Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

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

Organizations exploring Computerized Physician Order Entry (CPOE) might first pursue low-hanging fruit and implement an electronic workflow for results and keep a paper workflow for orders. Often times, electronic order entry can be cumbersome for end users and cause longer workflows.  As alluded to in a previous blog article, the benefits of implementing a solicited result interface are compelling – reducing paper and scanning, and offers the capability for automated result tasking.

In the Allscripts Enterprise EHR (AE-EHR), results can tie back to existing orders, facilitating completion of the order. This functionality is enabled and configured within the results interface deployed at a particular group and can be achieved in one of two ways:

• Order Number: the Order Number EXT generated from Allscripts is sent back with the results. The Order Number is tied directly to a specific order – a specific CBC order in a patient’s chart.
• Requisition Number: the Req Number EXT generated from Allscripts is sent back with the results. The Requisition Number is tied one or more orders – all orders on a single requisition. A requisition is defined by the Patient, Encounter, Performing Location and Ordering Provider.

For some organizations, a paper order work flow may be utilized, in which a paper requisition is presented to the lab instead of an electronic order. However, the Laboratory Information System (LIS) may not allow for discrete capture of the Allscripts-generated order number or requisition number. For that matter, the LIS also may not have the capability to send back this number in the result interface (typically a HL7 ORU result message).

Additionally, most organizations encounter a percentage of solicited results that do not complete the order. In the latter scenario, a lab may manually enter the order introducing the possibility for human error and can cause issue with not only reconciliation of the order, but potentially patient or provider matching.

Furthermore, if a lab has to change an order for any reason (for instance, changing the orderable item), the corresponding result will likely not reconcile the order (with the AE-EHR, the correct protocol would be to cancel the order and place a new order with the desired changes).

This situation can cause nightmares for organizations that are trying to gain semblance as to where lab vendors stand in terms of order fulfillment.  Additionally, order reconciliation reporting will likely be inaccurate.

This is especially pronounced in v11 AE-EHR, in which solicited results that are unable to reconcile to the original order create a “reported order.’ The original order is left unreconciled and a “duplicate” order renders in the patient chart:

We have resources available on our wiki to guide an organization through interfaced result-driven order reconciliation and can assist those organizations looking to gain control of order fulfillment and reconciliation. Please contact sales@galenhealthcare.com for more information.

Tags: Allscripts Enterprise EHR, CPOE, Crystal Reports, Custom Reports, Integration, Interfaces, Interoperability, Meaningful Use, Order Interface, Reconciliation, Reporting, Requisition, Results Interface

Galen will be hosting another in Enterprise reporting workshop this coming March.  This has been a popular course, so please sign up early!

What: A three-day course for report writers, DBAs and those in healthcare informatics on the Allscripts Enterprise EHR database.
When: March 1 – 3, 2010
Where: Boston, MA
Price: $2,500

The Galen Database Architecture and Reporting Workshop has furthered our understanding of the Allscripts Enterprise EHR database.  The clear presentation and substantial hands-on time helped us to greatly accelerate our production of customized reports.  And, the data dictionary documentation alone is invaluable.
– Chris Hyde, DBA, Albuquerque Health Partners

The attached announcement includes additional information regarding the course and suggested audience (report writers, DBAs, etc).

Please contact Mike Dow to register, or if you have any questions – mike.dow@galenhealthcare.com

Tags: Allscripts Enterprise EHR, Crystal Reports, Custom Reports, Database, EHR, Reporting, SQL Server

There is quite a bit of buzz in the healthcare IT community surrounding the ONCHIT/CMS release of the Meaningful Use Interim Final Rule and the  and the EHR certification requirements. The author of HISTalk kindly spent his New Year’s Eve poring over the documents to provide an excel worksheet summary of the actual criteria and thresholds and the author of the Medical Software Advice blog did a great job of outlining definition, features and measurement with his blog entry.  I thought I would take it a step further and provide some meaningful information to CFOs and PMs by taking a stab at quantifying the effort involved with each measure. First some background information and disclaimers:

• This estimated effort is based on 50 physician multi-specialty organization.
• It is intended to give a ballpark of effort involved and the numbers serve as estimates only.
• It does not necessarily scale linearly with number of providers or specialties.
• The effort only addresses four categories of effort – implementation, technical, interface and training.
• Categories of effort not addressed include project management, systems configuration and deployment, networking configuration and deployment, hardware (including desktop) deployment, and helpdesk and on-going support.

The meaningful use matrix with effort broken-out can be found on the Galen Healthcare Solutions Wiki.

Now that we have presented the effort involved, let’s delve into how EHR deployments – specifically  AE-EHR deployements – are typically phased:

Phase I: Base, Document, Scan and Dictate

Description: Provide a baseline level of EHR functionality to all users. Real-time access to physician schedules, transcribed and scanned documents, facilitation of dictation.  Data conversions, Scanned charts and documents, Base Deployment. This approach typically appeals to all providers regardless of technical aptitude and would not require significant workflow changes

Advantages: Clinical information access internal and external to the clinic, reduced level of change for physicians through the use of dictate, realized benefits of decreased errors and re-work.

Interfaces:

• Registration & Scheduling
  • Real-time inbound registration and scheduling feed from practice management system.
  • Initial bulk-load of existing active patients and appointments
• Transcription
  • Real-time inbound transcription interface from transcription system.

*Phase II: Rx+, Note, Forms, Results

Description: Add medication management, structured note and results

Advantages: Ability to collect structured information facilitating use of panel queries. Additionally, formulary compliance, and prescription faxing/e-prescribing to pharmacies and ability to capture results as discrete data elements

Interfaces:

• Results
  • Real-time inbound results interface from lab system.

*Phase III: Order, Charge

Description: Facilitates charge capture and order transmission.

Advantages: Completes the access to centralized patient data and further enhances the quality of care and service to patients.

Interfaces:

• Orders
  • Real-time outbound order interface to lab system
• Charge
  • Real-time outbound charge interface to the practice management system.

*Phase II and III can be combined based upon the organization requirements

In conclusion, one of the biggest questions that lingers for me is how the data is to be relayed to the government such that organizations can be evaluated as to whether or not they meet the thresholds to receive the incentives. Custom reporting comes to mind as precedent has been set here, specifically with PQRI and Medicare HCC. Galen Healthcare Solutions certainly can provide custom reporting specific to organizations needs in order to communicate meaningful use. Another solution is Allscripts Clinical Quality Solution powered by TeamPraxis. In the meantime, we wait for the rule to be finalized and anticipate announcement of how the meaningful use data is to be relayed.

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 Consultants, Allscripts Enterprise EHR, Custom Reports, EHR, EHR Certification, EHR Implementation, Integration, Interfaces, Meaningful Use, Meaningful Use Matrix, Reporting, Successful EHR Implementation

The requests for reports that we get runs the gamut. Most of the time, clients are looking to modify the existing canned reports that Allscripts offers with the Allscripts Enterprise Electronic Health Record (AE-EHR). Other times, clients envision a custom report that is unlike any of those currently offered and is unique to their particular organization. And still further, some organizations wish to fulfill reporting metrics to receive monetary incentives from initiatives such as the Physician Quality Reporting Initiatives (PQRI) and P4P (Pay for Performance) .  Given the commonalities in the requests we receive, with our reporting solutions store, we have attempted to pick the most popular reports requested from clients and offer them via on-demand payment, download and installation.

We also receive a substantial amount of inquiries from clients as to what exactly goes into customizing existing reports and creating new reports. Clients are often curious as to what types of skill sets are needed. These organizations may feel that they are better suited to have their own personnel develop custom reports. For instance, the organization may have performed an return on investment (ROI) analysis and determined it makes the most financial sense to train their own staff to supply the multitude of administrative and “print” reports they require in the coming future.

That said, let’s get to answering the question of what goes into developing custom reports for the AE-EHR:

1. AE-EHR Clinical Database Stored Procedures: These are used to extract data out of the database to render in the report. The stored procedures can be thought of as a “middle-man” between the database and the Crystal Report. More information on the basics of stored procedures can be found via the following link.
2. Crystal Reports: Most AE-EHR reports are developed using Crystal Reports. Crystal controls the how the data extracted from the stored procedures renders in the final report. Crystal offers functionality for pivot tables, summary of data fields, grouping, custom formulas, suppression based upon data values, etc. For more information on Crystal reports tutorials, follow this link .
3. Insert Scripts:  There are several places that reports can be installed within the context of the application’s user interface (UI) – these are called “Calling Points.” Reports can be printed from the administrative workplace, and also added to the UI for the traditional “print documents” – immunization or results “calling point” for instance.

The most important ingredient to custom AE-EHR report recipes comes in the experience – specifically knowledge of the database schema. Knowing what tables to pull from, how tables are related, and what functions, stored procedures and existing custom reports can be utilized so as to not re-invent the wheel. Knowledge of advanced SQL querying is invaluable as well. If you would like to learn more, Galen is offering free EHR Reporting webcasts.

Let us know if we may assist your organization in developing and delivering custom AE-EHR reports. In addition to the reporting solutions store, we also offer training courses and reporting services for the Allscripts Enterprise EHR database, ETL database, Analytics and the ConnectR  database.  Please contact sales@galenhealthcare.com for more information regarding these courses and our reporting services.

Tags: Allscripts Enterprise EHR, Crystal Reports, Custom Reports, Extensibility, Reporting, SQL Server, Technical

The benefits of a results data exchange between a vendor system and the Electronic Healthcare Record (EHR) are profound, as the need for redundant and often erroneous data is greatly reduced. More importantly, by implementing a results data exchange to the EHR, providers are delivered more timely and accurate clinical data, yielding an increased level of patient care.

Benefits

• Elimination of redundant entry of patient data.
• Result reconciled to order automatically
• Immediate availability of the results to the enterprise.
• Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc).
• Elimination of scanning of signed paper labs to the EHR.
• No more lost lab results.
• Run reporting on the data from labs in EHR (for example, blood sugar change over time).
• Automated result tasking as well as the ability to send copies to related providers, such as the referring provider or the patient’s primary care provider.
• Automated Tasking.
  • Verify result task.
  • Carbon Copy (Review result task).

  

• Automated synchronization of item dictionary.
• Drop a charge automatically to the PMS (assuming a charge data exchange is in place).
• Capability to automatically send insurance information to labs for lab direct client bill (assuming the insurance data exists in the EHR. This data is usually fed from a separate PMS data exchange).
• For PACs data exchanges, facilitates viewing of image result directly from EHR.
  

And perhaps the biggest benefit is that many groups are able to negotiate with their lab and radiology providers to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view, the lab and radiology providers are often happy to provide financial incentive for practices to participate in an electronic data exchange.

Return on Investment (ROI)

A three-hospital study conducted by LINK Medical and Philips Medical provides great insight into the return on investment that interfacing can provide. These hospitals analyzed and assessed the effectiveness of automating the process of Electrocardiogram (ECG) orders and test results, with the following realized outcomes:

• Reduction in direct annual labor costs ($11–25,000).
• Elimination of non-billable tests.
• Elimination of lost charges (1% to 2% of ordered tests).
• Short payback period (less than 12 months).
• On-going ROI – these savings and associated benefits continued.

Overall cost savings were in the range of $43,000 to $59,000 per annum.

Galen Healthcare Solutions: Interface Services

Tags: Custom Reports, EHR, Integration, Interfaces, Results Interface, Technical

When: July 28 – 29th, 2009
Where: Orlando, Florida during the ACE pre-conference sessions
Price: $1500

Expert training on the AE EHR database is key to understanding this complex data
model.

The Allscripts Database Architecture and Reporting Workshop will provide you with the
fundamentals necessary to build reports out of the Allscripts Enterprise EHR Database.
Throughout the two day event we plan to review the key tables within the Allscripts databases,
strategies for reporting repositories, deployment methods, and we will walk through reporting
examples provided by the different attendees.

• Course Highlights
  • Enterprise EHR Database Architecture Review (key tables)
  • Develop Reports Based on Attendee Submissions
  • Review Reporting Methodologies
  • Review Report Deployment Methods
• Recommended Audience
  • Reporting Analysts and Architects: Your decision support or reporting group is
    likely flooded with requests for reports from Allscripts. We recommend using a
    data warehouse of some sort for reporting (direct copy of production, or one
    populated by an ETL process). The reporting analysts and architect(s) within
    your organization will need to understand the Allscripts EHR data model in order
    to service these report requests. They will obtain a thorough review of the key
    tables in the Allscripts database, how they link together (foreign keys are
    frequently not available), and the challenges found in retrieving data from the
    EHR database. Data warehouse options and design considerations will be
    reviewed.
  • Database Administrators: The DBA will obtain a thorough review of the key
    tables in the Allscripts database, how they link together (FKs are frequently not
    available), and the challenges found in reporting from the EHR database – both
    in the data structure for reporting and performance impact of the queries and
    how the transactional data model affects the ability to write efficient reporting
    queries. Data warehouse options and design considerations will be reviewed.
  • Physician IT leaders – we have trained a handful of physician-cum-IT directors who have had great success in understanding the data model, and being able to use both ad-hoc queries to make quick analyses of situations, and help their team write meaningful reports.
  • IT leaders – often times the managers and directors of IT groups are not hands-on writing reports. There are times, however, that leaders within the IT organization need to understand the EHR data model at a detailed level. The course is a perfect match for this situation.
• Prerequisites
  • Prior knowledge of T-SQL is essential. Querying including multiple joins, CASE statements, temporary tables and GROUPing should be an area of comfort for the attendees.
  • An understanding of the Allscripts Enterprise EHR with regards to management/admin and end-user use is required.
  • A basic understanding of the Allscripts Enterprise EHR databases is preferred, but not necessary
  • Prior use of Crystal Reports and SQL Server Reporting Services will also be helpful.

Allscripts Analytics and ETL– this course is well-suited for groups who already have Analytics or the Allscripts ETL, as well as those who don’t. We will cover a variety of data not available in
Analytics/ETL, as well as allowing your DBA group to query the data real-time, such as needed during performance or error troubleshooting.

Attending this Course

Contact Mike Dow for more information and to sign up. Space is limited and seats will be filled
on a first-come, first-served basis.
Mike.Dow@GalenHealthcare.com
617-379-0840

Tags: Allscripts Enterprise EHR, Custom Reports, EHR Implementation

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