HIMSS 2014 represented Galen’s first as an exhibitor to the event. The results were simply fantastic. It was great to connect with clients, both new and old. We had conversations regarding ways we could help with initiatives that are top of mind for clients- assessment and optimization of existing application deployment, integration and conversion strategy and needs driven by HCO acquisition and EHR vendor switch, patient engagement enablement through solutions such as Dragonfly, public and private HIE participant on-boarding, and most importantly the roadmap to value-based-care. As an organization, we have evolved from our Allscripts roots, through partnerships and business lines with prominent vendors such as Orion, Meditech, Epic, RelayHealth, Aternity, Merge and Intersystems to name a few. It is clear that our methodology (empowering, nimble, ego free, one-stop shop, personable and collaborative) is well received, resonates with our clients, and really differentiates Galen in the overall client experience. If you have yet to work with us or are new to Galen, we encourage you to get a sample by attending one of our industry-leading free webcasts. The excitement generated from HIMSS is palpable, and we are thrilled to bring our passion, energy and commitment to better the industry.
Galen Note Form Reporting – Making Data Extraction from V11 Notes Simple, Maintainable, and Repeatable
v11 Notes in Allscripts TouchWorks™ EHR contain valuable discrete patient data. The problem, however, is the data is locked away in an inaccessible format that can’t be reported on even by experienced reporting analysts. Accountable Care Organizations (ACOs) and others using the Patient Centered Medical Home (PCMH) models need this data for various reporting functions.
Galen Note Form Reporting tool for reporting analysts makes Allscripts TouchWorks™ EHR v11 Note data easily accessible and puts the data in a format that makes reporting familiar and easy. Without Note Form Reporting, extracting v11 Note data from TouchWorks™ EHR in a meaningful way is nearly impossible. While users may be able to write a query that yields a desired set of data, it is extremely slow and nearly impossible to maintain. Galen’s Note Form Reporting resolves this issue by doing the hard work for the user, so retrieving custom data is quicker, easier, and more maintainable.
What are our clients saying about Note Form Reporting?
Galen Healthcare’s Note Form Reporting product has enabled Genesys PHO unlock the true reporting potential of Allscripts’ unstructured note. At the PHO, we use a combination of highly customized and original note forms. By utilizing this software, we are able to mine and analyze data that was once locked in an unstructured v11 Note document. This ability has allowed us to report opportunities in patient care and streamline many once burdensome workflows within provider offices. Additionally, Galen’s support has been tremendous, helping us maintain reporting availability through upgrades and technical issues. Galen has been very supportive of our needs and continues to be a valued partner of Genesys PHO.
Matthew Hoover, Manager of Systems and Application Development from Genesys PHO in Flint, MI
Beth is a reporting analyst at a large practice that is a Pioneer ACO. The group analyzes the reporting requirements for Accountable Care Organizations. After their analysis, they find many data points are currently stored in v11 Notes, and new data points are most easily documented in v11 Notes. One morning, Beth’s manager asks her to develop a report as proof to show the group how they will meet the ACO requirements. Beth finds that unlike all other data in the EHR, the v11 Note data is not found in discrete fields in the Works database. It’s found in complex V11 Noteform documents of which she cannot makes heads or tails. With Galen’s Note Form Reporting, Beth is easily able to build a query that returns the discrete patient data she requires.
For example, let’s say PHQ-9 screenings are needed on CCDs for this healthcare organization to successfully attest for meaningful use. Unfortunately, these PHQ-9 scores are recorded in the v11 note. There is no way to easily pull out the PHQ-9 score without having it be in a discrete field. The v11 notes are stored as Noteform data which makes reporting on them very difficult because they aren’t in discrete fields. By extracting the depression screen out of the note, we can gather useful data that we wouldn’t have been able to previously such as:
- Evidence that the physician actually administered the screening (important for physician quality measures)
- The patient’s answers for the screening
- PHQ-9 scores
Here are some other examples of questions our clients have answered using Note Form Reporting that they otherwise would not have been able to answer:
Which of our providers are not performing smoking counseling on smoker patients?
What is the percentage of diabetic patients who have received eye and foot exams in the past year?
Can’t we just search the note data directly from our database?
Unfortunately, no you cannot. The v11 Note data is stored in a complex, nested XML format, with frequent references out to other areas of the XML and to discrete look-up tables in the EHR. Each time a Note Form or Input Template is changed in the EHR, the resulting v11 Notes will have a different XML structure.
Galen Note Form Reporting processes the data into a more accessible, relational format so you can query it in minutes rather than months.
Who uses Note Form Reporting?
Note Form Reporting transforms the v11 Note data into a format that is queryable. Users of Note Form Reporting are SQL report writers. Galen will work with your reporting team to ensure you have proper training on the Note Form Reporting data structures, and Galen is also available to create reports on your behalf.
Can Note Form Reporting work without impacting our production EHR?
Yes. Note Form Reporting performs a brief nightly data extract that pulls the note data into a new database. This new database is completely separate from the production EHR database. It is designed to not interfere with the operation of your system.
Is there anything I can do with the data from Note Form Reporting other than reporting?
With NoteForm Reporting, not only can you turn non-discrete data into discrete data, but you can also use that data to incorporate into processes to improve workflow. As one recent example, Clark & Daughtrey, together with Galen, implemented a charge automation process utilizing Note Form Reporting. C&D uses the v11 Note to capture Healthcare Effectiveness Data and Information Set (HEDIS) measures assessed during a visit, which is important not only in assessing the quality of care for the patient, but also to the providers’ HEDIS Star rating score that is linked to their year-end compensation. More importantly, low scores for HEDIS measures can result in their insurance carrier moving their patients to another provider group. Needless to say, capturing the correct information from the notes is crucial for staff and providers at C&D.
Prior to implementing Note Form Reporting, staff at C&D manually reviewed the notes looking for the HEDIS CPT codes and would code the visit accordingly. With Note Form reporting, a SQL job process pulls the HEDIS CPT codes, assigns the correct ICD-9 code to the charge codes, sets and submits the charge in TouchWorks™ and from there, pushes the charge to Practice Management for billing. This is both a time and money saver, as it frees up the staff at C&D to work on other important projects.
Justin Campbell’s original debut of Note Form Reporting: http://blog.galenhealthcare.com/2011/07/11/ehr-unstructured-data-mining/
Here is a link to a webcast from Galen’s own Fallon Hartford regarding querying documents from the document table: http://wiki.galenhealthcare.com/Advanced_Queries:_Querying_the_Document_Table
Coauthored by Fallon Hartford and Evan Lea
Implementation of the Charge module can seem like an overwhelming task for many organizations. A lot of you are already struggling with enforcing proper documentation standards, implementing patient portals and meeting Meaningful Use, CQM & PQRS measures; all while struggling to remain viable from a fiscal standpoint. So, the question remains, why would we take on one more project in the midst of this chaos?
There are some fairly compelling reasons to consider automating your charge capture process and moving away from the use of the paper encounter form. To begin with, if implemented correctly, use of the Charge module should help your organization see an increase in revenue & accelerated cash flow. It is a whole lot easier to track missing electronic encounter forms than to figure out where Dr. Smith or Nurse Jones left that stack of paper encounter forms on his/her way out of the office last night. Additionally, because it is designed to prevent users from submitting chargers if they have failed to input required information, the Charge module helps reduce the occurrence of improperly filled out encounter forms. The use of electronic charging means doctors will be required to make fewer corrections for tickets marked in illegible hand writing or completed incorrectly.
Next, the fact of the matter is, the quicker charges are submitted, the quicker reimbursement is received from your carriers. Money in the bank means liquidity and financial options for any organization. From an EHR perspective, once a provider has completed the encounter form, tasks can be generated for the billing staff to immediately review and submit charges, ultimately decreasing the posting to payment turnaround time from days or weeks to hours. If, after auditing and review of a provider’s billing and charge submission, the organization feels it is reasonable to allow the provider to progress to “direct submission” of encounters, the process will be expedited even further. Remember, faster submission equals faster reimbursement and money in the bank.
Proper analysis and follow through in the build process will result in a reduction in billing errors. There is a decrease in the risk of human error while translating a provider’s scrawl from the paper encounter form into the electronic billing system. Transposing digits, inadvertently keying the incorrect primary diagnosis, misusing a modifier or failing to include the correct number of units for a medication administration fee are all simple, yet common errors in a billing office that cost organizations thousands of dollars each year. Fortunately, with some of the built in rules logic available in the Charge module, clients typically see a dramatic reduction in billing mistakes along with the risk of regulatory noncompliance.
And lastly, your organization should see an increase in efficiency in a variety of ways. The elimination of dual entry allows billing staff to spend more time on coding and reviewing more encounters. Centralized, electronic creation of encounter forms alleviates the need to print practice-specific super bills which can be quite costly and time consuming to distribute. Updates can take place quickly to the master files with limited interference in provider and staff workflows. Finally, the automated generation of reminder tasks can assist end-users and management with easily identifying missing charges, workflow bottlenecks and charging trends across the organization.
The final quarter of 2013 brought some new and exciting news to Galen. Over the course of the past four months, Galen has been preparing for and has begun the execution of its new strategic plan. The strategic plan is foundational, yet innovative in many ways. The plan reinforces Galen’s commitment to our team members, focusing on recruiting and retaining the best talent in the industry – bar none. We believe this to be our most important strategic pillar, and ensures that we can continue to deliver on our commitments to our clients. The strategic plan is also aggressive by taking us in directions that complement our existing services. With the healthcare world preparing for a value-based delivery model, we see a number of solutions that can help our clients turn a changing payment landscape into a competitive advantage. To that end, Galen signed two significant partner agreements in Q4 of 2013. You’ll be hearing more about this in the near future.
A key component of the strategic plan is broader industry awareness of Galen and the great value we deliver. In and of itself, I would not consider recognition and accolades a core part of the Galen DNA. It has never been that important to us for a number of reasons, but we recognize that to compete for the best people in the industry, we need them to know this is the best place to work. Third-party accolades are a great way to objectively share that message.
Although we were on a tight timeline for the late summer submission to Modern Healthcare, we were pleased to have been recognized in “Modern Healthcare Best Places to Work 2013.” We know this is a significant achievement, especially for our inaugural year. Just as important as the accolade, is the survey data we’ve received highlighting areas for improvement. This part we do believe to be the Galen DNA – continuous improvement. We know that we have a top 100 place to work in this industry, and now, we’re going to improve on it by making huge strides in 2014. This award is only one data point, but it is an important one, as it reflects how our team views Galen.
A second accolade was being ranked, again in our inaugural attempt, by KLAS. Let me first say thank you to all of our clients. We know that KLAS is a demand on your time, and we very much appreciate the candid feedback. As most of you know, being ranked by KLAS can take some time, and some organizations never reach the threshold of customer touch points. On a truncated timeline, KLAS was able to confirm our “Technical Services” scores. We ranked 4th overall, just a few points behind the leader, and in the company of dedicated technology organizations. We consider this a huge achievement, and every indication from KLAS is that we’ll be ranked in the mid-year report for “Professional Services” and other service lines we provide. If you haven’t seen our report card in KLAS, please take a moment to look us up. I am so proud of our team for having scored so well right out of the gate. Again, we are approaching KLAS as an improvement opportunity. You will see our scores rise, and feel the difference in your engagements with us.
Finally, with so many different solutions and offerings at Galen, this year we are going to HIMSS. It seemed like a logical next step as our portfolio has continued to expand. If you’re going to be there, please stop by our booth and check us out (Booth #7545).
I’ll close with a thank you to all of our clients. We appreciate your continued support and the show of confidence through KLAS or otherwise. We’re a growing, hungry company. Galen knows that we can’t rest if we’re to achieve our goals. It’s my hope that you feel this drive in your projects, and realize it in your outcomes. Until next time – take care and hope to see you at HIMSS.
In late spring of 2013, an ICD10 readiness survey showed some alarming statistics. It was the seventh in a long line of surveys performed by WEDI (Workgroup for Electronic Data Interchange) that indicated the lack of progress in the ICD10 journey to adoption. With the looming October 1, 2014 deadline quickly approaching, it seems that the extension granted has only delayed the prioritization of this mandate.
As the ICD10 compliance deadline is fast approaching, organizations are ramping up their efforts. This cooperation between Providers, Payers, Electronic Billing Clearing Houses, and Software Vendors is a huge undertaking for any organization. To assist on your ICD10 compliance journey, the follow checklist has been developed.
- Select an ICD10 Transition Team
It is vital that resources be chosen to transition from ICD9 to ICD10. A multidisciplinary team representing clinical, financial, and administrative staff is advisable. The size of this team, of course, should correlate with the size of the organization. However, the steps that need to be taken, are the same, no matter how large or small the organization.
- Perform a Readiness/Impact Assessment and Develop a Project Plan
CMS, AHIMA, & AMA all offer readiness assessments and high level project plans. As a matter of fact, the internet is clogged with resources for this step. Another, perhaps less thought about but valuable resource, is the Medical Society for your county or state.
- Contact Software Vendors
This is really part of the impact/readiness assessment, but since it can derail the timeline, it bears special mention. Practice Management and Electronic Health Records Software vendors have ICD10 compliant versions. Since updating software versions can be as simple to applying a patch or as complicated as full projects that take months to complete, it is important to verify the specifications directly with the vendor.
While we are discussing vendors, it also bears mention to document the charges capture process. For example, is there a paper encounter form that is keyed in by the billing staff? If so, then any ICD9 codes would need to be updated. If it is via electronic submission, then the PM/EHR dictionaries and interfaces would also need to be considered and tested.
- Analyze the Payer Mix
Revenue interruption is a very real concern for administrators at this point. It is vital to analyze the accounts receivable for position and mix of Payers. This will allow the team to target the highest payers first during the testing phase to help reduce potential income interruption.
- Communicate with Electronic Billing Clearinghouses
Testing claims to reach the Billing Clearinghouses is a crucial step in the end to end testing of claims. Once successful transmissions have been accomplished, the team can move on to the Payers specific testing.
- Contact Payers for Their ICD10 Readiness and Testing Schedules
Full end to end life cycle testing of claims will need to be performed for each Payer.
- Audit Current Documentation Practices
There may be some good news on this item. On the surface, moving from ICD9’s 17,000+ codes to the 141,000+ codes of ICD10 sounds intimidating. However, consider that the concepts are not new to Providers. In fact, approximately 1/3 of the codes are the same with expanded details of those problems. Some examples are:
- Initial, Subsequent, or Sequela Instance
- Acute or Chronic
- Laterality- Right, Left, or Bilateral
- Normal Healing or Delayed Healing
- Nonunion or Malunion
Many providers have been documenting these details within their notes already as matter of best practice patient care and to limit liability. Auditing current documentation will assist in developing a training plan for providers.
- Staff Training
The internet is flooded with training options. Accurately identifying who needs training will dictate the amount of training needed. For example, certified coders would certainly require more training than a front desk staff verifying insurance eligibility. Minimally, the following groups of staff members will need training consideration
- Front Desk Staff, prior authorizations,
- Coding/Finance Department Staff
- Any other Staff who use ICD9’s Currently
After spending the last 20+ years witnessing the day to day challenges facing providers, I am not surprised with the findings of the survey. Delaying the inevitable has just left more room for other issues battling for attention in today’s medical practices. Balancing competing initiatives such as EHR adoption, Meaningful Use Objectives, not to mention making sure patient care is a first priority, has made the healthcare environment very challenging.
How will your organization rapidly address the day to day challenges you are facing? Galen Healthcare Solutions provides a full support system, wealth of experience, and solutions for your EHR journey with the various services we offer. Our Technical, Upgrade, Project Management, and Implementation Professionals are available for large projects, as well as incremental solutions. Let us help you raise the bar in patient care for your organization.