Archive for the 'TouchWorks EHR' Category
Allscripts Enterprise EHR Custom Reporting
The requests for reports that we get runs the gamut. Most of the time, clients are looking to modify the existing canned reports that Allscripts offers with the Allscripts Enterprise Electronic Health Record (AE-EHR). Other times, clients envision a custom report that is unlike any of those currently offered and is unique to their particular organization. And still further, some organizations wish to fulfill reporting metrics to receive monetary incentives from initiatives such as the Physician Quality Reporting Initiatives (PQRI) and P4P (Pay for Performance) . Given the commonalities in the requests we receive, with our reporting solutions store, we have attempted to pick the most popular reports requested from clients and offer them via on-demand payment, download and installation.
We also receive a substantial amount of inquiries from clients as to what exactly goes into customizing existing reports and creating new reports. Clients are often curious as to what types of skill sets are needed. These organizations may feel that they are better suited to have their own personnel develop custom reports. For instance, the organization may have performed an return on investment (ROI) analysis and determined it makes the most financial sense to train their own staff to supply the multitude of administrative and “print” reports they require in the coming future.
That said, let’s get to answering the question of what goes into developing custom reports for the AE-EHR:
- AE-EHR Clinical Database Stored Procedures: These are used to extract data out of the database to render in the report. The stored procedures can be thought of as a “middle-man” between the database and the Crystal Report. More information on the basics of stored procedures can be found via the following link.
- Crystal Reports: Most AE-EHR reports are developed using Crystal Reports. Crystal controls the how the data extracted from the stored procedures renders in the final report. Crystal offers functionality for pivot tables, summary of data fields, grouping, custom formulas, suppression based upon data values, etc. For more information on Crystal reports tutorials, follow this link .
- Insert Scripts: There are several places that reports can be installed within the context of the application’s user interface (UI) – these are called “Calling Points.” Reports can be printed from the administrative workplace, and also added to the UI for the traditional “print documents” – immunization or results “calling point” for instance.
The most important ingredient to custom AE-EHR report recipes comes in the experience – specifically knowledge of the database schema. Knowing what tables to pull from, how tables are related, and what functions, stored procedures and existing custom reports can be utilized so as to not re-invent the wheel. Knowledge of advanced SQL querying is invaluable as well. If you would like to learn more, Galen is offering free EHR Reporting webcasts.
Let us know if we may assist your organization in developing and delivering custom AE-EHR reports. In addition to the reporting solutions store, we also offer training courses and reporting services for the Allscripts Enterprise EHR database, ETL database, Analytics and the ConnectR database. Please contact sales@galenhealthcare.com for more information regarding these courses and our reporting services.
Troubleshooting Healthcare IT Problems
The name of the game in Healthcare IT is problem-solving. As such, I find this is where my own background in engineering benefits me in that I was taught to take a methodical approach in troubleshooting and root-causing technical issues, fully documenting findings and results. That said I would be remiss if I did not mention some invaluable tools which aid technical issue investigation:
A Healthcare IT professional’s tools of the trade (must-haves):
- SQL Profiler
- Diff software (Notepad++)
- HTTP analyzer (Fiddler2)
- Screen capture software (Printkey2000)
- Paint.net
- Windows Process Monitor
- RedGate tools (SQL Toolbelt, Reflector)
- HL7 Editor
In addition to the technical component of the job, an equally-important component is communication. I’ve found that utilizing the proper communication channels can drastically reduce problem-solving time and effort. As Dr. Halamka alludes to in his blog yesterday, a good rule is if more than 3 rounds of emails go back and forth about an issue, it’s time to pick up the phone or have a meeting.
The first step in investigating an issue starts with having the proper background information provided by the client. Utilization of an issue submission form is invaluable to document all items surrounding the issue. With incomplete background information, the Healthcare IT professional is forced to solicit more information from the client – forcing unnecessary additional communication and driving up the time-to-resolution.
Once background information has been assimilated and an email thread has been opened, if the issue cannot be resolved in more than 3 rounds of emails as alluded to above, a conference call should be scheduled. The components and outcomes for a successful healthcare IT technical troubleshooting conference call are as follows:
- Well formulated problem statement and documentation provided to all parties on the call
- Issue submittal form to include short description, full description, screen shots, steps to reproduce, onset, frequency, users/devices affected, etc.
- Skeleton Agenda
- Ensure that the right representatives are on the phone (RIS analyst, Lab HL7 interface analyst, etc)
- Vet issues related to the different “layers”
- Application Analysts
- PC/Desktop Techs
- Network Analysts
- Server Techs
- Server Architects
- Storage Architects
- OS Architects
- DB Architects
- Application Architects
- Action items for representatives if the problem is not resolved
- Eliminate misinterpretation via oral communication
- Representative 1: “This is what we are expecting”
- Representative 2: “Really? Wow, we never expected that.”
- Representative 3: “We never would have interpreted the spec to mean that”
And finally, for a great article addressing troubleshooting complex IT problems, please see Dr. Halamka’s blog article posted in December of last year.
Please contact sales@galenhealthcare.com and visit our website for more information regarding our technical service offerings.
Announcing Galen EHR Reporting Webcasts
Galen Healthcare Solutions will be hosting the second series of free webcasts covering Allscripts EHR Reporting. The purpose of these webcasts is to provide insight into reporting options within your EHR database. We will cover approaches to reporting, database structure, and hands-on querying of the EHR database.
These will be structured in a similar format to university courses – the initial three classes will be at 100, 300 and 500 levels. The list of the webcasts and their times may be found below.
100 Series – Introduction to the Allscripts EHR Database: Overview of the database, patient demographics and dictionary linking.
- Wednesday, December 2nd, 2009 at 2:00pm EST
300 Series – v11 Order and Results: querying configuration and patient data.
- Wednesday, January 13th, 2010 at 2:00pm EST
500 Series – Advanced ConnectR Architecture and Querying
- Wednesday, February 3rd, 2010 at 2:00pm EST
To attend, please contact Mike Dow, mike.dow@galenhealthcare.com. You must be an existing Allscripts Enterprise EHR client to attend.
We also offer training courses and reporting services for the Allscripts Enterprise EHR database, ETL database, Analytics and the ConnectR database. Please contact sales@galenhealthcare.com for more information regarding these courses and our reporting services.
Integrating with the HIE
The benefits of Health Information Exchanges (HIEs) are quite profound. Recently we were able to assist one of our clients in exchanging data from the Electronic Healthcare Record (EHR) with their state’s HIE network – specifically registrations, radiology results and documents. The biggest challenges we faced in integrating the EHR and the HIE included the following:
- Patient identifiers – these can be different between driving system (Radiology Information System (RIS), Laboratory Information System (LIS), and EHR. Consistency with the Master Patient Index (MPI) across all interfaces is the desired outcome.
- Filtering – mental health document types, “celebrity patients,” preliminary documents, unverified results – the list goes on and on. Knowing the gamut of different options of configurability is helpful in deciding which filtering should take place.
These interfaces were built in the ConnectR interface engine utilizing the existing Application Programming Interface (API) to the Allscripts Enterprise EHR (AE-EHR) – inbound and outbound stored procedures. It should be noted that the ConnectR interface engine is used as the standard interface engine by Allscripts to facilitate the communication between healthcare systems, however there are alternatives.
This approach is not entirely desirable in that it requires customization of the interfaces to the particular vendor/client based upon their underlying data exchange implementation architecture. In an ideal sense, the data exchange would facilitate a “seamless” plug-in to existing AE-EHR users and HIEs. This is certainly what the industry is driving towards.
As Dr. Halamka alluded to in his blog posting yesterday, the ideal scenario is one in which CDA/CCD documents are used to exchange data between the EHR and the HIE as they offer a complete set of the patient record. HITSP (Health Information Technology Standards Panel) standards describe these transactions as there are thirteen original Interoperability Specifications (IS) into an EHR-centric view to facilitate alignment with Health Information Technology provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). For more information regarding Health Information Exchanges (HIEs) and “real-world” implementations and their utilization of HITSP products see the following HIMSS webinar. In the interim, for those Allscripts clients looking to get ahead of the game with meaningful use, we are left to develop interfaces within the framework of the existing API to/from the AE-EHR.
In closing, be very aware of the possibilities as the HIE landscape is changing. For example, Navinet now offers subsidization of HIE implementation costs. However, the challenge remains in determining the best business model to fund the exchange going forward.
For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service
Ingredients for a Successful Interface Project
More often than not – in the healthcare IT industry especially – the expectation is that “we want it done yesterday.” That said, it is not so surprising that often the first item addressed in discussing a new interface is the go-live date. Recently we faced two client projects that fit the aforementioned mold with fairly accelerated time-lines for their data exchange implementations with the Allscripts Enterprise Electronic Healthcare Record (AE-EHR). However, with a little bit of luck and more so by following the interface project recipe for success outlined below, we were able to bring the interfaces live within 30 days of project kickoff.
Break the interface project up into phases, and assign reasonable deadlines to each phase, identifying any dependencies up-front:
- Candidate – Initiated by the client, schedule kick-off call with Interface Analyst and Vendor
- Scope – Client review of high-level architecture and requirements with Interface Analyst
- Client Approval – Client signs-off on interface design
- Development – Interface Analyst implements interface in test/development environment, establishes connectivity and performs and validates unit test.
- Client Review – Client validates that interfaces are built to meet the needs of the organization. Clinician/End-user review is strongly recommended.
- Go-Live – Interface Analyst moves interface from test/development environment to production environment during non-production hours and connectivity/smoke test is performed.
Factors that influence the success of an interface project:
- Motivated client
- Motivated vendor
- Environment access up-front: Systems login and access, interface engine login and access, EHR login and access.
- Systematic approach
- Configuration options presented and discussed up-front.
- Decisions concerning configuration are documented.
- Weekly status calls with vendor/client and action item assignment
- Preparedness
- Documentation of current client work flow/data flow supplied for interface design.
- Functional prerequisites complete before volume testing phase
- Connectivity setup
- Unit test
- Complexity of the interface
- Standard versus custom interface
- Excessive business logic requirements (maintenance and supportability concerns).
- Dependencies in place: Module (such as charge, order or immunization) functional & stable and pertinent bulk loads have taken place (compendium, provider, etc. loads)
- Resource availability and experience: Focused and experienced client resources allocated and available for testing & go-live
- Interface support: Post go-live ensure there is a defined path for interface support – including working of errors (patient matching errors for instance)
- Experienced Interface Analyst/HL7 analyst
- IA with experience with the application programming interface (API) to the EHR – what options are available, common issues encountered, customizations to accommodate client’s work flow, etc.
- Quickly troubleshooting and mitigating any issues that arise.
For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service
Immunization Data Exchange with the EHR
In light of the highly publicized widespread outbreak of the Swine flu, it is certainly pertinent to touch on how organizations may utilize an Electronic Healthcare Record (EHR) data exchange from the EHR to an immunization registry to contribute in the effort to control this pandemic. Resolutions by the American Medical Association (AMA) and the American Osteopathic Association (AOA) note that the “lack of accurate immunization records represents a major reason for missed opportunities to vaccinate” and “immunization registries offer a cost-saving solution that ensures access to accurate immunization records at every visit.”
It is well-documented that registries can save health care provider money by drastically reducing the time it takes to pull a child’s medical record, review his immunizations, enter the new shots, and re-file the record. However, a stand-alone registry application requires duplicate data entry in the case where an EHR acts as the practice’s clinical data repository. In situations where a stand-alone immunization registry solution is already instituted in a practice, productivity increases of 30 to 50% can be realized by integrating the clinical repository system, namely the EHR, with the state registry via a data exchange.
Introduction
An immunization data exchange facilitates the share of data between the immunization registry and the EHR by bringing registry information into the EHR and also sending data to the immunization registry with every administered immunization. Integrating the EHR with the immunization registry offers the capability of sustaining high immunization rates and low disease levels via sharing of clinical data. As a result of these immediate benefits, providers will also realize many long-term benefits such as a reduction in paperwork, staff time and costs associated with immunization related activities. Most importantly though, are the direct patient outcomes in that the immunization data exchange prevents unnecessary (duplicate) immunizations.
Benefits
- Compliance – On average, less than 80% of shots given are entered
- Data Accuracy – Over 15% error rate when completed by clinical staff
- Data Availability – 50% of 2 year olds have 2 or more providers
- Provide record consolidation of immunization information
- Facilitate management of immunizations so that children receive only the vaccines they need within the appropriate time-frames
- Decrease time spent by office staff seeking immunization histories
- Generation of timely immunization reports to assist with reporting requirements and other quality improvement initiatives.
- Elimination of redundant entry of patient data in both EHR and registry application
- Immediate availability of immunizations to the enterprise.
- Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc)
- Custom reports can also be created and deployed to supplement current paper processes for documentation of immunizations (for instance a summer camp requires all medications, immunizations, allergies be documented)
And perhaps the biggest benefit is that many groups are able to negotiate with the immunization registry to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view – the practice actively contributes to the patient immunization record via a data exchange from the EHR to the registry – the registries are often happy to provide financial incentive for practices to participate in an electronic data exchange.
Cost Savings
A study published in the American Journal of Preventative Medicine found that the annual cost for a practice to participate in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $.65 to $7.74. It was noted in this study that annual per-patient costs were lowest in the sites that used an automated data-entry interface. The main conclusion reached from this study was that ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Implementation of an interface to accept and send electronic transfers of records avoid duplicate data-entry tasks and decrease provider costs.
For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service
Result Data Exchange with the EHR
The benefits of a results data exchange between a vendor system and the Electronic Healthcare Record (EHR) are profound, as the need for redundant and often erroneous data is greatly reduced. More importantly, by implementing a results data exchange to the EHR, providers are delivered more timely and accurate clinical data, yielding an increased level of patient care.
Benefits
- Elimination of redundant entry of patient data.
- Result reconciled to order automatically
- Immediate availability of the results to the enterprise.
- Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc).
- Elimination of scanning of signed paper labs to the EHR.
- No more lost lab results.
- Run reporting on the data from labs in EHR (for example, blood sugar change over time).
- Automated result tasking as well as the ability to send copies to related providers, such as the referring provider or the patient’s primary care provider.
- Automated Tasking.
- Verify result task.
- Carbon Copy (Review result task).
- Automated synchronization of item dictionary.
- Drop a charge automatically to the PMS (assuming a charge data exchange is in place).
- Capability to automatically send insurance information to labs for lab direct client bill (assuming the insurance data exists in the EHR. This data is usually fed from a separate PMS data exchange).
- For PACs data exchanges, facilitates viewing of image result directly from EHR.
And perhaps the biggest benefit is that many groups are able to negotiate with their lab and radiology providers to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view, the lab and radiology providers are often happy to provide financial incentive for practices to participate in an electronic data exchange.
Return on Investment (ROI)
A three-hospital study conducted by LINK Medical and Philips Medical provides great insight into the return on investment that interfacing can provide. These hospitals analyzed and assessed the effectiveness of automating the process of Electrocardiogram (ECG) orders and test results, with the following realized outcomes:
- Reduction in direct annual labor costs ($11–25,000).
- Elimination of non-billable tests.
- Elimination of lost charges (1% to 2% of ordered tests).
- Short payback period (less than 12 months).
- On-going ROI – these savings and associated benefits continued.
Overall cost savings were in the range of $43,000 to $59,000 per annum.
The Real Return on Investment: A story about the personal value of an electronic health record
When my father was in his early 60’s, he began to experience a mysterious, debilitating pain. He initially thought it might be arthritis, but it kept getting worse. It reached an extreme where my father could no longer move without discomfort. Our family was devastated when we received the diagnosis. He had a treatable cancer, that had moved past the point of treatment… it was in his bones.
We sought out specialists in our area and my father began treatment with a top of the line cancer center. Like me, my father was a bit of a geek. I can remember him becoming completely enthralled with the Electronic Health Record utilized by his team. The oncologist, the urologist and pain clinic managed all of my father’s information from one organized and easy to use electronic document. During the early stages of his illness, the computer in the room was something my father considered a “neat feature” of his care. I would call to see how he was doing and he would talk about his latest visit and tell me about how the It wasn’t until later that we all realized how valuable that “neat feature” truly was.
Time progressed, as well as my father’s illness, but his incredible treatment never wavered. There was a point where my father was taking more than 10 medications daily, in addition to the infusions and injections administered at the cancer center. Even with a complex schedule of medications to follow and numerous underlying medical conditions to monitor, his quality of life vastly improved through the blending of the specialists’ knowledge and the EHR’s accessibility. Once again, my father was able to enjoy life’s simple pleasures, like a walk through the woods or a trip to the market, without pain. Life however, was not without its ups and downs.
It was a complex medical situation and we needed to be prepared for the possibility of emergency intervention. I made an “Emergency Fact Sheet” that listed all of his Active problems, medications, allergies, phone numbers for all of his providers and immediate family members. We taped it to the inside of the front door so that it could be easily found for a trip to the ER or if the paramedics needed to be called.
The day arrived when the paramedics had to come to the house and rush my father off to the local community hospital. The experience of the local hospital was a stark contrast to the care of the cancer center. The paper process for providing care was so unbelievably cumbersome, that the simplest of tasks took days, even with the detailed background information we given the hospital. The time delay between visits from the appropriate physicians, ordering the correct medications, requisitioning the orders from the hospital pharmacy, and getting the medication to my father, caused a major disruption in his daily pain management schedule. This delay ultimately resulted in the recurrence of that intense bone pain while waiting for the medication schedule to be re-established.
The next hospitalization we had his medication list and were ready to advocate for him as soon as we stepped in the door. Advocacy was unnecessary as he had been admitted to the inpatient unit of the cancer center. The EHR contained not only all the information from my homemade “Emergency Fact Sheet”, but it contained the actual orders for the medication that could easily be transmitted to the in-house pharmacy. Dad didn’t miss a dose of his pain medication on that trip. I saw beauty in the simple efficiencies that resulted in excellent patient care and comfort.
Everyday there are news stories on the politics and profitability of electronic health records, but it is less often you hear this story being told. My loved one received better care, and because of that, suffered one less day of pain. Somewhere, someone’s father is receiving better care, because an EHR generated a reminder to perform a prostate screening blood test, which resulted in the early detection and treatment of his Prostate Cancer. Sometimes the Return on Investment is not about finances, sometimes it is about life.
Taking Allscripts Enterprise EHR to the Limits
As Allscripts Enterprise EHR v11 implementations continue across the country, many have found added value in the new functionality and enhancements. New features such as the clinical desktop, simplified navigation and right-click menus make Enterprise v11 easier for users at all points of patient care and conducive to greater utility. With clients ranging from small independent practices to massive health systems, the deployments are as diverse as the users logging in each day.
Over the past few months, I have had the privilege to be on a team of professionals that is genuinely navigating and building out v11’s newest functionality. St.Vincent Health (an Ascension Health ministry) , headquartered in Indianapolis, has been in the process of deploying v10 at the St.Vincent Physician Network since 2005 and in 2007, was awarded one of the first Allscripts Client Success Connect awards for their innovative interface development. Key accomplishments that have established their role as a leader in the area of integration are their interfaces with:
- St. Vincent Health’s inpatient facilities,
- Children and Hoosier’s Immunization Registry Program (CHIRP) which enables access to centralized pediatric immunization records,
- Surescripts,
- Transmitting Lab Orders, and
- Accepting Laboratory and Radiology results from multiple vendors.
I will feature more about these in a future entry. For almost a year, St. Vincent has been looking to initiate their v11 upgrade, then following their final v10 rollout in February, redirected all efforts to v11 design, build and change management.
Directed by Margie Cornwell (RT, RDMS, PMP), a veteran of the Enterprise EHR project, most of the team was sent to Enterprise EHR training in March and since then, dove headlong into its full-fledged deployment. About 6 weeks from go-live, the build activity workbook is complete, the broad training strategy is in motion, and testing is underway. Then when 11.1.6 was released, St. Vincent Health displayed their versatility and decided to proceed with the upgrade in stride, while sustaining the original go-live date. From the beginning, the schedule has been remarkably rapid, but by maintaining positive attitudes, team-focus, and a willingness to go the extra mile, the team remains on task.
As a member of this team, my efforts have been focused on bridging the v10 order and results data into v11’s structure as well as preparing the items for mapping to the Order Concept Dictionary. Gaining this insight has given me a great chance to explore the benefits and value of Careguides and the improved Health Management Plans from both an application and administrative perspective. The St.Vincent Health resources have essentially been responsible for their own destiny; supplemented by a diligent Allscripts upgrade team and a couple of other external experts.
Contributing to St. Vincent’s ongoing success is their support methodology. During a go-live, the Enterprise EHR team members are physically on-site. Having these diverse skills and backgrounds is very beneficial to the various users and troubleshooting required. As is common, the team members range from clinicians to IT, but St. Vincent makes a special point to assure all are available for rapid response.
The perpetual willingness to embrace the cutting edge demonstrated by St. Vincent Health has resulted in their being one of the first to stretch Enterprise EHR v11.1.6 to these limits and the chance to be a part of this talented team is enviable.
