Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

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

CMS released a couple of updates last month regarding Meaningful Use and the EHR incentive program. I wanted to pass this information along to our readers.

In their December 7 update, CMS indicated that “HHS announced its intention to delay the start of Stage 2 meaningful use  for the Medicare and Medicaid EHR Incentive Programs for a period of one year for those first attesting to meaningful use in 2011”.  The reason as such, according to them, is that the current schedule for compliance to Stage 2 could be a challenge for those that attested in 2011. The decision also was in consideration for vendors and practices.

 The CMS update identified some benefits from the proposal:

• The delay could provide vendors more time to develop their certified technologies for Stage 2
• The delay could also provide providers more time to implement the new software to meet Stage 2 requirements
• Expectations remain current so that providers attesting in either 2011 or 2012 begin Stage 2 in 2014
• And while 2011 has passed, CMS believed this idea would provide added incentive for providers to attest in 2011.

While I am sure there is a group of people out there that is ambitious enough to keep pace for this process, I am certain that we all can stand to benefit from the proposed delay.  The benefits from the added amount of time for both the vendors and practices/providers seem more appealing, in my opinion.

Back on December 1, CMS also announced a new tool to help Eligible Professionals (EPs) through the phases of Meaningful Use.  This tool is an eighty-five (85) page PDF file, dubbed as a “Beginner’s Guide”. This file provides a thorough, interactive walkthrough of Meaningful Use.

Among the items of information provided are:

• EHR Incentive Program basics
• How to participate (determining eligibility and registration)
• Meaningful use and choosing measures
• Attestation
• Helpful resources on the Medicare and Medicaid EHR Incentive Programs

Lastly, they also provided a link to their Educational Materials page for the EHR Incentive Program. This link offers an extensive array of files and tools regarding the EHR Incentive Program.  This is definitely a link to bookmark, as well as the guide previously mentioned.

If you haven’t already done so, visit the CMS EHR Incentive Programs webpage and register to receive their email notifications. 

Contact Galen Healthcare Solutions for any additional questions regarding Meaningful Use and Allscripts Enterprise^TM EHR.

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

Super-users are integral to an organization’s ability to be successful before, during and after an EHR implementation.  They serve a number of purposes, which include assisting during go-lives, being a first line resource to end users post go-live and helping to identify gaps in workflow. In order to provide the level of support needed, they also have a higher level of training than the typical end-user.  This training is often role specific and consists of:

• Monitoring the print queue
• Unlocking notes
• Troubleshooting basic EHR issues (e.g.  can’t get something saved, note attached to wrong encounter, etc…)

The selection of super-users plays an even bigger role in the overall EHR lifecycle.   Unfortunately, figuring out how to choose the “right” super-users can be quite challenging for many organizations.   The natural tendency seems to be to select office managers, people who are “good” with the EHR and/or long-time staffers, but this method often yields poor results for the following reasons:

• Office managers are not consistently actively working in the system.  There are exceptions to this rule however.
• End users who are “good” at using the EHR, may not be “good” at teaching others and/or troubleshooting issues within EHR.
• Long time staffers may know their job and the clinic well, but they also may not be the best teachers or be the most knowledgeable about the EHR.

Figuring out how to select the finest super-users can be as simple as following the process below.  You can be comfortable in knowing that this process has been followed my many organizations across the country (large and small) and far exceeds the alternative of figuring it out as you go, or figuring it out after the fact.

• Ask for volunteers.  Make sure to explain the position and the expectations clearly so that potential super-users can make good informed decisions.  People who WANT to take on the extra responsibility will undoubtedly do a better job than those who are forced into it.
• Recruit at least one front office and one back office super-user.  It would also be worthwhile to have back up super-users to account for vacations and sick days.
• Recruit those individuals who are well respected among their peers.
• Use people who not only have great computer skills, but who have great people skills, patience and who are good problem solvers.
• Always recruit people who actively use the system on a day-to-day basis.

Following the recommendations as outlined can help your organization achieve the best possible outcomes, while also providing  a more positive EHR experience to  end users overall.

-Litisha Turner, MS, BSN, RN

Clinical Consultant

Tags: Allscripts, EHR, Implementation, Super-users, Training

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 past Tuesday, I attended the NEHMISS Monthly Event and Social hosted at the Papa Razzi in Wellesley, MA with one of my colleagues, Patrick Zummo. It provided an invaluable opportunity to network with other healthcare IT professionals as the event had one of its best turnouts in the past two and a half years that we have attended (I would estimate about 65 attendees!) It was great catching up with folks and seeing new faces. The networking opportunity can’t be underscored enough!

The event featured a presentation on “An Approach to Meaningful Use” by Laura Leinin, Sr. Project Specialist, Clinical Information Systems at Partners Healthcare, and Jennings Aske, J.D., CISSP, CIPP, Chief Information Security Office at Partners Healthcare.

Laura started things off with an overview of the MU legislation to date:

• Original goal of MU legislation was to target full EHR adoption by 2014
• The three phase of EHR: Adoption – MU – Outcomes
• Compuer Sciences Corporation (CSC) estimated that for a hospital with 276 beds, the potential MU payout would be $4.2 million
• The major certifying entities for EHR software is Certified Commmunication for Health Information Technology (CCHIT) and the Drummond Group. The model utilized is a conformance tool where submission of data is required.
• Attestation if currently a manual process – submission of the numerator and denominator.

Jennings followed by addressing security compliance & MU:

• The main components of security compliance include access control, emergency access (“break-glass” capability), auto log-off, and audit log.
• Jennings noted that with the audit report, requirements included capture of userid, patientid, user activity and the ability to sort by time.
• An example of compliance presented was since Partners had a home-grown EHR system (longitudinal medical record – LMR), in order to comply with CCHIT & Drummond certification, the system needed to possess the capability to handle encrypted file import.
• Jennings expressed that Partners needed to exhibit compliance as described above, but in some scenarios (like the encrypted file import described above) they don’t actually intend on using the functionality. This led me to wonder what the percentage of cases were where the EHR needed to comply with security standards, but would never actually use or implement the feature in operational practice.

For the remainder of the presentation, Laura offered some statistics and updates with regard to Partners MU initiative:

• As of Thursday, September 30^th, 114,644 EPs & EHs have registered for attestation.
• As previously noted, attestation for stage 1 is currently a manual process and Laura warned of the high chance that organizations are likely to be audited post-attestation and as such they should have the records and data to back it up.
• She noted that Academic Medical Centers (AMCs) need to be self-certified in that they often have home-grown systems in the inpatient setting and noted that community hospitals often have commercial off the shelf (COTS) systems provided by the leading EMR vendors.
• She provides a project status dashboard each month to stakeholders and executives with more than 125 data points to track each month!
• Laura also mentioned the challenges of qualifying for MU in the presence of the healthcare information system mosaic at Partners that we’ve previously touched on in our blog in that of the different organizations that are affiliated with Partners (Brigham and Women’s Hospital, Massachusetts General Hospital), there are different vendor systems for ED (Electronic Discharge) systems, PM (Practice Management) systems, etc.
• In some cases, to qualify for meaningful use, workflows had to be adapted. One example was the handout of clinical summaries to patients.

Several great questions were posed by the audience including the following

• Q: Is standardization of vocabularies at Partners being handled by IT or the clinical staff? A: IT staff
• Q: What’s the headcount needed at Partners for the MU initiative? A: About 50 people across hospitals and LMR teams
• Q: How is Partners handling the case where smoking status is not captured discretely, but rather exists in a note? A: The homegrown LMR at Partners currently captures smoking status discretely. However, there are NLP (Natural Language Processing) solutions (Autonomy, Nuance come to mind) to post-process the non-discrete data for those applications which do not store it discretely. We have touched on data-mining non-discrete data in a previous blog post.
• Q: What happens if an organization decides to switch an EHR going forward? How is certification and MU qualification handled? A: No presenter or audience member had experience in switching organizations, but as we’ve witnessed with EHR vendor consolidation and an explosion of acquisitions requiring data conversions, this is likely to be a hot topic going forward.

Tags: Allscripts, Allscripts Data Mining, CCHIT Certification, Custom Reports, Drummond Group Certification, HIMSS Meaningful Use, Longitudinal Medical Record, Meaningful Use, Meaningful Use Security Compliance, NEHIMSS, New England HIMSS, Partners Healthcare Meaninful 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

When reading The Costs and Implications of EHR System Downtime on Physician Practice by Mark Anderson, it’s shocking to read that 87% of practices spend no time analyzing and valuating service levels, expected uptime, or estimated downtime for that matter. EMRandEHR recently touched on this point:

EHR down time is something that I don’t think most doctors put much thought into when they are selecting an EHR. I think that putting a dollar sign next to it will help many doctors to really consider the impact of EHR down time on their clinic. 

That leads us to question – why should practices be more cognizant of their EHR and its expected availability vs. downtime?

1. The industry’s shift towards EHR adoption over the past decade, the last five years in particular, can be attributed to the pressure to improve patient care, patient safety, and improving clinical reasoning while creating efficiencies and capturing the highest level of return on investment (ROI). These objectives are directly impacted by not only the actual uptime and availability of the system to the end users, but the acceptance and confidence that various end users have in their system.
2. There is a direct relationship between the dependency on technology (EHR) and cost of EHR downtime and practice’s dependency. As practices become more reliant on their EHR systems, the cost of that system being unavailable to their end users also rises.
3. Virtually every server platform is prone to some percentage of downtime throughout a year. Depending on the platform deployed, practices can expect 1%, 0.1%, or even .001% annually, which equate to 26, 2.6, and .25 hours respectively. This may not sound alarming at first, but when research shows that for each hour of downtime, practices can expect costs of $488 per hour per provider- these costs can be relatively substantial.
4. The average server deployed amongst practices to support EHR systems can expect 87 hours per year of downtime. Even the more expensive platforms based on cluster-server models average over 4 hours per year

There are various solutions and steps that practices can take to mitigate the risk of experiencing system downtime. These include not only questioning service levels of EHR vendor software, but selecting a hardware platform that not only fits the budget and expected availability levels. Outside of setting up cluster-model server platforms and continuous availability servers, there are few business continuity solutions out there.

Fortunately Galen Healthcare Solutions has committed to developing the industry leading business continuity solution – VitalCenter, a solution that allows their users to view the information needed to provide care for patients even then the system is down and then upload the data when the system is back up. Development of VitalCenter continues with the release of v2.2 this fall.  The latest version improves reliability and proactive monitoring of the system to ensure that patient charts are available at the point of care anytime the EHR is not.  We’re proud of Galen’s focus on ensuring VitalCenter “just works” every time you need it.

 It is obvious that system downtime occurs, but the intriguing unknown for all organizations - especially those practices that do not currently implement a high availability platform of clustered servers and continuously available server models - is the intrinsic value that the EHR system has for the practice. Is the statistically probable system downtime acceptable, or is it worth looking into options that only increase the value (ROI) of the system and invested monies each year the affects of downtime are avoided? I’m interested in hearing other’s thoughts.

Tags: Allscripts, Business Continuity, Cost of EHR Downtime, EHR Downtime, EHR High Availability, 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

In response to a guest post on EMRandHIPAA, we take a look at the top EHR data integration challenges faced today:

Technology

Proliferation of point-to-point interfaces instead of using a hub-and-spoke type of model (like that which Surescripts utilizes with electronic prescribing). Unfortunately, most organizations which exchange data in and out of the AE-EHR utilize highly-customized point-to-point interfaces for orders, results, documents, etc. The point-to-point model is highly inefficient and does not adhere with a “plug and play” model that so many organizations desire.

We’ve seen Allscripts make an effort to move away from this by introducing capabilities to automatically send immunizations to state registries via the Allscripts Hub by  simply modifying configuration setting (with the caveat that Allscripts has worked with the state to develop the intergration).  We’ve also witnessed companies like Medicity and its Novo Grid technologywhich offers electronic communication between physician practices, hospitals, and other health care providers. Novo embeds agents (small but powerful Java programs) in hospital data centers, physician practices and other locations. The grid component is an object oriented system that can replicate an object to multiple agents and keep it in sync across locations.

 Standards

As outlined in the EMRandHIPAA post, there are no mandated standards for EHR vendors to follow, thus making it difficult to coordinate data sharing between medical devices and other systems. Allscripts does offer the Universal Application Integrator (UAI),  which facilitates extendibility to other applications and devices. However, there is a certification process that needs to be pursued. In terms of the point-to-point interfaces previously mentioned, the Allscripts proprietary (API)  Application Programming Interface(which consists of inbound and outbound stored procedures to their primary clinical DB) does not segment out the data and configuration components of clinical exchange, something touched on in detail in a previous Galen Blog post.  Lastly, most vendors have their own specifications for HL7 message definitions. For instance, Quest may send ordering provider in OBR-16 in an interfaced result ORU message while LabCorp sends this in ORC-12. Another example is communication of “Ask at Order Entry” questions – something Quest expects to receive in repeating OBX segments while LabCorp expects this across Z-segments in an interfaced order ORM message.

Adherence to HL7, proprietary approaches.

Cost

John Halamka bravely predicted that when health IT vendors and providers began adopting new standards, the cost for interoperability would plummet: “We know that we won’t get precisely plug and play—this is a journey,” Halamka told Government Health IT. “But each year, we will get more constrained. We are going from a $20,000 -$30,000 venture hopefully to $5,000-$10,000.” Unfortunately the numbers quoted are accurate – and provide a high barrier to entry for smaller groups looking to electronically exchange data. There is the flip-side to cost and that is the ROI, which could include reduction in direct annual labor costs, elimination of non-billable tests, and elimination of lost charges.

Summary

The benefits of health information exchange are well documented. As outlined in the EMRandHIPAA post, there is a need for a “consistent, secure and reliable way to capture and share patient data among all systems and healthcare providers,” especially given that benefits in improved coordination of care and reduction of medical errors.

Tags: Allscripts, Extensibility, HIE, HL7, Integration, Interfaces, Interoperability, Results Interface, Standards

Analytics Analysis, also known as crosstabs, is a tool for sorting data. It allows users to drill down into the data using fields available from the database and is very flexible. It is often used for viewing data at multiple levels, comparing data across sites or providers, and providing detailed worksheets about the data.

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

Tags: Allscripts, Allscripts Analytics, Allscripts Crosstab Reporting, Analytics, Business Intelligence