Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

If there is anything that the Galen team enjoys, it is putting our heads together on a particularly challenging question or problem within Allscripts Enterprise EHR.  We are a group of people who love a problem that you can sink your teeth into, and when we develop solutions we love to share them with the user community.    We are thrilled to introduce a new program in this newsletter where we give our readers an opportunity to enhance the body of knowledge that we publish on our wiki by “Asking an expert.”

Our Wiki content has been driven so far by the knowledge and experience that our consultants gain in the field.    We have gotten great feedback from clients and end users that the wiki is a great resource, and we feel that this program will only serve to enhance that process.    We want to hear what you are struggling with, where you are stuck and where you need a work-around.

Using this link users can submit questions to our website and our team of experts will review the questions and use them to direct future content for the wiki.   We also plan to highlight one question from the “Ask the expert” series in each Newsletter.     We expect that there could be a high volume of questions and we may not be able to answer all of them,  but we will review all submissions and evaluate the utility of the answer to the greater user community as well as looking for trends when multiple users ask similar questions.       We are looking forward to hearing from you!

Tags: Allscripts

Galen Healthcare Solutions is proud to announce that we will be continuing our popular series of free webcasts this fall related to Allscripts Enterprise EHR.   These Webcasts will cover topics including Analytics, Allscripts Enterprise EHR Note, Interfaces, Reports, Allscripts Enterprise EHR Orders, Tech System maintenance.

Learn more »

Tags: Allscripts, Enterprise Order, Galen Webcast Series, Integration, Interfaces, Meaningful Use, Technical

It is with no small sense of pride that we at Galen Healthcare Solutions embrace our role as a leader in moving our community the Allscripts User Community towards its collective vision of improving health care through the use of technology.

Even before our inception nearly 5 years ago, our people have demonstrated an understanding that to achieve our individual goals, we must recognize the value in sharing our expertise and experiences with organizations across our industry that has similar objectives.  We know that to be successful, we must be willing to lend assistance, because we most assuredly will need the support of others from time to time.

It is because of this belief system that we make our combined knowledge freely available to whoever needs access to it through our Galen Wiki and Galen Blog.  We encourage every member of the community, user or vendor, to participate in this free exchange of information with the mindset that we are all in this struggle together.

Further, we are thrilled to introduce a new program in this newsletter where we give our readers an opportunity to increase and direct the body of knowledge that we publish on our wiki by “Asking an expert.”    Users can submit questions to our website and our team of experts will review the questions and use them to direct future content for the wiki.

Additionally, and with the concept of advancing the global effort in mind, we believe strongly in supporting the various regional and niche user groups currently active across the country.  We are witness to the power of these groups nearly every day.  We see email conversations involving dozens of organizations spanning several states sharing concepts with the intention of helping each other move past their obstacles.  We see thousands of users joining to form a single voice demanding resolution to persistent issues.  And we see the times when these groups gather physically, in a single location, to share their experiences, frustrations, and success stories all in an effort to support one another and move forward

We are, of course, in the midst of yet another injection of uncertainty in the form of “Meaningful Use”.  As a result, it appears that ACE 2010 couldn’t come at a better time.  Certainly, ACE is a great opportunity to see old friends and make new ones, but more importantly, it is a chance for the community to convene, give voice to its anxieties, and discuss steps to overcome them.  We relish the chance to participate in that process.

We hope that each of you attending ACE 2010 will stop by our booth, have a little fun (Spin to Win an iPad!), and share your thoughts, voice a concern, or just ask a question.  We know that the success of our organization depends on the success of the community overall.  We, collectively, can achieve that success through a commitment to promoting the greater objectives, freely sharing our knowledge, and continually moving the community concept forward.

Enjoy your summer and I hope to see you at ACE.

Steve McQueen

Tags: Allscripts

When an organization starts out on the long road of implementing an electronic health record the project manager will typically research what steps the organization needs to take to make their EHR project a success.  Learning from others is the most efficient use of resources. So what are the factors that those who have gone before you feel make an EHR project successful?  I will post a series of articles covering these many factors.

Part I- Organization Planning & Internal Governance

Developing a project charter is the first step. The project charter has several components that include the project description and business objectives and success criteria. This is an important part of the charter, if you do not know what you are hoping to accomplish or know what success of the project means to the organization the chances of reaching success will be difficult at best.  Other components of a project charter include listing the stakeholders, vision, project scope (another important piece, as scope creep will happen without it), assumptions and dependencies, constraints, milestones, business risks, resources and finally an approval section where the executive team’s signatures will be placed to demonstrate their approval and acceptance of the project charter.

The development of a formal project plan with identified milestones will assist not only the project manager but the executive steering committee to determine the health of the project. The creation of a great project plan includes receiving input from the project team.  This allows each member to buy into the journey that are about to embark upon.

The next component of planning for your organization’s EHR project is developing a communication strategy.  A well thought-out strategy that includes formal communication channels is crucial.  Once the project picks up speed the lack of communication can cause unnecessary hurdles.

Some additional components of organization planning and internal governance are determining a decision matrix that outlines how specific types of decisions will be made and ultimately approved.  Forming your committees that include providers, executives, and clinic leadership will facilitate the support required for your EHR project to be a success.  Having a commitment from the members of these committees is crucial as you may need their backing upon occasions throughout the project.

The final component is establishing a solid infrastructure and reliable network.  Addressing any infrastructure concerns before you begin your project is essential because once you pick up speed on the project, this area risks being left unattended which can cause hardship on reaching your goal of achieving SUCCESS!

Watch for Part II – Exceptional Project Management and Control

Tags: Allscripts, EHR Implementation, ehr project, Enterprise EHR, project success, Successful EHR Implementation

We here at Galen have seen a greater influx of requests to be able to integrate client’s EHR environments with 3rd party applications and/or internet websites.

I’ve created a few examples that I’ve added to our Wiki page.

1. http://wiki.galenhealthcare.com/Patient_Portal_Integration

With this case study Galen had a client who has implemented a patient portal application whereby patients are able to send messages to their doctors regarding tests, results and general questions. The client was looking for a way to have the provider be able to integrate this application directly into the EHR. With RelayHealth’s help we have succesfully built a prototype whereby a provider can seamlessly communicate with a patient in the most efficient manner possible!

2. http://wiki.galenhealthcare.com/images/5/57/Add_new_Web_framework_documents_to_the_EHR.pdf

In this example a client was looking for a new link on their vertical toolbar which would allow them to display any website in their current workspace (the main viewing pane of the EHR). This one example integrates the website directly into the EHR window without having to navigate through a new tab or window, showing a FRAX calculator. The other tab actually has the ability to take in patient context (height, weight, blood pressure, etc.) and pass it into a form automatically populating fields to save physicians valuable time. This article goes through the steps involved in setting up new vertical toolbars, horizontal toolbars, and workspaces to set up these outside websites in the EHR. The actual code to populate patient context is fairly complex but definitely something Galen would love to help out with!

Tags: Allscripts, EHR, EHR Implementation, HL7, Integration, Successful EHR Implementation, Technical

Galen Healthcare Solutions will be hosting a series of free webcasts covering ConnectR interfaces.  The purpose of these webcasts is to provide insight into advanced troubleshooting methods as well as advanced design and configuration options within your ConnectR environment.  We will cover various aspects of interface design, development and maintenance as well as best practice techniques.

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 – Configuration and Deployment of Imagelink: Overview of Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

• Wednesday, May 19th, 2010 at 2:00pm EST

300 Series – Advanced Troubleshooting: Error analysis and resolution as well as custom techniques for error remediation

• Wednesday, June 23rd, 2010 at 2:00pm EST

500 Series – Advanced Design: Interface filtering techniques and interface-driven tasking

• Wednesday, July 21st, 2010 at 2:00pm EST

To attend, please contact Justin Campbell, justin.campbell@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.

Tags: Allscripts, Allscripts Enterprise EHR, ConnectR, Database, Galen Webcast Series, HL7, Integration, Interfaces, Interoperability, Meaningful Use, SQL Server

As reported on EMR and HIPAA, CMS has made comments on the Meaningful Use Interim Final Rule public, providing an additive level of transparency and CMIO promptly provided a summary of the EHR comments. In light of the transparency CMS/HHC/ONC yields in regards to the Meaningful Use Interim Final Rule, we encourage members of the healthcare IT community to take full advantage of the comment period, which ends in less than a month from now. To encourage ongoing dialogue, we have published a Meaningful Use FAQ in which we anticipate aggregating questions that persist in the community and also encourage active participation. For instance, in a previous post, I pondered how meaningful use would be communicated.

Other items to note in regards to lingering questions surrounding Meaningful Use and ARRA as a whole:

• Dr. John Halamka also addressed the public comments on the Interim final rule on his blog post.
• Many questions persist surrounding interoperability standards, and as John over at EMR and EHR addressed on his blog post, the Healthcare Information Technology Standards Panel (HITSP) was recently extended to be operational until April 30th only. How will this impact communication of meaningful use from organization to the government?
• We recently updated our meaningful use matrix to include which functionality supporting MU measures are delivered in the Allscripts Enterprise EHR (AE-EHR). John at EMR and HIPAA is also collecting a number of the various matrixes that people have put together around the EMR meaningful use criteria

If your organization is looking for assistance in exhibiting meaningful use, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Meaningful Use, Meaningful Use FAQ, Meaningful Use Matrix, Successful EHR Implementation

Drawing on our past experience and expertise with data conversions, we recently assisted one of our clients with a conversion of administrative ICD9 diagnostic data extracted from their Practice Management system to clinical Medcin-based  problem data within the EHR. The project ultimately saved a tremendous amount of data entry time. Upon completion of the data-conversion, clinicians were then able to review the problem list in “Past Medical History” section of the patient chart within the EHR and categorize by either choosing to make the problem “active” or mark redundant or resolved problems as “Entered in Error”.

As with any data conversion, one must be cautious in terms of negative implications. For instance, administrative data has its limitations, and an example or where the process can go wrong is the highly-publicized case of e-Patient Dave.  Ultimately, problem conversions can be useful, but the data needs to be reviewed, and almost treated as suspect.  The value in the conversion is saving the entry of the problems that are accurate – say 80-90%.  Any that are incorrect, will be reviewed with the patient and can easily be marked EIE.

Statistics:

• 1,007,238 problems were loaded to the EHR for 205,831 patients via the interface engine, taking about 11 hours to process totally.
• PM Extract file statistics:
  • Total matchups of ICD9s to patients: 5,405,874
  • Total Unique ICD9s: 8346
  • ICD9s that only match up with 1 patient:1295
  • ICD9s that match up with 100 or more patients: 2027

Approach and Components:

• Master approved “ICD9” list provided by client
• Extract of ICD9 data from PM system provided by PM vendor
• Automated macro that attempts to match ICD9 to Medcin. Potential matches include the following:
  • 1 to 1
  • One to many (20 or less)
  • One to many (20 plus)
  • One to none
  • Each of the different flavors of matches were marked with an annotation (highlighted via an asterisk) to identify to clinicians the logic that was used in importing the problems:

• Once the translation was finalized, it was loaded into the interface engine and mapping logic loaded problems into the patient chart in the EHR via the API (existing stored procedure).

Known Issues Mitigated:

• Due to incorrect logic, some ICD9s were linked to patient profiles improperly. To mitigate this, a script was run to mark these problems as “entered in error”
• Problems were loaded to the “Past Medical History” section of the patient chart with a status of active. However, given this status, it didn’t facilitate providers to easily change the problem to be an active problem linked to a note.

Lessons Learned:

• Execute a proof-of-concept and as with any technical project, get clinician feedback. The client had a pilot group of 5 clinicians to vet out issues and bless the data before the live conversion was run.
• Do NOT use spreadsheets to track the cross-walk between administrative ICD9 diagnoses and clinical Medcin problems. Rather utilize a staging DB to serve as a single repository in developing ICD9 to Medcin translations. Also, the data from flat-file export from PM can be loaded into a staging environment via SSIS such that it can be analyzed and summarized while facilitating persistence.
• Make sure to tie the problem conversion load to a specific provider, that way if side effects or issues are identified after the fact, there is a clear way to identify which problems were loaded in the conversion via the provider they are tied to. The interface log should also have a record of this, but most organizations set the retention time to 90 days.
• Workflow validation – ensure that the workflow to move problems from PMH to Active will not be a barrier to use.

If your organization is looking for assistance in data conversion, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical service offerings.

Tags: Allscripts, Allscripts Enterprise EHR, Data Conversion, ICD9, Interfaces, Medcin, Problem Conversion, TouchWorks Problem

I’m excited to announce that we’ve added a new section to our site – a gallery of custom reports and print templates we’ve created for the Allscripts EHR. This isn’t a complete list (there are a couple hundred in total), but gives you a good idea of some of the things our Technical Services team has done in the past.

If you see anything that you like, or you have a request for a custom report, please visit our Contact Us page.

To visit the gallery, click the link above, or go to: http://www.galenhealthcare.com/ehr-reporting/

Tags: Allscripts, Custom Reports

In IT, the term for a software application’s ability to be “tailored”, without making core code changes, is Extensibility.  Extensibility is what allows us to have:

• “Toolbars” in Internet Explorer and FireFox, like the Yahoo and Google toolbars
• Mac Dashboard Widgets, and Sidebar Gadgets in Vista
• Customized Homepages, like iGoogle

The Allscripts Enterprise EHR does not have an extensibility model for its UI.  This doesn’t mean that there aren’t requests to tailor the AE EHR.

What it does mean, though, is we have to be careful when changes are made.  It means we do have to customize the application’s software code while not breaking the software and ensuring things won’t fall apart during the next upgrade.

The first thing that we need to do is ensure that it’s worth making the change.  John Halamka has a good article regarding Removing Complexity from IT, in which he comes down pretty hard on customizing commercial software products.  I cannot tell you the hard and fast rules on determining whether to make a customization, but I can tell you that it will:

• Add complexity to your application
• Require additional coordination and testing during upgrades
• And, customizations will not always be able to be carried forward to the latest version

What we have done at Galen to help ensure that a customization causes as few headaches as possible and provide the value that our clients hope for is:

• Documentation – clearly document all of the files, database objects, etc that are affected, providing both plain English descriptions for non-technical folks (e.g. a project manager) and the technical detail required by our programmers and technicians.
• Testing – test the changes thoroughly ourselves, and work with our clients to build robust test plans for the initial install, and to use during each upgrade.
• Tracking – encourage our clients to track each customization that we make, and we also add those customizations to the Allscripts CRM, the same place where Allscripts technicians track their customizations.

So far, we have been successful working with our clients to keep their systems running well with the customizations that we’ve made together.

We hope that our work to mitigate the risks of customizations will allow us to continue to be successful in this area!

Tags: Allscripts, Allscripts Enterprise EHR, Extensibility