Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

When an organization starts out on the long road of implementing an electronic health record the project manager will typically research what steps the organization needs to take to make their EHR project a success.  Learning from others is the most efficient use of resources. So what are the factors that those who have gone before you feel make an EHR project successful?  I will post a series of articles covering these many factors.

Part I- Organization Planning & Internal Governance

Developing a project charter is the first step. The project charter has several components that include the project description and business objectives and success criteria. This is an important part of the charter, if you do not know what you are hoping to accomplish or know what success of the project means to the organization the chances of reaching success will be difficult at best.  Other components of a project charter include listing the stakeholders, vision, project scope (another important piece, as scope creep will happen without it), assumptions and dependencies, constraints, milestones, business risks, resources and finally an approval section where the executive team’s signatures will be placed to demonstrate their approval and acceptance of the project charter.

The development of a formal project plan with identified milestones will assist not only the project manager but the executive steering committee to determine the health of the project. The creation of a great project plan includes receiving input from the project team.  This allows each member to buy into the journey that are about to embark upon.

The next component of planning for your organization’s EHR project is developing a communication strategy.  A well thought-out strategy that includes formal communication channels is crucial.  Once the project picks up speed the lack of communication can cause unnecessary hurdles.

Some additional components of organization planning and internal governance are determining a decision matrix that outlines how specific types of decisions will be made and ultimately approved.  Forming your committees that include providers, executives, and clinic leadership will facilitate the support required for your EHR project to be a success.  Having a commitment from the members of these committees is crucial as you may need their backing upon occasions throughout the project.

The final component is establishing a solid infrastructure and reliable network.  Addressing any infrastructure concerns before you begin your project is essential because once you pick up speed on the project, this area risks being left unattended which can cause hardship on reaching your goal of achieving SUCCESS!

Watch for Part II – Exceptional Project Management and Control

Tags: Allscripts, EHR Implementation, ehr project, Enterprise EHR, project success, Successful EHR Implementation

 When an organization is in the initial planning and budgeting phase of their EHR project, one of the most common questions to come up with is how much should I budget for this project? 

Several sources researched had varying numbers for the cost per provider. The cost for implementation, range from $25,000 to $60,000 with a mean of $42,500. Maintenance costs range from $5,000 to $18,000 per provider per year. The details from several sources are listed below: 

Harvard – “Based on the informatics literature, the initial implementation cost of an EHR for private practices averages between $40,000-$60,000 per provider and the cost of maintenance averages $5,000-10,000 per provider per year.” http://mycourses.med.harvard.edu/ec_res/nt/191A1C43-AEF8-4244-8215-F39C690A4E6B/EHRseries.pdf

 Ahrq.gov – “The research indicates that the average purchase and implementation cost of an EHR was $32,606 per FTE physician. Maintenance costs were an additional $1,500 per physician per month. Not surprising was the finding that smaller practices had the highest per-physician implementation cost at $37,204. The study also found that the average cost for EHR implementation was about 25 percent more than initial vendor estimates.” http://www.ahrq.gov/news/press/pr2005/lowehrpr.htm

Perot Systems – “For physician groups, the CBO reported that total implementation costs for office-based EHRs ranged from $25,000 to $45,000 per physician, with annual operating, licensing, and maintenance costs ranging between $3,000 and $9,000 per physician” http://www.perotsystems.com/MediaRoom/Library/ServiceOverviews/ServiceOverview_CostsAndBenefits.pdf

EMR and HIPAA – “It is estimated that the cost of purchasing an EHR system is $33,000 for each physician, with an additional cost of $1,500 per doctor per month for maintenance. This expense has cost challenges for many providers, especially those in small practices. Some estimate that the long-term cost-savings produced by a national health information network could reach $77.8 billion a year from a reduction in medical errors, diagnostic test duplication, and administrative expenses.” http://www.emrandhipaa.com/emr-and-hipaa/2009/06/01/scholarly-study-on-cost-of-ehr/

Since the federal incentive payments are being offered, the next question is whether or not those funds will cover the cost of implementing an EHR will be covered. 

Avalere Health - “These new incentives are intended to motivate doctors to adopt EHRs, yet for many physicians, the level of the incentive may not reflect current financial realities,” said Jon Glaudemans, a senior vice president at Avalere Health.  “Given this gap, EHR adoption will still require a significant investment by small physician practices.  In today’s economic climate, many physicians will struggle with this calculus.” http://www.avalerehealth.net/wm/show.php?c=1&id=808

MGMA - “…physician-owned practices with paper medical records generally spend $20,000 per full-time equivalent (FTE) physician on IT (chiefly for hte billing system) and have less profit (medican total medical revenue after operating cost per FTE physician) compared with groups with EHRs that spend more than $20,000 per FTE physician on IT have a substantially greater profit than those that spend $20,000 or less on IT.”   Gans, MSH, FACMPE, D. N. (2010, July). Investing in Technology: How Information technology expenditures affect the bottom line. MGMA Connexion,  19-20.

Jerri Cowper

Tags: Allscripts Enterprise EHR, EHR Implementation, Successful EHR Implementation

We here at Galen have seen a greater influx of requests to be able to integrate client’s EHR environments with 3rd party applications and/or internet websites.

I’ve created a few examples that I’ve added to our Wiki page.

1. http://wiki.galenhealthcare.com/Patient_Portal_Integration

With this case study Galen had a client who has implemented a patient portal application whereby patients are able to send messages to their doctors regarding tests, results and general questions. The client was looking for a way to have the provider be able to integrate this application directly into the EHR. With RelayHealth’s help we have succesfully built a prototype whereby a provider can seamlessly communicate with a patient in the most efficient manner possible!

2. http://wiki.galenhealthcare.com/images/5/57/Add_new_Web_framework_documents_to_the_EHR.pdf

In this example a client was looking for a new link on their vertical toolbar which would allow them to display any website in their current workspace (the main viewing pane of the EHR). This one example integrates the website directly into the EHR window without having to navigate through a new tab or window, showing a FRAX calculator. The other tab actually has the ability to take in patient context (height, weight, blood pressure, etc.) and pass it into a form automatically populating fields to save physicians valuable time. This article goes through the steps involved in setting up new vertical toolbars, horizontal toolbars, and workspaces to set up these outside websites in the EHR. The actual code to populate patient context is fairly complex but definitely something Galen would love to help out with!

Tags: Allscripts, EHR, EHR Implementation, HL7, Integration, Successful EHR Implementation, Technical

Last Thursday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 1 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference and look for a recap of day 2 of the conference on the Galen blog this Wednesday.

Keynote Address: The State and National Vision for Health IT and HIE

Dr. David Blumenthal, National Coordinator for Health Information Technology – U.S. Dept. of HHS,  presented his own anecdotal experiences with the EHR, namely a story of how he was going to prescribe a patient a drug containing sulfa, yet the clinical decision support software in the EHR flagged him for a drug-to-drug interaction. If CDS tools within the EHR not available, would the pharmacist have caught this? Could the patient potentially been adversely affected?

Dr. Blumenthal then elaborated on two key components to which he felt would impact behavior via policy: writing regulations and spending money.

Regulations

• There have been 2000 comments received on the Interim Final Rule, with the publication of the final regulation anticipated by the end of the spring
• No comments questioned the conceptual framework nor the direction of Meaningful Use.
• The framework of Meaningful Use consists of 5 domains – quality, efficiency, patients & family, coordination of care, protection and security
• In speaking of the Interim Final Rule, Dr. Blumenthal utilized the analogy of an escalator – allow providers ease of introduction and steps for clear path of usage while lowering barriers to entry.
• Information Exchange – infrastructure is poorly developed for information to follow the patient and thus policy needed to address this. Certification will be the key to interoperability and with tighter standards, HIX should be more interoperable.
• CLIA (Clinical Laboratory Improvement Amendments): Currently, legacy regulations are being addressed such that the barriers to LDX (Laboratory Data Exchange) can be removed.
• Privacy & security: Providing authorities with the means of penalizing individuals and organizations for violations to ensure controls, access, protection

Spending money

• Regional Extension Centers (RECs) are currently modeled after US agriculture, which was intended to disperse new info to the family farm. The goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation.
• Focused on <10 provider practices such that the full benefits of HIT can be reaped by the practice. Facilitation of re-design of work flows and mobilization of information for quality and efficiency improvements
• 50 states have been funded to promote RECs.
• Different localities will have different solutions for health information exchange (HIX)
• 70 community colleges were funded for workforce training and it is anticipated this will facilitate staffing of RECs

Next Year: Direction

• Implementation
• Finalize requirements for Meaningful Use
• Beacon Community Program – Fund 15 communities around the country directly through a grant program with the intent to offer a source of lessons and inspiration. There have been over 130 applicants to the program thus far.

F/U Questions/Concerns

• Physicians are worried that HIT happens to them, not with them and that users not intimately involved with the design

Panel – Consumer-Centric: The Role of the Patient in Health IT and HIE

• John Moore from Chilmark Research introduced term the term “citizen” as the term patient can often be paternal. He mentioned a John Halamka quote – “automating bad processes will not lead to improvement”.
• David Szabo, a partner, Edward Angell Palmer & Dodge brought up the point of how do we go about engaging citizens and brought up some serious concerns over privacy, especially in regards to patient portals. The topic of behavioral advertising in PHRs was brought up and it was mentioned that  FTC may provide governance to this regard.
• A question was posed about those surveyed and focused on in regards to Healthcare IT in that they are predominately affluent and white. John Moore responded with mobile health technologies being the enabler to reach all demographics and minorities.
• A comment was made concerning the power of secondary data to pre-populate EMRs. Barbra Rabson, Executive Director, Mass Health Quality Partners, provided a response and brought up a cautionary tale in the highly publicized case of e-patient Dave as published in the Boston Globe.
• To touch on concerns about patient security and privacy in regards to the Personal Healthcare Record (PHR), John Moore also brought up a really cool Massachusetts company called “Patients Like Me”  and highlighted the fact that through this vehicle,  “citizens” currently share their healthcare stories and experiences.

Regional Collaboration Meetings (CT, ME, MA, NH, RI, VT)

Later in the afternoon a breakout session allowed public officials to meet with neighboring states to discuss current plans, areas of concern, regional interoperability and opportunities for collaboration.

• NESCO (New England States Consortium Systems Organization) represents a business model built around collaboration and their Deputy Director, Nancy Peterson, acted as the facilitator.
• The idea of health delivery system reform was immediately brought up in that the system incentivizes and currently pays for sickness instead of for health via preventative and behavioral care.
• The model of the state of ME was addressed. Currently they have an operational provider-only HIE available to facilitate treatment improvement and representative of six of the largest healthcare systems in the state. The HIE, established in 2004 and live as of the summer of 2009, covers 50% of the hospitals 46% of ambulatory care.
• Some of the questions and comments posed by the audience included the following
  • How do we bridge between standards?
  • The business case needs to be established as this will drive investment. We need to clarify a vision and clearly express the financial incentive model.
  • Challenges with the business case in that savings on one side put costs on another.
  • We need to attack some of the low-hanging fruit first by implementing a common consent framework.
  • Ownership of the data: Who owns the data? The patient?
  • HIEs need to be consumer-driven.
  • Are we focusing too much on the standards with meaningful use, whereas we should be focused on the transport and the “network”?
  • Where are the interconnections in healthcare delivery that have the highest yields in terms of clinical data?
  • We face the underlying competing entities in clinical standards versus claims standards. Integration of the two needs to be addressed.
  • We are up against perverse incentives as there are many other resistive forces towards HIE, namely disincentives, in the health system.

Tags: EHR Implementation, HIE, HL7, Integration, Interfaces, Interoperability, Meaningful Use, RHIO

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