Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

It’s no secret that we all have busy lives.  As professionals and individuals, we are all important pieces of the larger puzzle of the healthcare community. As partners working towards a common goal, we continually collaborate and contribute to the bigger picture of an ever-improving healthcare system.

I’ll be the first to admit that it can be easy sometimes to get caught up in the day-to-day tediousness of all the little details that require my attention inseeing a myriad of projects through to their fruition. That being said, I think it is important to not lose sight of the bigger picture and to fuel the fire of our motivation by taking a step back from time to time.

Recently, someone shared an old story with me about a man who walks by a construction site and sees workers pushing wheelbarrows; each filled with an enormous stone.

The man asks one of the workers what they’re doing.

“What does it look like?” he says with a sneer.”Hauling rocks.”

Unsatisfied with that answer, the passerby asks another construction worker the same question.

The workman doesn’t bother looking up. “We’re putting up a wall.”

Frustrated, the man tries one last time. “I say there,” he asks the next worker, “can you tell me what you are doing here?”

The worker puts down his wheelbarrow, wipes his forehead and says with a broad smile, “We’re building a cathedral.”

Here are three workers, all doing the same job. One is hauling rocks. One is putting up a wall. One is building a cathedral.

This story says a lot about the attitude that each of us brings to our lives… or could if we were willing to change our perspective. At Galen, we pride ourselves on our attitude and I think this story speaks true to one of the main motivators of our collective outlook.

Each of us plays a vital role in our respective realms as we focus on ‘hauling our rocks’ to meet this deadline or solve that problem. As we move forward, we slowly but surely ‘build walls’ and accomplish individual and organizational objectives.

But the real objective of our efforts, whether we realize it or not, is actually helping to achieve a better healthcare system in this country, one small step at a time. In our own unique way, and with each accomplishment, we help to realize this collective dream.

Attitude truly is everything. Yes, it may sound like a cliché to some, but this simple statement speaks volumes towards one fundamental change of perspective we can make, which in turn can make an overwhelming impact on the level of happiness and enhance the quality of our day-to-day lives.

The choice is yours. You can haul rocks. You can put up walls. Or you can build a cathedral.

Galen’s Interface Team had a full house in Boston yesterday, hosting twelve interface analysts from ten healthcare organizations throughout the country, for Galen’s first Results Interface Conference

The training covered the topic of building and maintaining results interfaces within the Allscripts Enteprise EHR. The group covered ImageLink, order reconciliation, Requested Performing Location identifiers, auto synching, troubleshooting errors and the underlying data model.

While I have great confidence in our Interface Team and the instruction provided given their expertise, the best part of the day was the interaction that occurred between the different healthcare organizations that attended the training. Throughout the day, I saw attendees pulling each other aside during breaks. They were discussing approaches to resolving errors they saw in their own environments, best practices for building new interfaces and trading ideas on working with microbiology results in Enterprise (a perennial issue).

The group continued conversations started on the Allscripts Interface Developers Network, which I’m sure will continue today and in coming months.

We look forward to offering similar conferences and trainings, and would love to get your thoughts on what type of training sessions and conferences we should host in the future.

Client – UMass Memorial Health Care

Project:  UMassMemorial V11.2 Upgrade

Project Timeframe:  February 7, 2011 – June 13, 2011

Client Contact: Emily Lazaros, Allscripts Application Manager

“I would like to take this opportunity to tell you of our experience with our Galen upgrade team.   Troy Forcier and Kristie Gilbert are, in a word, fantastic.  They are professional and knowledgeable, and have been with us on this upgrade every step of the way.  Kristie’s project management skills and proficiency with the application are exceptional and Troy is about as calm a person as I have ever come across.  This gives us, the client, a real sense of comfort.  And as the IT Ambulatory EHR lead for this upgrade, in an organization of this size, that is invaluable.

….

Last, but not least, we have had lots of laughs and fun together through this process.  Thanks to them and Galen for helping to make our 11.2 upgrade a success.”   –Emily Lazaros, Allscripts Application Manger at UMass Memorial Health Care

 UMass Memorial Health Care is the largest health care system in Central and Western Massachusetts, and the clinical partner of the University of Massachusetts Medical School. The Medical Center has a total of 12,350 employees with approximately 1,700 physicians and 3000 registered nurses representing clinical expertise in Cardiology, Orthopedics, Oncology, Emergency Medicine, Surgery, Women’s Health and Children’s Medical Services.   UMass, on the cutting edge of technology, utilizes Allscripts Enterprise Electronic Health Record^TM (AE-EHR) as a means to help with continued excellence in clinical care and patient service.  Over the last several months UMass has worked, very successfully, with Allscripts and Galen Healthcare Solutions to upgrade their AE-EHR product to version 11.2.

The underlying motivation for this version upgrade was of course, Meaningful Use.  While there are incentives for moving to the new version, the idea of having to implement new functionality with potential workflow impact is regarded with dread.  There are dozens of models for how to complete an upgrade, most of which are painful.  The vendor and we, as your consultants, must take ownership over finding the best model for your practice to reduce the pain of upgrading.  Since Meaningful Use is the ‘next big change’ in healthcare, this change needs to happen for all medical practices across the US.  So the question remains, how do you increase your chances of success? Your Galen consultants will help lead the way.

The duration of this particular upgrade project was a brief 19 weeks, leaving us little time to configure the new AE-EHR version 11.2 functionality and guide UMass towards decisions that would qualify them for all Meaningful Use criteria.  In addition to a rapid project timeline we encountered other challenges: the release of process documentation simultaneously to the stages defined in our plan and shifting resource allocation as priorities changed.  Throughout the entire process, though, we were able filter the information, analyze the functionality, provide appropriate guidance, and enjoy the camaraderie of a great group of UMass team members!  We can now take great pride in knowing we were helping thousands of people use their version 11.2 AE-EHR product in a Meaningful Way.

A week after UMass has transitioned to end users, the real challenge of analyzing their data and incorporating their new configuration into their daily lives will prove to be a reality once the Galen team returns to assist with the Stimulus Set.  I know we are all up for the challenge!  Our willingness to help our clients, to test our knowledge of the latest cloud technologies and data reporting and to pass it along will be a very rewarding journey.  If the final product can be as great as the first steps in helping UMass upgrade their base AE-EHR version 11.2, then sign us up…Galen is ready to go! 

UMass was a fantastic group to work with and we look forward to helping them implement the Stimulus Set.  Congratulations to the staff at UMass for a successful upgrade!  We also appreciate the positive feedback from UMass and plan to make the same impact with other clients.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Meaningful Use, Successful EHR Implementation

Client: MedNetworx – Azalea Orthopedics

Project: MedManager PM -> Allscripts PM Conversion

Project Timeframe: April 15^th – June 1^st (6 weeks from initial scoping to go-live)

Client Contact: MedNetworx – Mark Johnson, President and CEO.

Description: Azalea Orthopedics, located in Tyler Texas, has been providing orthopedic surgery, sports medicine & pain management in East Texas for the past 20 years. Azalea employs 130 including 17 physicians who are specialists in orthopedic surgery, physical medication and rehabilitation. MedNetwoRx, a healthcare application service provider (ASP), located in Dallas, Texas, hosts the practice management and electronic healthcare record applications for Azalea. Azalea looked to convert from a legacy PM system, MegManager, to Allscripts PM, as part of consolidating systems to the Allscripts product line. Partnering with Galen Healthcare Solutions, MedNetwoRx leverage their own in-house Allscripts product and physician practice experts as well as Galen’s deep experience with clinical and administrative data conversion.

To facilitate this conversion, flat-file extracts were obtained from MedManager for dictionaries, demographics and appointments. However, instead of using these extracts to import into Allscripts PM, an alternative approach was taken in which real-time appointment and demographic interfaces were deployed from the client’s existing Allscripts Enterprise EHR to the new Allscripts PM environment. This offered the flexibility of having the PM data populate real-time. Interfaces were also required from Allscripts PM to Allscripts Enterprise EHR. Thus as part of the go-live, existing reg/sched interfaces from MedManager to Allscripts Enterprise EHR needed to be deployed.

Utilizing existing data in the Allscripts Enterprise EHR as well as flat-file extracts from MedManager (for more complete insurance and referring provider information), a conversion of dictionaries, registrations and appointments was executed.  Care had to be taken to ensure that appointments loaded into Allscripts PM would be able to map to existing appointments in the EHR and update appropriately instead of creating duplicate appointments. The same consideration had to be made for dictionaries to ensure proper matching on codes.

All patients (inactive and active) and appointments for the previous 2 years as well as future appointments were loaded from the Allscripts Enterprise EHR into Allscripts PM. Since insurance information wasn’t being captured in the EHR, and update of patient’s accounts in PM had to be executed, utilizing flat-file output from MedManager. Additionally, the patient MRN seed in PM needed to be reset as to avoid contention, and insurance and referring provider dictionaries were updated using extracts from MedManager, since the extracts contained more complete data than the EHR.

Conversion Statistics:

Tags: Allscripts, Allscripts Conversion, Allscripts Enterprise EHR, Allscripts PM, Clinical Conversion, Data Conversion, Galen Clinical Conversion Toolkit, Integration, Interfaces, MedManager, MedNetwoRx, MSO, Multi-Org, PM Conversion, Practice Management Conversion

Client: Lexington County Health Services District (LCHSD)

Project: Columbia Medical Group Greenway Primesuite EMR-> Allscripts Enterprise EHR Conversion

Project Timeframe: April 13^th – June 1^st (6 weeks from initial scoping to go-live)

Client Contact:  Donna Lyles Basden, Director of Physician Support Services, David Gavin, The Columbia Medical Group Practice Administrator

“A key success factor in the assimilation of The Columbia Medical Group into our organization was the conversion of data from their Greenway Primesuite EMR to the District’s Allscripts Enterprise EHR.  The Galen conversion team was able to successfully extract and convert the data, such that our patient demographic and discrete clinical data was available seamlessly within Allscripts EHR on day one . The technical expertise and support from Galen was impressive.” – Donna Lyles Basden, Director of Physician Support Services, Lexington County Health Services District

Background:

Lexington County Health Services District, Inc. (LCHSD), located in Lexington County, South Carolina, is a health care district comprised of more than 40 physician practices which span across multiple specialties (Primary Care, Internal Medicine, Ob-Gyn, Orthopedics, General and Bariatric Surgery, Pediatrics, Rheumatology, Endocrinology, Oncology); Community Medical Centers; Occupational Health and anchored by Lexington Medical Center, a 414 bed acute care facility. Lexington sought to incorporate Columbia Medical Group – an 8 provider multi-specialty practice with 7 Internal Medicine and 1 Neurology provider – into their organization and also have the group convert from Greenway PrimeSuite EMR to Allscripts Enterprise EHR.

The scope of the data conversion spanned approximately 6 months of clinical data from the Greenway PrimeSuite EMR.  The nature of the data included 1^st and 2^nd generation data from Greenway EMR; including data entered directly into Greenway as well as previously converted demographic data from the previous EMR in place at Columbia Medical Group (GE Centricity).

Challenges inherent in some of this information were embedded in the fact that on the fly “free text” entries were previously allowed for Greenway elements such as Problems, Allergens and Allergen reactions.  This presented situations where consolidated translations and additional application build were required in order to account for the different variations and combinations of the data.

Data Extraction:

The data extraction process was performed using SQL based extracts including a common delimiter and standardized field definitions for each data element.  Flat (text) files were generated for each data element from the source system, FTP’d to the interface engine server and ultimately placed in a directory for ConnectR to process.

Data Element Extract Breakdown:

Allergies – manual translations (T-tables generated) for both Med and Non Med Allergens.  Allergens incorrectly categorized or that were not able to map and build on the EHR side were also dealt with as Unverified allergens.  Reactions and comments were formatted, concatenated, and stored in EHR as Allergen annotations.

Immunizations – due to the manageable size of the source system peripheral dictionaries manual translations were performed and maintained in the extract for Vaccine Medication, Route, Site,  and Manufacturer.  Comments and various care providers were also dealt with as Immunization annotations in EHR.

Results –Lab results for all ordering providers which included discrete results spanning 3 previously used performing locations (LabDaq, LabCorp, and Quest).

Vitals – included height, weight, temperature, O2 sat, pulse, respirations, and blood pressure.  Also included were orthostatic vital entries from the source system.

Problems (Unverified) – because an unverified and unrecognized item is considered just that, various discrete elements were identified and concatenated to provide useful and relevant context to unverified Problems in EHR in order to assist in making the verification process manageable and reduce chart pulls and use of the legacy EHR.  Naming convention adopted for Active, PMH, PSH, FamHx, and SocHx: Greenway Problem Name + OnsetDate (or date of procedure) + Notes/Comments

In situations where ICD9 code values were associated with the problem entry in the source system it was passed to EHR in order to assist with codification requirements and provide assistance during the ACI search and problem verification process.

Medications (Unverified) – naming convention adopted for unverified medications. Greenway Medication Name + ‘*’ if RX originated outside of the practice + medication status (Active, D/C, etc.) + RX original date + RX provider + Notes/Comments

In situations where codification requirements could not be met or supplied the first 8 characters were defaulted into the Search Text for unverified medications in the ACI search field in order to assist with the ACI search and verification process.

Clinical Conversion Toolkit

The Galen Clinical Conversion Toolkit was utilized to load the extracted conversion data into the Allscripts Enterprise EHR. The conversion statistics for the go-live can be seen below:

*Note that all of the errors above were patient matching errors and were manually reconciled using the Allscripts Patient Bridge tool.

Tags: Acquisition, Allscripts Conversion, Allscripts Enterprise EHR, Clinical Conversion, ConnectR, Data Conversion, Integration, Interfaces, Success Story

We recently had the opportunity to assist clients in designing and deploying interfaces to automatically import charges into Allscripts Enterprise PM from not only Allscripts Enterprise EHR, but also other vendor EHRs including Mosaic and eCW. At one particular client, AEPM served as the aggregator for all charges generated in the enterprise. In addition to the inbound charge interface, an inbound demographic interface was required to ensure that the patient exists before trying to interface and import charges for them. Thus with each generated charge in vendor systems, a HL7 ADT registration message was sent immediately preceding the HL7 DFT charge message.

When importing registrations and charges into AEPM, several matching and translation considerations need to be made. In terms of inbound registration, the following list a subset of “linking” items and their respective options for match:

• Patient
  • Name/date of birth
  • SSN
  • MRN
• Policy
  • Policy Reference Number
  • Subscriber Certificate Info
• PCP
  • Default value
  • Cross Reference Link
  • Direct Map (Abbreviation)
• Carrier (Insurance)
  • CarrierID
  • Default Carrier
  • Cross-Reference Link *Note: a cross-reference link can be likened to a translation table – simply translating an input (vendor insurance code for instance) to a corresponding output (AEPM carrier abbreviation)

Additionally, import options exist including the following subset:

• Auto-Import
  • This function will allow for the automatic import of demographics which do not have any data errors or missing cross reference links. Only those patients which pass all of the validations will be auto registered.
• Allow Update of existing Demographics?
  • Answer Yes – if you wish to allow existing demographic information for patients to be changed to match the data that was imported.
• Default to update existing Demographics?
  • Answer Yes – if you will be updating information for all existing patients.
  • Answer No – if you wish to update patients one at a time or if you do not wish to import all of the patients included in the file.

Lastly, we can selectively block certain fields from importing. This will facilitate certain fields in AEPM to be maintained manually instead of receiving update when importing data. An example of this would be for indicating the Patient Student Status, or Employment Status, which may be required for billing purposes.

The following demonstration illustrates the process for importing interfaced charges and demographics into AEPM:

Tags: ADT, AEPM, AIE, Allscripts Enterprise EHR, Allscripts Enterprise PM, Charge, Data Conversion, Demographic, DFT, eCW, Enterprise EHR, Integration, Interfaces, Interoperability, Mosaiq, Practice Management

A recent article in Health Management Technology – Poised to touch all things -  highlighted the importance of Picture Archiving and Communication System (PACs) and offered the opinions of where PACs is headed from various leaders within the industry.

Additionally, as presented in a recent article in Health Data Management -  Is a Picture Worth a Thousand Interfaces?: “integrating imaging workflows – and images – in EHRs can be costly. But the benefits keep many trying.”

Many organizations utilizing Allscripts Enterprise EHR are unaware that image integration capability exists, and those that do figure it is too costly to implement.

In this demo, we will present Allscripts Imagelink capability. Imagelink is an Allscripts add-on that can be used to integrate outside systems with Allscripts Enterprise EHR.

More specifically, Imagelink provides organizations access to images and other documents associated with a result from a variety of different systems that have a web-based image viewer - from within the EHR.

With this solution, users of the EHR are presented with the clinical data they need to interpret, comment on, review or validate a particular result – without leaving the EHR application.

Just a few of the vendors we have experience in integrating to the Enterprise EHR via Imagelink include (but not limited to):

• NovaRad
• Stryker
• SCImage
• GE

Be sure to look out for one of our upcoming free webcasts covering Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

Contact us today to see if your organization can realize the compelling benefits of Enterprise EHR Imagelink integration.

Tags: Allscripts Enterprise EHR, Demonstration, Enterprise EHR, Extensibility, Imagelink, Integration, Interfaces, Interoperability, Meaningful Use, Results Interface

Integrating other web applications into the EHR is a dream for many.

Here, we take the risk calculator built based on the Framingham Heart Study, and integrate it into the Allscripts Enterprise EHR.  With the integration from Galen, the EHR sends the required fields into the Framingham Risk Calculator, like patient age, blood pressure and cholesterol, reducing the data entry and number of clicks for the clinician.  

Now’s it’s as simple to calculate the patient’s risk of heart attack, as it is to view their chart, all while in the EHR.

As we mention in the video, the Framingham Risk Calculator is just one example of integrating a website or web application into the EHR.

Galen has worked with groups on many types of EHR to web application integration – what would you add to the EHR, if you could?

Tags: Extensibility, Interfaces, Interoperability, Meaningful Use

Tags: Allscripts Consultants, Allscripts Demo, Allscripts Enterprise EHR, Data Conversion, EHR Implementation, Enterprise EHR, Extensibility, Integration, Meaningful Use, ScanMD

Issue:

A recent issue came up with one of our clients in that interfaced patient appointments from their Practice Management system were not making it in a timely manner to the EHR. The client witnessed that appointment messages built up in the interface queue and there was a delay in processing the messages. The client desired a resolution that would assist in speed up of the processing of the messages such that appointments booked in PM would render in the EHR quickly without a disruption to workflow.

Investigation:

Enter the ConnectR Toolbelt “Transaction Processing Time” report:

This report extracts transaction count, minimum, average, and maximum ConnectR processing time per hour. Using the report, the following analysis was conducted.

Findings:

Based on the aforementioned analysis, it was determined that in the clients Live Reg/Sched system target, blocked messages were being logged. Having blocked messages logged can be invaluable when first designing and developing interfaces. However, as evidenced in the analysis, it can lead to performance degradation as the system requires much less processing time when messages are not logged.

Outcome:

Logging of blocked messages in the Live Reg/Sched target was disabled on 6/30/2010 and as witnessed in the analysis spreadsheet the number of transactions decreased by roughly 70% and peak transaction processing time decreased by roughly 90%.

Tags: Allscripts Enterprise EHR, Business Intelligence, ConnectR, ConnectR Toolbelt, Integration, Interfaces, Meaningful Use, SQL Server Reporting Services