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

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

 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

Galen Certified – The New Standard for Allscripts Enterprise™ Expertise!

Our consultants have always been the experts when it comes to the Allscripts Enterprise EHR™ application and now they have the certification to prove it! We are proud to announce the Galen Certified-Enterprise EHR Application Specialist training and certification program. This week marks the completion of Galen’s second group of employees who have taken part in our intensive seven week training that concludes with both a written and verbal examination.

The training, which is designed and performed by our experts, consists of an in depth review of all the Enterprise Certified Workflows and build methodologies with an added emphasis on the clinical relevance of each. Much like that of the Configuration Workbook, we step through Base, Rx, Charge, Order/Result, Note, CareGuides, Dictate, Transcribe and Scan. Along with the module specifics, we provide an entire System Administration review with the latest 11.2 Enhancements and configuration techniques.

During the training each student is provided with their own virtual 11.2 Enterprise environment so they might build, test, and configure without the concern of being in a LIVE environment or configuring over another user. As part of the testing process each student is required to build out a mock client environment from scratch. They are given mock client build specifications that begin with the organization set up and build of users, right down to the assignment of all Task List and Worklist views. They participate in “real-life” patient care/documentation scenarios to ensure that they are prepared to support the actual day to day needs of the end user without hesitation or delay.

We began the training and certification with newly hired employees and then expanded it to include verifying the overall level of understanding of the Enterprise product by including our Senior Consultants. We are proud to announce that as of today 15 employees already hold the distinction of being Galen Certified Enterprise EHR Application Specialist, with 7 more preparing to test in the next 2 weeks.

We are currently working to complete the training and certification for all the consultants on our Service Team. As well, the future will include Advanced Certifications in areas of V11 Note, Order/Results, Charge, CareGuides, and System Administration.

Please join me in congratulating the following employees:

Michael Dale, Associate Consultant

Michael joined Galen in April 2011 as an Associate Consultant. He attended the initial class for Galen’s Certification program. He was the first employee to officially become “Galen Certified – Enterprise EHR Application Specialist”. In his six months in this industry, he has grown very familiar with Allscripts Enterprise EHR™ and has become a frequent contributor to the Galen Blog. In the coming months, he plans to contribute to the Galen Public Webcast series.

Michael graduated from Iowa State University in 2005 with a Bachelor’s Degree in Management. His background includes analytical experience in the Healthcare industry and a variety of leadership positions.

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Zia Rahman, RHIA, Associate Consultant

Zia works primarily from the Chicago office and focuses on Allscripts Enterprise EHR™ implementations. He is a recent graduate from the University of Illinois with a Bachelor of Science in Health Information Management and is also RHIA certified. Most recently he has been assisting a large client in the Midwest as their dedicated resource to help the implementation go as smoothly as possible. Zia is always dedicated to ensuring the project is a success.

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Christy Erickson, Consultant

Christy joined Galen in March of 2011 as a Consultant serving clients in either Project Manager or Implementation Consultant roles specializing in clinical workflows and v11 Note. Before joining Galen, Christy was Operations Manager for Abraxas Medical Solutions (now Merge Health) responsible for implementations, support, technical services, and client education. Prior to that, Christy spent three years at Allscripts in both project management and consultant roles where she was named the 2008 Allscripts Service Employee of the Year and promoted to Manager, Professional Services. Before entering the health IT industry, Christy worked in nursing as a nurse and nurse practitioner with experience in outpatient, hospital, and hospice, including several years in Spain as an ICU/OR nurse where she became fluent in Spanish. Christy earned both her Bachelor of Science and Master of Science in Nursing from Salisbury University in Maryland and currently lives in Southern California.

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David Burkhead, Managing Consultant

David joined Galen in March 2010 as a Consultant and recently transitioned from Senior Consultant to Managing Consultant. In his 6 years working with Allscripts Enterprise EHR™, his project experience has included Project Management, Implementation Consulting, Conversion Analyst, and Interface Analyst roles. In his recent experience with Galen, he has been involved with an Enterprise EHR™ READY deployment, external webcasts, and an occasional contributor to the Galen blog. David graduated from The University of Vermont in 2005 with a Bachelor’s Degree in Business Administration along with a concentration in Management of Information Systems.

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Cecil Hunter, Senior Consultant

Cecil has been an integral part of the Galen team since April 2008. He has more than 11 years of experience in the health care Industry and 6 years of experience with Allscripts Enterprise™ EHR deployment. Cecil has most recently worked on a deployment of Enterprise EHR™ Version 11 modules for a large comprehensive network of affiliated physicians in Columbia, South Carolina. Cecil is certified in Allscripts Enterprise EHR™ Version 11 System Administration, as well as, Allscripts Enterprise EHR™ Version 11 Upgrades. Prior to joining Galen, Cecil served as an Allscripts Super User at a major University Healthcare Group in South Florida.

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Steve Cotton, Managing Consultant

Steve has been with Galen Healthcare Solutions since January 2010 and has recently transitioned from Senior Consultant to Managing Consultant. Following his years of experience at Allscripts Healthcare Solutions as a Senior Implementation Consultant and the Lead Internal Educator, he has continued to exhibit his expertise in project management, implementations, and education. In his recent Galen experience, he has contributed to the Galen external webcasts, assisted multiple clients with the Order Synchronization process, and serves as the primary implementation resource for Galen’s business continuity solution, VitalCenter. Steve has a Bachelor’s degree in Health Information Management and a Master’s degree in Health Informatics; his educational background has provided him with a strong understanding of the Healthcare Industry.

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Carl Fulton, Lead Consultant

Carl has more than eight years experience with healthcare information systems, specializing in Project Management and Implementation Consulting for Allscripts Enterprise EHR™. He has led implementation efforts for a range of clients, affecting thousands of providers, using all modules within Enterprise EHR™. In addition to his background in healthcare information systems, Carl has a Masters Degree in Organizational Leadership from Gonzaga University and Bachelors Degree in Management Information Systems from Washington State University.

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Cyn Gerson, Senior Consultant

With over ten years of health information systems experience, Cyn has played an integral role in many client projects; including implementation & deployment of all Allscripts Enterprise EHR™ modules, for many healthcare systems around the country. Most recently Cyn took a lead role with a major multi-specialty organization to get them live on their latest implementation phase, which included multiple Order/Result interfaces, Charge and v11 Note.

Cyn has demonstrated her skills in project management, workflow analysis, application build, interface testing and end-user training & support. She has a strong work ethic combined with a commitment to excellence in all projects undertaken, and continuously strives to cultivate positive relationships with her clients while providing objective guidance in accomplishing their goals.

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Tony Yelacic, Senior Consultant

Tony Yelacic has been with Galen Healthcare Solutions since 2007. He came to Galen with 30 years of healthcare experience across clinical, operational, and information systems areas. His unique blend of skills has provided many opportunities for the Galen community.

 

 

 

 

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Karla Koertner, Consultant

Karla Koertner is a software implementation professional with more than 11 years in healthcare. She is experienced with both acute and ambulatory care software systems and has functioned as a Project Manager, Subject Matter Expert, and Implementation Consultant on several large scale Allscripts installs. Karla resides in Charlotte, NC and looks forward to a long career with Galen Healthcare Solutions.

 

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Matt Woodside, Managing Consultant

Matt has been involved with the design, build and implementation of clinical software for over 10 years, including extensive experience with clinical application testing and evaluating end-user readiness. Most recently, he has been working with Senior Implementation staff, Clinical Analysts and Hospital Management to roll-out Allscripts Enterprise EHR™ to the first Beta sites in the network at one of the largest Allscripts clients in the Northeast. Matt was also involved with leading the client team through their recent Allscripts Enterprise EHR™ version11.2 upgrade. Matt is looking forward to continuing to apply his knowledge and experience to current and future client needs.

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Steve Stahr, Senior Consultant

Steve joined Galen in April 2008, and has been integral in assisting clients with their EHR projects, both as a Project Manager as well as Implementation Consultant. More recently, Steve became more involved with the Galen Upgrade Team, assisting with the increased demand of upgrading clients trying to achieve Meaningful Use and report from the Stimulus Set. His interest in the Orders and Results modules of Allscripts Enterprise EHR™ has given him the opportunity to assist many different clients with navigating this significant and strategic process. Steve has also been very involved with hosting webcasts through Galen’s Free Webcast Series, and conducted on site training with clients, as well.

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Will Ditton, Senior Consultant

With more than 10 years experience in Healthcare IT and working with Allscripts products, Will has had the opportunity to be involved with clients ranging in size from small to large MSO. His experience includes implementing Allscripts Enterprise EHR™ as well as assisting clients with optimization. In addition to his main focus on the Enterprise EHR™ application, Will has experience with Network and System Administration. Will has proven to be a huge asset to Galen’s clients and he looks forward to assisting future clients in achieving their goals.

 

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Litisha Turner, MSN, Clinical Consultant

Litisha has been with Galen as a Clinical Consultant for one and half years. She is a Registered Nurse with a Master’s Degree in Nursing Informatics. Her focus has been on building notes, forms, text templates and flowsheets for various clients including Northwest Community Hospital, Scripps, North Florida Surgeons and University Physician Associates. She has provided remote System Administrator training and end user training to a number of clients, as well as v11.2 Upgrades and work on bidirectional lab interfaces.

 

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Laleen Shah, Associate Consultant

Laleen Shah has been with Galen Healthcare Solutions since May 2011. In her recent experience she has been involved with a large healthcare organization in Iowa, assisting in system build, go live support, and data gathering for upcoming go-live events. She is currently a Galen Certified Enterprise EHR Application Specialist. Laleen graduated from the University of Illinois at Chicago in 2011 with a Bachelors Degree in Health Information Management.

 

 

 

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Tags: Allscripts Consultants, Allscripts Enterprise EHR, Galen Certified - Enterprise EHR Application Specialist

I attended my first New England Healthcare Information and Management Systems Society (NEHIMSS) event.  And I must say I was impressed!  There were five wonderful presentations and opening and closing remarks by Lisa Ewing, NEHIMSS President.  I had the privileged honor to meet:

• Jim Albert CIO – Charlotte Hungerford Hospital, Connecticut
• Dan Feinburg (Director, NEU Masters in Health Informatics Program)
• Arthur Harvey (Professor, Brandeis University Masters in Health Informatics Program, Director IT Operations, Boston Medical Center)
• Sue Schade (CIO – Brigham and Women’s Hospital) and,
• Many other influential people within the healthcare IT industry.

Jim Albert’s presentation was on the topic of Skillsets required in the new world of automation in healthcare.  A few of the points he touched on were the recent rise of merger and acquisitions within the healthcare world.  According to Mark Reiboldt (VP – Coker Capital Advisors), in 2010, the number of hospital merger and acquisitions have risen 25% to 30% (for full article, http://goo.gl/JOnXk).  Jim also mentioned a very interesting, recent implementation which involved 250 IPhones.   The IPhones are used throughout the Hospital as a way to communicate silently to hospital employees and much more.  Jim also talked about creating an IT department solely of clinicians who have a deep understanding of the intricacies of a hospital workflow.  I thought all of his ideas/recent implementations are very bold and out-of-the-box thinking.  What do you think?

Dan Feinburg and Arthur Harvey talked about The Changing Face of HIT Education.  There seems to be a place for everyone in healthcare IT.  Whether you are assisting with data analysis or dissecting complex workflows; with the right training and education, you can have a happy and successful career in healthcare IT.  So where do you fit in?  One topic that was brought up was the difficulties some MBA graduates face once they re-enter the workforce or are entering the workforce for the first time.  Because Healthcare IT is such a risk averse industry MBAs are facing a competitive market.  Some strategies exposed from hiring managers are simply hiring within or stealing from competitors.  We all know this happens and it can be frustrating sometimes, especially if you are trying to get your foot in the door.  I can say there are no shortages of opportunities, so keep up the hard work!

Sue Schade talked about the Challenge of recruiting and retaining talent in today’s competitive health care IT market.  She talked about some of the strategies Partners Healthcare are using to keep their employees interested and committed.  She talked about Connected Work Space, similar to the structure of a consulting company.  This strategy allows employees to work from home a few days a week and office and desk space is shared between employees.  Another strategy she discussed was Career Growth Initiative, which is a structured mentorship.  One I was particularly fond of is the IS Innovation Program.  This program allows exceptional and hardworking employees the opportunity to pilot an idea for a four month period.  The employee is allowed to put on hold all, or majority of their regular responsibilities to try something new.  The program allows the chosen employees to dive-in head first and develop a creative and new project.  Some of the things this program accomplishes are encouraging risks and learning.  It also promotes staying curious, committed, open, and energized.

The event ended with a networking reception sponsored by Microsoft.  This gave everyone and a chance to talk in a casual setting.  Hope to see you at the next NEHIMSS event!  Did I mention the food was delicious?

As a Registered Nurse, I know that provider satisfaction is key to the utilization of the EHR.  Having worked directly with providers for many years, I have come to find that one of their biggest areas of contention within EHR is with the way the noteforms render.  While these forms do typically convey the  story about the patients overall health, they do so in a way that tends to sound grade schoolish, the equivalence of  “See dog run” in a children’s book instead of sounding like it has come from a professional.  For example, clinicians fully understand that rendering “auscultation of heart” as “normal” does not appropriately define or detail, what was “normal” about the exam (e.g. normal rate, rhythm and S1-S2, no murmurs, gallop or rub heard), thus a major rework of the form would be required.

Having worked with a plethora of providers over the past year alone, I have been told by most, if not all of them, that they want their electronic notes to sound as if they had been dictated.  While this can certainly be done, you must first do the following to ensure success:

• Determine which forms need to be modified.  Typically it is the Review of System and Physical Exam forms, more specifically the General Multi-system Exam form.
• Obtain a few sample dictations (Pre-EHR), preferably from the Specialty Specific Physician Champion.  These will be used as the basis for changing the rendering on the delivered forms.  This will often give you an idea, of what is examined and what is a “normal” exam.

Once you have done the aforementioned, you must ensure that the right resources are also in place to be able to get the job done.  Depending on how many providers are in your organization, you may need to dedicate 1 FTE to this task over the long haul.   This resource should be someone with a clinical background, an MD, RN or LPN because providers have stated to me through the years that it is important to have someone who “speaks their language” working on their forms.  This is important because a part of this transition involves a great deal of interpretation of medical terminology and perhaps the need for someone who can also translate between what the physician has stated and what is actually listed in EHR.  Finding Medcin equivalents can be very difficult if you don’t have someone who can do this translation.

Another important skill set for this resource would be that they have been properly trained in building and modifying forms.   From my perspective, someone is “properly” trained if they fully understand how forms work and they are able to teach someone else the art of building forms.  In my situation, it took 2 years for me to feel comfortable enough to offer forms training to someone else.

Finally, the person who takes on this task/role must be a great communicator.   Although it is probably easier to have someone physically commuting from clinic to clinic to meet with Physician Champions and discuss their needs, this isn’t always a viable option.  Not only is it time consuming, but it can often be difficult to coordinate schedules and meeting times.   As an alternative, I would propose that this resource make the best use of email and screen-sharing tools.  Given the fact that much can be lost in translation via email, I would also recommend the use of screenshots where applicable as most people tend to be visual learners.  The screenshots can be followed by verbal descriptions of the questions and/or changes.   Once the forms are reworked, screen-sharing tools such as Webex® and GoToMeeting® can be used to demo the completed form to the Provider Champion, at which point he/she can test the form and request final tweaks before it is moved to the Production environment.

Once you have completed a few forms, you can then use those same forms as the starting point with other providers instead of starting completely from scratch again.  While the “All Normals” may not be exactly the same, you will find that the verbiage is similar across the board and ultimately, your job will become easier.  In the end, the physicians will appreciate having more concise notes that are also more aesthetically pleasing.

Ultimately you must remember that a provider’s first responsibility is to give safe, competent, appropriate patient care.  However the second part of their role is to convey a story about the patient and the care that they provided.  This should be done in a way that is professional, efficient and logical not just for themselves but also for the patient and all other care providers.

To see an example of a complex form, with its associated rendering click here: Custom Migraine Form

-Litisha Turner, MS, BSN, RN/Clinical Consultant

 

Tags: AEEHR, Allscripts Enterprise EHR, V11 Structured Note

The system is upgraded to Allscripts Enterprise EHR^TM (AE-EHR) version 11.2.x- now what to do? Evaluation of current workflows and deciding on the Meaningful Use measures the organization will be using are the next steps. This article will cover some basic key concepts of Meaningful Use as it related to the application and processes as well as examples to provide the foundation to move forward and build. Ideally, obtaining a baseline of the workflows currently used today in each site/clinic prior to the upgrade itself is the recommended approach. This article will highlight at the end the recommended timeline and priority items to provide the best success of not only the upgrade but more importantly capturing meaningful use.

Step 1- Evaluate current state workflows of each site and the role of the end user population

Even if the site recently went Live or had training- end users continuously find new ways to use the application. AE-EHR version 11 in general provides multiple ways to enter information and despite the best training and/or trainer, an end user may change their behavior over time.  Not only will a potential different workflow result in inaccurate testing of what is believed in the workflow; it may potentially allow for an area of missed training when moving to version 11.2. Here’s a great example, suppose clinical staff were not trained to enter problems, however over time the providers and office managers of a site have asked clinical staff to enter the problems for physicians. This would have an impact on training for meaningful use. Or, perhaps the staff is trained to enter smoking status on the social history but behavior has recently changed by the end users and they started capturing it in the comments field in vitals because the end user thought it would be quicker.

The best approach is to go to each site and evaluate each role on what they currently do in the application, as well as how they document in the application. This will allow the testing team to accurately test the role based workflows as well as train as appropriate on workflows. Once the current workflow is established then the foundation for configuration and re-training can begin.

Step 2- Decide which of the Meaningful Use Measures will be used by the organization.

The 15 Core measures will be required by all eligible providers, however only 5 of the 10 menu sets are required.   Additionally, of the 44 Clinical Quality Measures, three of the Core or Alternate Core will need to be used and three of the remaining Clinical Measures will need to be decided upon in order to have a total of six Clinical Quality Measures.

This step can be quite a task depending on your organization. Here are some sample questions to ask:

• Who will be the lead decision maker?
• What teams need to be informed of the Meaningful Use objectives- Business Admin, Executive, Physician Core team?
• Are there multiple teams that will make decisions on different aspects (clinical versus business versus administrative)?
• Do those key decision makers know about Meaningful Use and if so at what level – high-level or detailed?
• Will basic ARRA- Meaningful Use training be required?
• How will government incentives be paid out (to the organization, to the physician, to the site)? This will be asked at meetings and better to be prepared when instituting workflow change.
• What providers are eligible in the organization?
• Will the eligible providers report for Medicare or Medicaid?
• Who is responsible to enroll each provider with CMS?
• Does an analysis of potential eligible providers need to be assessed to make the decision of MU reporting?
• Does an analysis need to be done, and what patient population and/or diagnoses are seen by eligible providers to select the appropriate Clinical Quality Measures?
• Will eligible providers have a choice on whether to participate in MU reporting or will it be decided by the organization?
• Will each site, specialty, or provider select the measures (MENU and Clinical Quality Measures selections) or will it be directed from the organization?
• Will there be a team dedicated for Meaningful Use?
• Who will track the user’s behavior to ensure the necessary information is obtained?

These basic questions will allow the core Upgrade/Meaningful Use team to be prepared for configuration, workflow re-design, testing, and end user training. Each item can have a direct affect on one of the aspects of the upgrade/MU project. For example, if all eligible providers will be allowed to decide which measures they will select for reporting then the configuration team will need to configure to all CORE, MENU, and all 44 Clinical Quality Measures. In addition, if each provider selects their own measures ideally the training would be tailored around the measures for that eligible provider. Training all providers on all 44 Clinical Quality Measures or all 10 MENU items that may not pertain to that provider will not increase retention of the information and workflow change and likely decrease the MU reporting success.  Another example, from the above proposed questions is Medicaid provides a greater financial return if the measures are met however what if no one meets the necessary 30% of patients? Does it make sense as an organization to increase an eligible provider’s percentage of Medicaid patients to capture the higher value and if so who makes this decision and how does the front office staff know to direct more new patients of a certain insurance to a certain provider?

Step 3- Workflow Redesign for Meaningful Use

Once the system is configured and reviewed by the implementation consultant during the upgrade process, the workflows will need to be re-designed to meet the Meaningful Use Measures to guarantee success! A workflow is not just the use of the application but also the process in place for monitoring the Meaningful Use within the organization. At this point, the system has been configured by the organization configuration team (system analyst) based on Steps 1 and 2.  However, unless the users actually change behavior Meaningful Use will not count. Here are some examples below that will need to be considered based primarily on the CORE, MENU and Clinical Quality Measures.

• CORE EXAMPLE:  Suppose that currently the organization doesn’t allow clinical staff to enter and/or update problems or medications on patients, however the providers have not been keeping these lists up to date. Will the organization allow the clinical staff to begin to perform these tasks? Does configuration need to change to allow for retrospective/prospective authorization? Does enable verification of problems need to be added? Do clinical staff need to be trained how to do this item?

Remember there are many new alerts for Meaningful Use however everything doesn’t have an alert and likewise an end user can ignore an alert.

• MENU EXAMPLE:  Providing a Summary of Care Record to the patient and Patient Education. First, who will be responsible for providing the Summary of Care Record- clinical staff or providers? Will the Clinical Summary provided by Allscripts be used or will it print out from the v10 or v11 note? If the patient is a portal patient and you don’t want to provide a Clinical Summary or a non-portal patient how will the provider state if no Clinical Summary is to be provided? What/Who/How is the workflow to be defined, tested, and trained? Regarding Patient Education, will there be a standard developed if not already implemented such as every new medication prescribed by the provider the patient will receive the Drug Ed for that medication? How will the patient instructions be populated and printed?
• Clinical Quality Measure EXAMPLE:  Adult Weight Screening and Follow Up- many sites may already obtain the patient weight today and this may appear as an easy Clinical Quality Measure to capture. However, there are a couple of items to consider, by adding a free text box for comments to document if a patient denied obtaining their weight and if used would count for Meaningful Use. Is this configured already and/or do end users know to enter this information to count for Meaningful Use? In addition, to meet this measure the BMI of the patient needs to be evaluated and based on the patient’s age and BMI an additional workflow must be completed. Part of that measure states if the BMI is greater than 25kg/m2 a follow up plan must be in place. What will that plan be if not already used by an organization/site/provider? Will there be a dietary consultation or a BMI Management Follow Up Order? Will the end user be able to select from any of the potential recordable actions: Dietary consult with the appropriate SNOMED or the BMI Management Follow Up order with the appropriate CPT code? Will the clinical staff perform this action at the time the vital is taken or will the provider be responsible for adding this item on the patient.

These are some examples of Meaningful Use and all the decisions, configurations, and workflow changes that could be affected. This article is not all inclusive, rather, it is intended to begin the process for the team to meet the Meaningful Use objectives.  Please feel free to contact Cary Bresloff, Cary.Bresloff@GalenHealthcare.com, for further questions, guidance, or consultation on Meaningful Use and the impact to an organization.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Meaningful Use, v11

In an effort to improve the way patient data is accurately maintained, the Health Care Industry is undergoing a historical transformation.  The initiative is fueled by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Reinvestment and Recovery Act (ARRA) of 2009.  There are certainly a lot of preparations in the works to make this movement the next big shift in how medical care is provided.  With that comes advances in health technologies and the computer systems we incorporate to make it all happen.

The standard now has become an advanced network of cloud technologies, interfaced labs, pharmacies and networked providers all at your fingertips.  One would need a full team of dedicated professionals to navigate through the bests tools available to be ahead of the game, or a specialized group now called, the Upgrade Team.  A team of technically advanced, inquisitive and dedicated people to spend tireless hours scouring through new developments and documentation, who choose the proper tools and encourage you to set up your organization to succeed. 

The next best thing for an organization has now become Allscripts Enterprise EHR^TM version 11.2 (AE-EHR).  Because many clients have not yet participated in an upgrade process, but have instead experienced a net new implementation, service pack update or simple hot fix, we want you to be as prepared as possible. 

To begin, you will be assigned an Upgrade Team from the vendor which will include a Project Manager, an Upgrade Technician, an Upgrade Consultant and an Interface Analyst.  Your internal team should have representation for those same roles,  and in total your team should have at least 8 to 10 resources.  In addition to this core team, a group of Physician champions, super users, testers, trainers and help desk personnel is recommended to help run the command center and support each other during the actual Go Live week.

When the process begins, we hope that you take time to review all documentation available to you. Please refer to the Galen wiki and various Webcasts, Sales Force, and Client Connect.  You will be instructed to partake in the Allscripts eLearning courses, as well as an 8 hour instructional guide to the process by your Upgrade Consultant.  The Upgrade Team will introduce you to all the new functionalities in AE-EHR version 11.2, the Meaningful Use attestations, and will assist you in building your system to work seamlessly with your organization.  Part of the process will also incorporate the newly released Stimulus Set to the base AE-EHR version 11.2 application.  You will be responsible for attesting that your system is set up correctly to handle all the new requirements.  For this, you will need to allow various members of the Technical Team access to analyze and report how you have organized, mapped and set up your data.

To make sure the project stays on track, two weekly meetings will be held over the course of your 19 week upgrade.  The Project Manager will coordinate all resources for their action items and responsibilities, while the Upgrade Consultant meets to discuss the application, testing and build stages of the upgrade.  The Upgrade Tech and Interface Resource are invaluable pieces to the puzzle that will help you throughout the process, and will be available to you in addition to these meetings.  To start, a copy of environment is created to mirror your live system and is then upgraded to the new 11.2 version.  To personalize this base and to utilize the application, we need to configure the new parts to their full potential.  Many of the new functionalities in AE-EHR version 11.2 are in the areas of Security, Preferences, and new Tasks that all have been designed to help you meet the Meaningful Use criteria. 

As the go-live date approaches, testing has been as thorough as possible and all training has been passed along to your end users, we encourage you to prepare everyone for the new version.  It is recommended to provide reference materials for all users to avoid high traffic through your call center on go live Monday.  We also recommend an organized ticketing system to track the concerns that may arise, and a resource that may be available to uninstall and reinstall controls for various computers, tablets and devices that may not have been updated.  Your Upgrade Consultant will be with you throughout the entire go live process remotely, and host an open bridge screen share to walk you through the build process, testing concerns and later onto issue resolution.  You may request that the consultant be on site for this and an additional contract will have to be submitted.  Either way, the entire team will have constant contact with you throughout the first week of your live system.  Post upgrade, the one week transition period will help all team members decompress from the previous 19 weeks.  We will hold meetings to review our outstanding issues that came from the go live weekend as well as any outstanding Sales Force tickets that could be considered critical to your success.  Once we have transitioned past this first week, all outstanding minor concerns will be processed by the Allscripts post live queue and closed appropriately. 

For those of you who may be taking the Stimulus Set component after your go live with AE-EHR base version 11.2, you will once again be in contact with your Project Manager and Upgrade Consultant to repeat the process in building the set and moving forward successfully in attempts to use your Electronic Health records in a Meaningful Way.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Upgrades, v11

The configuration and workflows relating to the Core Meaningful Use objective Record Smoking Status can get confusing; and recent information was released indicating a change in some of the setup for this measure.  Record Smoking Status requires that providers report that more than 50% of all unique patients 13 years-old or older seen by the eligible professional (EP) have “smoking status” recorded as structured data.  CMS has altered its reporting requirements for this measure so that now reports should only include the CDC smoking statuses.  Those smoking statuses include:

• Current Every Day Smoker
• Current Some Day Smoker
• Former Smoker
• Never Smoker
• Smoker, Current Status Unknown
• Unknown if Ever Smoked

You may be asking yourself, what do I do because providers at my practices have been entering terms other than the ones above as the patient’s smoking status?  Allscripts has developed a script that links previous smoking terms to the terms required to meet the measure in order for the provider to get credit on all smoking terms documented.  One thing to keep in mind when running the script is that it does not always match the terms on the patient’s chart to the most accurate CDC term.  For instance, a denial of smoking documented on the patients chart could fall under two separate CDC terms, “Former Smoker” and “Never Smoker”, but since the script can only link to one term, it chooses “Unknown if Ever Smoked”.  “Unknown if Ever Smoked” is not the most accurate, but the provider does get credit for the Meaningful Use measure. 

Because the script does not give the most accurate information for reporting, it is recommended that providers discontinue using the “denied” option when documenting smoking statuses and add the CDC smoking diagnoses to their quick list for easy reference for physicians.  Providers should attempt to use the CDC smoking terms to identify a patient’s smoking status as often as possible.

The CDC smoking diagnoses can be added to provider’s quick lists using SSMT.  The Content Categories of Favorites: Patient Hx – Active Problem or Favorites: Patient Hx – Social History can be utilized to identify the quick list items.  The steps are as follows:

1. Manually add all of the CDC smoking diagnoses to a user’s social or active problems list. (depending in which problem section the providers will be documenting the smoking status)
2. Extract for that user the Favorites: Patient Hx – Active Problem or Favorites: Patient Hx – Social History content categories from SSMT.
3. Open an Excel spreadsheet.
4. Highlight the whole spreadsheet, right click, and choose Format Cells.
5. Choose the Category of Text and click OK.
6. In SSMT, use CTRL+A to highlight all the text and CTRL+C to copy the text.
7. Paste the text in the Excel spreadsheet.
8. Copy columns B through J and paste on a new Excel spreadsheet. With the same formatted cell settings.
9. In column A, type the username of the provider you want to add the favorites to.
10. Make sure a Y is in the column labeled TopFavoriteFlag and in the column labeled Create.
11. Repeat steps 8 through 10for all providers that need the smoking statuses added to their Quicklist.
12. Copy all fields and paste them into SSMT.
13. Click the Import button.
14. Confirm the import worked for a few users.
15. Repeat these steps if setting the quick list in both Active and Social History problems.

It is important to note that the CDC smoking terms were delivered in Q3 and Q4 2010 Medcin releases.  It is required that these releases be installed in Enterprise EHR in order to meet the Record Smoking Status Meaningful Use objective.  In Allscripts Enterprise EHR^TM version 11.2 HF 9, the Record Smoking MU Alert will be linked to the CDC smoking terms and the provider will be able to reconcile this alert by selecting the appropriate term from the list of smoking terms.

An additional recommendation for configuration includes setting the TWAdmin preference Smoking Status for Patients 13 and Older is Not Documented to “Show in My Alerts”.

The configuration and workflows for the Core Clinical Quality Measure Preventative Care and Screening Measure Pair: Tobacco Use Assessment and Tobacco Cessation Intervention is often confused with the configuration and workflows for the Meaningful Use measure Record Smoking Status.  Although the terms used for recording the smoking status are applicable for recording tobacco use, additional workflow is required to meet the Quality Measure.  The Quality Measures can be reviewed in more detail in the Quality Measures PDF on the Allscripts Client Connect website.

Tags: Allscripts Enterprise EHR, Meaningful Use