the floating clinical toolbar upon login.  The preference is called “HideClinicalToolbarUponLogin”. This is geared towards users that log in and land directly at the Daily Schedule, or other “framework” workspaces like the Task List.

Allscripts initially delivers this preference with a default value of “N”. A value of “N” prompts the system to display the floating clinical toolbar upon logging into the system. System administrators can set this preference so that users can override and opt for the setting of their choice, Y or N. Allowing users to override gives them the opportunity to select their value for this preference using the Personalize feature.

Prior to this preference, users would always be prompted with the floating clinical toolbar on the Daily Schedule, for example.  The toolbar would need to be manually closed either by the X on the upper right hand window of the toolbar or by going to Tools -> Show/Hide Clinical Toolbar (shown below) after logging into each session.

Now, system administrators can spare users that extra click and prevent the users from seeing the floating toolbar. This might be beneficial for front desk users who need to land directly on a Daily Schedule but do not need the floating toolbar to perform their duties. In addition, if users have restricted security and the icons on the clinical toolbar are disabled, it makes sense to set this preference for those users to “Y” and hide the toolbar anyway.

In addition to setting the preference in TWAdmin -> General, system administrators can utilize the SSMT v2.2 content category “TW .NET Preferences” to load the settings for multiple users at one time, for convenience and efficiency.

In my example below, I’ve kept the default value of N at the Enterprise level and allowed users the ability to override, but set the user twfrontdesk to hide the clinical toolbar upon logging into the EHR.

While it’s a small addition, this preference is a nice welcome feature to allow some added convenience and efficiency.

As always, please contact us at Galen if you need any assistance building your system or training. We offer a wide variety of services and solutions to supplement the Enterprise EHR^TM application.

Tags: Allscripts Enterprise EHR, Enterprise EHR, TouchWorks

     There are many exciting new enhancements and features in Allscripts Enterprise EHR versions 11.2 and higher which mostly address meeting meaningful use requirements, however, there are also many other useful enhancement that are not quite as well known. This article will highlight one of those features.

     Within the TWUser Admin workplace under the User Details tab, there is a new checkbox labeled “Prohibit Task Assignment”. As the name suggests, checking this box will prohibit the user account from receiving tasks. An important distinction to be aware of, however, is that this will only prevent the user from receiving manually generated tasks sent by other users. Until the user account is completely deactivated or the Electronic Workflow box is unchecked, they will continue to receive system generated tasks, such as Verify Results or Sign Note, depending on how their user account is setup in other areas.

     This is an important new feature because when a provider leaves an organization, they will continue to receive Results-related tasks which they had previously ordered and need to be reviewed, verified and acted upon by someone. For this reason, the user account should remain active for a period of time until all of those outstanding results have been received. During that window of time, this new feature addresses the challenge of managing other task types that are manually generated by other users that may not yet have known that the user in question was no longer with the organization.

     Users for whom this check box is selected will not display in the favorites lists associated with the “Assigned to” box on the Task Details page or the Reassign Task page. These users also are not returned as a search result when a user clicks “All” on the Task Details page or Reassign Task page to search for someone to assign the task to, essentially making it impossible for someone to manually assign a task to the user.

     For more information on this and other new features in versions 11.2 and higher, subscribe to our blog by entering your email address on right, or you can visit the Galen Healthcare Solutions Wiki. There is also an upcoming FREE webcast on May 25^th regarding a number of other important organizational considerations to be aware of when staff terminate. You can register for this and other webcasts by visiting Galen’s upcoming webcast schedule.

With most of our attention on Stage 2 of Meaningful Use, I was caught a bit off guard when reminded that Stage 1 has policy adjustments being proposed. 

On May 1, Elizabeth Woodcock presented the webcast “Meaningful Use: Gearing Up for Stage 2”, where she presented some of the latest information available on the 2nd stage and infused her experience and helpful context. The presentation focused heavily on the growing role patient access has in Stage 2, but early in the agenda, Ms. Woodcock revisited Stage 1 and some changes that have been proposed. I wanted to highlight a few of these, and be sure to point out that these are only proposals and would not apply to Eligible Providers that are currently in their attestation periods. If accepted, it is likely the changes would go into place for those reporting on Stage 1 in 2013. 

Proposed changes to Stage 1 attestation:

1.  CPOE – Changing the denominator counting the “number of unique patients with at least one medication” to the “total number of medication orders”
2. Capturing Vital Signs – Split the Blood Pressure and Height/Weight exclusions so that excluding one does not count against both vital signs and proposing the age limitation be adjusted 
3. Exchange Key Clinical Information–Due to confusion, could be removed
4. Submission of data to registry – May add “Except where prohibited” to criteria

To watch the full presentation by Elizabeth Woodcock, follow this link.
http://event.on24.com/r.htm?e=449183&s=1&k=ACA228A9394671E72B35701408889DAB

Tags: #IntuitHealthMU2, Elizabeth Woodcock, Meaningful Use

Do you create reports from Allscripts data? Are you tasked with making changes to existing reports? Do you track Meaningful Use data? Do you create worksheets to track Bridges to Excellence, GPRO, or IPRO data? Have you ever wondered how to utilize the Allscripts Analytics reporting tool? Do you want to learn how to create your own custom reports? If you answered yes to any of these questions, Galen’s Technical Services team would like to invite you to a full day of reporting training in Boston.

Who: Allscripts Reporting Analysts

What: Allscripts Analytics and Reporting Training

Where: 70 Federal Street, 7th Floor, Boston, MA 02110.

When: Wednesday, June 13th, 2012 from 9AM-5PM with lunch provided. There will also be a cocktails and networking hour from 4PM-5PM with beer, wine, and light snacks.

Why: Learn about the details of reporting with Analytics and working with custom reports.

Cost: $250/seat

Agenda:

• Analytics overview
• Analytics reporting review
• Developing a report with Analytics
• Review of reporting within Allscripts
• Demonstration and customization of a report
• Deployment, testing, and best practices
• Much more!

Please contact us if there is a topic you would like to learn more about that isn’t in the list above.

Travel: If you are driving into the city, there are parking garages nearby. The cheapest and most convenient is the Winthrop Square Parking Garage at $20/day. If you are coming in from out of town, there are many hotels in the area. Also note that we will have wireless internet and workstations with a hardwired internet connection available for those who need it.

Space is limited – register today!  If you can’t make the training, it’s OK! Galen offers free webcasts about every two weeks.

Tags: Allscripts Analytics, Business Intelligence, Reporting, Technical, Training

It has been 30 years since the last ICD release here in the United States. Many codes are outdated and obsolete as they are limited in their capabilities to collect data. The world is using ICD-10 and yet despite all the known benefits, the United States has yet to successfully transition to ICD-10. Why delay what the whole world has been doing for years?

Back in 2008 when ICD-10 compliance was generating a lot of momentum, it was set to replace all diagnosis coding in all settings by October 1, 2013. The compliance date was set as it was said to be too costly to delay due to the importance of date of service because they would have to go back and change all the dates and reprogram. There was no grace period and one implementation date applied to everyone including physician clinics.

However these past few months many healthcare entities have been experiencing anxiety as a result of the imminent ICD-10 compliance date set for October 1st, 2013 and the burden of meeting all the regulatory requirements. Many organizations are against it while others caution against the financial and implementation liability. In response, despite their commitment not to push back the date last February; President Obama promised to help alleviate some of the pressure and shortly after Health and Human Services Secretary Kathleen G. Sebelius announced that the HHS would initiate the process to postpone the date.

Since then, the  US Department of Health and Human Services (HHS) has proposed the replacement of the ICD-10-CM code sets to be effective Oct. 1, 2014. However, pushing back the deadline for specific entities is only slowing down the process and putting greater burden on the government to have to change other deadlines and commitments. In fact, major insurance companies like Blue Cross Blue Shield have openly stated that ‘to maintain their operations while still supporting their members and provider networks they will only accept ICD-10 codes on claims for dates of service or discharge dates on or after the compliance deadline. Additionally, they are prepared to adapt to any modifications that Congress or the federal government may make to the compliance requirements.

Allscripts is well prepared for this transition and has been working on developing clinical behavior, workflow along with payer compliance strategies to comply with ICD-10 requirements.  Allscripts Enterprise EHR^TM version 11.4.1 will contain ICD 10. The sooner clients aquire that version once it is released, the greater they proactively transition to ICD-10.

Resources:

http://www.cdc.gov/nchs/icd/icd10cm.htm

http://www.healthdatamanagement.com/news/icd-10-codes-coding-hhs-sebelius-compliance-delay-44021-1.html?ET=healthdatamanagement:e2358:198023a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_021612-1.html?ET=healthdatamanagement:e2358:198023a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_021612)
http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20120410icd-10date.html

Tags: Allscripts Enterprise EHR, Healthcare IT, ICD-10

In order to succeed you must fail, so that you know what not to do the next time.

- Anthony J. D’Angelo

One of the things that has made Galen Healthcare Solutions as successful as it has been over the past 6 years is its belief that, when used optimally, an Electronic Health Record can radically improve the quality of care in this country.  We are consumed with the challenge of eradicating outdated concepts and processes carried forward from a paper-based system that has no place in today’s digital age.  Further, we believe that the EHR we specialize in, the Allscripts Enterprise EHR^TM, is in a class by itself as the premier Ambulatory Electronic Health Record in the industry.

No organization knows better than we do, however, how significant the gap is between the current state of the EHR in the vast majority of health care organizations and the potentially fully optimized state.  Most organizations, daunted by the magnitude of the task of simply deploying an EHR have, to a large degree, replaced the paper chart with a computer.  Few, if any, have fully re-engineered their clinics to best leverage the power of the EHR and, as a result, are experiencing a significant reduction in patient throughput.  This is not news, and most organizations we talk to acknowledge that “Clinical Adoption” is the “Next Great Challenge”.

Here at Galen, our shift to meet this “Next Great Challenge” is well underway.  We are involved in hundreds of projects where the focus is on augmenting workflows, connecting and presenting information where it is needed most, re-building Note Forms to minimize the amount of time a provider spends clicking the screen, and, through much of the aforementioned work, changing perceptions amongst the user community that an EHR can be elegantly designed and efficiently utilized.

The simple reality, however, is that workflow redesign and EHR tweaks can only improve the patient engagement process a finite amount.  Despite every effort to tailor the application and the clinical environment to mesh perfectly, providers still must function within its boundaries and are often stepping outside of the software to review ancillary sources of information necessary to provide the highest level of care.

As our name suggests, Galen endeavors to be a solutions oriented organization.  So, rather than accepting what the EHR necessitates, we have chosen to expand on its capabilities.  We know that if we minimize the additional effort involved in an encounter, providers will see more patients, quality of care will improve, and throughput will grow to a level beyond what it was prior to the EHR deployment.

We have several solutions that will significantly improve clinical efficiency:

eCalcs

eCalcs are commonly used health calculators fully integrated into Enterprise EHR^TM, removing the need to step outside the EHR to access them.  The patient’s information is pre-loaded into the calculator, reducing time and errors, and the patient’s score is seamlessly documented into the patient’s EHR chart.

Learn more at: http://wiki.galenhealthcare.com/ECalcs_-_Integrated_Health_Calculators

Location Aware Printing (LAP)

Location Aware Printing allows you to print based on where you are, rather than who you are. As you move from exam room to exam room, back to your desk, and throughout the office, LAP will print to the printer that’s closest to you. You save time during every visit, up to an hour per day.

eNotify

eNotify provides Outlook-style notifications for urgent tasks right on the provider’s screen, eliminating the need to check the tasks screen in the EHR.  By pro-actively notifying a provider of a task, it removes one more item the provider has to remind themself to do.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Enterprise EHR, Healthcare IT, Integration

One of my first client-related activities after joining Galen Healthcare Solutions was doing data collection for a Technical Assessment. One of our senior resources was on-site, and he thought this would be a good opportunity to get my feet wet.

A full Technical Assessment of a client’s EEHR environment involves reviewing server hardware, software, settings, network configuration, etc. The benefit to the client of these assessments is two-fold. First, we can identify and attempt to resolve performance bottlenecks, typically stemming from misconfiguration. Second, we can identify general areas of concern, such as staffing, hardware, software, or future growth concerns.

To begin, I went through and confirmed a server listing with the client for both their production and test environments. I then proceeded to collect pertinent information for each server, including a number of role-specific items, for example, the version and service pack level of SQL used in the Clinical Database Server. This process is akin to the System Certification process done during EHR upgrades.

I collected a considerable amount of the necessary data with a VBScript-based application, which leveraged Windows Management Instrumentation (WMI) and dumped most of what I needed into text files for each server. I then proceeded to populate that information into my reports, and I shared those with my team. The details of those findings were compiled into a written report by the senior resource and presented to the client.

Shortly after the report was delivered, I was notified that one of my findings had been found to be the cause of one of their most significant issues. A misconfigured “Lock pages in memory” Local Security Policy setting was hindering their ability to properly fail over the clinical database cluster to another node. It is required that the user running the SQL Server service is configured to have this ability.

I have done a number of similar assessments for other clients over the years, and it is always interesting to find out what new information we can provide our clients to help them better utilize their systems. It is also great to be able to put a face with a name. As part of the Upgrade Team here at Galen Healthcare Solutions, we look forward to helping clients through the changes necessary to implement new and upcoming versions of EEHR and the updated technology that goes along with it.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Enterprise EHR, Healthcare IT, Technical

Approaching the design, configuration and implementation of Clinical Quality Measures can be a daunting and overwhelming process. There is a great deal of information available about what the measures are, how the reports are run in Allscripts Enterprise EHR and what counts in the numerators and denominators. The more elusive question in the process is how do we make decisions about what measures to report on – and how do we translate this information into meaningful workflows for our providers?

Every provider reporting for meaningful use needs to select three core (or alternate core) and three additional measures. If a provider reports a zero on any of their additional three measures, they will have to attest that they also received a zero within the reporting tool for all of the additional measures. This makes it critical to review the Clinical Quality Measures with the goal in mind of selecting quality measures that will be appropriate and achievable for the providers in your practice.

In order to review clinical applicability, configuration considerations and workflow design – it is ideal to pull together a team that includes clinicians, analysts and members of your clinical informatics teams. Together this group can evaluate each measure for ease of use, design considerations and workflow design. Each Clinical Quality Measure will need to be reviewed in depth with the following points in mind:

For Each Measure:

• Determine what exists currently in Enterprise
• Determine the gaps between current build/Infrastructure and what is needed for MU
• Determine options for meeting the measure
• Decision: are providers at the organization reporting on this measure
• Decision: What build will best meet the needs of the organization long-term
• Complete build and configuration needed for the measure
• Document the future state workflow
• Add new workflow to testing plans moving forward
• Test the ability to meet the measure and the future state workflow
• Train current end users
• Add future state workflow to training curriculum for new users.
• Roll out feature/functionality and/or workflow

One of the more challenging aspects of this process is developing an easily understandable workflow. This sounds elementary, but many of the measures are calculating a large number of variables, and some work needs to be done to move from considering *every action* that will meet a measure, to developing a consistent workflow that will meet the measure every time.

An example of this is the measure for Chlamydia screenings. The measure itself is simple: The percentage of women 15-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year….but the actual calculation is a lot more complex, as it takes into consideration almost 50 different discrete data elements that would count in the denominator as “sexually active.” It’s important for providers to understand at a high level how the measures are calculated, but it is unrealistic to think that they will remember all 50 ways the reporting will catch the status of “sexually active.”

It is preferable in this situation to develop a simple workflow for asking patients within the age range about sexual activity, recording a standard item in the patient chart (Social History: Sexually Active) and ensuring that patients with this item on their chart are offered a Chlamydia screening annually.  

Ultimately the key to making these measures meaningful to your practice and providers is to not to simply ensure that you are getting the numbers that you need, but that your team is working in concert together to ensure the workflow meets the needs of your organization and the route to meeting the measure is easily understandable.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Meaningful Use

As seen in the trend from past newsletters, Galen continues to grow not only as a company, but as a presence in the Healthcare IT industry.  Galen’s success continues this quarter with the help of those from within; those that help propel us forward. While we could recognize the talents and valuable contributions of the entire staff, we are pleased to recognize three individuals in their promotions.

Christy Erickson, MSN, Senior Consultant

Christy came to Galen a year ago this February with a strong clinical background. Christy is quite knowledgeable in many areas of the application. She has been focused on upgrade projects, including note upgrades, as well as Stimulus Set work.  Christy has contributed to the Galen Webcast series, featuring topics like Meaningful Use and SSMT/CMT. 

Please join us as we congratulate Christy on her promotion to Senior Consultant!

Joe Nyiri, Senior Upgrade Technician

Joe has brought a great deal of experience to Galen with previous experience supporting Healthcare systems. He certainly accomplished quite a bit since his hire in March 2011. He has been greatly involved in server maintenance and upgrades. He has provided valuable internal tools in terms of server resources. Joe has provided several sessions in the Galen Webcast series and is in queue to provide many more!

Congratulations Joe on your promotion to Senior Upgrade Technician!

Ryan Hunt, Senior Interface Analyst

Ryan joined Galen in May 2010 as an Interface Analyst, bringing experience with a Master’s Degree in Healthcare Informatics. He worked diligently on several upgrade projects, took lead on several teammates’ projects, and interface development.  Ryan successfully led the move for the Boston office to its new location.  With the new office up and running, he is now moving forward with more interface development and conversions.

Congratulations Ryan on your promotion to Senior Interface Analyst!

Tags: Allscripts Consultants

In last quarter’s newsletter we were excited to announce our Galen Certified-Enterprise EHR Application Specialist training and certification program. Today we are proud to share the news that this quarter we added two more employees to this distinguished group!  

During the 7 weeks of training not only are all modules of the Enterprise product discussed in great detail with an added emphasis of clinical relevance, but each student must demonstrate a complete knowledge and understanding of the Certified Workflows. Prior to taking both a written and verbal examination on Enterprise fundamentals, each student must successfully build out an entire Enterprise environment from the ground up!

Please join me in congratulating the following…Galen Certified™ Enterprise EHR Application Specialist!

Noah Orr, Consultant

Noah joined Galen in January of 2011 with 3 ½ years of experience on Allscripts Enterprise. Over that time, he acquired a depth of knowledge of the entire application and most recently has been specializing on Note implementation and advanced note build, among other things. Noah is also a frequent contributor to the Galen Blog. When he’s not hard at work, you’ll find him on the baseball diamond or pursuing his passion for photography. Noah currently resides in San Diego with his beautiful wife and daughter.

Tracy Kimble, Consultant

Tracy joined Galen in May 2011 as an Implementation Consultant.  She graduated from Ohio University with a degree in Management Information Systems.  Tracy offered more than five years of experience in Healthcare IT covering a variety of Allscripts EHR modules, interface, ancillary systems and clinical workflows.  Over the last year, Tracy has had the opportunity to work with several large, multi-specialty organizations, assisting with multiple upgrades, Meaningful Use configurations, and Go-Live rollouts.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Enterprise EHR, Healthcare IT