Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Galen Certified – The New Standard for Allscripts Enterprise™ Expertise!

Our consultants have always been the experts when it comes to the Allscripts Enterprise EHR™ application and now they have the certification to prove it! We are proud to announce the Galen Certified-Enterprise EHR Application Specialist training and certification program. This week marks the completion of Galen’s second group of employees who have taken part in our intensive seven week training that concludes with both a written and verbal examination.

The training, which is designed and performed by our experts, consists of an in depth review of all the Enterprise Certified Workflows and build methodologies with an added emphasis on the clinical relevance of each. Much like that of the Configuration Workbook, we step through Base, Rx, Charge, Order/Result, Note, CareGuides, Dictate, Transcribe and Scan. Along with the module specifics, we provide an entire System Administration review with the latest 11.2 Enhancements and configuration techniques.

During the training each student is provided with their own virtual 11.2 Enterprise environment so they might build, test, and configure without the concern of being in a LIVE environment or configuring over another user. As part of the testing process each student is required to build out a mock client environment from scratch. They are given mock client build specifications that begin with the organization set up and build of users, right down to the assignment of all Task List and Worklist views. They participate in “real-life” patient care/documentation scenarios to ensure that they are prepared to support the actual day to day needs of the end user without hesitation or delay.

We began the training and certification with newly hired employees and then expanded it to include verifying the overall level of understanding of the Enterprise product by including our Senior Consultants. We are proud to announce that as of today 15 employees already hold the distinction of being Galen Certified Enterprise EHR Application Specialist, with 7 more preparing to test in the next 2 weeks.

We are currently working to complete the training and certification for all the consultants on our Service Team. As well, the future will include Advanced Certifications in areas of V11 Note, Order/Results, Charge, CareGuides, and System Administration.

Please join me in congratulating the following employees:

Michael Dale, Associate Consultant

Michael joined Galen in April 2011 as an Associate Consultant. He attended the initial class for Galen’s Certification program. He was the first employee to officially become “Galen Certified – Enterprise EHR Application Specialist”. In his six months in this industry, he has grown very familiar with Allscripts Enterprise EHR™ and has become a frequent contributor to the Galen Blog. In the coming months, he plans to contribute to the Galen Public Webcast series.

Michael graduated from Iowa State University in 2005 with a Bachelor’s Degree in Management. His background includes analytical experience in the Healthcare industry and a variety of leadership positions.

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Zia Rahman, RHIA, Associate Consultant

Zia works primarily from the Chicago office and focuses on Allscripts Enterprise EHR™ implementations. He is a recent graduate from the University of Illinois with a Bachelor of Science in Health Information Management and is also RHIA certified. Most recently he has been assisting a large client in the Midwest as their dedicated resource to help the implementation go as smoothly as possible. Zia is always dedicated to ensuring the project is a success.

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Christy Erickson, Consultant

Christy joined Galen in March of 2011 as a Consultant serving clients in either Project Manager or Implementation Consultant roles specializing in clinical workflows and v11 Note. Before joining Galen, Christy was Operations Manager for Abraxas Medical Solutions (now Merge Health) responsible for implementations, support, technical services, and client education. Prior to that, Christy spent three years at Allscripts in both project management and consultant roles where she was named the 2008 Allscripts Service Employee of the Year and promoted to Manager, Professional Services. Before entering the health IT industry, Christy worked in nursing as a nurse and nurse practitioner with experience in outpatient, hospital, and hospice, including several years in Spain as an ICU/OR nurse where she became fluent in Spanish. Christy earned both her Bachelor of Science and Master of Science in Nursing from Salisbury University in Maryland and currently lives in Southern California.

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David Burkhead, Managing Consultant

David joined Galen in March 2010 as a Consultant and recently transitioned from Senior Consultant to Managing Consultant. In his 6 years working with Allscripts Enterprise EHR™, his project experience has included Project Management, Implementation Consulting, Conversion Analyst, and Interface Analyst roles. In his recent experience with Galen, he has been involved with an Enterprise EHR™ READY deployment, external webcasts, and an occasional contributor to the Galen blog. David graduated from The University of Vermont in 2005 with a Bachelor’s Degree in Business Administration along with a concentration in Management of Information Systems.

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Cecil Hunter, Senior Consultant

Cecil has been an integral part of the Galen team since April 2008. He has more than 11 years of experience in the health care Industry and 6 years of experience with Allscripts Enterprise™ EHR deployment. Cecil has most recently worked on a deployment of Enterprise EHR™ Version 11 modules for a large comprehensive network of affiliated physicians in Columbia, South Carolina. Cecil is certified in Allscripts Enterprise EHR™ Version 11 System Administration, as well as, Allscripts Enterprise EHR™ Version 11 Upgrades. Prior to joining Galen, Cecil served as an Allscripts Super User at a major University Healthcare Group in South Florida.

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Steve Cotton, Managing Consultant

Steve has been with Galen Healthcare Solutions since January 2010 and has recently transitioned from Senior Consultant to Managing Consultant. Following his years of experience at Allscripts Healthcare Solutions as a Senior Implementation Consultant and the Lead Internal Educator, he has continued to exhibit his expertise in project management, implementations, and education. In his recent Galen experience, he has contributed to the Galen external webcasts, assisted multiple clients with the Order Synchronization process, and serves as the primary implementation resource for Galen’s business continuity solution, VitalCenter. Steve has a Bachelor’s degree in Health Information Management and a Master’s degree in Health Informatics; his educational background has provided him with a strong understanding of the Healthcare Industry.

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Carl Fulton, Lead Consultant

Carl has more than eight years experience with healthcare information systems, specializing in Project Management and Implementation Consulting for Allscripts Enterprise EHR™. He has led implementation efforts for a range of clients, affecting thousands of providers, using all modules within Enterprise EHR™. In addition to his background in healthcare information systems, Carl has a Masters Degree in Organizational Leadership from Gonzaga University and Bachelors Degree in Management Information Systems from Washington State University.

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Cyn Gerson, Senior Consultant

With over ten years of health information systems experience, Cyn has played an integral role in many client projects; including implementation & deployment of all Allscripts Enterprise EHR™ modules, for many healthcare systems around the country. Most recently Cyn took a lead role with a major multi-specialty organization to get them live on their latest implementation phase, which included multiple Order/Result interfaces, Charge and v11 Note.

Cyn has demonstrated her skills in project management, workflow analysis, application build, interface testing and end-user training & support. She has a strong work ethic combined with a commitment to excellence in all projects undertaken, and continuously strives to cultivate positive relationships with her clients while providing objective guidance in accomplishing their goals.

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Tony Yelacic, Senior Consultant

Tony Yelacic has been with Galen Healthcare Solutions since 2007. He came to Galen with 30 years of healthcare experience across clinical, operational, and information systems areas. His unique blend of skills has provided many opportunities for the Galen community.

 

 

 

 

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Karla Koertner, Consultant

Karla Koertner is a software implementation professional with more than 11 years in healthcare. She is experienced with both acute and ambulatory care software systems and has functioned as a Project Manager, Subject Matter Expert, and Implementation Consultant on several large scale Allscripts installs. Karla resides in Charlotte, NC and looks forward to a long career with Galen Healthcare Solutions.

 

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Matt Woodside, Managing Consultant

Matt has been involved with the design, build and implementation of clinical software for over 10 years, including extensive experience with clinical application testing and evaluating end-user readiness. Most recently, he has been working with Senior Implementation staff, Clinical Analysts and Hospital Management to roll-out Allscripts Enterprise EHR™ to the first Beta sites in the network at one of the largest Allscripts clients in the Northeast. Matt was also involved with leading the client team through their recent Allscripts Enterprise EHR™ version11.2 upgrade. Matt is looking forward to continuing to apply his knowledge and experience to current and future client needs.

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Steve Stahr, Senior Consultant

Steve joined Galen in April 2008, and has been integral in assisting clients with their EHR projects, both as a Project Manager as well as Implementation Consultant. More recently, Steve became more involved with the Galen Upgrade Team, assisting with the increased demand of upgrading clients trying to achieve Meaningful Use and report from the Stimulus Set. His interest in the Orders and Results modules of Allscripts Enterprise EHR™ has given him the opportunity to assist many different clients with navigating this significant and strategic process. Steve has also been very involved with hosting webcasts through Galen’s Free Webcast Series, and conducted on site training with clients, as well.

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Will Ditton, Senior Consultant

With more than 10 years experience in Healthcare IT and working with Allscripts products, Will has had the opportunity to be involved with clients ranging in size from small to large MSO. His experience includes implementing Allscripts Enterprise EHR™ as well as assisting clients with optimization. In addition to his main focus on the Enterprise EHR™ application, Will has experience with Network and System Administration. Will has proven to be a huge asset to Galen’s clients and he looks forward to assisting future clients in achieving their goals.

 

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Litisha Turner, MSN, Clinical Consultant

Litisha has been with Galen as a Clinical Consultant for one and half years. She is a Registered Nurse with a Master’s Degree in Nursing Informatics. Her focus has been on building notes, forms, text templates and flowsheets for various clients including Northwest Community Hospital, Scripps, North Florida Surgeons and University Physician Associates. She has provided remote System Administrator training and end user training to a number of clients, as well as v11.2 Upgrades and work on bidirectional lab interfaces.

 

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Laleen Shah, Associate Consultant

Laleen Shah has been with Galen Healthcare Solutions since May 2011. In her recent experience she has been involved with a large healthcare organization in Iowa, assisting in system build, go live support, and data gathering for upcoming go-live events. She is currently a Galen Certified Enterprise EHR Application Specialist. Laleen graduated from the University of Illinois at Chicago in 2011 with a Bachelors Degree in Health Information Management.

 

 

 

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Tags: Allscripts Consultants, Allscripts Enterprise EHR, Galen Certified - Enterprise EHR Application Specialist

Have you ever found yourself asking how the heck does Imagelink work?  How is it possible to click a button in the Allscripts application and view an X-ray?  Have you ever wanted to know how a result closes an order is closed without a Touchworks Order number?  Have you ever heard someone say, did you check the requested performing location dictionary, and not know what they’re saying?  Have you ever wanted to know more about Allscripts result interfaces?

Well you are in luck! The Galen technical services team is proud to host a Free Results Interface Training hosted at it’s brand new office!

Who: Allscripts Interface Analysts

What: Free Result Interface Training

Where:  70 Federal Street, 7th Floor, Boston, MA 02110.

When:  Wednesday, December 14th, 2011 from 9AM-5PM with lunch provided.  There will also be a cocktails and networking hour from 4PM-5PM with beer, wine and light snacks.

Why: Learn about more of the intimate details, nuances, and best-practices surrounding Allscripts result interfaces

Agenda:

• Imagelink
• Reconciliation w/ and w/o eletronic order interface
• Common errors
• Requisitions
• Requested Performing Location
• Auto synching
• Much More!

Please contact us if there is a topic you would like to learn more about that isn’t in the list above.

Travel:  If you are driving into the city, there are parking garages nearby. The cheapest and most convenient is the Winthrop Square Parking Garage at $20/day.  If you are coming in from out of town, there are many hotels in the area.  Also note that we will have wireless internet and workstations with a hardwired internet connection available for those who need it.

Space is limited – Register Today! If you can’t make the training, it’s ok!  Galen offers free webcasts about every two weeks.

Tags: Allscripts, Allscripts Enterprise EHR, Allscripts Interface, ConnectR, ConnectR Training, Galen Webcast Series, Integration, Interface Training, Interoperability, Results Interface

This webcast will review at a high-level the Menu and Clinical Quality Measures and considerations when selecting you’re the options for your organization. In addition, we’ll review the basic of Clinical Quality Measure configuration.

Visit http://www.galenhealthcare.com/webcasts for more upcoming webcasts.

Tags: Allscripts Enterprise EHR, Clinical Quality Measures, Meaningful Use

With the release of version 11.2, Allscripts Enterprise EHR^TM has the ability to define acceptable ranges for vital sign readings based on age and gender. Once this range is defined, when a vital sign is input and falls outside the defined range, users are alerted that this value is an abnormal result.  The alert is shown as a red beaker, displayed next to the value in either the Health Maintenance Plan (HMP) or as bolded, red text in the Note Authoring Workspace (NAW).

While four vital signs (Systolic Pressure, Diastolic Pressure, Heart Rate, and Respiration Rate) are pre-delivered with ranges, clients can create their own ranges for any other vital sign, such as Weight.  These ranges are defined solely using the SSMT tool using the RID – Reference Range content category.  This means that clients do not define these ranges anywhere inside the Enterprise^TM application, instead, are only able to be defined using SSMT.

Tip:  The four pre-delivered vital signs will need additional values populated as the user configures the reference ranges.

First and foremost, the organization needs to ascertain what the actual ranges will be.  The NIH Clinical Center provides their guidelines of vital sign ranges. One example of guidelines they provide is Pediatric resting values.  The organization should be aware of the resources should determine which guidelines to follow, whether it is the American Heart Association or NIH Clinical Center.

Once the decision has been made for which data will drive the decision to move forward and be used by the organization’s EHR, the System Administrator can begin to use those decisions to load the data to the system.

Now let us explore the basic fundamental steps to set up the Vital Sign Reference Ranges.

1. First be sure to backup any data prior to making changes in SSMT.
2. Access SSMT and extract the data from the RID – Reference Range content category
3. Copy the data to a spreadsheet that has the cells formatted to “text”
4. Edit the spreadsheet; the following are the applicable column headers:

• [A] HDRResultable Entry Code: value from the Code field in the Resultable Item dictionary
• [B] Resultable Entry Name: value from the Name field in the Resultable Item dictionary
• [C] Where Performed: can be a null value – if populated the range will apply to the resultable item specific to that preforming location
• [D] Reference Range Type: must be set to Numeric
• [E] SEX: leave blank if using for both genders, otherwise M for male and F for female
• [F] Lowest value: lowest allowable value for the vital sign to be considered normal
• [G] PanicLowValue: needs to be a unique value and at least one more than [F] and less than [H]
• [H] LowNormal: needs to be a unique value and at least one more than [G] and less than [I]
• [I] HighNormal: needs to be a unique value and at least one more than [H] and less than [J]
• [J] Panic High Value: needs to be a unique value and at least one more than [I] and less than [K]
• [K] Highest Measureable: highest allowable value for the vital sign to be considered normal
• [L] Reference Text: This can be set to indicate the text to be displayed in the Results Entry dialog screen indicating the range. So if the range from [F] to [K] is 40-90, indicate such in this field.
• [M] Answer: This field is left null.
• [N] Abnormal Flag: Does not need to be set to any value
• [O] Is Inactive (Y/N): Set to Y if setting an item to be inactivated, otherwise set to N
• [P] Create (Y/N):  Must be set to Y if creating a new entry, otherwise set to N
• [Q] Age Min: beginning point for the age range; the lower number
• [R] Age Max: ending point for the age range; the higher number
• [S] Age Units: units of the age range; ex: Days, Months, Years

1. Save the spreadsheet
2. Be sure to clear the text box field in SSMT
3. Copy all applicable rows of data from the spreadsheet and paste into the SSMT box (do not copy the header row)
4. Load the data
1. Return to the Enterprise EHR^TM application and validate using a test patient the applicable vital(s)

While these are basic instructions to successfully set the reference ranges, the steps should provide success in loading the reference ranges.  There are a few main points to reiterate in this process:

• Please back up any data prior to using SSMT.
• Pay close attention to the bullet steps for the column headers indicated above. Certain columns require certain information.
• Ensure the Resultable Item information is reflected in the spreadsheet as it is in the RID
• Keep in mind that columns [F] through [K] must be populated with unique values, that are not 0. [F] must be the lowest acceptable normal value, while [K] must be the highest. The numbers in between CANNOT be the same value!
• Set [P] to a value of Y when creating new values
• Try loading one line to begin – to ensure set up is correct.

 It is important to note that this enhancement has no direct effect on Meaningful Use Core Measure 8 – Record Vital Signs. The Record Vital Signs Objective states: “Record and chart changes in the following vital signs: (A) Height (B) Weight (C) Blood pressure (D) Calculate and display body mass index (BMI) (E) Plot and display growth charts for children 2-20 years, including BMI”. The measure being “for more than 50 percent of all unique patients age 2 and over seen by the Eligible Professional, height, weight, and blood pressure are recorded as structured data”. In reviewing the measure documentation, there was no mention of measuring whether or not the vitals being recorded are being flagged as abnormal.

Allscripts Enterprise EHR^TM version 11.2 offers a plethora of excellent features and this functionality certainly allows users to optimize the system and how charts are viewed. The return from defining these ranges is to provide the visual indicator that certain recorded vitals are abnormal for the patient in context.  So, while there may no added benefit from a Meaningful Use standpoint, there is certainly clinical benefit to utilizing this functionality.

Tags: Allscripts, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, v11

It’s not necessarily a mystery as to why practices shy away from evaluating the costs of EHR downtime, both monetary and intangible costs. These numbers can be convoluted and difficult to valuate; conducting research to pin point these costs would only attribute to the overall cost of the system and diminish the ROI. With an industry that is so diverse, there must be some compromise.

In the Mark Anderson article touched on in a previous blog post, there has already been some research done on various practices of differing sizes and specialties. The AC group conducted research in which an important message could be gleaned; downtime is virtually impossible to eliminate and the costs associated ($488 dollar per hour per provider) should be equally difficult to ignore.

A simplified calculation of EHR downtime costs based upon the formula presented from the table Anderson’s article is shown below:

1. Compute the practice’s average annual salary costs (including benefits).
2. Multiply that value by 2.15 (the calculated cost (in dollars)/minute of system unavailability).
3. Divide by 2080 (average number of hours paid per staff member annually (52 weeks *40 hours per week)).
4. Determine the amount of hours in which the system needs to be available to staff. *Note: Even though operational hours may only be 9AM-5PM, users may need access the system before and after this period.
5. Multiply the value from step 4 by 52 (weeks/year) and again by (1% or the expected % of downtime given your server platform). The product of this equation represents the expected hours/year of downtime.
6. Take the value from step 3 (which represents the cost of staff per hour) by the estimated downtime per year found in step 5. The final value is the estimated cost per year of unplanned EHR downtime.

Beyond the monetary costs of system downtime, there various affects that can be difficult to valuate but can be felt throughout an organization and patient population. When a system goes down and users are forced to switch to downtime procedures, there is a certain level of frustration and angst amongst the users. Patients may suffer from longer visit times, patient safety issues such as automated drug interaction notifications, and the luxuries of picking up their prescriptions at a nearby pharmacy. Providers depend on electronic health records when seeking patient information; with downtime the organization faces the risk of delayed care to patients and medical errors. 

In closing,  a recent article in Becker’s Hospital Review offered 3 strategies for delivering business continuity by preventing downtime:

1. Adopt Resilient Technologies
2. Practice Proactive Management
3. Implement Best Practices

Galen Healthcare Solutions is proud to assist it’s clients and partners in realization and execution of the above strategies through it’s industry leading business continuity solution – VitalCenter.

 

Tags: Allscripts Enterprise EHR, Business Continuity, EHR Business Continuity, EHR Downtime, EHR downtime costs, EHR ROI, VitalCenter

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

As a Registered Nurse, I know that provider satisfaction is key to the utilization of the EHR.  Having worked directly with providers for many years, I have come to find that one of their biggest areas of contention within EHR is with the way the noteforms render.  While these forms do typically convey the  story about the patients overall health, they do so in a way that tends to sound grade schoolish, the equivalence of  “See dog run” in a children’s book instead of sounding like it has come from a professional.  For example, clinicians fully understand that rendering “auscultation of heart” as “normal” does not appropriately define or detail, what was “normal” about the exam (e.g. normal rate, rhythm and S1-S2, no murmurs, gallop or rub heard), thus a major rework of the form would be required.

Having worked with a plethora of providers over the past year alone, I have been told by most, if not all of them, that they want their electronic notes to sound as if they had been dictated.  While this can certainly be done, you must first do the following to ensure success:

• Determine which forms need to be modified.  Typically it is the Review of System and Physical Exam forms, more specifically the General Multi-system Exam form.
• Obtain a few sample dictations (Pre-EHR), preferably from the Specialty Specific Physician Champion.  These will be used as the basis for changing the rendering on the delivered forms.  This will often give you an idea, of what is examined and what is a “normal” exam.

Once you have done the aforementioned, you must ensure that the right resources are also in place to be able to get the job done.  Depending on how many providers are in your organization, you may need to dedicate 1 FTE to this task over the long haul.   This resource should be someone with a clinical background, an MD, RN or LPN because providers have stated to me through the years that it is important to have someone who “speaks their language” working on their forms.  This is important because a part of this transition involves a great deal of interpretation of medical terminology and perhaps the need for someone who can also translate between what the physician has stated and what is actually listed in EHR.  Finding Medcin equivalents can be very difficult if you don’t have someone who can do this translation.

Another important skill set for this resource would be that they have been properly trained in building and modifying forms.   From my perspective, someone is “properly” trained if they fully understand how forms work and they are able to teach someone else the art of building forms.  In my situation, it took 2 years for me to feel comfortable enough to offer forms training to someone else.

Finally, the person who takes on this task/role must be a great communicator.   Although it is probably easier to have someone physically commuting from clinic to clinic to meet with Physician Champions and discuss their needs, this isn’t always a viable option.  Not only is it time consuming, but it can often be difficult to coordinate schedules and meeting times.   As an alternative, I would propose that this resource make the best use of email and screen-sharing tools.  Given the fact that much can be lost in translation via email, I would also recommend the use of screenshots where applicable as most people tend to be visual learners.  The screenshots can be followed by verbal descriptions of the questions and/or changes.   Once the forms are reworked, screen-sharing tools such as Webex® and GoToMeeting® can be used to demo the completed form to the Provider Champion, at which point he/she can test the form and request final tweaks before it is moved to the Production environment.

Once you have completed a few forms, you can then use those same forms as the starting point with other providers instead of starting completely from scratch again.  While the “All Normals” may not be exactly the same, you will find that the verbiage is similar across the board and ultimately, your job will become easier.  In the end, the physicians will appreciate having more concise notes that are also more aesthetically pleasing.

Ultimately you must remember that a provider’s first responsibility is to give safe, competent, appropriate patient care.  However the second part of their role is to convey a story about the patient and the care that they provided.  This should be done in a way that is professional, efficient and logical not just for themselves but also for the patient and all other care providers.

To see an example of a complex form, with its associated rendering click here: Custom Migraine Form

-Litisha Turner, MS, BSN, RN/Clinical Consultant

 

Tags: AEEHR, Allscripts Enterprise EHR, V11 Structured Note

This webcast gives an overview of the reporting capabilities of ConnectR. In addition, it touches on ConnectR’s administrative capabilities such as merging message definitions and exporting translation tables and interface mappings for documentation purposes. The webcast concludes with the ConnectR Toolbelt, which is an imbedded, add-on reporting tool developed by Galen.

For more webcasts visit: http://www.galenhealthcare.com/calendar

Tags: Allscripts Enterprise EHR, ConnectR, Reporting

The system is upgraded to Allscripts Enterprise EHR^TM (AE-EHR) version 11.2.x- now what to do? Evaluation of current workflows and deciding on the Meaningful Use measures the organization will be using are the next steps. This article will cover some basic key concepts of Meaningful Use as it related to the application and processes as well as examples to provide the foundation to move forward and build. Ideally, obtaining a baseline of the workflows currently used today in each site/clinic prior to the upgrade itself is the recommended approach. This article will highlight at the end the recommended timeline and priority items to provide the best success of not only the upgrade but more importantly capturing meaningful use.

Step 1- Evaluate current state workflows of each site and the role of the end user population

Even if the site recently went Live or had training- end users continuously find new ways to use the application. AE-EHR version 11 in general provides multiple ways to enter information and despite the best training and/or trainer, an end user may change their behavior over time.  Not only will a potential different workflow result in inaccurate testing of what is believed in the workflow; it may potentially allow for an area of missed training when moving to version 11.2. Here’s a great example, suppose clinical staff were not trained to enter problems, however over time the providers and office managers of a site have asked clinical staff to enter the problems for physicians. This would have an impact on training for meaningful use. Or, perhaps the staff is trained to enter smoking status on the social history but behavior has recently changed by the end users and they started capturing it in the comments field in vitals because the end user thought it would be quicker.

The best approach is to go to each site and evaluate each role on what they currently do in the application, as well as how they document in the application. This will allow the testing team to accurately test the role based workflows as well as train as appropriate on workflows. Once the current workflow is established then the foundation for configuration and re-training can begin.

Step 2- Decide which of the Meaningful Use Measures will be used by the organization.

The 15 Core measures will be required by all eligible providers, however only 5 of the 10 menu sets are required.   Additionally, of the 44 Clinical Quality Measures, three of the Core or Alternate Core will need to be used and three of the remaining Clinical Measures will need to be decided upon in order to have a total of six Clinical Quality Measures.

This step can be quite a task depending on your organization. Here are some sample questions to ask:

• Who will be the lead decision maker?
• What teams need to be informed of the Meaningful Use objectives- Business Admin, Executive, Physician Core team?
• Are there multiple teams that will make decisions on different aspects (clinical versus business versus administrative)?
• Do those key decision makers know about Meaningful Use and if so at what level – high-level or detailed?
• Will basic ARRA- Meaningful Use training be required?
• How will government incentives be paid out (to the organization, to the physician, to the site)? This will be asked at meetings and better to be prepared when instituting workflow change.
• What providers are eligible in the organization?
• Will the eligible providers report for Medicare or Medicaid?
• Who is responsible to enroll each provider with CMS?
• Does an analysis of potential eligible providers need to be assessed to make the decision of MU reporting?
• Does an analysis need to be done, and what patient population and/or diagnoses are seen by eligible providers to select the appropriate Clinical Quality Measures?
• Will eligible providers have a choice on whether to participate in MU reporting or will it be decided by the organization?
• Will each site, specialty, or provider select the measures (MENU and Clinical Quality Measures selections) or will it be directed from the organization?
• Will there be a team dedicated for Meaningful Use?
• Who will track the user’s behavior to ensure the necessary information is obtained?

These basic questions will allow the core Upgrade/Meaningful Use team to be prepared for configuration, workflow re-design, testing, and end user training. Each item can have a direct affect on one of the aspects of the upgrade/MU project. For example, if all eligible providers will be allowed to decide which measures they will select for reporting then the configuration team will need to configure to all CORE, MENU, and all 44 Clinical Quality Measures. In addition, if each provider selects their own measures ideally the training would be tailored around the measures for that eligible provider. Training all providers on all 44 Clinical Quality Measures or all 10 MENU items that may not pertain to that provider will not increase retention of the information and workflow change and likely decrease the MU reporting success.  Another example, from the above proposed questions is Medicaid provides a greater financial return if the measures are met however what if no one meets the necessary 30% of patients? Does it make sense as an organization to increase an eligible provider’s percentage of Medicaid patients to capture the higher value and if so who makes this decision and how does the front office staff know to direct more new patients of a certain insurance to a certain provider?

Step 3- Workflow Redesign for Meaningful Use

Once the system is configured and reviewed by the implementation consultant during the upgrade process, the workflows will need to be re-designed to meet the Meaningful Use Measures to guarantee success! A workflow is not just the use of the application but also the process in place for monitoring the Meaningful Use within the organization. At this point, the system has been configured by the organization configuration team (system analyst) based on Steps 1 and 2.  However, unless the users actually change behavior Meaningful Use will not count. Here are some examples below that will need to be considered based primarily on the CORE, MENU and Clinical Quality Measures.

• CORE EXAMPLE:  Suppose that currently the organization doesn’t allow clinical staff to enter and/or update problems or medications on patients, however the providers have not been keeping these lists up to date. Will the organization allow the clinical staff to begin to perform these tasks? Does configuration need to change to allow for retrospective/prospective authorization? Does enable verification of problems need to be added? Do clinical staff need to be trained how to do this item?

Remember there are many new alerts for Meaningful Use however everything doesn’t have an alert and likewise an end user can ignore an alert.

• MENU EXAMPLE:  Providing a Summary of Care Record to the patient and Patient Education. First, who will be responsible for providing the Summary of Care Record- clinical staff or providers? Will the Clinical Summary provided by Allscripts be used or will it print out from the v10 or v11 note? If the patient is a portal patient and you don’t want to provide a Clinical Summary or a non-portal patient how will the provider state if no Clinical Summary is to be provided? What/Who/How is the workflow to be defined, tested, and trained? Regarding Patient Education, will there be a standard developed if not already implemented such as every new medication prescribed by the provider the patient will receive the Drug Ed for that medication? How will the patient instructions be populated and printed?
• Clinical Quality Measure EXAMPLE:  Adult Weight Screening and Follow Up- many sites may already obtain the patient weight today and this may appear as an easy Clinical Quality Measure to capture. However, there are a couple of items to consider, by adding a free text box for comments to document if a patient denied obtaining their weight and if used would count for Meaningful Use. Is this configured already and/or do end users know to enter this information to count for Meaningful Use? In addition, to meet this measure the BMI of the patient needs to be evaluated and based on the patient’s age and BMI an additional workflow must be completed. Part of that measure states if the BMI is greater than 25kg/m2 a follow up plan must be in place. What will that plan be if not already used by an organization/site/provider? Will there be a dietary consultation or a BMI Management Follow Up Order? Will the end user be able to select from any of the potential recordable actions: Dietary consult with the appropriate SNOMED or the BMI Management Follow Up order with the appropriate CPT code? Will the clinical staff perform this action at the time the vital is taken or will the provider be responsible for adding this item on the patient.

These are some examples of Meaningful Use and all the decisions, configurations, and workflow changes that could be affected. This article is not all inclusive, rather, it is intended to begin the process for the team to meet the Meaningful Use objectives.  Please feel free to contact Cary Bresloff, Cary.Bresloff@GalenHealthcare.com, for further questions, guidance, or consultation on Meaningful Use and the impact to an organization.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Meaningful Use, v11

In an effort to improve the way patient data is accurately maintained, the Health Care Industry is undergoing a historical transformation.  The initiative is fueled by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Reinvestment and Recovery Act (ARRA) of 2009.  There are certainly a lot of preparations in the works to make this movement the next big shift in how medical care is provided.  With that comes advances in health technologies and the computer systems we incorporate to make it all happen.

The standard now has become an advanced network of cloud technologies, interfaced labs, pharmacies and networked providers all at your fingertips.  One would need a full team of dedicated professionals to navigate through the bests tools available to be ahead of the game, or a specialized group now called, the Upgrade Team.  A team of technically advanced, inquisitive and dedicated people to spend tireless hours scouring through new developments and documentation, who choose the proper tools and encourage you to set up your organization to succeed. 

The next best thing for an organization has now become Allscripts Enterprise EHR^TM version 11.2 (AE-EHR).  Because many clients have not yet participated in an upgrade process, but have instead experienced a net new implementation, service pack update or simple hot fix, we want you to be as prepared as possible. 

To begin, you will be assigned an Upgrade Team from the vendor which will include a Project Manager, an Upgrade Technician, an Upgrade Consultant and an Interface Analyst.  Your internal team should have representation for those same roles,  and in total your team should have at least 8 to 10 resources.  In addition to this core team, a group of Physician champions, super users, testers, trainers and help desk personnel is recommended to help run the command center and support each other during the actual Go Live week.

When the process begins, we hope that you take time to review all documentation available to you. Please refer to the Galen wiki and various Webcasts, Sales Force, and Client Connect.  You will be instructed to partake in the Allscripts eLearning courses, as well as an 8 hour instructional guide to the process by your Upgrade Consultant.  The Upgrade Team will introduce you to all the new functionalities in AE-EHR version 11.2, the Meaningful Use attestations, and will assist you in building your system to work seamlessly with your organization.  Part of the process will also incorporate the newly released Stimulus Set to the base AE-EHR version 11.2 application.  You will be responsible for attesting that your system is set up correctly to handle all the new requirements.  For this, you will need to allow various members of the Technical Team access to analyze and report how you have organized, mapped and set up your data.

To make sure the project stays on track, two weekly meetings will be held over the course of your 19 week upgrade.  The Project Manager will coordinate all resources for their action items and responsibilities, while the Upgrade Consultant meets to discuss the application, testing and build stages of the upgrade.  The Upgrade Tech and Interface Resource are invaluable pieces to the puzzle that will help you throughout the process, and will be available to you in addition to these meetings.  To start, a copy of environment is created to mirror your live system and is then upgraded to the new 11.2 version.  To personalize this base and to utilize the application, we need to configure the new parts to their full potential.  Many of the new functionalities in AE-EHR version 11.2 are in the areas of Security, Preferences, and new Tasks that all have been designed to help you meet the Meaningful Use criteria. 

As the go-live date approaches, testing has been as thorough as possible and all training has been passed along to your end users, we encourage you to prepare everyone for the new version.  It is recommended to provide reference materials for all users to avoid high traffic through your call center on go live Monday.  We also recommend an organized ticketing system to track the concerns that may arise, and a resource that may be available to uninstall and reinstall controls for various computers, tablets and devices that may not have been updated.  Your Upgrade Consultant will be with you throughout the entire go live process remotely, and host an open bridge screen share to walk you through the build process, testing concerns and later onto issue resolution.  You may request that the consultant be on site for this and an additional contract will have to be submitted.  Either way, the entire team will have constant contact with you throughout the first week of your live system.  Post upgrade, the one week transition period will help all team members decompress from the previous 19 weeks.  We will hold meetings to review our outstanding issues that came from the go live weekend as well as any outstanding Sales Force tickets that could be considered critical to your success.  Once we have transitioned past this first week, all outstanding minor concerns will be processed by the Allscripts post live queue and closed appropriately. 

For those of you who may be taking the Stimulus Set component after your go live with AE-EHR base version 11.2, you will once again be in contact with your Project Manager and Upgrade Consultant to repeat the process in building the set and moving forward successfully in attempts to use your Electronic Health records in a Meaningful Way.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Upgrades, v11