Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

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

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

VitalCenter 2.0 introduces dozens of new features, including:

Scanned Documents

View scanned images, along with the rest of your patients’ charts. Learn More >

Automate Payer Audits

Generate custom-configured charts, based on a list of hundreds to thousands of patients. Learn More >

Improved Security

Lock down VitalCenter, even on shared PCs. Learn More >

Peer-to-Peer Connectivity

Improved availability of clinical information, with a reduced impact on your network. Learn More >

Same Day Appointments

Access to patient charts during EHR downtime, even when they are scheduled same-day. Learn More >

Tags: Allscripts, Allscripts Enterprise EHR, Business Continuity, Enterprise EHR, VitalCenter

Last Friday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 2 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference.

Keynote from the Surgeon General – Vice Admiral Regina M. Benjamin

• She covered how Hurricane Katrina affected her community in Alabama and the fact that due to the natural disaster, they were reliant on pharmacy chains to provide a record of what medicine the patients were taking.
• She also touched on a story of how members of her clinic were drying out the patients records after Hurricane Katrina and after they had them completely dried; a fire burned the entire clinic down. This brings to light the need for disaster recovery and collocation in some circumstances. Galen Healthcare Solutions proudly offer a downtime solution in its VitalCenter product.
• After the fire, Bentley college students came down to assist and one of those classes contacted the president of e-ClinicalWorks and convinced him to donate the EHR – integrated with both labs & referrals
• She stressed that prevention is the foundation to the National health System and as such we should be incentivizing prevention.
• She also mentioned how the EHR played a major role in prevention of errors

Getting Clarity – Developing Effective Health IT Policies and Standards

• Need to integrate claims and clinical data to provide total model for exchange
• 15 cents of every dollar in healthcare goes to administrative overhead
• Two key issues for data exchange – identity and consent
• Public Health entities currently receive data, however not every public health entity has the infrastructure to receive data
• How do we pull quality measures out of unstructured text?
  • Analogy of querying for alcoholics, but free text match is returned about using alcohol to swab skin before applying needle.
• The tough part of concerning clinical quality measures is the balance of structured and unstructured data
• Healthcare delivery is complex in that there is heavy fragmentation – 80% are solo or two physician practices
• Dr. John Halamka mentioned that we are the stewards of our own data and architecturally that is the design of the system

Jobs, Jobs, Jobs – Health IT, Business Opportunities, and Job Creation

• Healthcare workers do not have not enough IT in their educational curriculum
• Howard Messing, the President of Meditech mentioned that in Massachusetts in particular the cost of living is a barrier – Meditech actually has commuters from Atlanta.
• Girish Kumar Navani, CEO of e-ClinicalWorks indicated that they currently employ greater than 1000.
  • He anticipates hiring 500 new workers over the next 2 years for programming and business analyst positions
  • He also mentioned the analogy of the electrical socket – broadband network need to be as irreplaceable in physician office as the electrical socket.
  • He believes there is a need for a  new type of worker, the knowledge worker, who understands workflow and is able to analyze and make better decisions about population health
• Richard Reese, Executive Charmain of the Board, Iron Mountain, anticipates helping hospitals clean up paper mess.
  • He mentioned non-compliance in healthcare IT to storage and backup standards
  • Lesson in compliance can be drawn from Wall Street years ago and that healthcare organizations must design for workflow, but compliance as well
• Brad Waugh, President & CEO at Navinet, indicated that the network his company providers connects payers and providers, saving $800 million per year.
  • They currently require Microsoft .NET certified engineers and have over 30 openings
  • He indicated that the educational system must produce the folks needed in healthcare IT and currently it is just not doing so domestically
• This discussion brought to light a deeper seeded issue in American society in that as a society we are not pushing computer technology anymore as it is no longer the glamorized industry.
• There is a major need for qualified issues and it is a supply versus demand issue with the roots in education and society.
• One member of the audience mentioned that the goal of healthcare reform is to eliminate costs and the irony is that in a sense we are creating jobs to eliminate jobs
• Another member of the audience commented on the arrival of programs for night healthcare professional courses, much like it was the trendy thing to get a night MBA in the 90s
• Finally the point was made that by the middle of the current decade, we will be facing baby boomers hitting Medicaid and the amount of care they need is incredible. With less dollars, we will need to re-engineer the system and what could come as a result is care rationing

Panel: Successful HIEs – How They Did It and How It Helps

Fallon Clinic HIE

• Emergency care was the highest reason for HIE usage
• Some quotes from physicians on the value the HIE provided
  • “Importing the CCD expedited documentation”
  • “Reduced need to ask patients questions”
  • “Expedited verification of medication and allergy list”
  • “Saved time”
  • They estimate phone calls were avoided for 75% of hospitalist and were extremely beneficial for new patient visits
  • They estimate they spent 3 years and $3 million learning and developing “trust” and $1M in building and implementing in the final 2 years
  • Lesson learned:
    • They pre-registered all of their patients in the community (bulk-load) and this helped with performance as they didn’t have to query the state
    • They felt the key to sustainability was to reduce operating expenses
    • Each organization in the HIE was responsible for server maintenance – ends up being $2000/year/organization which represents rounding error in most healthcare IT budgets
    • Key points – earn trust – utilize real-world workflows – value of low cost

Indiana Health Information Exchange

• Federated data model – 62 hospitals – 3 billion structured results – doubling time of 4 months
• They meet the providers where they are whether it be delivery of data to the EHR or physicians receiving data as PDF or view into a portal
• They view sustainability in the sense of funding via offering services
  • work with public health services for syndrome surveillance and track immunizations
  • Their business model for sustainability is such that scale is needed and again they emphasized avoiding grants for operational costs.

NEHEN

• Their sustainability model is such that their organization provides governance – decide what has value – much as a board of directors would
• Federated model works better than centralized – more accepted in the marketplace
• Lessons learn include integrating processes across the enterprise
• The case of the transfer of information to public health is needed to sustain HIEs as well as the capability to sell other products within the network.

Tags: Adoption, Business Continuity, HIE, HL7, Immunizations, Integration, Interfaces, Interoperability, Meaningful Use

Galen Healthcare Solutions announced today that Queens Long Island Medical Group has gone live with VitalCenter™, the business continuity solution for health care organizations that rely on the availability of their electronic health records to provide patient care.

Garden City, NY October 30, 2009 – Galen Healthcare Solutions today announced that Queens Long Island Medical Group, (QLIMG) has deployed VitalCenter for its 350 physicians in multi-specialty practices as their business continuity solution for Electronic Health Record (EHR) downtime.

VitalCenter fills a long standing void within the marketplace, addressing the needs of every specialty, by delivering off-line copies of patients’ charts when the EHR is unavailable. A PC configured with VitalCenter, receive updates of patients’ chart information on a regular schedule, without impacting the EHR’s responsiveness. VitalCenter provides the ability to view or print copies of a patient chart on PC’s within a clinic. In addition, the solution allows the provider to electronically document and upload the visit details back into the EHR.

We’ve experienced a number of incidents that have prevented access to the EHR. As a leader in our community we feel it is imperative to provide our patients with unparalleled care. This solution provides the continuity of clinical information that allows that to happen. We researched other downtime solutions, including full disaster recovery solutions, but in addition to being expensive to both deploy and maintain, those solutions did not solve the problem of localized network outages”, said Lenny Brunson, Chief Information Officer of Queens Long Island Medical Group.

Galen’s VitalCenter is integrated with the Allscripts Enterprise Electronic Health Record and will distribute off-line copies of patient charts to each clinic based on the location of the appointment. The solution is flexible enough to accommodate the needs of all of the specialties and allows for each provider to customize the data that is delivered.

Shutting down clinics early for maintenance is an inconvenience for patients and is also a missed opportunity for physicians. An upgrade to the server environment, network or EHR may require that the EHR be unavailable to providers. VitalCenter will continue to deliver crucial patient information to caregivers with no interruption in service.

VitalCenter is the answer to the first question on everyone’s mind when they move to a paperless practice,” said Stephen McQueen, CEO of Galen. “‘How do I safely and effectively see patients if I can’t get to my charts?’ VitalCenter overcomes that obstacle and provides our clients with predictable encounter volumes, regardless of the circumstances.”

The implementation of VitalCenter is a quick and secure process by which it is installed and deployed through a PC installer. The VitalCenter Management Suite allows for client-specific configurability.

VitalCenter allows physicians to document their patient encounters while the EHR is offline. The documents, called VitalNotes are then automatically uploaded to the EHR once a connection can be made.

Another advantage of the VitalCenter Solution was the ease of installation. The system works in such a way that we do not need to impact our production system.   With many concurrent projects, and dependencies, the ease of deployment and support are critical to QLIMG,” said Mr. Brunson.

For additional information or to schedule a demo of VitalCenter please contact Cary Bresloff at 888.GALEN.44 ext 706 or visit vitalcenter.galenhealthcare.com.

About Queens Long Island Medical Group: Queens-Long Island Medical Group, P.C. is a physician-owned medical group that staffs and operates twenty-two medical center offices throughout Queens, Nassau and Suffolk Counties. For more information, please visit www.qlimg.com.

About Galen Healthcare Solutions, Inc.: Galen Healthcare Solutions was founded in 2005 with a specific focus on assisting members of the health care community with the challenging, sometimes daunting task of migrating to a predominantly paperless world. Galen resources possess decades of clinical and electronic health record experience. Galen has been on the forefront of the EHR movement and offers a vast array of skills from database architecture to senior-level project management and implementation services. Galen resources have been involved in hundreds of EHR implementations, from inception to completion, varying in size from 6 physician specialty practices to 1,200 physician multi-specialty organizations. For more information, please visit www.galenhealthcare.com

Galen Healthcare Solutions is the foremost third party expert on Allscripts Enterprise EHR.

Tags: Business Continuity, MSO, VitalCenter