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.

Does your practice utilize the Finish Note task in Allscripts Enterprise EHR^TM? 

If you answered yes, then this blog is for you.

In this article, I wanted to show you two possible outcomes when working in your  v11 Note. You will notice that there are two similar workflows to add and commit clinical data in the note that will impact how a Finish Note task appears in a user’s task list.

While you will find that these two workflows are scaled down to be very basic and generic, I wanted to limit them to clearly demonstrate the difference between the two.

Workflow #1: Committing data while saving and closing the v11 note

In this workflow, we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Select “Save and Close” in the Note window
4. Select “Save and Continue” on the Encounter Summary
5. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- One Active Finish Note task

So in this case, using the Current Patient – All or Current Patient – Active task views, you will see that just one Finish Note task has been created in an active status.  The task indicates that the note has been created and saved.  Keep in mind, at this point, that the commit action occurred while the user selected Save and Close in the Note. In this workflow, the system only reviewed the data once.

Workflow #2: Committing data prior to saving and closing the v11 note

As we did in the first workflow, here we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Click the Commit button
4. Select “Save and Continue” on the Encounter Summary
5. Select “Save and Close” in the Note window
6. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- A Complete Finish Note task and an Active Sign-Note task

If you use a task view that simply shows Current Patient – Active, you would not typically see the Finish Note task in this instance, but instead the Sign-Note task.  This means the note has not been signed and might not be the task you expect to receive if you seek the Finish Note task.

While a Finish Note task has been generated and marked as Complete, there may yet be information to add to the note.  The logic behind this workflow is that the second action of “Save and Close” is the second review after having hit “Commit”, and therefore results in the outcome we see here.  In this case, the system has reviewed the data twice, and the Finish Note task in regards to this note is completed and the active Sign Note task is automatically generated.

My advice in this situation is to follow Workflow #1 when working in a v11 Note. If users are creating a note and adding clinical data, but need a provider or second user to receive a Finish Note task and add additional items to the note; use the first workflow.   This way, the Finish Note task will be assigned and visible to the correct person, and users will be trained in such a way that ensures the success of this workflow.

Please don’t hesitate to leave your feedback below or Contact Galen Healthcare Solutions should you have further questions!

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, Galen Webcast Series, Tasks, TouchWorks, v11, v11 Note

Recently, I’ve seen several clients struggle to understand this issue and I’d like to give some information about what causes it and how to correct it.

There are several levels at which a Requested Performing Location (RPL) can be linked to a Billing Location. The highest such level is in the Requested Performing Location Dictionary (TWAdmin > Dictionaries > Requested Location). When an RPL and Billing Location are linked at the dictionary level, any order placed for that RPL will inherit the respective Billing Location.

Some of the AEEHR implementations (Ready, Gold, etc) are delivered with the In Office RPL linked to the Touchworks Clinic Billing Location. Most clients will want to change this setting, but in certain releases, this setting cannot be changed from within the RPL Dictionary.

One workaround that I seen attempting to fix this problem would be to inactivate the Touchworks Clinic Billing Location entirely. Unfortunately, this will not correct the issue. Front end users will find that their In Office orders still default to the Touchworks Clinic Billing Location.
The only way undo the linkage is via SSMT. The steps are listed below:

1. Extract the Performing Location content category.
2. Find the column DefaultBillingLocationEntryName.
3. Delete every instance of Touchworks Clinic.
4. Reload into the same content category.

If the Touchworks Clinic Billing Location has already been inactivated, you may see the In Office RPL linked to a blank cell in the DefaultBillingLocationEntryName column. If this is the case and the RPL is still defaulting to Touchworks Clinic, then we recommend copying and pasting another Blank row into the DefaultBillingLocationEntryName column. This should do the trick!

Now you should logout of AEEHR then back in and test the behavior. A blank billing location is what you are hoping to see.

Tags: Allscripts Charge Module

This week, the world lost one of the most innovative people of our time. Steve Jobs, co-founder of Apple Computer, passed away leaving behind quite the legacy. I feel obligated to honor Steve Jobs this week and reflect on how he affected technology in health care.

It is amazing to reflect upon the history of Apple computers. It seems not too long ago, I was learning how to use a Macintosh computer playing Number Crunchers and Oregon Trail in Elementary school. Back then, the idea of a computer with a mouse was relatively new technology! Twenty years later, Jobs’ vision has evolved technology well beyond that grey box, keyboard, and mouse.

Take this timeline for example:

• May 1984 – Macintosh was released using a graphical user interface controlled by a mouse (courtesy of Xerox technology)
• April 2010 – Apple releases the first iPhone, optimizing a user interface that would pave the way to the iPad and an extensive library of applications that remains the most popular OS to developers today.

What an advancement in technology in twenty six years! So while the only Apple product I own is an iPod, I remain deeply amazed at the technology Apple offers and how much its technology touches our lives. Apple products remains as probably the most popular choice for mobile computing in the United States.

Business Insider published an article in July 2010 titled “10 Ways The iPad is Changing Healthcare”.  While it’s a quick click through the list, you certainly get a feel for the opportunities the iPad has presented to healthcare. Examples included “Going Green”, cost savings, and information consolidation. All this was made possible with the vision of Steve Jobs.

Did you know?:

According to Wikipedia on Steve Jobs:  “Jobs is listed as either primary inventor or co-inventor in 338 US patents or patent applications related to a range of technologies from actual computer and portable devices to user interfaces (including touch-based), speakers, keyboards, power adapters, staircases, clasps, sleeves, lanyards and packages.”

Being in the Electronic Healthcare Record industry, I want to share a couple examples that resulted from Jobs’ technology.

Thank you to the iOS software and the work by developers at Allscripts^TM, there are two applications that Allscripts^TM offers that can be utilized using an iPad or iPhone.

ePrescribe:

This application allows providers to use their iPhone/iTouch to view patients from their Practice Management System.

Features:

• Summary page that identifies and presented problems, allergies, unprocessed medications, and any active medications
• Allows providers to write prescriptions using an excellent, user-friendly design
• Displays formulary indicators and DUR
• Can submit Rx’s direct to Pharmacy, Send to Mail order, and send to a printer

For more information on Allscripts^TM ePrescribe, visit their webpage to learn more.

Remote EHR:

This is another excellent application that is utilized by healthcare facilities using the iOS software that allows providers to remotely control their AllscriptsTM Electronic Health record from any location.

Features:

• Provides real-time access to patient summary information
• Includes ePrescribing to the patient’s pharmacy
• Integration with Charge capturing and attaching diagnosis codes to scripts
• Compatible with Allscripts^TM Enterprise EHR v11 (among other Allscripts products!)

For more information on Allscripts^TM, visit their webpage to learn more. Additionally, Galen Healthcare Solutions offers a Wiki page with more information regarding Remote EHR.

So, thank you Steve Jobs for making such applications possible. Remote EHR and ePrescribe are two examples of the results of Jobs’ achievements and have allowed for better patient care.

Share your thoughts! Give us your feedback on how you’ve used this technology in healthcare and how you see its benefits or contributions.

As always, do not hesitate to contact Galen Healthcare Solutions for more information.  Galen is a Preferred Platinum Partner of Allscripts^TM .

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, ePrescribe, Healthcare IT, iOS, Remote EHR, Steve Jobs, v11

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.

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

What a week!  As with returning from any trip to Las Vegas, it seems to take forever to settle back in to the normal routine.  This time it seems that the “magic”, however you want to define it, of Las Vegas was simply overshadowed by the excitement of ACE. 

For us here at Galen it was a great time to see old friends and clients, as well as, meet new friends and clients all in a setting that facilitated learning, sharing and connecting our collective community; of course, having a little bit of fun along the way doesn’t hurt.

By far the most rewarding part of ACE is connecting with our clients and hearing about the successes our people have made, both on an individual level as well as a community level.  There is nothing more rewarding than hearing a client’s success story and being able to share with our group the service that someone from Galen provided.

In the coming year, we look forward to our continued contributions and learning from our people, clients and community.  Nothing contributes to innovation more than a passionate community.

It was great to see all of our old friends, and we look forward to making new ones.

Matt Nice

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, Enterprise EHR

Galen Healthcare Solutions will be hosting a series of free webcasts covering Allscripts EHR Infrastructure. The purpose of these webcasts is to provide insight into the integration of server roles in your EHR environment. We will cover the Message Server role in our first instance.

Tech – The Message Server

This webcast provides insight into the flow of data for the processes handled by Allscripts’ Message Server role. Topics covered will include configuration and troubleshooting of the TW Spooler service, as well as the workspaces involved in printing administration.

July 20, 2010 – 2:00pm-3:30pm: To register and reserve a spot please click here.

July 22, 2010 – 10:00am-11:30am: To register and reserve a spot please click here.

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