Archive for the 'Meaningful Use' Category

Patient Portals: 3 Hot-Button Items

As we start the fourth quarter, we enter the final 3-month reporting period for Meaningful Use (MU) Stage 2 in 2014.  Many healthcare organizations will be working feverishly this quarter to ensure that their eligible providers (and supporting staff) are performing all of the necessary tasks in order to successfully attest to MU Stage 2 in 2014.  Stage 2 has three core objectives that require patients to interact with their health information and communicate with their provider electronically.  All three of these objectives can be satisfied by the use of a patient portal.

Recently, Galen Healthcare forged a partnership with MedfusionTM to help expand their portfolio of EHR’s that integrate with the MedfusionTM Patient Portal.  This project got me thinking about some of the bigger picture issues with patient portals.

Organizational Benefits.  By now, most healthcare organizations have selected a patient portal allowing them to achieve the MU objectives.  While MU was likely the driver for many providers to implement patient portals in their organization, there are many other reasons to integrate a patient portal with the organization’s EHR solution.  Secure communications between providers and patients, appointment requests, prescription renewal requests, and automated delivery of visit summaries are a few examples of office workflows that can be made more efficient when using a patient portal, freeing up time for office staff.  What are the next wave of patient portal features that will help optimize the healthcare organization?  Will e-visits gain traction amongst providers, patients, and payers?  Is there a place in the patient portal for e-visits and will they benefit the healthcare organization?

Patient Adoption.  Not only does the patient portal provide many benefits for the healthcare organization and its staff, but patients also benefit from the features and functionalities added by the portal.  Patient portals provide patients with innovative functionalities that are not only new and exciting (smart phone apps, cloud services, etc.), but also provide services that yield streamlined and improved healthcare outcomes.  And while a patient portal can reduce the amount of effort required of the patient to get the needed healthcare, and even result in healthier patient care, portal adoption is still a big struggle.  How can adoption be increased?  Most of the burden falls on the organization to get the message out to their patients to join in many different ways, but can patient portal vendors create a user-interface that is simple to use while also including trendy and exciting features (possibly including some element of gamification) to attract younger generations, enhance the patient experience, and motivate individuals to live healthier lives?

EHR-Tethered Patient Portals.  Does the tight relationship between EHR vendors and patient portals reduce the adoption of patient portals by patients?  Each vendor has their own patient portal solution, creating the need for patients to possibly maintain multiple portal accounts.  As much as providers don’t want to be required to login to multiple applications to see a patient’s full clinical record, a patient doesn’t want to have to login to multiple portals in order to see their full health record.  Much like HIE was the next step for getting data out of EHR silos, what is next for providing patients with a way to combine their data across multiple portal “silos?”  Is the best solution to tether patient portals to HIE’s, which already aggregate data across multiple providers in a community, rather than EHR’s?  There are definitely some design costs associated with this type of solution, but is it more sustainable and desirable in the long-term?

Patient portals have been developed and deployed for many years, but the adoption still seems relatively low.  Meaningful Use Stage 2 is trying to increase their usage, but there need to be more benefits (for both the healthcare organization and the patient) in order to sustain and augment their utilization.

Feel free to provide your thoughts and comments, including your own experiences, on patient portals below.  What current features are most useful?  What features are still needed?  What is the future of patient portals?

The Importance of Interoperability and How Galen Can Help You

Earlier this year, the Centers for Disease Control and Prevention released a report called, “Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices”.  This report detailed statistics and trends describing the rates of adoption of Electronic Health Records systems among practice-based physicians in 2013.  The report showed that over 78% of office-based physicians are now using some type of electronic health record system.  This is a dramatic increase over the 2001 figure of 18%.  In addition, over 69% of office-based physicians intended to participate for “meaningful use” incentives (  It’s become very clear that EHRs are the primary method that healthcare will be practiced, administered, and recorded in the future.


Now that practices and hospitals have largely adopted EHRs, there is a big push to connect them.  The ability for healthcare organizations to access data from disparate systems is more important than ever.  Access to a patient’s complete record at any location they are seen will enable healthcare providers to leverage their data in order to gather new insights.  These insights will lead to the development of new strategies for improving care.  Nearly all of CIOs, CTOs, and IT managers know that integration is a top priority.  When surveyed in 2012, 90% of respondents answered that integration is a main concern and is critical to success.  Healthcare integration is at an all-time high as government incentives have created a race towards meaningful use money. Over 40% of healthcare organizations responded that they achieved Meaningful Use stage 1 from this 2012 report. (

Core Health Technologies conducted an “HL7 Interface Technology” survey in 2012 in order to gather information on where we were as an industry with healthcare interface integration and where we are headed.  The survey asked CIOs, CTOs, IT Managers, and HL7 Professionals questions about interface technology.  The data was collected, “…during a 14 day period in August 2012 through their website…over 1,350 individuals participated in [the] survey.  All participants lived and worked in the United States and [were] employed by healthcare organizations, predominantly providers, using HL7 interfaces.” (

Corepoint Technologies drew some powerful insights from their 2012 survey.  While the report is a couple of years old, it still gives a high-level picture of the challenges that healthcare IT face in tackling interoperability.  The first thing to notice when reading the report is that there are a wide variety of interface engines being used throughout the healthcare IT market.  Having so many different solutions can be a positive in that it creates competition (competition means the consumer wins), but when every healthcare organization is using a different piece of software, it can be difficult to be on the same page.

Cloverleaf, as of 2012, was the market leader in interface engines controlling around 13% of the market.  Epic, Mirth, eGATE JCAPS, OPENLink, and Iguana came in with impressive market share numbers as well.

HL7 Technologies being used from respondents of Core Health’s survey (2012):

Cloverleaf [Lawson (Quovadx)] 13.10%
Point-to-Point 11.70%
Epic Bridges [Epic] 10.20%
Mirth Connect [Mirth Corporation] 7.60%
JCAPS/ICAN/e*Gate/DataGate… 6.60%
OPENLink [Siemens] 5.80%
Iguana™ [iNTERFACEWARE] 5.70%
Open Engine [Cerner] 5.50%
eLink [Allscripts (Eclipsys)] 5.30%
Rhapsody [Orion Health] 4.50%
Pathways [McKesson] 4.40%
Corepoint, NeoTool [Corepoint Health] 4.20%
BizTalk [Microsoft®] 4.10%
Ensemble [Intersystems] 3.50%
Fusion Middleware [Oracle] 2.30%
I don’t know 1.90%
EasyConnect [Iatric Systems] 1.80%
e-Biz Impact [Sybase] 1.40%
iWay [iWay Software] 0.40%

It’s also interesting to see where CIOs, CTOs, IT Managers, and HL7 Professions saw interface engines going 2-5 years in the future.  When asked which interface engines would be leading the market in 2-5 years, respondents answered with Cloverleaf, Microsoft BizTalk, Corepoint, Epic, and Orion Rhapsody in that order.  What interface engines will be used in the future is a valuable piece of information when considering where the industry is headed.

Some other important conclusions that came from Core Health Technology’s report is that high turnover is an issue in Healthcare IT and interfacing specifically.  Whether this is because of the difficulty of these implementations or just a lack of fit, it is a worthwhile investment to try and identify the source of this high turnover.  Having an experienced interface team who understands your system and individual characteristics and challenges is invaluable.  Creating a retention strategy for these employees and trying to identify the reasons they leave is crucial.  The tacit knowledge that these employees begin to possess is difficult to teach, and is very useful.

With all this being said, it’s important that a healthcare organization have a team of experienced, flexible, thoughtful, and prepared healthcare professionals who are ready to meet your healthcare needs.  Galen’s integration services team are a group of talented professions that are fluent in HL7, Orion Rhapsody, ConnectR, and SQL.  They have worked in small clinics and large hospital networks alike and always work with the organization to find a solution that works best for them.  Find out more about our suite of solutions below:


The 2012 Hl7 Interface Technology Survey Results. “The 2012 HL7 Interface Technology Survey Results.” 2012 HL7 Interface (n.d.): n. pag. Web. <>.

“Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 Jan. 2014. Web. 15 Sept. 2014. <>.


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.


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, . 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.


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