Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

I love working go-lives. I prepare for them like I’m heading out to “The Big Game”.  I uniform myself with my knowledge, my game face, and the desire to really help people be successful.  It’s normal to be anxious when going out on go-live.  However, users are always more anxious than we could ever be.  Our presence signals one of the biggest changes they may ever make in their career.  Some users feel like they will never recover from the change, that they may even fail, and possibly lose their jobs.

I recently finished in a six-month project working on v11 Note and Order Implementation at a major health organization in California.  I worked with users from all levels…staff, nursing, providers and administrators.  However, nothing prepared me for my encounter with a Nurse Practitioner I will call “Marie”.

I entered Marie’s office with my game face and my knowledge.  She looked distressed and angry the moment she laid eyes on me.  “You’re one of those people”.  Marie started nervously jabbing at her keyboard.  “I’m really overwhelmed, and I know we’re supposed to be doing the new stuff today.  I can’t keep up with what I’m doing now, I don’t know what I’m going to do”. 

It certainly wasn’t the reception I was looking for.  I had come bouncing in, all ready to shine, but Marie wasn’t having any of it.  She was nervous, scared and angry, at what I represented, and what she felt I was trying to force on her.

I sat down, and asked her how I could help her.  Marie started waving her hands around.  “My Task List is out of control.  I know it isn’t what you want to help me with, but I have prescriptions to fill and results to look at.  I just can’t look at this Note/Order stuff right now”.

I took a deep breath, and told Marie I was there to help her, in any way I could.  It didn’t matter if we worked on Notes/Orders, I wanted her to feel better about her work.  I told her I would sit with her, and she could ask me her questions when she was ready.

The ability to help people is what drives me as a consultant.  I get frustrated when I can’t reach people, and reassure them that AEHR isn’t their enemy, but their friend, that the system is good for medicine and good for patients.  I wasn’t sure if I was going to be able to reach this user, or leave her office without some serious bruises to my ego.  I don’t give up very easily, so I stayed put.

We started looking at the phone calls in her Task List; most were related to renewal requests for medications already in the patient chart.  She began to enter a new prescription.  I gently suggested to Marie that it wasn’t necessary to enter a new prescription every time, that she could find the existing medication in the chart and utilize the “Renew with Changes” button.  This would enable her to build a renewal history for the patient, as well as shorten the time it took her to work her prescriptions.  Marie turned to me slowly, raising her voice.  “You have got to be kidding me…that’s all I have to do?”

I prepared myself to be chewed out.

Instead…Marie’s eyes teared up as she said, “You have changed my life forever”.  She continued to say that she was certain that someone had likely explained this to her before, but that she had dreaded the change to an electronic chart so much, she had been unable to absorb much of the previous training provided to her.  I showed her a few other system tips…working from her Worklist, how to utilize the QuickChart, how to navigate through chart documents quickly.

These may seem to be simple, obvious system features, but to a user overwhelmed by a major career change, they are easily missed.  The lesson I learned was this:  You never know when or how you can make a difference to someone, by hanging tough with an unpredictable user, and by being patient.

Tags: Allscripts Enterprise EHR, Successful EHR Implementation

It’s official: year one is in the books for Meaningful Use. 2011 was the first year that Stage 1 attestation was possible for eligible professionals, hospitals and critical access hospitals. There were a number of organizations that partnered with us last year to get the ball rolling on the attestation process. Let’s take a closer look at the MU statistics for 2011:

• 123,921 Eligible Professionals have registered for EHR Incentives, yet only 15,255 successfully attested to meaningful use in the Medicare program.

That’s just a little over 12% of those who registered actually attested. Expect 2012 results to be quite a bit higher. This percentage doesn’t take into account EP’s who did not register for 2011, either.

• 3.077 Eligible Hospitals have registered EHR Incentives and 604 of those have successfully attested to meaningful use.

This figure is higher at almost 20% of hospitals which registered actually ended up attesting in 2011, but again this does not take into account hospitals which did register in 2011. Expect this number for hospitals to climb for 2012 as well.

• $2,533,689,145 has been paid out in Medicare and Medicaid Incentives.

2.5 billion out of the total $19.2 billion put aside for the HITECH Act has been paid out so far. That’s a relatively small slice of a very large pie. If you missed the train in 2011, attesting in 2012 still allows for the maximum reimbursement amount to be collected for the Medicare incentive program.

• 277 hospitals have received payments under both Medicare and Medicaid and of those 12 were CAHs.

Almost half of the hospitals which attested collected both Medicare and Medicaid incentives.

• 22% of eligible professionals that have been paid EHR incentives are Family Practitioners and 20% are Internal Medicine.

This is an encouraging figure in that specialists are capitalizing on the meaningful use opportunity as well.

• 41 States Medicaid programs were open for registration. Two additional States launched in January of 2012.
• More than 1500 EHR products have been certified by ONC-ATCBs.

As illustrated in a previous article, Allscripts remains the industry leader.

The 2011 Meaningful Use Statistics tell us that the majority of eligible provider and hospitals are likely planning to attest Stage 1 in 2012 if they plan on obtaining the maximum reimbursement amount under the Medicare incentive program.

As we can see, attesting in 2012 will yield the same total over a 5 year period, assuming that meaningful use is also achieved in each successive stage of attestation. This fact suggests that 2012 will be an incredibly busy year for most organizations who are striving to meet this goal.

We all already know that the carrot and stick policy is in full effect, shown by a 1% per year decrease in reimbursements should Meaningful Use not be met by 2015. Additionally, the HITECH Act authorizes CMS to further reduce the reimbursement rate beginning in 2018 if the proportion of meaningful users is less than 75% by that time.

Here at Galen, recently we’ve seen a tremendous demand for Allscripts Enterprise EHR^TM and Meaningful Use-related consulting services. Whether it is upgrading to the Meaningful Use certified version of Allscripts Enterprise EHR^TM: (v11.2), data conversions, or augmenting your staff with Allscripts subject matter experts to assist in ongoing build & implementation efforts; Galen is uniquely positioned as the perfect partner for organizations which are looking to meet their meaningful use goals.

When there is so much at stake and resources are stretched thin as it is, why choose anyone other than the industry leader to assist in accomplishing your organizational goals? Contact us for more information and let us know how we can help.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Meaningful Use

Success always comes when preparation meets opportunity ~Henry L. Hartman

As I reflect on my experience in AEHR, the above quote resonates.  Working on projects in the roles of an 11.2 Allscripts Enterprise Upgrade Project Manager, as well as an Implementation Consultant for new builds, my clients who achieve their desired results are consistently the ones who own the process and perform extensive due diligence on behalf of their organization.

Below are four factors to explore when preparing for your success. I have outlined “opportunity”, in the form of questions that must be thoughtfully answered, to optimally position your organization for seamless transition to a new Allscripts Enterprise AEHR release or platform.

1. Product Functionality, Design and Additional Considerations

2. Workflow Analysis, Testing and Training

3. Go Live Preparation

4. Leveraging HIT

Product Functionality, Design and Additional Considerations

In this day and age, “You don’t know what you don’t know” is no longer a valid response when making critical design and configuration considerations for your Enterprise AEHR.  Resources are available.

• Are you engaging in dialog with the Allscripts Community online via Client Connect  and referencing the Allscripts Application Design and Behavior Resource?
• Have you reviewed the latest Allscripts Client Release Notes that outline Known Issues lists and any issues for a release of which you should be aware?
• Have you registered for available educational opportunitiesprovided by leading professionals in the industry?
• Are you maintaining your Build Activity Workbook to reflect not only your decisions, but the thought process behind them, to ensure that a re-visitation will not constitute a reinvention of the wheel?

Workflow analysis, Testing and Training
These three elements are imperative to understanding how your build decisions will impact your organization, individual clinics and employees, right on down to your end consumers.

• Have you thoroughly vetted and documented your current and future state workflows?
• Have hybrid roles effectively been addressed?  For example, if a user is acting in a Front Desk, Medical Records, Call Processing and Referral capacity, should a customized Clinical Desktop be created to accommodate the various components necessary to perform all the associated responsibilities?
• Are your worklist and tasklist views capturing the correct data and utilizing the most meaningful criteria to cater to the specialty of your clinic?
• Are there too many views?  Is there a view for a supervisor to monitor all overdue tasks?  Is it more effective to assign tasks to specific users or to a team?
• Are your users educated on how to change their preferences to complement their individual work style within their workflows?

Go Live Preparation
Successful implementation only becomes relevant upon going live.

• Do you have adequate staff onsite to support your users and providers experiencing workflow, application and/or hardware problems?
• For Upgrades, have you created and distributed job aids highlighting new or altered functionality that may require different or unfamiliar behaviors within identified workflows (satisfying clinical quality data reporting initiatives to demonstrate Meaningful Use, for example)?
• Do you have a rollback plan if you encounter a system crippling issue? Will this necessitate a return to paper records (and are they available for reference)?  If so, who will be that decision maker and how will this message be communicated?
• Do you have a Command Center in place to serve as a centralized hub for user support, in addition to a systematic process for issue documentation and ticket submission across multiple vendors?  Is there a point person or team tracking these issues and their resolution?

Leveraging HIT
Now that you are live on AEHR, are you leveraging your Health Information Technology to fully facilitate the efforts of physicians and clinicians to meet the highest standards of patient care?  Some considerations for Enterprise organizations include:

• Participation in Meaningful Use
• A business continuity solution
• Integrated Health Calculators
• Integration with HIE

When it comes to the implementation, deployment and maintenance of your Allscripts Enterprise AEHR, success is no accident.  I encourage you to Embrace the New World of Healthcare; please contact Galen Healthcare Solutions at sales@galenhealthcare.com for more information.

Tags: Allscripts Enterprise EHR, Business Continuity, Galen Webcast Series, Successful EHR Implementation, VitalCenter

While reviewing 11.2.3 release notes there are some enhancements I thought are worth pointing out. These particular enhancements did not fall under the distinction of “Major Enhancements”, but nonetheless, some of these are going to make Providers and Users very happy.

• The font size in the Clinical Desktop:
  • The font size for the worklist and clinical desktop has been increased to 10 pt. This increase also applies to the Note Authoring Workspace.
  • This increase in font size does not affect the ACI.
• Two users updating the same clinical item:
  • Previously if two users were updating a clinical item at the same time, only data saved by the first user to click save. The second user lost their changes and was notified of that when they committed but they were not told which item was in contention. In 11.2.3 an alert is now displayed in the patient header and user is notified that work is in progress. As well you can hover over a clinical item and see which user is updating the record and how long they have been editing the item.
  • Note that this is not related to “Note Contention” notifications.
• View the QChart and QAppointments from Task Reassign and Task Reply windows”
  • Previously if you were replying or reassigning a task there was not a way to view the QChart or QAppointments (if you needed quick access to patient info). This will solve that.

There are some other enhancements that will be nice as well and the release notes for 11.2.3 have some more great info, as well as how to test the enhancements. The release notes are available on ClientConnect or I am sure if you asked a Galen representative they would be glad to point them your way.

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 in seeing 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 our 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.

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

We’re excited about this one.

For years, doctors have been using tools like the Framingham Risk Calculator to estimate risk for a number of different disease states – like cardiovascular disease, diabetes and breast cancer. These calculators use information commonly found in the patient’s chart like vital signs, lab values and age. The risk scores are increasingly being typed back into the chart.

eCalcs are . . .

Integrated into the EHR – with one click of a button you are brought to a host of the most common health calculators, including the Framingham Risk Calculators.

Patient Specific – pulling in the relevant data from the current patient’s chart.

Documented back into the EHR – the risk scores can be added back into the patient’s chart with a single click.

For a full product overview, and a link to the eCalcs brochure, visit the eCalcs page on our wiki.

Contact information

Cary Bresloff, VP – Sales and Marketing, 312-878-2349 or Cary.Bresloff@galenhealthcare.com

Drew Bradle, Account Manager, 312-239-6648 or Drew.Bradle@galenhealthcare.com

Are we in an EHR bubble? Evan Steele, CEO of SRSsoft, predicts that much like the dot-com era, the EHR market is in the midst of a bubble which is soon to burst. He foresees a shakeout in which consolidation of the current 472 EHR vendors takes place. Steele envisions causes of the popped bubble to be attributable to missed growth projections, government money drying up and physician dissatisfaction with existing vendors, ultimately resulting in a survival-of-the fittest among the EHR vendors.

Several industry leading bloggers have made bold predictions to this same point. John Moore from Chilmark Research offered the following:

Bloom is Off the Rose, EHR Market Plateaus
Going out on a limb, we see 2012 as the year when we start talking of the post EHR-era. Yes, there will be plenty more EHR sales in the year to come but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4’12. You heard it here first folks, it is time to collect your EHR winnings and seek new places to invest.

iHealthbeat had its own 2012 predictions for the outpatient EHR market:

• The use of cloud computing;
• The use of mobile devices; and
• Vendor consolidation.

Over the past several months, Galen has seen quite a bit of consolidation in the industry specifically with conversions in support of acquisitions. We have converted groups to the Allscripts Enterprise EHR from a number of legacy vendors – among them AmazingCharts, eClinicalWorks, Greenway, GE Centricity, SRSSoft, SAGE, MedManager – in support of these groups absorption by larger organizations and Integrated Delivery Networks (IDNs).

We continue to see an increasing amount of conversions on the horizon, supporting the claim made by Mr. Steele regarding consolidation in the industry. Organizations are certainly in acquisition and consolidation mode – will the same hold true for vendors? Will we see more mergers and acquisitions in the outpatient EHR space in 2012? I think it is a safe bet to expect activity from those vendors that own most of the market share. The following is a recent ambulatory market share analysis as offered by American EHR:

Tags: EHR Acquisition, EHR Market Analysis, EHR Merger, EHR Predictions, EHR Vendor Consolidation, Healthcare IT, Meaningful Use

Does your practice utilize the Finish Note task in Allscripts Enterprise EHR^TM? 

If you answered yes, then this blog is for you.

In this article, I wanted to show you two possible outcomes when working in your  v11 Note. You will notice that there are two similar workflows to add and commit clinical data in the note that will impact how a Finish Note task appears in a user’s task list.

While you will find that these two workflows are scaled down to be very basic and generic, I wanted to limit them to clearly demonstrate the difference between the two.

Workflow #1: Committing data while saving and closing the v11 note

In this workflow, we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Select “Save and Close” in the Note window
4. Select “Save and Continue” on the Encounter Summary
5. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- One Active Finish Note task

So in this case, using the Current Patient – All or Current Patient – Active task views, you will see that just one Finish Note task has been created in an active status.  The task indicates that the note has been created and saved.  Keep in mind, at this point, that the commit action occurred while the user selected Save and Close in the Note. In this workflow, the system only reviewed the data once.

Workflow #2: Committing data prior to saving and closing the v11 note

As we did in the first workflow, here we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Click the Commit button
4. Select “Save and Continue” on the Encounter Summary
5. Select “Save and Close” in the Note window
6. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- A Complete Finish Note task and an Active Sign-Note task

If you use a task view that simply shows Current Patient – Active, you would not typically see the Finish Note task in this instance, but instead the Sign-Note task.  This means the note has not been signed and might not be the task you expect to receive if you seek the Finish Note task.

While a Finish Note task has been generated and marked as Complete, there may yet be information to add to the note.  The logic behind this workflow is that the second action of “Save and Close” is the second review after having hit “Commit”, and therefore results in the outcome we see here.  In this case, the system has reviewed the data twice, and the Finish Note task in regards to this note is completed and the active Sign Note task is automatically generated.

My advice in this situation is to follow Workflow #1 when working in a v11 Note. If users are creating a note and adding clinical data, but need a provider or second user to receive a Finish Note task and add additional items to the note; use the first workflow.   This way, the Finish Note task will be assigned and visible to the correct person, and users will be trained in such a way that ensures the success of this workflow.

Please don’t hesitate to leave your feedback below or Contact Galen Healthcare Solutions should you have further questions!

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, Galen Webcast Series, Tasks, TouchWorks, v11, v11 Note

 In this demo, we will present Allscripts Enterprise EHR and RelayHealth Portal integration capability. This solution facilitates seamless integration between the two applications, offering single sign-on, messaging between provider and patient,and patient online indicator functionality.

Contact us today so your organization can realize the compelling benefits of Enterprise EHR RelayHealth Portal integration.

Tags: Allscripts Enterprise EHR, Allscripts Patient Portal Integration, Application Integration, EHR Patient Portal Integration, Enterprise EHR, Extensibility, Integration, Patient Online Indicator, Patient Portal Integration, RelayHealth, Single Sign-On