Archive for the tag 'EHR'

Urgent Care Centers – Epic ASAP or EpicCare Ambulatory

You work in an urgent care center (UCC) and your organization has chosen Epic for your electronic health record. The next question may be, “should we use the ASAP or the EpicCare Ambulatory module?” Keep reading! I will share my experience and give some helpful tips.
At an organization I recently worked at, we didn’t initially have a choice. Our emergency department and UCC were using a legacy application specifically designed for the ED. At initial implementation, the decision was already made to go-live with the ASAP module. Advice from Epic convinced us that this was the correct decision; our UCC evolved from our ED and the biggest difference was that the UCC treated fewer acute patients. Our UCC was not like our ambulatory clinics because of the fact that we didn’t schedule patients; we actually used a third party ADT system. All was well, or at least we thought.

As our project went along and the clinics started to roll out with EpicCare Ambulatory, the UCC staff started to question the choice. New providers were coming on board. Most of them were now using EpicCare Ambulatory in their office. We started investigating whether to switch the UCC to the ambulatory module.
Epic has excellent guidelines to make this decision. We started by reviewing four basic workflows –

  • Staff mix and whether they work in other departments
  • The ADT process
  • Patient tracking needs
  • Our admission to the hospital process

We already knew that the acuity of our patient population was varied from low to medium-high acuity. These patients would be treated more efficiently with the ASAP module. The use of the Nursing Narrator facilitated documentation of staff, medication administration, and vital signs, to move many patients through the system efficiently. These tools provide for much more efficient documentation. Even though very acute patients were diverted to the main hospital, our workflows were enhanced by tools like the Nursing Narrator.

At initial go-live, most of our nursing staff worked full time at our UCC and they were comfortable with the emergency room application they were currently using. If the majority of your staff also work in an office environment, you may want to consider EpicCare Ambulatory. The transition may be smoother.
If your patients are pre-scheduled and checked in when they arrive, this may also indicate that EpicCare Ambulatory is a better choice. Because we worked with a third party ADT system that was also used for billing, our choice at the time was non-negotiable.
The most important topic, that confirmed we wanted to stay with ASAP, was the tracking functionality built into ASAP. We already tracked patient wait times, throughput times, and were already using an electronic ‘grease board’. We knew where the patients were located and their status. This was functionality that we ultimately decided we could not give up.

The final decision was also based on our admission and billing process. If a patient needed admission to our hospital, we had to discharge them first, due to billing concerns, and then “arrive” them to the hospital. This was also non-negotiable and made our decision to stay with ASAP final. Often your billing process will influence the decision. If your patients are admitted directly to a hospital, does the UCC bill roll over to the hospital bill or are they kept separate?

When making your decision, you also need to consider Meaningful Use (MU). ASAP is not part of the software package Epic certified for EP MU. Consider your options and workflows carefully before making this decision.

So, which module works best for you? This can be answered by researching your current state workflow. If you are like my previous organization, our UCC is run like an ED, the staff do not work in an office setting, the ADT process is similar to the ED, and most importantly, we rely on the patient tracking functionality for the majority of our day, you may choose the ASAP module. Your choice may be EpicCare Ambulatory if your providers are planning to attest to EP MU guidelines, your workflows are more similar to an office visit where patients are scheduled and checked in, and the patient population is more similar in acuity to an office visit. And lastly, collecting co-pays in EpicCare Ambulatory is an easier process than attempting to document copay collection in ASAP.

The good news is that whichever application you choose, you may be able to use functionality from both modules. If you chose ASAP, and still want the ability to schedule patients, you can use the ‘expected patient’ workflow to pre-create a patient encounter. You can free-text the reason for the visit and the expected time of the patient’s arrival and then arrive them in ASAP. For EP MU attestation, when using the ASAP module, you will may need to create custom reports. Also, EpicCare Ambulatory does track some patient event times like check-in, registration, and total stay times. This may satisfy your patient tracking needs. If you have staff who work in both the UCC and the ED, the user roles can be configured to allow them to access tools needed in both departments.

The choice of which module to use, ASAP or EpicCare Ambulatory should only be made after reviewing your current state workflows and prioritizing what functionality you must have. After evaluating which MU incentives apply to your organization, your choice should clearly be one over the other. Let me hear about your experience.

Responsibility Matters: A Message from a Data Analyst

I recently read an article that raised the question of who owns your health data. By ownership, I am referring to who has the power to either access or give someone access to your medical information. There are many interested parties in knowing all about you for valid reasons:

  • Your PCP wants to know what care you have received so s/he can effectively manage your health
  • Your specialists want to know your medical history so they can rule out contra-indications and assess for conditions that could affect the effectiveness of your treatment plan
  • Your insurance providers want to know the health status of their covered patients so they can effectively calculate the risk of their covered members
  • Your state and federal governments want to know population level data so they can effectively manage public health and policy initiatives

Those are a lot of players interested in what is recorded about you in EHRs around the country. Do each of those players need to know everything about you? When we visit a physician to deal with a problem, we are putting our trust in them to make medical decisions for us. Certainly they may need to know your medical history. Therefore, we could say that every physician we interact with should have the right to access your medical record. I don’t know about you, but as a patient that sounds scary. A dermatologist doesn’t need to know about a patient’s erectile dysfunction to remove a wart!

I am currently working on HIE and ACO integrations and have been grappling with the technical challenges of seamlessly integrating information from Medicare’s Opt-Out program and from the ACO’s opt out program with the care management programs that the PCPs have signed up for. This got me thinking, if I have the right to withhold medical information from my physicians, can I hold them responsible for missing a diagnosis when they did not have a complete medical history or medication list? Providers certainly don’t think so! While we haven’t found it yet, there is a balance between sharing enough information for everyone to do their jobs, and the patient taking responsibility for managing their medical record. At the core of the ACO model is the concept of a PCMH which focuses on the physician-patient relationship as a way for both of them to manage the patient’s health together. If we as patients want to have ownership of our medical identity yet still provide the necessary information for everyone to do their jobs, then it is time for us patients to become more involved with all the members of our health management team and to understand the implications of both sharing and withholding information.  As a data analyst, I know most organizations share healthcare data securely with only those who need it and data is not being abused. As a consumer, I also know that nobody predicted that FICO scores would be used by insurers and employers. We need to know who is using our data for what purposes and voice our concerns to our healthcare providers and lawmakers.There are many benefits to sharing data openly with ER docs, ACOs, state HIEs, etc. that I am sure you can imagine. So if you are choosing to withhold your information, I urge you to review the implications of withholding information and the responsibility it places on you with your PCP.

As a childhood hero of mine was once told: “with great power, comes great responsibility!

Let My Data Go!

I recently had a nice chat with a colleague analyzing HIT industry trends for Kalorama Information. Kalorama does industry research for the medical and life sciences for many of the major news and consulting organizations. I got in touch with her specifically because of Kalorama’s analysis on EHRs in 2012 which was used by Bloomberg Government for their (very expensive) EHR industry analysis for provider and vendors. She found that in 2012 one of the most immediate challenges for providers was implementing EHR systems that meet meaningful use standards. She also found that vendors were having trouble with interoperability and usability.

Fast forward to 2013; a lot has changed. Epic has grown to dominate many markets. Allscripts has a new CEO and a few new toys to play with. eClinicalWorks has become a force to be reckoned with in the small practice space. However, the challenges the providers are facing have changed. My colleague and I talked for a while about various organizations we each have worked with and came to the same conclusion: providers are now having trouble with interoperability and conversions of data.

2013 Priorities

The majority of physician offices have implemented EHRs, but they must now communicate with other entities such as HIEs and ACOs. With the increase in mergers and acquisitions, we are also seeing an increased demand for conversions from one system to another. These problems involve a thorough understanding of the underlying data structure as well as a solid foundation in interoperability standards such as LOINC, HL7, SNOMED, and CDA. The vendors have the expertise to work on the problems for their products, but they are not enthusiastic about helping clients switch off their platform. Selling the EHR has been the primary goal for vendors in the past, not technical support that moves a client away from their product. Vendors are under the assumption that if they make switching off their product difficult, then clients will be less likely to undertake the conversion or integration with a product that is not part of the vendor’s family of products. While this is definitely true for disgruntled clients, it only makes it frustrating for clients who do not have a choice in the products they work with. This reality has led to some very important questions.

Where is an organization to go when their own vendor is not supporting their efforts? How do organizations extract meaningful data from such complicated or cloud based databases? How can we become self-sufficient in managing our data? How does an organization meet new institutional and government requirements? Galen can help clients with these challenges, but vendors need to help by making products that play nice with others.

At the end of our conversation my colleague and I simultaneously came to the same conclusion: “Organizations feel like their data is being held hostage!

Analytical ACOs, the next Dot-com bubble… ?

In the mid to late 90’s, at the beginning of the Dot-com bubble, the World Wide Web was available to anyone as long as you had a computer and a dial-up connection.  If you had these, you had the necessary resources to get connected and were likely eagerly seeking new websites to explore.

Now, imagine you are providing healthcare services, and you have the following resources available to you to enhance your practice that you did not have 15 years ago:

With plenty of IT staff and government money, the next best step is to invest in a major analytical/data mining department. To be able to effectively use an ACO, there is a critical need for analytics or the use of “Big Data.” According to a report by IDC Health, advanced analytics is a top priority for participants in ACOs. The question I keep asking myself is; “Who is the first to the pie?” Insurers? Hospitals? Medicare?

When 40 hospitals and 30 health insurance companies, as well as interviews with industry experts and vendors were asked the different ways they were interested in using analytics:

  • 66% of survey respondents cited identifying at-risk patients;
  • 64% cited tracking clinical outcomes; and
  • 57% cited clinical decision-making at the point of care (Government Health IT, 3/15).

The difficult question that hospitals are faced with is how they can implement a sound, efficient analytics department. The first company to emerge that satisfies this need will benefit greatly from this opportunity. At this point, you may still be wondering what the Dot-com bubble has to do with analytical ACOs. The picture I’m trying to paint is the hospitals are the stockholders; the government is the venture capitalists, and the companies providing analytical tools are the web site companies. I think the ACO analytics market is very fragile right now because of immature or inexperienced buyers investing in a very green market. The lingering question out there is; where will you be when the bubble pops?

ACO bubble_Dollar

Allscripts Strategic Acquisitions

A couple of weeks ago I wrote a blog post on the current trends in the EHR industry. I mentioned that users of Allscripts products have increasingly been switching away from Allscripts to other vendors. Either Paul Black at Allscripts is following this blog, or he looked at the Allscripts client list because he is looking to reverse that trend. On March 6th, Allscripts announced its acquisition of two companies dbMotion and Jardogs in an attempt to improve both their Allscripts product lines and to continue to enhance to the Allscripts community’s ability to share information openly. For those of you who may be worrying about Allscripts’s commitment to its own products, don’t fret! Concurrent with this acquisition, Allscripts has pledged over $500 million to improve its own product offerings. However, some of you may have never heard of either of these newly acquired companies, so I thought I would provide a brief overview of each acquisition.


Sold for $235 Million 

dbMotion was founded as an independent company in 2004 in Israel with a significant investment from the University of Pittsburgh which hoped that dbMotion could help solve some of its data interoperability needs. dbMotion lets healthcare companies take data from many different electronic records systems and normalize it to a common data structure That data normalization helps hospitals with business and clinical intelligence, and it lets patients access all their health data in one central location. Allscripts likely bought dbMotion because data analytics and open sharing of information is where the value and growth will be in healthcare now that most hospitals and physician groups have a core electronic record system in place.



Sold for undisclosed amount

Jardogsis a Springfield, IL based company that has seen use of its FollowMyHealth online health record grow to about 13,000 hospitals and other health-care providers nationwide. The cloud based FollowMyHealth solution, which Jardogs launched in January 2011, gives patients access to a single online portal in order to send and receive information to and from their doctors, hospitals and other health-care organizations. This means that patients can have immediate access to their medical records, including test results and doctors’ notes.  As a founding member of the CommonWell Health Alliance, Allscripts sees the Jardogs product line, specifically FollowMyHealth , as a promising opportunity for increased patient engagement which aligns with the Allscripts Open platform strategy.



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