Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

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 another eight 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!

Steven Beaucaire, Consultant

Steven joined Galen on September 11, 2011. He comes with us with over 14 years of healthcare experience. He has extensive experience in project management and business operations as well as in-depth knowledge on how technology and healthcare can work together to ensure patient safety and continuum of care. He has significant knowledge on how ambulatory clinics and acute facilities interact within a healthcare organization. His extensive experience as a manager in both clinical and business settings within a healthcare consortium provides an exceptional perspective on today’s healthcare demands. He looks forward to a long and prosperous career at Galen. Steven currently resides in Lewiston, Maine.

 August Borie, Consultant

August joined Galen in January 2011 as a member of the upgrade team, helping to get clients ready to demonstrate Meaningful Use. He worked as both a Project Manager and Upgrade Consultant on this team, while building his Enterprise EHR application experience. Most recently he is working with a client in Portland, Maine on an upgrade and implementation rollout. August graduated from the University of Vermont in 2010 with a Bachelor’s degree in Computer Science Information Systems.

Elise Brault, Associate Consultant

Elise joined Galen in November 2011 as an Associate Consultant and completed Galen’s Certification program in December. Elise graduated from the University of Vermont with a Bachelor’s Degree in Recreation Management. She completed master’s degree coursework in Business Administration at St Michael’s College and also recently completed the Health Information Technology Certificate Program at the Community College of Vermont. Elise brings her diverse background in business, healthcare, and management with her drive for customer service excellence to the Galen team. She looks forward to providing Galen clients with EEHR systems expertise and unsurpassed service.

 Barry Chamberland, Associate Consultant

Barry joined Galen in November 2011, having previous experience as a Software Quality Analyst testing clinical applications and workflows. He has been involved in website development for many years and looks forward to expanding his knowledge and expertise in the Allscripts Enterprise EHR™. Barry lives in Burlington VT, and graduated from the University of Vermont in 2004 with a Bachelors Degree in Recreation Management.

Jon Deitch, Associate Consultant

Jon joined Galen Healthcare in November of 2011. He graduated from the University of Vermont in 2009 with a BA in Political Science and English. He enjoys Skiing, Music, World History, and Traveling.

Evan Lea, Consultant

Evan joined Galen in May of 2011 as an Implementation Consultant. He graduated in 2009 from The University of Vermont with a degree in Marketing. Since joining Galen, he has quickly come up to speed with the front end and configuration of Enterprise EHR. He has recently been working closely with Catholic Health Initiatives in the Midwest with user support, EHR configuration, and build work as they move towards bringing over 500 clinics live in one integrated system.

Kyle Paya, Consultant

Kyle came to Galen in 2011 from UVM with a Bachelor’s Degree in business administration with a concentration in entrepreneurship. Kyle has been part of the success of a multi-million dollar company with focus on project management, inventory management, and operations planning. During his tenure at the aforementioned company; he also designed, built, and implemented the company’s first formal inventory management database mainly for the managerial accounting initiative he introduced. Kyle has been a Project Manager on six (6) v11.x to v11.2 upgrades in 2011. He also became a Galen Certified – Enterprise EHR Application Specialist during this time. As 2011 came to a close, he made a transition to consultant on the professional services team and joined the Galen group at Lexington Medical Center. There, he is helping bring sites live on Allscripts EEHR while also working with the hospital group’s upgrade team as they under-go their own v11.2 upgrade.

Chelsea Stovall, Consultant

Chelsea joined Galen in September of 2011 as an Implementation Consultant. She graduated from the University of Texas at Austin with a B.S. in Human Biology. Following graduation, she completed a Postbac program at UT Austin in Health Information Technology and received her Health Information Technology Manager and Exchange Specialist certification. She has over a year of experience in EHR training, work flow design, go-live support and EHR customization.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, EHR Certification, Enterprise EHR

One of the “Menu Set” CMS Final Rule Meaningful Use Stage 1 objective and measures specifies that “at least 40% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.” Additionally, the Certification Commission for Health Information Technology (CCHIT  - certifying body for EHRs) indicates via IO-AM 07.02 that “The system shall provide the ability to receive and store microbiology laboratory results with organisms recorded as free-text. (Not MU).” This brings to question the handling of interfacing microbiology results into the EHR.

Microbiology results are often longer, textual results including sensitivities. Additionally, microbiology results can have 3 levels of hierarchy:

1. Orderable item(s) (Urine Culture)
2. Culture(s)/Organism(s) (Light Growth Escherichia Coli)
3. Susceptibility(ies) (Amplicillin)

The problem is that most EHRs are not well-suited to rendering interfaced results with three-levels of hierarchy; rather, the EHR is suited for just two levels of hierarchy:

1. Orderable(s)
2. Resultable(s)

When the interfaced result is sent by the vendor as a “discrete” result, the result likely will not render in the EHR properly:

To accommodate for this, most vendors have the capability of sending the interfaced result as “non-discrete,” or in other words, sending a free-text version of the result.  However in an instance where the vendor is able to send “discrete” microbiology results only, the interface analyst is charge with developing a interface customization to translate the “discrete” result to file into the EHR as a “non-discrete”:

The disadvantages of filing the result as “non-discrete” include the likely lack of ability to aggregate or report on these types of results.

For reference the original printed report from the Laboratory Information System (LIS) for the example above (recall that if an interface is not setup, this is the report that is usually provided by the LIS via fax).

Please contact sales@galenhealthcare.com if you or your organization would like assistance in interfacing discrete/non-discrete results to your EHR.

Tags: Allscripts Enterprise EHR, CCHIT, Certification Commission for Health Information Technology, ConnectR, Database, Enterprise Order, HL7, Integration, Interfaces, Interoperability, Laboratory Information System, LIS, Meaningful Use, Microbiology Results

The Path to Meaningless Use:

As many of you know the ACE 2010 event just took place last week. As I was pouring through some of the handouts I couldn’t help but be drawn into the “Handy Trail Guide” which Allscripts has touted as “The Path to Meaningful Use” This is a great high level guide to reaching Stage 1 of Meaningful Use – Capture and Share Data.

The more I read through this the more I thought of how clients will be looking at this with an eye to the shortest path to receiving their stimulus check, and rightfully so – every group should be looking to take advantage of this, from the largest hospital to the smallest single-doc practice. However, I wanted to make sure we don’t lose sight of the forest from the trees here and bring this trail guide back to the true reason for the stimulus – improving patient care! Hence the genesis of this article, The Path to Meaningless Use.

There are a couple of main points I’d like to highlight before dissecting the step by step approach.

1. Sell benefits of the EHR – I feel like this process is woefully underappreciated. In order for your rollout to be a success you absolutely need buy-in from all end-users, including physicians, nurses, data-entry folks and really any person that will touch the EHR on any level. How is this product going to improve their productivity? Make their job easier? Make their work experience more enjoyable?
2. Change is a good thing – Change is the process by which innovation and improvement are instilled. I know that people are comfortable with the status-quo and yes, change for change sake is useless, but there’s a reason for change here, I promise! Challenge your co-workers to look at everything objectively and really question if the products and processes currently in place really make sense or if there could be a better way.
3. Make concessions, don’t over-customize – The product is designed to work best when used in an out of the box capacity, sans customizations. The reality is that you probably aren’t going to be able to sell the idea of changing every workflow to fit the product, but that doesn’t mean you shouldn’t try. Ultimately in the long term the stability of the system is most closely tied to how close you stay to it’s intended use, therefore fight for those process changes to model the system, there’s a reason the EHR was designed the way it was! This point goes back to selling the benefits, be able to show how using the new workflows will actually improve the end-user experience!

With those main points made here are a few comments on the step in the Path to Meaningless Use, enjoy!

1. Understand Stimulus – Don’t just aim for the stage 1 level of capturing and sharing data, yes this can improve productivity but don’t lose sight of the true end goal, improving patient care.
2. Assess Gaps – Be honest with yourself. Are the tools you are using as efficient as they could be? Don’t keep old processes and tools in use just because people are “comfortable” with them, if there is a better tool out there, use it! Sometimes taking people out of their comfort zone is exactly what is needed to promote healthy growth.
3. Design New Workflows – Don’t be unwilling to change workflows simply because that’s the way it’s always been done. Be prepared to pitch workflow re-design to physicians with benefits for them in mind.
4. Upgrade EHR & Stimulus Set – Don’t rush this upgrade. There are many factors that go into an upgrade (depending on how many versions you are jumping) and simply upgrading for the sake of getting the stimulus approved version may end up biting you if you haven’t correctly re-worked process flows to use the EHR in a meaningful way.
5. Rollout – During training stress benefits to end users, a 3 day crash course on the new EHR system is great but if you can’t prove to your end users why the new product and workflows make sense you aren’t going to receive full buy in and consequently won’t get the most out of the product.
6. Begin 90-day Meaningful Use – Metrics should be kept on an ongoing basis, not just for 90 days. It’s great to hit the 90 day plateau to receive the stimulus check but the true purpose of the EHR is to improve patient treatment, and you can’t improve what you don’t measure.
7. Report & Claim Stimulus – Nothing meaningless about this step, claim the money and move on to the next stage!

Tags: Allscripts, EHR, Meaningful Use, v11 upgrade

Galen Healthcare Solutions will be hosting a series of free webcasts covering ConnectR interfaces.  The purpose of these webcasts is to provide insight into advanced troubleshooting methods as well as advanced design and configuration options within your ConnectR environment.  We will cover various aspects of interface design, development and maintenance as well as best practice techniques.

These will be structured in a similar format to university courses – the initial three classes will be at 100, 300 and 500 levels.  The list of the webcasts and their times may be found below.

100 Series – Configuration and Deployment of Imagelink: Overview of Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

• Wednesday, May 19th, 2010 at 2:00pm EST

300 Series – Advanced Troubleshooting: Error analysis and resolution as well as custom techniques for error remediation

• Wednesday, June 23rd, 2010 at 2:00pm EST

500 Series – Advanced Design: Interface filtering techniques and interface-driven tasking

• Wednesday, July 21st, 2010 at 2:00pm EST

To attend, please contact Justin Campbell, justin.campbell@galenhealthcare.com.You must be an existing Allscripts Enterprise EHR client to attend.

We also offer training courses and reporting services for the Allscripts Enterprise EHR database, ETL database, Analytics and the ConnectR  database.  Please contact sales@galenhealthcare.com for more information regarding these courses and our reporting services.

Tags: Allscripts, Allscripts Enterprise EHR, ConnectR, Database, Galen Webcast Series, HL7, Integration, Interfaces, Interoperability, Meaningful Use, SQL Server

There is quite a bit of buzz in the healthcare IT community surrounding the ONCHIT/CMS release of the Meaningful Use Interim Final Rule and the  and the EHR certification requirements. The author of HISTalk kindly spent his New Year’s Eve poring over the documents to provide an excel worksheet summary of the actual criteria and thresholds and the author of the Medical Software Advice blog did a great job of outlining definition, features and measurement with his blog entry.  I thought I would take it a step further and provide some meaningful information to CFOs and PMs by taking a stab at quantifying the effort involved with each measure. First some background information and disclaimers:

• This estimated effort is based on 50 physician multi-specialty organization.
• It is intended to give a ballpark of effort involved and the numbers serve as estimates only.
• It does not necessarily scale linearly with number of providers or specialties.
• The effort only addresses four categories of effort – implementation, technical, interface and training.
• Categories of effort not addressed include project management, systems configuration and deployment, networking configuration and deployment, hardware (including desktop) deployment, and helpdesk and on-going support.

The meaningful use matrix with effort broken-out can be found on the Galen Healthcare Solutions Wiki.

Now that we have presented the effort involved, let’s delve into how EHR deployments – specifically  AE-EHR deployements – are typically phased:

Phase I: Base, Document, Scan and Dictate

Description: Provide a baseline level of EHR functionality to all users. Real-time access to physician schedules, transcribed and scanned documents, facilitation of dictation.  Data conversions, Scanned charts and documents, Base Deployment. This approach typically appeals to all providers regardless of technical aptitude and would not require significant workflow changes

Advantages: Clinical information access internal and external to the clinic, reduced level of change for physicians through the use of dictate, realized benefits of decreased errors and re-work.

Interfaces:

• Registration & Scheduling
  • Real-time inbound registration and scheduling feed from practice management system.
  • Initial bulk-load of existing active patients and appointments
• Transcription
  • Real-time inbound transcription interface from transcription system.

*Phase II: Rx+, Note, Forms, Results

Description: Add medication management, structured note and results

Advantages: Ability to collect structured information facilitating use of panel queries. Additionally, formulary compliance, and prescription faxing/e-prescribing to pharmacies and ability to capture results as discrete data elements

Interfaces:

• Results
  • Real-time inbound results interface from lab system.

*Phase III: Order, Charge

Description: Facilitates charge capture and order transmission.

Advantages: Completes the access to centralized patient data and further enhances the quality of care and service to patients.

Interfaces:

• Orders
  • Real-time outbound order interface to lab system
• Charge
  • Real-time outbound charge interface to the practice management system.

*Phase II and III can be combined based upon the organization requirements

In conclusion, one of the biggest questions that lingers for me is how the data is to be relayed to the government such that organizations can be evaluated as to whether or not they meet the thresholds to receive the incentives. Custom reporting comes to mind as precedent has been set here, specifically with PQRI and Medicare HCC. Galen Healthcare Solutions certainly can provide custom reporting specific to organizations needs in order to communicate meaningful use. Another solution is Allscripts Clinical Quality Solution powered by TeamPraxis. In the meantime, we wait for the rule to be finalized and anticipate announcement of how the meaningful use data is to be relayed.

If your organization is looking for assistance in exhibiting meaningful use, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Custom Reports, EHR, EHR Certification, EHR Implementation, Integration, Interfaces, Meaningful Use, Meaningful Use Matrix, Reporting, Successful EHR Implementation