Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Client – UMass Memorial Health Care

Project:  UMassMemorial V11.2 Upgrade

Project Timeframe:  February 7, 2011 – June 13, 2011

Client Contact: Emily Lazaros, Allscripts Application Manager

“I would like to take this opportunity to tell you of our experience with our Galen upgrade team.   Troy Forcier and Kristie Gilbert are, in a word, fantastic.  They are professional and knowledgeable, and have been with us on this upgrade every step of the way.  Kristie’s project management skills and proficiency with the application are exceptional and Troy is about as calm a person as I have ever come across.  This gives us, the client, a real sense of comfort.  And as the IT Ambulatory EHR lead for this upgrade, in an organization of this size, that is invaluable.

….

Last, but not least, we have had lots of laughs and fun together through this process.  Thanks to them and Galen for helping to make our 11.2 upgrade a success.”   –Emily Lazaros, Allscripts Application Manger at UMass Memorial Health Care

 UMass Memorial Health Care is the largest health care system in Central and Western Massachusetts, and the clinical partner of the University of Massachusetts Medical School. The Medical Center has a total of 12,350 employees with approximately 1,700 physicians and 3000 registered nurses representing clinical expertise in Cardiology, Orthopedics, Oncology, Emergency Medicine, Surgery, Women’s Health and Children’s Medical Services.   UMass, on the cutting edge of technology, utilizes Allscripts Enterprise Electronic Health Record^TM (AE-EHR) as a means to help with continued excellence in clinical care and patient service.  Over the last several months UMass has worked, very successfully, with Allscripts and Galen Healthcare Solutions to upgrade their AE-EHR product to version 11.2.

The underlying motivation for this version upgrade was of course, Meaningful Use.  While there are incentives for moving to the new version, the idea of having to implement new functionality with potential workflow impact is regarded with dread.  There are dozens of models for how to complete an upgrade, most of which are painful.  The vendor and we, as your consultants, must take ownership over finding the best model for your practice to reduce the pain of upgrading.  Since Meaningful Use is the ‘next big change’ in healthcare, this change needs to happen for all medical practices across the US.  So the question remains, how do you increase your chances of success? Your Galen consultants will help lead the way.

The duration of this particular upgrade project was a brief 19 weeks, leaving us little time to configure the new AE-EHR version 11.2 functionality and guide UMass towards decisions that would qualify them for all Meaningful Use criteria.  In addition to a rapid project timeline we encountered other challenges: the release of process documentation simultaneously to the stages defined in our plan and shifting resource allocation as priorities changed.  Throughout the entire process, though, we were able filter the information, analyze the functionality, provide appropriate guidance, and enjoy the camaraderie of a great group of UMass team members!  We can now take great pride in knowing we were helping thousands of people use their version 11.2 AE-EHR product in a Meaningful Way.

A week after UMass has transitioned to end users, the real challenge of analyzing their data and incorporating their new configuration into their daily lives will prove to be a reality once the Galen team returns to assist with the Stimulus Set.  I know we are all up for the challenge!  Our willingness to help our clients, to test our knowledge of the latest cloud technologies and data reporting and to pass it along will be a very rewarding journey.  If the final product can be as great as the first steps in helping UMass upgrade their base AE-EHR version 11.2, then sign us up…Galen is ready to go! 

UMass was a fantastic group to work with and we look forward to helping them implement the Stimulus Set.  Congratulations to the staff at UMass for a successful upgrade!  We also appreciate the positive feedback from UMass and plan to make the same impact with other clients.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Meaningful Use, Successful EHR Implementation

With a majority of healthcare organizations being multi-site as well as an increasing trend in MSO oriented healthcare systems, the ability to effectively manage and deploy EHR to entire physician networks is critical to achieving an integrated patient record and reducing disparate records across physician networks.  The release of Allscripts Enterprise EHR version 11.2.x brings the movement towards meaningful use and reimbursement incentives; as well as penalties.  This requires that organizations develop the capacity and knowledge required to take on, prioritize, and execute multiple EHR initiatives simultaneously.  In many cases this involves what seems like the never ending rollout of sites, practices, and acquisitions that comprise these complex physician and community based networks.

So what is really involved in order to make this happen?  Is it really just about system configuration, setting system preferences, writing interfaces, analyzing workflows, and installing hardware?  Cumulatively it is, but who makes this happen and why don’t they grow on trees?  This article aims to take a step back and take a hard look at the soft skills needed to ensure not only a successful initial installation of EHR, but the underlying principals needed in order to ensure a fully functional, well seasoned, and confident EHR deployment team.

Perhaps a quite common question or source of anxiety presented to on site vendor support is “Well what happens once you’re gone?  Who is going to take care of us?”  The following are pre-emptive measures that organizations can take in order to ensure that once the “experts” leave, the pace of the EHR implementation can maintain its course.

Initiate the Transfer of Knowledge

The fast and furious pace of installing EHR at a particular practice can sometimes leave the remaining implementation and support staff straddling between new support duties and ramping up additional practices.  Don’t wait for the knowledge to come to you….go to where the knowledge is.

• Identify the key drivers and what the critical build aspects are for the organization or practice installation.  Don’t just now what they are, but take the next steps and get a head start in building towards expert level knowledge in those areas.
  • Attend product focused webinars
  • Invest in either remote or on site focused system maintenance or functionality driven education courses
• Granted these elements can require time and some capital to achieve, but the long term return on investment will come in the form of self sufficiency

First Impressions Are Everything

Remember that through the eyes of a practice going live on a brand new electronic health record the initial round of go-live support and change management will set the tone for the long term relationship between the practice(s) and the core EHR implementation team.

• Get the core team’s faces out there and work to establish a positive rapport with new and upcoming practice(s), but keep in mind not to overwhelm them.
• Make sure the practice(s) know that as a team they will be working together directly with the EHR implementation team and that they will not be experiencing this change alone.
• Let the practice(s) know that it’s okay to ask questions prior to go-live and work to eliminate that potential perception go-live day is a just a silent time bomb waiting to explode.

Cross Training & Skill Set Ramp Up

Get as many of the core EHR and support team involved in all phases of the project life cycle for a given practice.  This will help build the perspective and broaden knowledge needed not only to maintain autonomy and depend less on other team members, but also increase the support capacity of each team member.  This can translate into increased support bandwidth and end user satisfaction.

• Encourage every core team member to participate in clinic walkthroughs, workflow assessments, go-live support, and the post-live optimization process.
• Provide internal or “brown bag” presentations (post-live) so that other team members can become familiar with each other’s focus or area of product specialty.

Remember that once the “experts” leave, the core EHR implementation and support team is the lifeblood of the implementation and a key driver to any organization’s long terms success with EHR.

Good Luck!

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

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?  This is Part II in a series of blog articles on steps to make your EHR project a success.

Part II – Exceptional project management and control

First and foremost is to have an enthusiastic leadership team.  When the leadership team is excited and committed to the project the enthusiasm will be contagious.  That enthusiasm will spread throughout the providers and staff.  Buy-in definitely starts from the top down.  Any end user or recipient of a change implemented can sense when leadership is on the fence about the change.  Therefore demonstrating enthusiasm of the leadership in any and all public forums will be crucial when trying to achieve full buy-in of your organization.  A crucial role of an effective leadership team is to stand behind important decisions made during the life of the project.

 The next item that contributes to exceptional project management and control is holding ongoing meetings with EHR committee & sub-committees. When establishing who your committees should be comprised of make sure you include representation from providers, clinical staff, front desk staff, billing staff, medical records, clinic managers, and key members from you EHR project team.  Sub-committees may need to be formed in order address more specific design decisions needed for certain modules. For example when designing your charge module the sub-committee may be a charge workgroup that consists of billing and coding personnel, managers and those involved on the project team in the build of the charge module.  Holding regularly scheduled meetings provide the avenue for continual and effective communication. An essential component of the meetings is working from an agenda and keeping thorough minutes for tracking purposes.  Being able to have a list of actions items from your meetings is key in keeping the project on target. 

Establish champions of the EHR will help in so many areas of your implementation.  When a provider is struggling with either a workflow or concept of the EHR a champion can step in and provide some much needed assistance and support.  Champions of the EHR are not just your physician champion, your project team, or your leadership team.  These champions are also identified individuals who are supporters of your project.  They are the individuals in the field who hear the day to day struggles that users are experiencing.  When provided an avenue to either assist or report these EHR champions can be extremely instrumental in the continued success of your implementation.

When the project manager is initially beginning the EHR project he or she should set realistic project management processes.  This could include obtaining input from those involved in the build or establishing an effective method of communication to obtain status updates. 

Gather appropriate data and perform necessary research is another significant step in the management your EHR project.  For example when creating flowsheets you will want to gather any and all flowsheets being used in the clinics today.  Or when you are creating your future state workflows not only should you document the current state workflow but your organization should also spend a couple hours following a patient flow.  Simply asking the questions necessary to document the current state workflow is not enough.  As a project team your understanding of the patient flow is a key principle to complete your research. 

 One of the final components of exceptional project management and control is establishing hardware needs and planning accordingly. This would be equivalent to teaching someone how to build a house then not giving them the correct tools.  A provider will find their patient visit difficult to get through documenting if they do not have access to the EHR in the exam rooms.  The success of your EHR implementation is reliant upon this activity taking place long before you begin your implementation.

The final component in exceptional project management and control is to determine staffing needs and do not short change your project. Staffing of your project beyond the project manager includes analysts, who will perform the build activities, a well-trained help desk, trainers, and those who will provide onsite go-live support.  When you feel you have just enough staff members, add a couple more, you will be surprised how long activities take and what all is involved in successfully implementing an EHR.

Over the past year we continued to experience tremendous change as a company, an Allscripts community and as an industry.

As a company we can point to our proficiency with the Allscripts PM and Professional products. Prior to 2010, our Technical Services team had been involved with a handful of interfaces with Allscripts Enterprise PM, primarily the standard interfaces with the Enterprise EHR. In 2010, however, the team took its knowledge of PM interfaces from elementary to expert as demonstrated in the PM Integration article in this newsletter. The team became experts in inbound demographics conversions, customized outbound registration and scheduling interfaces, and began to explore the world of general ledger interfaces. Additionally, the company performed its first conversion of an Allscripts Professional EHR system – splitting a single environment into three as part of a four-party acquisition. Galen also had the fortune of bringing on a handful of experienced Allscripts PM Implementation Professionals in 2010.

It wouldn’t be entirely fair to categorize 2010 as the year of Allscripts PM and Professional at Galen. Our advancements in these areas simply showcase the organization’s willingness to embrace change. Our commitment to learning and, more importantly, sharing what we learn requires us to constantly move into unexplored territory as we strive to add measurable value to our clients. We share our experiences and newfound knowledge within the industry via the Galen Wiki and the Galen Blog. We also see the Allscripts community sharing its knowledge through the Regional User Groups, the AmberSight forums and at ACE each year.

The upcoming year promises to bring even more change to all of us in Healthcare IT. Many groups are aiming to achieve Stage 1 Meaningful Use in 2011. This means an upgrade to Allscripts Enterprise EHR version 11.2. It means capturing new data, like smoking status and language. It means new interfaces, including lab and immunizations. New workflows. New reporting. We all have a lot to do.

At Galen, we began our journey towards Meaningful Use in earnest in 2010 following the release of the Interim Final Rule. Our Meaningful Use Committee began meeting bi-weekly to discuss the rules, their impact and how we can quickly and effectively assist our clients to meet MU in 2011. Galen’s Upgrade Team will be performing nearly 20 upgrades to v11.2 this summer, ensuring the systems are there for our clients to achieve meaningful use in 2011. Additionally our Interface Team has been furiously working the past 12 months on interfaces that aid in achieving Meaningful Use, and will continue to do so over the next two years.

At Galen, we welcome the opportunity of another year working with some of the best health care providers in the nation. We look forward to overcoming the challenges that will come with implementing the software, workflows and procedures necessary to achieve Meaningful Use.
We will stay the course of learning and sharing – with our colleagues, with our existing clients and with the broader Allscripts community.

Mike Dow

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Interfaces, Meaningful Use

As more providers go live with Allscripts, we often hear the request for better integration between the EHR and external devices. With all the biometric equipment in a modern practice, the goal should be to pull as much data directly into the EHR as possible. One of Allscripts’ largest clients in the Northeast is leading the way by pulling data directly from Welch Allyn vitals devices and Midmark EKG devices across Citrix.  There are also plans to integrate Holter monitors soon as well. This shows that it can be done, but there are some things to consider when going this route.

Device integration obviously takes some effort to set up and support. When you bring in third-party devices to the EHR, you need to take responsibility for that connection. Resources and time will be needed to manage and troubleshoot their communication.  It is critical that you have strong Allscripts technical resources available during this integration. Similarly, a strong partnership with the device vendor is important. Fortunately, device communication is getting increased attention from both Allscripts and many of the biomed device vendors. Make sure you are working with someone who understands the requirements.

Overall in our experience, the benefits usually outweigh the cost of support efforts, especially if the device is used frequently in a practice. Think about a clinic that takes vitals for each patient. The time that a nurse or medical assistant would otherwise spend manually entering each vitals panel can now be directed back towards the patient. The EHR becomes simpler to use, and its data becomes more accurate and reliable.

 For a Cardiologist who orders 15 EKG’s a day, being able to view them effortlessly from the patient’s chart is a great time-saver. One of the biggest complaints we hear from EHR users is that they spend too much time on the computer. By integrating external devices, you can give them some of that time back.

Allscripts is in the process of expanding its list of UAI certified devices, so be sure to check with an Allscripts representative for the latest list of certified manufacturers. The capabilities for device integration are improving quickly.

Tags: Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Integration

Integrating other web applications into the EHR is a dream for many.

Here, we take the risk calculator built based on the Framingham Heart Study, and integrate it into the Allscripts Enterprise EHR.  With the integration from Galen, the EHR sends the required fields into the Framingham Risk Calculator, like patient age, blood pressure and cholesterol, reducing the data entry and number of clicks for the clinician.  

Now’s it’s as simple to calculate the patient’s risk of heart attack, as it is to view their chart, all while in the EHR.

As we mention in the video, the Framingham Risk Calculator is just one example of integrating a website or web application into the EHR.

Galen has worked with groups on many types of EHR to web application integration – what would you add to the EHR, if you could?

Tags: Extensibility, Interfaces, Interoperability, Meaningful Use

As physicians migrate to the Electronic Health Record, there are many new systems and processes they have to learn and adapt to.  One of these systems is voice recognition software, such as Dragon Medical 10.  I have worked with some physicians recently who were implementing a new EHR in their office, as well as transitioning from a transcription service to Dragon voice recognition.  This introduced some new challenges which I hope to shed some light on in this article.

Dragon Medical has the ability to ‘Type as you Talk’, which allows the user to dictate blocks of text and see this appear in their note in the EHR.  This has a huge benefit to the provider by allowing them to review and finalize their documentation for the visit immediately, rather than waiting a few days to receive the note back from a transcription service.  We discovered that there are some steps that you can take to improve the performance and/or accuracy of Dragon.  Here are a few to note:

1. Spend the time training Dragon to recognize your voice.  During this process, the application will learn how you speak, and adapt to your voice patterns.  This will prove to be very beneficial in the long run.
2. Follow the recommendations for the settings for your EHR vendor.  The Dragon representative will have recommendations on how settings should be configured based on the EHR you are using.
3. When words are not typed correctly, correct them using the built in features of Dragon to Train it on how you speak those words.  This will save you time and energy as you become a more advanced user of the speech recognition software.
4. Have reasonable expectations.  Dragon is a tool that improves over time.  When you first begin using speech recognition software, it only has a basic understanding of your vocabulary and how you speak.  It will take time for the application to improve, which will occur naturally as you train it when words are not recognized correctly.

These are a few items that will hopefully help you be more successful when using speech recognition software, such as Dragon Medical.  I have also found that it is beneficial to have a follow-up training session with Dragon after the user has been using it for a few weeks/months.  At this point, the user understands some basic functionality, and is usually interested in how to do more complex functions such as Macros.

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

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