Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

How many times have you asked yourself during the process of creating workflows if the exercise was worth it? I posed this question to Joseph Solin, project manager at ABQ Health Partners. He explained that he spends two hours reviewing the workflows with each clinic one week prior to their go live week. During this review he goes step by step through each workflow with the clinic that is affected by the phase. He explains that the workflows are like “learning to dance with the EHR so you are not tripping over each other.” For example if users don’t understand that certain electronic prescriptions will not transmit to the pharmacy until the provider authorizes the task, the clinical staff may end up duplicating efforts trying to get the prescription to the pharmacy.

Many important questions are sparked by the users during these meetings as Joe reviews the differences in their workflow today and what their workflow will look like with the EHR. These are questions that are typically answered during the meeting and often times reassure any anxieties the group may be experiencing prior to their go live. A thorough review and understanding of the clinical workflows will give users an appreciation for the need to adjust their workflow to the EHR and provide more efficient use of the EHR from day one

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

As reported on EMR and HIPAA, CMS has made comments on the Meaningful Use Interim Final Rule public, providing an additive level of transparency and CMIO promptly provided a summary of the EHR comments. In light of the transparency CMS/HHC/ONC yields in regards to the Meaningful Use Interim Final Rule, we encourage members of the healthcare IT community to take full advantage of the comment period, which ends in less than a month from now. To encourage ongoing dialogue, we have published a Meaningful Use FAQ in which we anticipate aggregating questions that persist in the community and also encourage active participation. For instance, in a previous post, I pondered how meaningful use would be communicated.

Other items to note in regards to lingering questions surrounding Meaningful Use and ARRA as a whole:

• Dr. John Halamka also addressed the public comments on the Interim final rule on his blog post.
• Many questions persist surrounding interoperability standards, and as John over at EMR and EHR addressed on his blog post, the Healthcare Information Technology Standards Panel (HITSP) was recently extended to be operational until April 30th only. How will this impact communication of meaningful use from organization to the government?
• We recently updated our meaningful use matrix to include which functionality supporting MU measures are delivered in the Allscripts Enterprise EHR (AE-EHR). John at EMR and HIPAA is also collecting a number of the various matrixes that people have put together around the EMR meaningful use criteria

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, Allscripts Consultants, Allscripts Enterprise EHR, ARRA 2009, EHR Implementation, Meaningful Use, Meaningful Use FAQ, Meaningful Use Matrix, Successful EHR Implementation

Drawing on our past experience and expertise with data conversions, we recently assisted one of our clients with a conversion of administrative ICD9 diagnostic data extracted from their Practice Management system to clinical Medcin-based  problem data within the EHR. The project ultimately saved a tremendous amount of data entry time. Upon completion of the data-conversion, clinicians were then able to review the problem list in “Past Medical History” section of the patient chart within the EHR and categorize by either choosing to make the problem “active” or mark redundant or resolved problems as “Entered in Error”.

As with any data conversion, one must be cautious in terms of negative implications. For instance, administrative data has its limitations, and an example or where the process can go wrong is the highly-publicized case of e-Patient Dave.  Ultimately, problem conversions can be useful, but the data needs to be reviewed, and almost treated as suspect.  The value in the conversion is saving the entry of the problems that are accurate – say 80-90%.  Any that are incorrect, will be reviewed with the patient and can easily be marked EIE.

Statistics:

• 1,007,238 problems were loaded to the EHR for 205,831 patients via the interface engine, taking about 11 hours to process totally.
• PM Extract file statistics:
  • Total matchups of ICD9s to patients: 5,405,874
  • Total Unique ICD9s: 8346
  • ICD9s that only match up with 1 patient:1295
  • ICD9s that match up with 100 or more patients: 2027

Approach and Components:

• Master approved “ICD9” list provided by client
• Extract of ICD9 data from PM system provided by PM vendor
• Automated macro that attempts to match ICD9 to Medcin. Potential matches include the following:
  • 1 to 1
  • One to many (20 or less)
  • One to many (20 plus)
  • One to none
  • Each of the different flavors of matches were marked with an annotation (highlighted via an asterisk) to identify to clinicians the logic that was used in importing the problems:

• Once the translation was finalized, it was loaded into the interface engine and mapping logic loaded problems into the patient chart in the EHR via the API (existing stored procedure).

Known Issues Mitigated:

• Due to incorrect logic, some ICD9s were linked to patient profiles improperly. To mitigate this, a script was run to mark these problems as “entered in error”
• Problems were loaded to the “Past Medical History” section of the patient chart with a status of active. However, given this status, it didn’t facilitate providers to easily change the problem to be an active problem linked to a note.

Lessons Learned:

• Execute a proof-of-concept and as with any technical project, get clinician feedback. The client had a pilot group of 5 clinicians to vet out issues and bless the data before the live conversion was run.
• Do NOT use spreadsheets to track the cross-walk between administrative ICD9 diagnoses and clinical Medcin problems. Rather utilize a staging DB to serve as a single repository in developing ICD9 to Medcin translations. Also, the data from flat-file export from PM can be loaded into a staging environment via SSIS such that it can be analyzed and summarized while facilitating persistence.
• Make sure to tie the problem conversion load to a specific provider, that way if side effects or issues are identified after the fact, there is a clear way to identify which problems were loaded in the conversion via the provider they are tied to. The interface log should also have a record of this, but most organizations set the retention time to 90 days.
• Workflow validation – ensure that the workflow to move problems from PMH to Active will not be a barrier to use.

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

Tags: Allscripts, Allscripts Enterprise EHR, Data Conversion, ICD9, Interfaces, Medcin, Problem Conversion, TouchWorks Problem

Business Need/Problem Statement

Some of our clients have recently expressed the desire for a limited, read-only view in to the AE-EHR to extend access to audit entities. For instance, the requirements of one organization included a limited patient-access read-only environment to be in compliance with FDA Research Part 11 restrictions for clinical trials. Another organization needed it for insurance audit purposes. And still again, others desired to provide an extended environment to allow hospitalists, ED physicians, and critical care physicians access to selective patient charts.

Approach

One of the more popular approaches has been to segment out a separate read-only organization in the Allscripts Enterprise Electronic Health Record (AE-EHR). The AE-EHR handles organizations quite nicely and facilitates an approach of segmenting out entities – the following Galen Wiki article covers a scripted means of deploying a new organization in v10 AE-EHR.

Once the organization has been created, patients can then be “bulk-loaded” to the organization via SQL scripts. New AE-EHR users can then be created and associated to this organization. Finally, to setup the read-only portion, security gates can be implemented.

Extendability

An additional requirement of one of our clients included an approach that offered the capability to dynamically add/remove patients to the “Audit” organization real-time. We facilitated this via creation of a file-based interface from ConnectR to the AE-EHR. The interface accepted its input from a well defined flat-file (comma-delimited, including MRN, Action – Add or Remove, and OrganizationID) and utilized that data to add/remove patients to the org via a custom stored procedures – the de facto application programming interface (API) to the AE-EHR clinical database.

And still further, another client requested that the audit/read-only entities (users of the system) be granted the ability to create tasks . For example, the client desired a specific, high priority task, identifiable as originating from the audit/read-only entity – in this case hospitalists which could be assigned to the patient’s PCP. In this case, the clients’ hospitalists could communicate high priority continuity of care tasks, which require prompt reaction, to the PCP at discharge. However, the PCPs should not be able to task back to the hospitalists, and this can be achieved by setting the EnableOrgFilterFlag preference in the AE-EHR.

If your organization needs assistance in setting up a audit environment to provide limited, read-only access to the AE-EHR, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts Enterprise EHR, Audit, EHR, EHR Implementation, Extendability, Interfaces, Read-Only, Tasking

A recent engagement with a large multi-specialty client gave some insight into increasing physician acceptance and adoption of the Electronic Health Record. It became apparent very early on during the rollout of ePrescribe and Call Processing, that easier accessibility equals higher acceptance. The physicians want to be able to access the EHR instantaneously while with the patient: order medications, input visit data, submit charges. This proved to be a difficult task when workstations were not available in the exam rooms. We discovered that the providers were less likely to exit the exam room at the end of the patient visit to print/send prescriptions and return to the exam room with the patient.

There are different options available to increase accessibility. Permanent workstations in each exam room provide the providers with the ability to access the EHR directly from the exam room and complete any tasks needed for the current visit: order medications, diagnostic tests, submit charges, input visit data. Tablet PCs give the provider the flexibility of moving around the clinic and working in different areas. They are able to access the EHR while in the exam room, in their office, or standing at the nursing station.

I have seen the use of both the Permanent workstations and Tablet PCs in different sized organizations. They are both viable options that depend on the needs and infrastructure of the organization.

Tags: Allscripts Consultants, EHR, EHR Implementation, MSO