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.

—Discrete Clinical Data Elements as the building blocks to a Connected Health Platform—

Broken down to its basis, any vision of a truly connected Health Network will be reliant on the ability to pass, and ultimately present, discrete data elements.  Although the audiences for the information will be diverse, and the front-end systems will vary, the foundation of the information is the same.  In order to unlock the value that lies in the data being captured every day, an organization must have solid planning and execution. 

Each organization we work with is unique, but overall themes are constant: Reporting for Meaningful Use, Optimizing Health Care Decisions with Analytics, and Growth through Acquisition or Partnership.     

If we consider Clinical Data as building blocks that will be used, in whole or part, to support these efforts, we need to ensure both the ease of access and integrity of that data.  Galen has leading expertise and insight on conversions, reporting, and interfaces that can help you down this path. 

So how do you take the first steps in creating solid building blocks?  We would recommend to:

Define and establish consistency in electronic documentation and workflow.  This starts by understanding the EHR build and configuration decisions that will impact both availability and integrity of the data.   This consistency will also pay dividends to the organization by making the support of the Enterprise EHR system more predictable and efficient. 

Independent of your organization’s current state, Galen has the breadth and depth of expertise to help achieve your vision.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Clinical Conversion, Data Conversion, EHR Implementation, Enterprise EHR, Healthcare IT, Interoperability

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

As seen in the trend from past newsletters, Galen continues to grow not only as a company, but as a presence in the Healthcare IT industry.  Galen’s success continues this quarter with the help of those from within; those that help propel us forward. While we could recognize the talents and valuable contributions of the entire staff, we are pleased to recognize two individuals in their promotions.

 Troy Forcier, Team Lead – Upgrade Technicians

 In the time since our last Spotlight article, Troy was promoted to Team Lead of the Upgrade Technicians. In this role, Troy serves as the front man for his team’s education, client relations, and resource planning. Troy continues to perform assessments and training on effectively maintaining Allscripts server environments, also drives the webinar schedule for the Technical Team’s topics. Since his arrival in 2008, Troy has continuously found ways to work efficiently within his group and will continue to help shape the direction his team as the IT group evolves moving forward.

Join us as we congratulate him stepping into this new role as Team Lead!

 John Buckley, Senior Consultant

 This month, John not only celebrated his fourth year with Galen, but he also was promoted to Senior Consultant. He has been a powerful asset working with clients such as North Shore – Long Island Jewish and Mercy of Maine. Early in his career with Galen, John worked as a technical resource with the upgrade team and continued to grow his working knowledge of the various components of the Enterprise EHR^TM program. In addition to his assignments, he contributes to the Galen Newsletter, Blog, and assists with other internal technical projects. John is very motivated and serves as an excellent role model to others in Galen.

Congratulations John with your promotion to Senior Consultant!

Tags: Allscripts Consultants, Healthcare IT

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

This month’s New England HIMSS event filled our usual meeting place, Papa Razzi in Wellesley, MA to near capacity.  While the events typically start off with networking and socializing, it was difficult to walk around the room because of the crowd on hand.  The draw? Mac McMillan, the National Chair of HIMSS Privacy and Security Task Force and Chuck Podesta, the CIO of Fletcher Allen Healthcare were here to talk about a real life security incident that threatened the integrity of the organization’s data, and how they responded.

First, some statistics:  Fletcher Allen Healthcare is Vermont’s academic and university medical center located in Burlington, VT (also home to offices of Galen Healthcare Solutions as well as Allscripts). There are 562 beds and in 2010 there were 50,419 outpatient admissions, and 60,356 ED visits (FletcherAllen.Org).  Podesta currently runs a staff of about 150 people that support 10,000 end users on 6,000 work stations.

In the evening of March 29^th, end users of Fletcher Allens’ system were infected with a virus.  Six users, who were physicians, clicked links in emails purported to be delivery tracking updates.  Instantly the system was infected with a variant of the virus known as ‘PinkSlipBot’, for which there was no virus definition available.

Podesta’s team reacted immediately and was able to ‘secure the perimeter’, including blocking outbound traffic, and isolating the effected networks.  Luckily, only a handful of packets had escaped the network and they were actually analyzed and found to have not contained any protected health information, or PHI.  The virus was very aggressive.  It was programed to obtain local admin rights, shut down the virus scanner that was installed (McAfee), install a rootkit which hid itself from detection, and lastly, install a keystroke logger. Podesta and his team were able to learn off of this after analysis of the temp files left behind by the virus. Before it was brought entirely under control and mitigated, the virus had infected over one thousand hosts!

“The whole org is much more focused on [security] as a result of the virus”, Podesta told the NEHIMSS audience.   At the time of the incident, the team at Fletcher Allen consisted of less than ten people.  In the 48+ non-stop hours spent protecting and cleaning up their networks, the initiative grew to include about sixty people, which spent ninety minutes on each infected host, and ultimately cost the organization “in the 6 figures”.

At the conclusion of the presentation the speakers asked the audience (by a show of hands…) if security is a regulatory issue, or a patient safety one.

While no PHI was disclosed, and no patients were harmed, the answer is simple: it’s both.

While the EHR remained functional and connected throughout the ordeal, portions Fletcher Allen’s network were down for periods of time.  Galen Healthcare Solutions offers VitalCenter, a downtime solution for the Allscripts Enterprise EHR – no matter why the EHR is unavailble.  For more information visit vitalcenter.galenhealthcare.com.

If you missed it, check out my PHI related blog from last month here.

CMS released a couple of updates last month regarding Meaningful Use and the EHR incentive program. I wanted to pass this information along to our readers.

In their December 7 update, CMS indicated that “HHS announced its intention to delay the start of Stage 2 meaningful use  for the Medicare and Medicaid EHR Incentive Programs for a period of one year for those first attesting to meaningful use in 2011”.  The reason as such, according to them, is that the current schedule for compliance to Stage 2 could be a challenge for those that attested in 2011. The decision also was in consideration for vendors and practices.

 The CMS update identified some benefits from the proposal:

• The delay could provide vendors more time to develop their certified technologies for Stage 2
• The delay could also provide providers more time to implement the new software to meet Stage 2 requirements
• Expectations remain current so that providers attesting in either 2011 or 2012 begin Stage 2 in 2014
• And while 2011 has passed, CMS believed this idea would provide added incentive for providers to attest in 2011.

While I am sure there is a group of people out there that is ambitious enough to keep pace for this process, I am certain that we all can stand to benefit from the proposed delay.  The benefits from the added amount of time for both the vendors and practices/providers seem more appealing, in my opinion.

Back on December 1, CMS also announced a new tool to help Eligible Professionals (EPs) through the phases of Meaningful Use.  This tool is an eighty-five (85) page PDF file, dubbed as a “Beginner’s Guide”. This file provides a thorough, interactive walkthrough of Meaningful Use.

Among the items of information provided are:

• EHR Incentive Program basics
• How to participate (determining eligibility and registration)
• Meaningful use and choosing measures
• Attestation
• Helpful resources on the Medicare and Medicaid EHR Incentive Programs

Lastly, they also provided a link to their Educational Materials page for the EHR Incentive Program. This link offers an extensive array of files and tools regarding the EHR Incentive Program.  This is definitely a link to bookmark, as well as the guide previously mentioned.

If you haven’t already done so, visit the CMS EHR Incentive Programs webpage and register to receive their email notifications. 

Contact Galen Healthcare Solutions for any additional questions regarding Meaningful Use and Allscripts Enterprise^TM EHR.

Tags: Allscripts, Allscripts Enterprise EHR, EHR Certification, Enterprise EHR, Meaningful Use

In the professional world, most of us spend a varying amount of time on conference calls. This can be said of folks both in an office or remote location.  For those that can remember, meetings mainly use to be face-to-face in a meeting room. There was not a dial in number or participant code. People joined around a table or in an audience. Telecommuting was very limited not too long ago.

Technology has certainly driven a shift in how we do business now. More and more people in the workforce perform their jobs remotely. Meetings, for the most part, rely upon a toll-free number and the comforts of your desk at the office or at home. Being a remote employee myself, I wanted to contribute this week with some tips that I have learned regarding conference calls.

 Scheduling

 -          Software

• Be aware of what scheduling program others use. One example is Microsoft Outlook. External recipients may not have the same program and therefore you increase your risk of someone not receiving important invite information

-          Time Zones

• It is important to know if there are differences in the time zones that attendees currently reside. This is critical for arranging the meeting time.

-          Length

• Try to keep meetings to an appropriate length. Estimate a realistic amount of time to set aside. This is beneficial to stay efficient and make the best of everyone’s schedule.

-          Coordinate

• Actively coordinate times between standing meetings both for yourself, and attendees.  Keep in mind that it may not always be possible to accommodate 100% of the requested attendees. It is however good practice to accommodate most attendees, especially essential attendees.

-          Prepare

• For more formal meetings, or meetings that have structured purpose, create an agenda both for yourself as a host and attendees.
• An agenda helps hosts prepare for the meeting, as well as attendees prepare for relevant talking points as necessary. Share the agenda if necessary

-          Arrival

• Try to join the call at least three (3) to five (5) minutes prior to the call start time. This will allow the host to begin the meeting on time. The exception to this would be when calls are scheduled back to back.

During the call

-          Noise

• As an attendee, it is absolutely critical to not cause background noise during a call. My main rule: If I’m not talking, I’m on mute.
• Some conferencing services allow the host to mute all attendees. That feature is excellent for webinars, as this is often used during the Galen Webcast Series.
• Less formal calls don’t require this kind of mind set; therefore it is best to gauge the call to determine your actions.

-          Start

• Meetings should begin on time as best as possible. Starting a meeting on time respects the efficiency of everyone’s schedule and optimizes the time allotted to tackle an agenda. Again, a barrier to accomplishing this occurs when meetings are frequently scheduled back-to-back.

-          Stick to the point

• Meeting hosts should manage the call effectively. Stick to agenda items.
• Prevent yourself and attendees to digress or side track from the topics at hand.  Meetings will often end too early or extend past a planned time if participants speak “off topic” or ineffectively discuss agenda items.

-          Listen

• Active participation in a call is expected of attendees.
• Try at every extent to not multitask during a call. You never know when the conversation might turn to you. Calls are not efficient when a participant is not paying attention; additionally the participant’s image is reflected poorly.
• Be mindful of any language barriers. Diversity is an excellent aspect of the globalization business operations. Respect and pay closer attention to those you might not easily understand, both in dialect and grammar.

-          Parking Lot

• Keep a “parking lot” list during the call for action items. This is something best done by the host or delegated to an attendee to maintain and share after the call.
• Other participants should keep their own list as well, in case of personal action items. This way, you aren’t waiting for the list from someone else for your items.

-          Notes/Minutes

• As similar to the parking lot list, someone should actively take minutes for more formal calls to share with the meeting participants. This helps solidify any items mentioned in the call and records for future reference.
• For formal and non-formal calls, it is very effective to take notes for personal use for future reference.

-          End

• Hosts and attendees that manage the time effectively often may finish early and return some time to the day.
• Be aware of the time relative to the scheduled end time. Once it draws about five (5) minutes before the scheduled end time, determine the best next course of action. The action either could be one of three possibilities: Continue with all or a portion of the participants, reschedule the call to proceed with the conversation, or end the call as it stands. The latter being the least likely course of action.
• If the meeting needs to be rescheduled, be mindful of the scheduling tips mentioned previously. Scheduling a new call can be done after the current call.
• Clearly express any expectations prior to adjourning the call.
• Thank everyone for their time!

 After the call

-          Wrap up

• Send out any new meeting invites as soon as the prior call has ended.
• If any minutes or notes were taken, be sure to share the documentation with the attendees (as necessary) as soon as possible.
• Act upon any action items either for the parking lot list or assigned items as necessary. The sooner something is completed, the sooner it is off the list!
• For more formal calls and as a host, be sure to send a follow up thank you note to participants for their time.

-          Feedback

• For webcasts or formal calls, request feedback for continuous improvement.

Some of these tips do blend into the topic of time management. I think time management becomes more crucial before, during, and after conference calls. As we are more remote these days, more effort is needed to close any loops between meeting attendees. Some meetings are simpler and require less attention, whereas some meetings are more formal and require great effort.

The tips I shared are simply from personal experience. I know people with far greater experience have dedicated books to this topic. I thought some might benefit from a brief article regarding conference calls and some friendly advice.

I am absolutely positive there are people that agree, disagree, and have their own perspective or tips to add!  Please, share your thoughts, feedback, stories, and tips in terms of conference calls! I look forward to seeing this discussion continue and what others might have to contribute to this matter.

Tags: conference calls, Galen Webcast Series, Training

 The Allscripts Enterprise EHR is a wonderful example of the healthcare industry utilizing technology to improve the overall quality of the care provided to its patients, who are ultimately its customers.  While many arguments can be made in favor of the electronic health record, perhaps none is more prevalent than the ability to have a patient’s chart only a few clicks away.  The EHR stores an incredible amount of information about patients – from general information that helps identify, such as name and mailing address, to more personal and medically relevant information such as diagnoses and allergies. Let us examine the Allscripts Enterprise EHR, and the various resources that help it work, in the context of Protected Health Information security and privacy.

HIPAA, the Health Insurance Portability and Accountability Act of 1996, is legislation that protects health insurance coverage when workers change or lose their jobs, while also limiting restriction of benefits for preexisting conditions.  It also created several programs to control fraud and abuse within the healthcare industry.  These initiatives are contemplated by HIPAA’s Administrative Simplification Rules, two of which are summarized below:

-        The Privacy Rule

“The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals’ privacy rights to understand and control how their health information is used. Within HHS, the Office for Civil Rights (“OCR”) has responsibility for implementing and enforcing the Privacy Rule with respect to voluntary compliance activities and civil money penalties.”  (www.hhs.gov/ocr/privacy/hipaa)

-        The Security Rule

“The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI). Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules with voluntary compliance activities and civil money penalties.” (www.hhs.gov/ocr/privacy/hipaa)

Protected Health Information (PHI) is generally defined as follows:

“ Any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.”

ePHI, or electronic PHI is described the same way, except it refers to information only in the electronic form.  If you’re using Allscripts Enterprise EHR to look at a patient’s chart on a computer screen, smartphone, iPad, etc., it’s considered ePHI, but if you utilize the application’s print function and then are physically holding a piece of paper in your hand, it’s PHI.  PHI encompasses ePHI and the differentiation only serves to indicate whether or not the information was in electronic form.

HIPAA specifically lists 18 types of information that qualify as PHI.  That list can be found here.

Where do we find PHI within an Allscripts Enterprise EHR implementation?

There are three major ways to encounter PHI within Allscripts:

-        Allscripts Enterprise EHR – the application itself.

-        Works database – the back end database that houses most information filed into and out of the EHR.

-        ConnectR interface engine – this software processes messages, primarily in the HL7 format, to get information in and out of the EHR.

In the screenshot below we see the Clinical Desktop for patient Kelly Test within the EHR. In this single screenshot we see pertinent information in the patient banner that is used to uniquely identify Kelly Test – her first and last name, date of birth, and phone number.  We also see a current health problem of Emphysema, laboratory orders and results, and the fact that she is allergic to Morphine/Morphine Derivatives. All of this is Protected Health Information.

In the next example we’ll look at the Works database, the SQL Server database that houses most of the data found in the EHR.

The SQL in the example queries several tables within the database, including the Person table and the Problem table.  Several other tables and specific columns are integrated into the query; the result of which produces a listing of all of the patients that have electronic health records within this (test) hospital or clinic, along with the corresponding problems and specific ICD-9 codes for those patients.  This query illustrates the nature of the information inside the Works database and emphasizes the PHI it contains as well.

Lastly, let’s examine an HL7 message being used to communicate a laboratory result for Kelly Test.

Most HL7 messages will contain a PID (Patient Identification) segment.  This message segment alone is full of protected health information, as it is designed to communicate a patient’s full name, date of birth, address, phone number, and MRN, among other types of information.  From this single message we learn that there is a patient named Kelly Test, born on January 1, 1981, currently living at 101 Tremont St. in Boston, MA.  Also contained in this example HL7 message is a DG1 segment, which contains information pertinent to Kelly’s diagnosis.  In this specific example we find the value ‘1540’ in DG1-3.  The value ‘1540’ is an ICD-9 code, so this HL7 message tells us that Kelly Test has been diagnosed with a type of cancerous tumor.

The Allscripts EHR and the components of its implementation, such as the Works database and interface engine, store, utilize, and make available an incredible amount of information. Much of this data is Protected Health Information (PHI) and should be secured and protected in accordance with HIPAA and other legislation such as the HITECH Act.  We want you to be aware of the most common ways to access PHI while using Allscripts Enterprise EHR, and encourage you to contact us with any questions or concerns.

Tags: Allscripts Enterprise EHR, ConnectR, HIPAA, HITECH, PHI, Privacy, Protected Health Information, Security, Works DB

The New England Chapter of HIMSS had their Monthly Event and Social last week at Papa Razzi in Wellesley, MA.  There was a great turn out, including many first time attendees.  The topic of this month’s meeting was ICD-10.  The presenters provided a great overview of ICD-10, how it compares to ICD-9, as well as identified some of the most common and significant concerns about the historic change.

• Currently, there is a CMS mandate to be compliant with ICD-10 by 10/01/2013.
• The United States is the last industrialized nation to adopt ICD-10.  Some countries have been utilizing ICD-10 for years and are now looking down the road at ICD-11.

ICD-9 is approximately 30 years old and is running out of codes. With age, the standard has lost some of its effectiveness.  For example, ICD-9 has no code to describe H1N1 (Swine Flu), an outbreak that effected tens of millions of Americans over the past few years.

One of the perceived benefits of adopting ICD-10 is the level of specificity with which diagnoses and treatments can be described.  There are 14,000 ICD-9 codes, which are composed of 3-5 digit numbers. By comparison, ICD-10 has more than 68,000 codes, which are made up of 7 character alpha-numeric sequences. Transitioning to ICD-10 will mean a five-fold increase in the number of available diagnosis codes. 

 An example referenced during the presentation concerned an ‘open wound on finger’. Using ICD-9 there are three codes available to describe that diagnosis.  Under ICD-10 there are about 400 codes that could apply.  Again, that is directly related to the level of specificity used to describe the wound, combined with putting it into an historical context.  For example, ICD-10 can be used to specify the finger (ie ‘left ring finger’), whether or not the nail was damaged, and whether the diagnosis is being made as part of an initial or subsequent encounter. Below is a diagram from the General Equivalence Mapping (GEM) user guide, published by CMS. 

Note that the same ICD-9 code is used for all four scenarios.

The participants in the event’s panel discussion provided some interesting insight regarding how their respective organizations are working to prepare, train, and ultimately implement ICD-10.  Two common themes discussed by several presenters were that importance of both senior management and physician ‘buy-in’, as well working with the Massachusetts Health Data Consortium to help ease into the transition with providers.  In one example, provided by Lahey Clinic, coders provide feedback to doctors after audits of their computer assisted coding have been reviewed.

Ultimately, physician acceptance and adoption will mostly likely be correlated to policy of CMS to withhold Medicare and Medicaid payments from doctors that are not using ICD-10.

 In the days following the November NEHIMSS event, the American Medical Association (AMA) announced its intentions to stop the implementation of ICD-10:

“RESOLVED, That our American Medical Association vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine (Directive to Take Action); and be it further”

“RESOLVED, That our AMA do everything possible to let the physicians of America know that our AMA is fighting to repeal the onerous ICD-10 requirements on their behalf. (Directive to Take Action); and be it further”

“RESOLVED, That our American Medical Association work with other national and state medical and informatics associations to assess an appropriate replacement for ICD-9. (Directive to Take Action)”

 Galen Healthcare Solutions offers project management, implementation, and training solutions. Contact us to find out how Galen might assist your ICD-10 transition.

Tags: Galen Healthcare, HIMSS, ICD-10, ICD-9, NEHIMSS