Do you know what’s going on before your end-users? Be the first to know— before your end-users report it.

How many times do you find out something is wrong with the application from your end-users? Do you wish you knew before them, if possible, so there can be a more proactive versus reactive approach? I am going to highlight some tips that may help organizations get ahead, to ensure the best possible communication to end-users of any outages or issues within the application. In some small organizations, the IT staff actually don’t have the time to do application maintenance like a larger organization, and they rely on either office managers or super users to assist in monitoring. Either way, it would be nice to be able to inform users before they inform you!

Tips

  • Sign up for all Client Connect blog updates that are potential areas of concern, based on your organization. For example, if you want to proactively see when Surescripts may have connectivity issues with inbound or outbound prescriptions, follow the blog to get those notifications. Allscripts utilizes this to notify their client base for designated areas of the application. This also allows you to be notified of updates/releases that are available. Links to TouchWorks EHR Advisory and Updates Blog Directory: https://clientconnect.allscripts.com/docs/DOC-19659

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  •  Monitor the TouchWorks application queues. I recommend that a designated resource monitors the queue for printing, faxing , message queue for Rxs (inbound/outbound), CDS patient match (POC alerts), and the error queue if you use CIE. Understanding resources can be limited, I’d suggest every 30- 60 minutes someone goes in and checks each queue for failures. This actual task shouldn’t take more than 5-10 minutes to look to see everything is working as expected.
  • Under TWAdmin> Queue Admin> Print queue – any print or fax jobs can be evaluated for failures. Note: for faxing, depending on setup, a completed fax may be misleading, and you may need to look at RightFax as well.
  • Under TWAdmin>Message Queue – any inbound/outbound Rxs (DUR events/RX Faxed events can be seen as well), Immunization registry transmissions, and CDS successes/failures for Point of Care recommendation alerts.
  • Under TWAdmin> Error Queue – monitor CIE interfaces for backlog of messages and/or failures

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 ** items in the “Look for” Column would indicate to notify users and take action for resolution, which may include server administration action, or Allscripts case, or wait until notification if an expected outage from a cloud/connectivity solution.

  • Check on the Interface application if using ConnectR (recommend every 30-60 minutes). Evaluate any backlog of messages and/or failures.
  • Server Maintenance can also be a great tool to get ahead by checking various items. Below is a table of suggested items to develop a regular maintenance program.

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The above list is not an all-inclusive monitoring plan of your application and environment. It is meant to highlight areas during the normal course of the business day that should be evaluated or established to increase your proactive time versus you reactive time. Depending on the size of your organization, some of the suggestions may not be viable. However, hopefully this article has stimulated areas of thought in the general maintenance area. Lastly, I invite readers to check out our formal 3 day on-site Allscripts TouchWorks Architecture, Maintenance, and Monitoring Training on our website (http://www.galenhealthcare.com/products-services/technical-services/training/). I’d love to hear what others recommend and are doing to ensure they try to stay ahead of their end-users.

 

Custom Reporting

“Allscripts TouchWorks is a great EHR, but is lacking in reporting.”  This sentiment has been expressed over and over by the people who use it daily. There are a thousand and one reports needed to deal with the wide variety of measures, and the differences between the reports can be subtle enough that a single canned report won’t cover many scenarios.

When it comes down to it, the EHR is meant to assist in the delivery of care; reporting, while useful, is a secondary consideration. That’s not to say that reports shouldn’t be included in the EHR, because a lot of value can be derived from them. They are useful in a multitude of ways, from simple reports such as problem-based patient populations, to reports on scheduled appointments or charges. Still, reporting often requires a finer level of detail than a canned product can provide, and even input parameters may not allow for that necessary level of control. Often, small differences in workflows cause data to be found in different fields, making out-of-the-box reports less practical. As requirements evolve, the complexity of even a simple report can multiply, and the reporting logic should have the adaptability to accommodate these changes.

In today’s data-centric environment, custom reports are incredibly useful in tracking progress on both external measures, such as HEDIS or PQRS, and internal organizational initiatives. There have been many variations of referral reports, such as the one Acton Medical Associates uses to analyze their internal vs. external referrals. Sunny Herguth, the Clinical Director at Acton, had this to say about their report:

The referral tracking report is used all the time to track referral trends and to use to see who we do not receive reports back from once a patients sees a specialist.

This is a great example of a custom report used for internal purposes. Knowing where referrals are going, and from which providers, can give an organization insight into areas that might be improved.

Another example, from OrthoVirginia, addressed the issue of providers not signing notes. Rhonda Coor, COO, explains how they use the report:

When my group decided to more closely monitor the signing of notes, I turned to Galen to write a custom report so I could track my physicians’ compliance.  The report is the only way I can stay on top on how the physicians are timely dictating and signing their notes.

This particular report was used to guide providers to complete their charting, though other reports have been used as a carrot rather than a stick incentive.

Custom reporting also contributed to the American Medical Group Association’s (AMGA) Measure Up/Pressure Down program, an initiative to improve hypertension patient care and the general health of this patient population. Rather than a regularly run EHR report, this report was designed to pull percentages of patients who met certain blood pressure criteria. Baptist Medical Group collaborated with Galen on the necessary parameters for the patient groups, and Galen developed several queries to extract and compile this data. The AMGA and Baptist leveraged the data to deliver better care to their hypertension patients, with the end goal of building a healthier patient population and reducing healthcare costs for the organization.

I’d like to conclude with an anecdote from Tom Goodwin, manager of Clinical Systems and Clinical Data Quality at MIT Medical:

In this electronic age it is hard to tell an exciting story about a printed sheet of paper. But if the sheet of paper serves as many purposes as I am about to describe I think you would agree that it is at least worth a smile.

In order to provide a high level of service, MIT Medical, like every other healthcare organization, needs to collect a tremendous amount of information from our patients. This information feeds billing, supports Meaningful Use and Joint Commission initiatives, ensures patient safety, and most importantly helps to improve the patient clinician relationship.

The MIT Medication Worksheet is unique to the presenting patient and can be printed from the schedule in a batch for the day or on the fly from a number of spots within the chart. Based on information we already have in our electronic health record, the patient is asked to verify standard demographic information, to support Meaningful Use they are asked to verify race, ethnicity, preferred language, their smoking status, and if they would like a clinical summary. For Joint Commission they are asked about special needs. For safety they are asked to verify existing allergies, the medication list as displayed in the electronic health record, and they are asked to write down any medications prescribed by an outside clinicians as well as over the counter or herbal medications that are taken on a regular basis.

Using this worksheet gives our patients a sense of how well we know them. They are more active participants in the care they receive and they aren’t frustrated by being asked to newly produce the same information at each visit.

Our friends at Galen Healthcare helped to make this and many other enhancements to our electronic health system possible. We truly value our partnership with Galen.

Custom reports can provide tremendous value. They can expose workflow deficiencies, assist in clinical and administrative decision making, and provide necessary data to third parties for patient care or financial reimbursement. Let Galen help your organization make better use of your EHR data. For further information, please check out a sampling of custom reports on our website or contact sales@galenhealthcare.com.

Not another meeting?

If I polled my friends/colleagues on how many meetings they attended in the last week that they felt were unproductive and not useful, my guess is the majority would just laugh and say “that’s most meetings I attend!” In the Healthcare IT business, it seems the number of meetings I attend continues to grow, leaving little or no time to actually do the work that comes out of the meetings. I personally believe meeting volume has grown due to poorly planned and facilitated meetings – resulting in repeat meetings on the same topic that wasn’t addressed in the previous meeting. You know the saying “let’s have a meeting to have another meeting”.

Conference calls only add to the complexity of the meeting due to fading cell phones, the dreaded mute button, multiple people trying to speak simultaneously, and clashing organizational cultures. There has been a great parody recently that laughs at what happens on conference calls and how that would look for an in-person meeting (http://www.youtube.com/watch?v=DYu_bGbZiiQ). My head is already starting to hurt just thinking about it, and I think most folks get the point. Any search on the internet returns a gazillion tips on how to run an effective meeting, so why doesn’t it seem to make the meetings better?

Well in hopes of improving the next meeting in some way shape or form, I have been researching ways to improve – not just the meetings I am facilitating – but also how to be a better participant. What I found is that the biggest way to make meetings more effective is a number of simple concepts:

How to avoid having to have another meeting?

1. Have an agenda for every meeting that is attached in the invite at least 24 hours prior to the meeting. It is essential to let people know the expectations of what will happen in the meeting. Include the goal of meeting, topics to be discussed (with the responsible facilitator for each item) and the associated time limit. In addition to an agenda, be sure to send any background material required well in advance if participants must read it to participate effectively. A meeting without any information other than a subject line discourages participation because you’re likely competing against the two, three or more meeting invitations people have at the same time. Including detailed information also allows attendees the chance to reach out to the meeting coordinator to include other key stakeholders or attendees that would add value to the subject matter.

2.  Invite the right people and ensure their acceptance in advance of the meeting. Either require acceptance/ decline or use the phone/text to ensure the right attendees are present. If you don’t have the right folks invited or key participants don’t show up, you’ll end up wasting everyone’s time if you proceed with the meeting anyway. Reschedule the meeting if you know the key folks are not able to attend. If you don’t know all the right people to invite, spend time prior to the meeting networking and ensuring the right attendees are invited.

3. Stay on track, on time, and on target. This is the hardest task – to facilitate or attend the meeting and see it not following anything that was laid out in the agenda and it ends up going off on a tangent. Keep everyone’s eye on the ball during the meeting for the specific topic and defined time allotment. If unrelated subjects are raised quickly push them off with a “let’s do this outside of this meeting or offline.” If your meeting has a number of those tangents perhaps reminding participants the meeting is an interaction on a stated topic will help. There are certainly appropriate times where a subset of folks need to meet (call it a ‘working group’) to gather related information and have a slot on the agenda to share their findings. Staying on track and time really is controlled by the facilitator who is running/leading the meeting. However, keeping the meeting on target is both the facilitator and the attendees’ responsibility.

4. Engage all participants! If you invited an army to the meeting, did you really need to? If participants had no comment/interaction, did they really need to be invited? Even worse, was input needed by certain attendees who did not share because they were distracted or maybe too shy to speak up? Control the meeting by calling on people to provide their input. Put a stop to multi-tasking during a meeting, gently ask attendees to put down the devices/emails/Facebook and listen. Lay down ground rules early and refer to them as needed.

5. Close out every meeting formally with the group. Take the last 2-5 minutes to review the high-level items the group discussed/reviewed/decided and outline any actionable items with the respective owner and timeline to complete the task. Thank everyone for their time and active participation. Get verbal commitment from the team with understanding of the next steps and deliverables. Finally always show your appreciation for the value each of them brings to the initiative.

6. Document the meeting, distribute to all members (attendees/absentees) and follow up! Write up Meeting Minutes/Summary/Recap that can be clearly understood even by those who didn’t attend the meeting. Write the summary so it can be referenced one week to one year from the meeting date to avoid the “didn’t we already decide or go over this item before” issue. Every meeting should have defined action items or take-aways (or whatever you want call them). Rarely would your day be filled with meetings to announce something without a discussion, so capture the main points. If that was the case then we could just read an email or newsletter. Make sure the action items agreed to are clearly written with defined timeline so each task owner can remember their commitments. Follow up after the meeting to ensure progress on action items from the meeting and track progress.

Everyone is busy in the rapidly changing healthcare IT arena and we are pulled in every direction. If we can improve on meeting planning and execution, we will have more time to do the work needed to be done in this –fast moving business sector.

References

http://www.forbes.com/sites/forbesleadershipforum/2014/02/05/seven-steps-to-running-the-most-effective-meeting-possible/

http://humanresources.about.com/od/meetingmanagement/a/meetings_work_3.htm

Means, J., Adams, T., Spivey, M. (2007). Facilitating Effective Project Meetings. PMI Global Congress Proceedings- Atlanta, GA. (http://marketplace.pmi.org/Pages/ProductDetail.aspx?GMProduct=00101071200)

Whitten, N. (1999). How to Run and Effective Meeting. PM Network, June, pg. 19. (http://marketplace.pmi.org/Pages/ProductDetail.aspx?GMProduct=00100459500)

 

 

Galen’s 2nd Annual GPAC!

 

Galen is excited to announce the second annual GPAC event in August 2014! The Galen Partner Advisory Council exemplifies what continues to make Galen successful – innovating and collaborating with our remarkable Allscripts user community. Our GPAC event is set to align with ACE – Allscripts Client Experience and will be held August 11 and 12 in Chicago.

Participants of this exclusive event include senior management, physician champions, and experienced EHR analysts from our client groups throughout the country.  The Galen team will consist of our senior leadership, as well as representation across professional services, technical services, and our product teams.

The focus of GPAC will be the hot industry topics that are challenging and important to our partner organizations.  Topics will range from Value Based Care to P4P Reporting to Clinical Documentation Improvement and Meaningful Use II. These discussions not only help shape the future of Galen and how we can best support our clients in the ever-changing health care landscape, but are great for organizations to share ideas and build relationships with peers from other organizations.

The success of our first GPAC event paved the way for us to hold this event again, and we are thrilled.  We look forward to joining forces with some of our most valued clients to renew and transform health care!

GPAC

 

The Promise of Value-Based Care

Here at Galen Healthcare, we believe in the benefit and opportunity value-based care provides.  Over the past year, I’ve had hundreds of discussions with our clients about the shift from fee-for-service to value-based care.  There is a fair amount of anxiety for provider organizations and their IT teams.  This is completely understandable.  Many wonder exactly what value-based care means?  How many models are there?  Does it mean I have to be an ACO?  Do commercial bundles and medical tourism packages count?  How do I technically achieve it?  Do I need a consolidated technology platform, or can I just swap out my patient accounting system?  These are just a few of the questions I hear in my travels.

The fact is that value-based care has taken many shapes, and almost all of them are customized to the provider organization.  The fact is that very few payers have a standardized approach to value-based care, because it is early, and everyone is still trying to figure this out.  At Galen we believe that is OK.  When revolutionary ideas appear, they’re often messy and take time to form their shape.  That said, we do not believe that our customers can wait on the sidelines for a more mature model to appear; we want to help you start now.  While some may deny it, fee-for-service is dead.  It’s still walking around like a zombie, but it’s dead.  Healthcare is going broke, and US patients aren’t remarkably healthier than other nation’s patients.  The country needs a shot in the arm to get moving, and value-based care will do the trick, because well, it works.

Galen strives to be pragmatic about the opportunity of value-based care.  The idea is to not upset your current revenue stream, but to take advantage of areas where pay-for-performance and other value-based care initiatives makes sense. We then build those capabilities that will create serious long-term strategic advantage for your organization.  The benefits of value-based care are obvious and lasting.  Through people, processes, and tools, you create a model where people get better with fewer resources.  That makes a lot of sense.  It can seem confusing to decide which value-based model requires what technology components, but through assessment and discovery tools, a path can be found, and we can help.

In furtherance of this vision, Galen Healthcare is pleased to announce a very exciting partnership with Pinpoint Health. This partnership creates terrific synergies between the healthcare consultative and technical expertise of Galen and a transformative new solution provider in the value-based delivery space. Pinpoint Health has an exciting new platform that will make care plans the centerpiece of coordinated care. We believe deeply that care coordination can only be achieved with lightweight, cost-effective platforms that simplify the experience of the physician and create a plan for the patient. In Pinpoint Health, we have found that platform. This partnership was created to bring a coordinated care alternative to our customers, and you’ll be hearing much more about it in the future.

As healthcare consumers and healthcare IT consultants, we’re very excited about the potential of payment reform.  We look forward to a conversation with you on how your organization is taking this journey.

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