Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Why would an independent practice or community clinic benefit from sharing an electronic record system with a larger organization? After all, they often view these organizations as their competition. They are private clinics for a reason. They want to make their own decisions. They want the flexibility of staffing who they want in what roles they deem appropriate. They want to keep their patient lists private. They value their independence.
So, just what are the benefits for a community clinic to join the EHR of the larger healthcare organization?

• Continuity of patient care. Physicians have access to the patient’s history at the click of a mouse. The physician knows the patient’s history from experience; decisions and new information can be integrated from a whole-patient perspective efficiently without extensive investigation or record review.
• Transparency of data. Clinical data can be shared freely while keeping finances and scheduling completely separate and private.
• Improved referral process. The referral process is made more efficient and the results turn-around is much faster and more consistent.
• Better communications between patients and providers. There are fewer chances for errors and “missed” communications, both provider-to-provider and provider-to-patient.
• Centralized system maintenance and troubleshooting. Community providers benefit from sharing technical resources of the host organization, including support and upgrades.
• More affordable cost option. Community physicians and hospitals can have all the benefits of a shared record, often at a lower cost than implementing a free-standing EHR.
• Benefit from lessons learned from a completed implementation. The larger organization does all the work after having had a successful implementation. They have picked a meaningful use (MU) approved vendor, efficient and meaningful workflows have been tested and proven, and quality reports are already created and readily available. This avoids the risks and time consumed by starting from scratch.
• Government financial incentives are theirs to keep. Meaningful Use dollars are their own.

Ultimately, joining a program such as Epic’s Community Connect gives these practices the access to share medical records with the larger organization in an easy, proven and affordable manner. Private clinics and community hospitals can maintain their independence while their access to a shared medical record contributes to better, safer patient care.

The New England Journal of Medicine published an article this past week on the reduction of MRSA infections at hospitals. This is particularly exciting for me as I worked on this research and I am named as a contributor to the article.

The REDUCE MRSA trial was conducted at 43 HCA hospitals involving almost 75,000 ICU patients. The results of this study are important, as they show the potential to reduce bloodstream infections by up to 44 percent and significantly reduce the presence of MRSA in ICUs.

We started performing this research and analysis a little over three years ago. With the article being published last week, I’ve recently thought a lot about the work that I do and the impact I have on the health care system.

My role has changed some. I am currently working on reporting and data conversion projects at Galen. But like with my work on research studies, attention to detail and striving for perfection is essential to a successful project outcome.

My colleagues and I love what we do because we help make a difference in the care of patients. We work behind the scenes to ensure that those who deliver medical care have the tools they need to do their job, and do it well. The implications of the impact we make is bigger than ourselves. The smallest recommendations of clinical guidelines can help save money on health care costs, deliver more efficient and safer care, and ultimately has the potential to save lives.

I hope that everyone reading this blog article takes the time to think about the impact we are all making in the industry. Please pat yourself on the back for the difference you are making.

Metrolina Nephrology has nine offices and forty-six providers; it is the most recognized and experienced nephrology group in the Charlotte, NC area.  Metrolina pursued Galen’s help with migrating lab vendors from CHC lab to Orchard.  The Orchard system is able to route orders to and send results from multiple vendors.  This migration project involved 6 interfaces, an ADT interface, an orders interface, a results interface, a dictionary interface, an inbound orders interface and an inbound charges interface. The project utilized two requested performing locations, CHC and Orchard.  Metrolina wished to keep their existing tasking, patient matching, and provider matching logic from their CHC interface.

The ADT interface provided the orchard system with patient demographic information.  The ADT interface was a pass through interface from the PM interface to Orchard.  This interface required a race translation table because the races in Orchard differed from the races in Metrolina’s PM system.   It was necessary to do a bulk load of patient demographic information after the go-live date to get all the patient data loaded in Orchard.

The inbound orders interface was utilized to change the status of the orders from active to in progress once the specimen was collected.  Metrolina utilized the inbound orders interface to generate an electronic lab waiting list.  When the status is changed to in progress the patient is removed from the waiting list.

The outbound order interface to Orchard was built from the existing CHC interface to insure that important logic was carried over.  The outbound order message involved a custom vbscript with a SQL query to look up the scheduling location where the order was placed from.   It was necessary for the scheduling location to be sent out in the outbound order message because Orchard needed to send it back in the inbound charge message.   The RPL was sent out in OBR-18 so that Orchard could send back the correct RPL in the inbound charge message and the inbound result message.  The inbound result interface was also built from the existing CHC interface and did not have any special customization other than the RPL mapping which is usually hard coded.

The inbound charge interface utilized the scheduling location that was originally sent out in the Allscripts order and sent back in the Orchard result.  The patient type was used to determine the billing department and Orchard sent the place of service in the charge message.

The dictionary interface was set up to automatically add unit codes, and orderables and resultables.  The dictionary utilizes a stored procedure to store the order data and result data into the appropriate works database tables and sync them to their correct RPL.

Many providers have desired the ability to order multiple items with one click within Allscripts EEHR. Starting in v11.4.1, this functionality will now be available!  Stage 2 Meaningful Use (MU)- Core 1-Computerized Order Entry (CPOE)  includes medications (like it does in Stage 1) however it will also require a percentage of labs and imaging studies.  Allscripts has enhanced the order entry functionality to assist providers in meeting this MU Core item by increasing order entry adoption and also improving the end-user experience.

Using a new prenatal visit as an example of what I’m referring to —-providers often order a series of tests (typically called a prenatal panel) and would like to have the ability to order them all with one click. A prenatal panel can consist of a CBC, Chemistry panel, ABO grouping, and STD panel. Currently, this requires the user to select each test separately within the ACI since each test is an individual order. The new functionality will allow the end user to order multiple items with one click  as listed above and includes spanning over different orderable items categories ( Medications, Labs, Imaging, Follow Ups).

Starting in v11.4.1, the user could define an Order Group that can be inclusive of multiple orders and tailored to that specific provider, assigned to a specialty, and isn’t necessarily problem based like Careguides/Quicksets.

What does it look like? I’m going to walk through a scenario of how a user on the front end can develop their own order group and then steps for people to begin to think what would work best for their organization as prep work for moving to v11.4.1.

Building the Order Group
1. In the ACI Window any orderable item that you’d like to be part of your order group first needs to be a personal favorite. It is likely that it already is however if not, you can search for the item under the appropriate classification (i.e. Lab/Diagnostic, Imaging, Rx etc) then right-click and click on Favorite item. See Diagram 1

 

2. To begin the Order group, right-click on any favorite item and select Organize Favorites (new feature in v11.4.1)- See Diagram 2 

 

 

3. A new screen called Organize Favorites will open and allows you to edit an existing order group or build a new Order group. See Diagram 3

 

4. To build a new order group, click on New Order Group and type your desired name of the new order group. See Diagram 4 

 

 

5. To add orderable items— simply highlight, drop and drag to the folder or you can highlight and click Move item and drop into the appropriate order group folder.

6. Once the order group is complete with all the potential orderables items it will display in the ACI denoted by a folder in front of it. See Diagram 5

Using the Order Group

1. To use the Order — begin in the ACI and best practice highlight the diagnosis or diagnoses to link to the order group then click the Order group. See Diagram 6

You will be able to click the Order Group folder from any tab that has orderable items in it. In the example above, you can expect to see a Prenatal- Nausea- Medium Risk under the Rx, Lab, Rad, Instruction, Follow up tabs in the ACI since there are orderable items in each category.

This is ONE click to have multiple orderable items ordered now using this new functionality across different order classifications (labs, imaging, etc).

Considerations
This feature will streamline adoption and increase end user efficiency tremendously.

1. How is this different from Careguides or Quicksets”?
   a. First, Careguides/Quicksets are problem based. Order groups are not problem based and in fact can be anything the provider/specialty would like them to be. For example, you can build a routine annual exam visit or better yet- I often have providers state Careguides or Quick sets are great however if I have a complex patient that is being treated for Hypertension, Diabetes, Coronary Artery Disease- there are tests that overlap (i.e. Chemistry, Lipid, etc) and they get caught with needing the diagnosis linked to the order for billing but then they get prompted for duplicate checking screens (a configuration feature).
   b. With order groups a provider can completely think outside the box. You could build something called Complex Patient Visit- 3 Chronic and include all of those orderable items desired so when all 3 problems are highlighted in the ACI and the order group selected- all the diagnosis would be tied to those items. Additionally, you’d want to be more inclusive versus exclusive in building your order group. As you can see in the Diagram 6, if a test wasn’t desired you could simply uncheck an orderable item if it didn’t apply for that patient and/or visit.
2. Can this be built and automatically given to providers or specialties so our provider don’t have to build their own?
   a. Yes. A system analyst/provider could build the desired Order Groups under their profile then using SSMT you can extract and either load to another user or specialty. See Diagram 7

What can you do now?

One suggestion would be to begin to capture what order groups a particular provider or specialty would like built and begin to capture the naming convention and/or orderable items for each group. Perhaps there are even more decisions your organization has related to Order Groups such as- how many will be pre-built to assist in adoption/end user experience versus training the providers to build themselves.
This new feature in v11.4.1 will greatly improve the order entry process for the end users.

• References
  Allscripts-v11.4.1 Functionality Overview- Client Connect
  Stage 2 Core Measure 01- Computerized Order Entry_Draft- Client Connect

 

Patient engagement is one of the key tenets of a Patient-Centered Medical Home (PCMH) and the focus of many of the Accountable Care Organizations (ACOs) we work with. Without it, care coordination and population health improvements will never work. However, it seems as though few organizations really know how to achieve the levels of patient engagement that are needed to see tangible results. Further, there is little data on patient engagement techniques on a large scale. What we do know is that we will never reach the levels of patient engagement necessary for continuous health improvement and monitoring without technology.

 

Galen offers reporting services that enable organizations to identify patients in need of care. Our integrations team assists organizations send information to and from Patient Portals and Health Information Exchanges (HIEs). Our products help providers display information to patients in ways that make sense to them. That said, Galen cannot drive patient engagement alone. That is why MedCity is hosting the ENGAGE conference in Washington D.C. on June 5^th and 6^th. ENGAGE brings together some of the brightest minds and leading organizations at the forefront of patient engagement and healthcare delivery to discuss various approaches to patient engagement as well as the challenges that accompany them. If you are looking for a better understanding of the healthcare landscape, look no further than this conference.

ATTENDING ENGAGE WILL GIVE YOU:

• A shared understanding of the current care environment and the major policy and market drivers behind care innovation
• Perspectives from federal policy leaders on future government support of patient engagement
• Perspectives from health leaders on the business case for exceptional patient engagement
• Panel sessions dedicated to ACOs, patient-centered medical homes, chronic disease management, as well as employer wellness and behavioral change
• Insight from engagement experts from a variety of different fields and how to apply those principles to healthcare
• Access to innovators “in the trenches” and demonstrations of the latest technology platforms to communicate with and encourage patient behavior

To register simply click here

I hope to see some of you there! Please reach out if you are attending: Christopher.Libby@GalenHealthcare.com 

Tags: Conference, Events, Healthcare Innovation, Healthcare IT, Patient Engagement