Archive for the 'Meaningful Use' Category

Considerations when implementing Imagelink

co-author: Ryan Hunt

imagelink button

One of my clients recently implemented Imagelink for the Allscripts TouchWorksTM EHR application, and I would like to take this opportunity to outline some of the customizations required in order to meet expectations and policies set forth by the client. For those who are not familiar with Imagelink, it is an Allscripts add-on used to bridge a connection from the EHR to a PACS (Picture Archiving and Communication System) by passing a dynamic URL to the end-user that is populated through an inbound interface.

Imagelink will help your organization meet meaningful use (MU) as CMS established the MU menu #3 measure for stage 2 as “more than 10% of all tests whose result is one or more images ordered by the by the eligible professional during the EHR reporting period are accessible through the certified EHR technology.” Not only will it help you meet this measure, but it will also improve the process for your providers as they can then view imaging results in their primary EHR application without having to jump into another application

Some of the customizations and lessons learned by my client include:

  • Testing:
    Part of testing should include all data that is sent thru the configured interface. Since enabling Imagelink requires a few edits to the parameters of the FileResult_CMS call, we want to make sure no other parts of the results are affected.  During initial testing we found that the written report was being overwritten by the execution of the additional mapping.
  • Image Viewer:
    Be aware that the additional window that opens to view the Image will remain open even if one user logs out and another logs in. The user will also need to remember to close the window so that when they go to another patient record they are not confusing the Image with the next patient. The use of single sign on may make this a moot point.
  • Timeout:
    In order to improve security the client required that the URL become unusable after a set amount of time. This required a timestamp to be sent in the URL outbound from the EHR to the PACS. This particular timestamp is generated from the server natively and is sent in Epoch Time. The format needed to be altered in order for the PACs system to recognize the timestamp.
  • Encryption:
    A custom javascript file was written to take in the variables generated from the URL and encrypt them. Once the string was encrypted we utilized a .html file to launch the fully encrypted URL which made the image available to the end user.
  • User Configuration:
    In order for a user in the TouchWorksTM EHR application to be able to use Imagelink, we created a connection for each and every user to the “StentorImagelink” application. See screenshot (TWAdmin >> Users):

A demonstration of Imagelink provided by Galen Healthcare is available here.

For further information or technical assistance with implementing Imagelink at your organization, please feel free to contact us.

Meaningful Use Stage 2: Ready or not here it comes!!

On August 23, 2012, CMS announced a final rule to govern Stage 2 of the Medicare and Medicaid EHR Incentive Programs. The rule specifies the Meaningful Use Stage 2 (MU2) criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to participate in the EHR Incentive Programs. The final rule for MU2 intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information. The majority of the new measures focus around this intent.

Don’t be fooled into thinking that your organization is ready because you sailed through Meaningful Use Stage 1 (MU1) attestation.   MU2 has higher thresholds for the existing MU1 measures, such as increased and/or expanded percentages compliance for CPOE orders, recording Vitals, and electronic submission of prescriptions.

In addition, there are many new measures including direct messaging, electronic referrals, and secure health information messaging that will require getting your patients onboard and communicating with you electronically via your portal. All of this can be achieved with detailed preparation and planning, resulting in a positive financial outcome for your organization.

As we move forward into Quarter 3 of 2014, the push to get MU2 configured and rolled out to providers for attestation is being felt by many organizations. While the task may seem to be a daunting one, there are things you can do now to prepare and ease the transition for your staff and providers. It’s imperative to take a good, hard look at your present configuration, how your numbers stood up for MU1, and develop a plan of attack moving forward for MU2.

To get started, take a look at your providers MU1 numbers and begin the analysis of what has changed for those measures your organization plans to attest to again for MU2. There are a lot of good articles and checklists available on Client Connect to help get this particular step underway immediately.

Next, if you don’t have a patient portal in place, you need one immediately. The need to enroll as many patients as possible cannot be overstated. Multiple measures rely directly on the use of the portal, and many others can be tied in as well. The larger the initial pool of potential patients you have available for some of the more specific measures, the more likely your organization is to succeed with these particular pieces of MU2. With all that in mind, get the portal implemented, and aggressively market it to your patients immediately.

MU2

This is also a great opportunity to take a look at your Orderable Item Dictionary (OID) and clean that thing up! Reclassify OIDs to the appropriate parent class, if you haven’t done so already. If it’s not really a referral, don’t list it under the Referral parent class. Sorry, but there is no such thing as a “Referral for a Colonoscopy” or a “Referral for a Mammogram”. If you’ve created similar orders to meet provider’s requests along the way, now is a great opportunity to standardize that workflow, and move the staff towards a process that will allow for capturing of results data to boost your numbers.

It’s time to take a look and verify: do all the OIDs that should have resultable items attached actually have them? Do your RIDs have LOINC codes? Should there be LOINCs attached? Are you missing information from a specific vendor or compendium? Have you started analyzing your Referral parent class entries and attaching SNOMEDs that might be appropriate from the provided value set?

While we’re on the subject of clean up…the Referring Provider dictionary needs to be examined closely as well. Any providers with multiple entries need to be resolved, and your organization will need to reach out to those providers whose referrals are sent out regularly to obtain the Direct IDs for those individuals. Keep in mind, the MU2 package moves away from the Allscripts Referral Network™ and towards the use of the ACDM (Allscripts Community Direct Messaging). If you aren’t familiar with the ACDM, the video can be found here, https://clientconnect.allscripts.com/videos/5429 . It is a great way to gather base line information.

What can you do now to get ahead of the game? Commit to knowing the material. Allscripts Learning Center, Client Connect, CMS website, and the Galen wiki all contain a broad array of information available to help. Really read the measures and understand how they are calculated and recorded within Touchworks. Know what workflows within your organization are going to need to be adjusted to meet the measures.

Many of the measure-specific PDFs available on Client Connect contain detailed information on set up, workflow considerations, sample test scenarios, and report validation checklists. After your organization decides which measures you will be configuring for, download and thoroughly digest all applicable PDFs. Become familiar with the Value Sets on the MU2 Clinical Quality Measure Configuration Workbook; watch all the videos already available on Client Connect and sign up for all upcoming webinars and presentations. Now is the time to educate yourself in order to make informed decisions when moving forward in the process.

Finally, be realistic about the amount of time your internal staff have available to commit to MU2 configuration moving forward. While they still have their day to day responsibilities to address, there are a myriad of measures available to configure and piles of documentation to read through. Complicated configuration choices will need to be made for each of these measures, AAP set ups will need to be completed for each provider and any other designated end-users, thorough testing needs to be designed and documented, and eReferrals have to be coordinated with other organizations. With all of the demands of busy healthcare organizations, if the light at the end of the tunnel is dim, we are here to help. Galen has the knowledge, resources, and connections to assist you with your configuration, implementation, testing, and training effort to attest to MU2.

eCalcs’ First Steps towards Meaningful Use Compliance

eCalcs are health calculators seamlessly integrated with Allscripts TouchWorksTM. Designed as a separate tab in the user workspace, eCalcs pulls relevant data from a patient’s chart such as demographics, results, and vitals directly into the calculator. This eliminates the need for clinicians to utilize external tools. The concept of eCalcs materialized when a trusted client requested that Galen build a tool that would allow their physicians to seamlessly perform Framingham Risk for Heart Attack calculations within the EHR. When our clients saw the usefulness of that calculator they realized we had built a powerful platform that could host multiple health calculators. Three years and over 50 calculators later, eCalcs not only provides a range of integrated calculators, it also contains questionnaires and comprehensive workflow modules. In 2013, we introduced the AntiCoag and Wound Care Modules. These modules have the capability to track a patient’s information over an extended period of time.

The next step in our eCalcs journey is to make pertinent calculators compliant with EHR incentive programs such as Meaningful Use Stage 2. Currently, we have two meaningful use compliant calculators; PHQ 2014 Depression Screening and Falls Risk Assessment. We are currently working on making many more compliant.

The PHQ 2014 Depression Screening is a questionnaire. It refers to the Meaningful Use standard, Clinical Quality Measure NQF 0418. Allscripts TouchWorksTM documentation recommends building answers that are associated with SNOMED codes in the answer dictionary. To conform to those recommendations, we have associated our result outputs to the positive/negative answers within the answer dictionary. The PHQ 2014 questionnaire has the PHQ 2 and PHQ 9 built into one. A configuration option allows organizations to use both or just the PHQ 9.

ecalcs MU2 2

The Falls Risk Assessment is another questionnaire with Meaningful Use compliance. It refers to the Meaningful Use Clinical Quality Measure NQF 0101. Allscripts TouchWorksTM documentation recommends that we build answers with SNOMED codes in the Answer dictionary and associate them with the results. To conform to those recommendations, we have associated our result outputs to the answer dictionary items. The two questions in the questionnaire are also Allscripts recommended.

ecalcs MU2 3

Over the next several months, we will continue to build calculators that are compliant with EHR incentive program standards such as Meaningful Use Stage 2. The steady growth of eCalcs would not have been possible without our clients. Their feedback, requests, and suggestions have driven eCalcs from a single calculator into the powerful tool that it is today.

 

It’s All in Your Head

“We have some custom workflows and configurations but, it’s not documented anywhere.” These are challenging words for a consultant to hear. It should not be “All in Your Head”. Without documentation, resources must sometimes rely on several unfamiliar sources to gather pivotal information. This could unknowingly lead to time and effort spent on a futile process. With larger organizations, many departments function with complete autonomy and that can sometimes lead to fragmentation within an organization.  Consultants focus not only on the individual user role, but on the entire patient care process as is flows through the organization and each user role involved.

Having an accurate EHR Configuration Workbook (CW) to offer consultants, or even new vendor resources coming on board, may not only save all parties from performing redundant work, but also the some billable hours. When a client contracts a consultant to assists them with a project, one of the first things they are asked for is their EHR System “Configuration Workbook (CW)”. Unless the project is very refined or specific to one function, this is an invaluable tool to give to a new resource at the project kick off. As consultants, we are hired by clients to not only consult, but more often than not implement system changes that touch many aspects of the organization. One small change to a client’s current system configuration can affect groups of users, entire departments, and sometimes even teams that function outside of the CEHRT.  Because of the intricacies of each client’s organizational set up, it is important for onboarding resources to have a clear understanding of how all the pieces work together.

Examples of items that organizations could include in their CW in addition to the standard:

  • List of all moving pieces – The PM that is used, the various environments being maintained, server diagrams and lists, Patient Portal, HIE, etc.
  • A grid w/ Products version and status – Upgrades, Installs Patches or hot fixes, dates etc.
  • Organizational Hierarchy with high level process – Does your Org have a separate support team for the EHR, a Network team, an MU Team, a compliance department, or a separate training team?
  • List of ‘Go-to’ people for information – Who should be contacted and how for questions.
  • MU Status – What stage, which CQMs are being reported, are there any EPs that are exempt, etc.
  • Custom workflows or processes – Is there a call processing or triage team, do certain sites have POC lab testing, does the org use and follow the standard work/task lists?
  • Up to date user list – The list of users should be current with a process in place for on-boarding new users or inactivating user profiles and assuring that user EHR assignments are captured and reassigned as needed.
  • List all interfaces – What interfaces are in place and what department monitors these.  Does your org primarily use Quest, LabCorp, or a local hospital?

The scramble to meet imposed deadlines is a common denominator amongst clients and documentation that is not an obvious and immediate requirement may not seem like a priority. However, organization should maintain a current CW with managers and/or departments leads doing their part in keeping the information captured up to date. All organizations no matter what product they are running would find this a tool that could be used for many purposes as a whole and information extracted from for many reasons.

Lastly, it is important to have a department or team take ownership of this documentation and commit to maintaining its accuracy. Evolving governmental requirements have pushed the industry of EHR technology to develop and roll out new functionality at a rate most organizations struggle to comply with. Having an accurate Configuration Workbook for the organization both now and going forward will become an invaluable tool of reference not only for hired resources or consultant but most importantly, for the client’s organization.

New TWUser Admin Preferences in 11.4.1

There are a few new enhancements available for Allscripts TouchWorks EHR (formerly Enterprise EHR) beginning in version 11.4.1.  The first feature allows you to assign all sites or specific sites to a user’s primary organization while establishing a default site for each.  This is an ideal feature for users that do not need access to all the sites for whatever reason your organization may decide.  Be aware that post upgrade, all users are assigned to all sites at all organizations by default.  This would apply to any new users created as well.  To configure any changes needed for users there is now an Assigned Sites section within TWUser Admin>User Admin.  Previously the controls for changing sites were located in the User Details section.

You can see by the screen shots below that you can select “All Sites” or un-check the desired sites as needed in order to limit the choices that the user will see.  Be sure to select a Default Site as well which will automatically be the choice if only one site is selected.  Notice that when Western Colorado Pediatric Associates unchecked, it is no longer an option for the user within Site Selector.

 

Site_Selector_001

 

Keep in mind that if  there is only one site assigned to a user, the user bypasses Site Selector even if  the Always Present Site Selector preference is set to Y.

 

The next new feature available within User Admin is the ability to add multiple licenses and ID’s previously not supported in earlier versions of Allscripts TouchWorks EHR.  The new Licenses/ID’s Section offers enhanced tools for defining provider licensing information, including support for multiple Drug Enforcement Administration (DEA) registrations.   When a provider has multiple DEA numbers, the application selects the correct DEA license for a controlled substance prescription based on the prescribing location (Site).

You can add multiple licenses and ID’s for users in specific states or sites, or for use at all sites as well.   These are  used for enrollment, prescription routing, prescription eligibility, and prescription history transactions.  Also be sure to enter applicable information for any users who enter orders for Physicians.  Clinical Quality Measures for Meaningful Use Stage 2 require that for an order to count towards an encounter provider’s computerized provider order entry (CPOE) measure, the user entering the order on behalf of the physician must be certified.

Licenses_ID's

As always, be sure to test any new features and enhancements first to ensure they are working as designed and are appropriate for your organization.

To learn more about 11.4.1 features and enhancements,  be sure to visit  http://www.galenhealthcare.com/events/ for upcoming free public webcasts.

  • References
    Enhancement Supplement Prescriber, Site, and Pharmacy Setup Changes for Electronic Prescribing- Available on Client Connect
    Enhancement Supplement Assigned Sites- Available on Client Connect

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