Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

—Discrete Clinical Data Elements as the building blocks to a Connected Health Platform—

Broken down to its basis, any vision of a truly connected Health Network will be reliant on the ability to pass, and ultimately present, discrete data elements.  Although the audiences for the information will be diverse, and the front-end systems will vary, the foundation of the information is the same.  In order to unlock the value that lies in the data being captured every day, an organization must have solid planning and execution. 

Each organization we work with is unique, but overall themes are constant: Reporting for Meaningful Use, Optimizing Health Care Decisions with Analytics, and Growth through Acquisition or Partnership.     

If we consider Clinical Data as building blocks that will be used, in whole or part, to support these efforts, we need to ensure both the ease of access and integrity of that data.  Galen has leading expertise and insight on conversions, reporting, and interfaces that can help you down this path. 

So how do you take the first steps in creating solid building blocks?  We would recommend to:

Define and establish consistency in electronic documentation and workflow.  This starts by understanding the EHR build and configuration decisions that will impact both availability and integrity of the data.   This consistency will also pay dividends to the organization by making the support of the Enterprise EHR system more predictable and efficient. 

Independent of your organization’s current state, Galen has the breadth and depth of expertise to help achieve your vision.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Clinical Conversion, Data Conversion, EHR Implementation, Enterprise EHR, Healthcare IT, Interoperability

It’s been an exciting quarter for everyone in the Allscripts community as more and more physicians are adopting EHR technology and health systems across the country are positioning themselves for Meaningful Use. As our industry continues to evolve, Galen has recently made some key promotions designed to give our employees additional support needed to provide high-quality services to a growing client base. Their leadership allows our company to stay better connected. Please join us in congratulating the following people on their recent promotions.

Dave Burkhead, Managing Consultant

Dave knows the configuration of the Enterprise EHR application front and back and has worked on the interface and technical side of the application. In addition to this product knowledge, Dave has project management experience and a natural ability to lead. This combination of product knowledge and higher level vision is at the heart of what Galen provides, and it’s what makes Dave such a valuable asset to both his clients and team members. Congratulations to Dave on this well-deserved promotion.

Steve Cotton, Managing Consultant

Steve came to Galen with superior product knowledge and a willingness to do whatever it takes to help his clients, and that has not changed. Steve does all things Enterprise EHR™; trainings, onsite support, orders/results build, interfaces, VitalCenter™ implementations, external Galen webinars, and much more. In addition to his client work, he has been a steady contributor to internal projects and is the true epitome of a team player. In his new role as Managing Consultant, Steve will be able to bring years of consulting and application experience to his team. We congratulate Steve on this well-deserved promotion.

Michael Ficociello, Upgrade Manager

Michael was one of the original upgrade team members who started in 2008 and has made immeasurable contributions to its success in the years since. His work ethic and attention to detail have allowed him to provide superior services to his clients, and his passion for process improvement has allowed the entire upgrade team to stay organized and on point. In his new role of managing the upgrade consultants and upgrade project managers, Michael will continue to provide leadership to the team in addition to his full workload with his own upgrade clients. Congratulations to Michael and thanks for all the hard work.

Troy Forcier, Senior Upgrade Technician

Troy has been upgrading Galen’s client base for the past three years, working with just about everything between V10 and V11. During that time, he has taken on some of our largest clients as well as some of our smallest, and done great work at every stop. In addition to his upgrade work, he has also gone on-site with clients to perform assessments of their Allscripts infrastructure, visited clients to perform Galen’s System Maintenance Training, and hosted educational webcasts.  He has also been a tremendous help in on-boarding some of our newer upgrade resources, allowing Galen to bring top-quality technical services to a growing client base. We congratulate Troy on his promotion to Senior Upgrade Technician.

Carl Fulton, Lead Consultant

Carl has been with Galen since September 2007 and has worked with multiple clients throughout his time with Galen.  The common theme with each is that they keep coming back to Galen for support with their implementations, upgrades, and other projects. He has tremendous product knowledge and combines his great sense of humor with a level of professionalism that makes him a great resource for all clients. In addition to his client-side impact, Carl plays a large role internally for the service team. He is truly an asset to the clients and to Galen. Carl has made the transition from Consultant to Senior Consultant to Lead Consultant in his four years here, and we congratulate him on his newest promotion.

Matt Woodside, Managing Consultant

Matt has been promoted to Managing Consultant and will now take on responsibilities for managing part of the service team in addition to his continued full-time client work. Matt has a combination of extensive product expertise and excellent leadership capabilities. His strong project management skills have helped him provide direction and leadership to one of Galen’s largest clients as they move towards Meaningful Use. Within Galen, he has helped with the recruitment of new employees, ensuring that Galen employees continue to represent the highest standard. Congratulations to Matt on his exciting new role as Managing Consultant.

Tags: Allscripts Consultants, EHR Implementation

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

With a majority of healthcare organizations being multi-site as well as an increasing trend in MSO oriented healthcare systems, the ability to effectively manage and deploy EHR to entire physician networks is critical to achieving an integrated patient record and reducing disparate records across physician networks.  The release of Allscripts Enterprise EHR version 11.2.x brings the movement towards meaningful use and reimbursement incentives; as well as penalties.  This requires that organizations develop the capacity and knowledge required to take on, prioritize, and execute multiple EHR initiatives simultaneously.  In many cases this involves what seems like the never ending rollout of sites, practices, and acquisitions that comprise these complex physician and community based networks.

So what is really involved in order to make this happen?  Is it really just about system configuration, setting system preferences, writing interfaces, analyzing workflows, and installing hardware?  Cumulatively it is, but who makes this happen and why don’t they grow on trees?  This article aims to take a step back and take a hard look at the soft skills needed to ensure not only a successful initial installation of EHR, but the underlying principals needed in order to ensure a fully functional, well seasoned, and confident EHR deployment team.

Perhaps a quite common question or source of anxiety presented to on site vendor support is “Well what happens once you’re gone?  Who is going to take care of us?”  The following are pre-emptive measures that organizations can take in order to ensure that once the “experts” leave, the pace of the EHR implementation can maintain its course.

Initiate the Transfer of Knowledge

The fast and furious pace of installing EHR at a particular practice can sometimes leave the remaining implementation and support staff straddling between new support duties and ramping up additional practices.  Don’t wait for the knowledge to come to you….go to where the knowledge is.

• Identify the key drivers and what the critical build aspects are for the organization or practice installation.  Don’t just now what they are, but take the next steps and get a head start in building towards expert level knowledge in those areas.
  • Attend product focused webinars
  • Invest in either remote or on site focused system maintenance or functionality driven education courses
• Granted these elements can require time and some capital to achieve, but the long term return on investment will come in the form of self sufficiency

First Impressions Are Everything

Remember that through the eyes of a practice going live on a brand new electronic health record the initial round of go-live support and change management will set the tone for the long term relationship between the practice(s) and the core EHR implementation team.

• Get the core team’s faces out there and work to establish a positive rapport with new and upcoming practice(s), but keep in mind not to overwhelm them.
• Make sure the practice(s) know that as a team they will be working together directly with the EHR implementation team and that they will not be experiencing this change alone.
• Let the practice(s) know that it’s okay to ask questions prior to go-live and work to eliminate that potential perception go-live day is a just a silent time bomb waiting to explode.

Cross Training & Skill Set Ramp Up

Get as many of the core EHR and support team involved in all phases of the project life cycle for a given practice.  This will help build the perspective and broaden knowledge needed not only to maintain autonomy and depend less on other team members, but also increase the support capacity of each team member.  This can translate into increased support bandwidth and end user satisfaction.

• Encourage every core team member to participate in clinic walkthroughs, workflow assessments, go-live support, and the post-live optimization process.
• Provide internal or “brown bag” presentations (post-live) so that other team members can become familiar with each other’s focus or area of product specialty.

Remember that once the “experts” leave, the core EHR implementation and support team is the lifeblood of the implementation and a key driver to any organization’s long terms success with EHR.

Good Luck!

Tags: Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Successful EHR Implementation

Over the past year we continued to experience tremendous change as a company, an Allscripts community and as an industry.

As a company we can point to our proficiency with the Allscripts PM and Professional products. Prior to 2010, our Technical Services team had been involved with a handful of interfaces with Allscripts Enterprise PM, primarily the standard interfaces with the Enterprise EHR. In 2010, however, the team took its knowledge of PM interfaces from elementary to expert as demonstrated in the PM Integration article in this newsletter. The team became experts in inbound demographics conversions, customized outbound registration and scheduling interfaces, and began to explore the world of general ledger interfaces. Additionally, the company performed its first conversion of an Allscripts Professional EHR system – splitting a single environment into three as part of a four-party acquisition. Galen also had the fortune of bringing on a handful of experienced Allscripts PM Implementation Professionals in 2010.

It wouldn’t be entirely fair to categorize 2010 as the year of Allscripts PM and Professional at Galen. Our advancements in these areas simply showcase the organization’s willingness to embrace change. Our commitment to learning and, more importantly, sharing what we learn requires us to constantly move into unexplored territory as we strive to add measurable value to our clients. We share our experiences and newfound knowledge within the industry via the Galen Wiki and the Galen Blog. We also see the Allscripts community sharing its knowledge through the Regional User Groups, the AmberSight forums and at ACE each year.

The upcoming year promises to bring even more change to all of us in Healthcare IT. Many groups are aiming to achieve Stage 1 Meaningful Use in 2011. This means an upgrade to Allscripts Enterprise EHR version 11.2. It means capturing new data, like smoking status and language. It means new interfaces, including lab and immunizations. New workflows. New reporting. We all have a lot to do.

At Galen, we began our journey towards Meaningful Use in earnest in 2010 following the release of the Interim Final Rule. Our Meaningful Use Committee began meeting bi-weekly to discuss the rules, their impact and how we can quickly and effectively assist our clients to meet MU in 2011. Galen’s Upgrade Team will be performing nearly 20 upgrades to v11.2 this summer, ensuring the systems are there for our clients to achieve meaningful use in 2011. Additionally our Interface Team has been furiously working the past 12 months on interfaces that aid in achieving Meaningful Use, and will continue to do so over the next two years.

At Galen, we welcome the opportunity of another year working with some of the best health care providers in the nation. We look forward to overcoming the challenges that will come with implementing the software, workflows and procedures necessary to achieve Meaningful Use.
We will stay the course of learning and sharing – with our colleagues, with our existing clients and with the broader Allscripts community.

Mike Dow

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Interfaces, Meaningful Use

As more providers go live with Allscripts, we often hear the request for better integration between the EHR and external devices. With all the biometric equipment in a modern practice, the goal should be to pull as much data directly into the EHR as possible. One of Allscripts’ largest clients in the Northeast is leading the way by pulling data directly from Welch Allyn vitals devices and Midmark EKG devices across Citrix.  There are also plans to integrate Holter monitors soon as well. This shows that it can be done, but there are some things to consider when going this route.

Device integration obviously takes some effort to set up and support. When you bring in third-party devices to the EHR, you need to take responsibility for that connection. Resources and time will be needed to manage and troubleshoot their communication.  It is critical that you have strong Allscripts technical resources available during this integration. Similarly, a strong partnership with the device vendor is important. Fortunately, device communication is getting increased attention from both Allscripts and many of the biomed device vendors. Make sure you are working with someone who understands the requirements.

Overall in our experience, the benefits usually outweigh the cost of support efforts, especially if the device is used frequently in a practice. Think about a clinic that takes vitals for each patient. The time that a nurse or medical assistant would otherwise spend manually entering each vitals panel can now be directed back towards the patient. The EHR becomes simpler to use, and its data becomes more accurate and reliable.

 For a Cardiologist who orders 15 EKG’s a day, being able to view them effortlessly from the patient’s chart is a great time-saver. One of the biggest complaints we hear from EHR users is that they spend too much time on the computer. By integrating external devices, you can give them some of that time back.

Allscripts is in the process of expanding its list of UAI certified devices, so be sure to check with an Allscripts representative for the latest list of certified manufacturers. The capabilities for device integration are improving quickly.

Tags: Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Integration

“The achievements of an organization are the results of the combined effort of each individual.”

                                                          -    Vince Lombardi

When Matt, Jason, and I co-founded Galen Healthcare Solutions in 2005, we made a promise to ourselves that we would embrace the things that we loved about the companies we had previously worked for and endeavor to eliminate or avoid the things that we didn’t. 

As we approach our 5^th anniversary, I think it is fair to suggest that the “hyper-growth” we have experienced as an organization has challenged our commitment to that objective.  One area that I believe we have remained steadfast, however, is that other than our people and the culture we collectively create, nothing else really matters.

The easiest part of managing Galen is setting expectations in terms of our people’s approach, attitude, and level of accountability.  We are truly blessed with a collection of professionals who simply relish the opportunity to make our clients successful.  The level of infrastructural support the group provides to one another constantly amazes me.  It often seems as though our people take more pride in the success of their fellow “Galeneer” than that of themselves.  Our culture has become self-governing; rewarding high-performers with the respect they deserve, but at the same time mentoring and nurturing those of us still in the earlier stages of the learning cycle.

It is for these reasons that when Galen recently received a bit of national acclaim, being listed 333rd among the Inc. 5000’s fastest growing companies in America (http://www.inc.com/inc5000/profile/galen-healthcare-solutions), we took it well in stride and celebrated, as a company, with an understated round of self-congratulatory emails and a few pats on each other’s backs.  Certainly, this was a nice recognition for all of the hard work that all of us at Galen have put forth, but alas, there are mountains that still need climbing and they obviously won’t climb themselves.  We’ll save the more “tangible” celebration for when we make our annual pilgrimage to the warm weather in a few months at our 2011 National Meeting.

During his keynote speech at the HIMSS conference earlier this year, National Health IT Coordinator Dr. David Blumenthal suggested that there is a need for more than 40,000 additional Health IT workers to support increasing demand brought on by EHR adoption, driven through HITECH funding.  Colleges and universities across our nation are actively training the people who will fill these roles today.  It is comforting to me to know that some small percentage of these individuals will have an opportunity to become a part of our organization.  That they will be embraced by a culture that won’t allow them to wander aimlessly, but instead will provide a foundation of guidance and support from which they can become impactful, accountable, and successful in their desire to see our vision for interconnected health care become a reality.   

They will, after all, be Galen People.

Steve McQueen

CEO

Tags: Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation

As physicians migrate to the Electronic Health Record, there are many new systems and processes they have to learn and adapt to.  One of these systems is voice recognition software, such as Dragon Medical 10.  I have worked with some physicians recently who were implementing a new EHR in their office, as well as transitioning from a transcription service to Dragon voice recognition.  This introduced some new challenges which I hope to shed some light on in this article.

Dragon Medical has the ability to ‘Type as you Talk’, which allows the user to dictate blocks of text and see this appear in their note in the EHR.  This has a huge benefit to the provider by allowing them to review and finalize their documentation for the visit immediately, rather than waiting a few days to receive the note back from a transcription service.  We discovered that there are some steps that you can take to improve the performance and/or accuracy of Dragon.  Here are a few to note:

1. Spend the time training Dragon to recognize your voice.  During this process, the application will learn how you speak, and adapt to your voice patterns.  This will prove to be very beneficial in the long run.
2. Follow the recommendations for the settings for your EHR vendor.  The Dragon representative will have recommendations on how settings should be configured based on the EHR you are using.
3. When words are not typed correctly, correct them using the built in features of Dragon to Train it on how you speak those words.  This will save you time and energy as you become a more advanced user of the speech recognition software.
4. Have reasonable expectations.  Dragon is a tool that improves over time.  When you first begin using speech recognition software, it only has a basic understanding of your vocabulary and how you speak.  It will take time for the application to improve, which will occur naturally as you train it when words are not recognized correctly.

These are a few items that will hopefully help you be more successful when using speech recognition software, such as Dragon Medical.  I have also found that it is beneficial to have a follow-up training session with Dragon after the user has been using it for a few weeks/months.  At this point, the user understands some basic functionality, and is usually interested in how to do more complex functions such as Macros.

Tags: Allscripts, Allscripts Enterprise EHR, Dragon, EHR Implementation, Enterprise EHR, Integration, Successful EHR Implementation

Tags: Allscripts Consultants, Allscripts Demo, Allscripts Enterprise EHR, Data Conversion, EHR Implementation, Enterprise EHR, Extensibility, Integration, Meaningful Use, ScanMD

As many of our loyal blog followers know, the Allscripts Client Experience (ACE) is Allscripts annual user conference, and a huge event for Galen. It’s a time for us to reconnect with clients, Allscripts contacts, and build new relationships. The theme of this year’s conference was “GO” – the time is now to implement an EHR, and ensure groups are setup to exhibit Meaningful Use.

Some of my own key highlights and takeaways from ACE:

• “The Path to Meaningful Use”
  • Allscripts offered a handy trail guide for ACE:

• The theme of “Community”
  • Our CEO, Steve McQueen, exhibited some pre-conference foresight in lending his own insight into Galen’s community
  • MyAllscripts - client portal for all Allscripts products facilitating collaboration via discussion forums, enhancement idea exchanges and blogs.

• Analytics
  • Dan Mingle, Chief Physician Execute from Maine MSO and Dan Reber, Lead Product Architect at Precision BI led an informative session on the Analytics product, touching on the correct process to implement Analytics as well as using the cross-tab analysis and linked group analysis.
  • I was unaware of its existence, but a user group community has been established for analytics
  • Precision BI has a roadmap for several improvements

• Aternity – an Allscripts performance monitoring solution
  • The ideal tool is non-invasive, comprehensive, accurate and provides an aggregated analysis
  • Facilitates user-centric proactive IT management
  • Yields performance by location, variation by site, and performance over time

• Allscripts Product Portfolio Roadmap – Jon Zimmerman, Allscripts Senior VP Solutions Management
  • Revenue Mix Changes:
    • Today: Fee for Service and Bonus Payments
    • Tomorrow: Fee for Service, Bonus Payments for Savings, Contract per Patient per Month, and Other P4P
  • Systems Evolution
    • Paper Health Records -> Electronic Health Records -> Electronic Health Systems -> Intelligent Networks
  • Connectivity Blueprint:
    • Allscripts HUB: Connecting commercial lab, hospital, pharmacy, payer, HIE, government registries, and sate RHIO
    • Services Framework: EntEHR, PM, ProEHR, MyWay

For more information regarding the topics touched on above, be sure to visit MyAllscripts to view presentations from ACE.

Thanks again for everyone who stopped by our booth to say hello. It was both great to see old friends and establish new relationships. And a special congrats goes out to Melissa Singh, Analyst at NSLIJ, for winning the grand prize – an Apple IPAD – in our “Spin and Win” drawing.

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