Archive for the tag 'EHR'

The Viral Workflow: The Bug That Spreads Within Your Organization’s EHR

Viral Workflow

You’re at your desk minding your business when Suzie Sneezer walks in, coughing, sneezing, and blowing her germs all over the office. She’s come to help you with a project and wants to show you something. So it begins, within two days everyone in your office is also sick with the sneezing and coughing. Suzie Sneezer, though well-intentioned, has spread her virus throughout the office like wildfire.

This can also happen with incorrect workflows, bad data entry habits, or unapproved workarounds which can be highly contagious. With the best intentions users often share “short cuts” or “tips” amongst themselves, and these can spread like a virus from user to user throughout an organization and infect the healthiest of EHRs. Some of these “Viral Workflows” might be just a case of the sniffles. On the other hand some viruses, if not treated aggressively, could lead to wide spread issues and have systemic effects throughout the entire organization.

As consultants we are constantly vigilant, always concerned with the health of our clients’ EHR systems and the well-being of the entire organization. While engaged with a single client, consultants may work with numerous members spanning the spectrum of roles within an organization, as well as other hired resources and vendors. This variance in role relations often allows us to witness firsthand the processes and/or workflows of many of the organization’s users, and are in a sense indirectly exposed to these “viruses”.

Below are some examples of “Viral Workflows” my colleagues and I have diagnosed and eradicated recently.

  • While managing an upgrade project for a client, our consultants discovered that 80% of their EHR users were logged onto webserver #1. Upon further research, they found that several months prior, webserver #2 began having issues but it had gone unreported. Instead of reporting the problem with webserver #2 to the proper department so it could be resolved, a user had concocted a “work around” to bypass the load balancer altogether. The provider showed a few users how to edit the URL to hit a specific server (clearly webserver #1), and before long the viral workflow had spread. To the provider this seemed benign so he shared his shortcut with everyone around him, though on a large scale it proved detrimental to the health of the EHR.
  • Optimization assessments often uncover chronic “viral workflows”. A clinical staff person was observed clicking the “reconcile” button during a patient work up in preparation for a provider appointment. Other than allergies, medications were not discussed during the time with the patient. When questioned by the consultant the user stated, “I was told in training if it is yellow, click it”. This user was not aware that reconciling the patient medications actually meant reviewing each medication with the patient. The clinical staff had been doing this for several years.
  • This viral workflow is very common and has been discovered by several consultants: in Allscripts TouchWorksTM, clinical staff who are pressed for time will search for a patient by name or MR# instead of selecting a patient from a provider’s schedule as prescribed by the best practice workflows. When saving any data changes, the application presents the user with an Encounter Selector, forcing the user to choose an existing encounter or create a new one. In haste a new encounter is often created. This virus has a trickledown effect that spreads to billing and coding, causing reporting issues that providers may eventually have to deal with as well.
  • While optimizing in preparation for an EpicTM conversion, consultants uncovered an issue while dissecting preliminary reports. They discovered that many providers were “removing” tasks or messages from the message basket rather than actually completing them according to the best practices. While seemingly harmless to the providers, they found that this fragmented process of “removing” instead of resolving was very cumbersome and was spreading like an infection throughout the system. Order cycles were not completing correctly, reports were not accurately capturing data, and a large number of results and un-signed notes would not have converted as desired by the organization.

Okay, I have some good news and some bad news. Why don’t we go with the good new first? There is a treatment and prevention for these viruses. That treatment is knowledge. Knowledge is the antidote that should be administered to eradicate many viruses within your organization’s EHR system.

As with the human body, some viruses are easily prevented with the proper inoculation. In this case, the vaccine would be proper initial training coupled with ongoing reinforcement, along with policies and procedures to keep users informed and up to date. This could prevent the majority of diseases from spreading throughout the EHR.

Just as with the health of humans, some viral workflows are hard to diagnose and have symptoms that are subtle or go unnoticed for lengths of time.  Until a secondary diagnosis becomes acute and causes severe symptoms or widespread problems throughout the EHR, users and administrators would never even know the system was “sick”.

Now for the bad news. It may take some cognitive effort to resolve the symptoms and cure your organization of the virus. Sometimes the treatment plan can be as simple as retraining users on a certain workflow or process, but that is not always the case. Evaluating and treating one “virus” can often lead to discovering another. Having an “if it ain’t broke don’t fix it” attitude can be detrimental to your system. With this mindset, organizations are most likely addressing one symptom at a time, nescient to the fact that eventually every group needs to consider a full system optimization.

Every organization should treat their system proactively and have a plan to maintain the health and wellbeing of their EHR. A full system optimization is the panacea for your organization’s EHR and its “viral workflows”. Think about it, your EHR is a like a living being, constantly growing, changing, and evolving. With upgrades, new versions, employee turnover, changes in government requirements, etc., your system is bound to need a checkup. Like a hacking cough, your organization may only be treating the “viral workflow” symptoms that become bothersome. The best plan of care for every organization’s EHR is to have a full top to bottom health evaluation (aka System Optimization) that eventually leads to a treatment plan to achieve a healthy system. Furthermore, a plan should be put in place to maintain the optimum level of health for your organization’s EHR.

Forget about the EHR, learn how to use a computer first

zoolander2

Zoolander. Dir. Ben. Stiller. 2001.

As I sat in an exam room last month awaiting my orthopedic surgery consult, my mind swelled with a lot of atypical patient questions, primarily due to the nature of my Healthcare IT background. Some of these thoughts included:

  • What kind of EHR are they using?
  • Do they have a patient portal?
  • Will they remember to give me a clinical summary?
  • Do all the departments use the same system? Or at least have interfaces to share this information?

Before I could even ask these questions or peek at what application they were using, we hit our first road block… the nurse could not log into her computer. It wasn’t because of a complex system setting or other unique set up, it was because of the dreaded…wait for it…CAPS lock! All of my questions were now replaced with wondering why standard computer training is not a part of EHR training?

Once she was able to login to her PC, she then had to login to a separate server to access the application which required another password. Again, she could not get logged in, this time because she couldn’t remember the password. After 15 minutes of this she finally gave up and did not document one thing electronically. It’s very easy to see that just a simple operation like logging into a system can create many minutes of waste for the staff and the patients, ultimately reducing the quality of care.

I have supported numerous EHR go-lives and not once do I remember a basic computer operation or typing class being part of the process. Many times during go-lives, the biggest obstacle I would face would be getting through to staff who were not comfortable using computers, let alone the EHRs. It’s one thing to train and support somebody on how to do their job using an EHR – but if they can’t even figure out how to login, click around, or type efficiently, you are going to have a very difficult time.

What can be done about this?

  • Conduct a computer skills aptitude evaluation to determine who would benefit from basic computer training
  • Implement SSO (Single Sign On) for applications so that once users login to their workstation, they can easily login to the EHR software as well
    • Badge readers can further streamline workflows because they allow users to swipe their ID cards to login and logout of systems.
    • This minimizes the amount of clicks and keystrokes required to access workstations and necessary applications
  • Condense the number of disparate systems throughout the organization to flatten the learning curve for new applications
    • This makes it much easier to share resources across an organization, enabling staff to more efficiently collect important patient information, and ultimately reduce patient wait times
    • Another side, but obvious benefit to this is a reduction in the unnecessary support and maintenance that comes from using one system in the hospital and another in the outpatient clinics
  • Simplify clinical documentation for your providers
    • Personalize the application to be as similar to your providers’ handwritten notes to make the transition easier for them
    • Consider incorporating some kind of voice recognition software, like Dragon, for providers and staff who are not efficient at typing

Although there’s a greater initial investment to train users on these basic skills, it will save everyone time in the long run and most importantly, it will increase the quality of care for your patients. Ultimately, isn’t that why we use computers in the first place?

Are You Ready for the Shift to Value based Payment Models? – Part 3

Erin's image

The level of excitement organizations are feeling with the prospect of moving to a value-based care approach, which we discussed in Part 2, is trumped only by the questions and apprehensions with how to get there.  Galen Healthcare Solutions is excited about the benefits of moving into value-based care, but how do our partners and our clients achieve the Triple Aim, while at the same time, adopting new payment models?  Is it possible to improve the experience of care, improve the health of populations, all while reducing costs?

The simple answer is, yes.

As organizations begin their journey to assume the financial risks associated with managing the care for large populations of patients, knowing where to start that journey is the challenge.  At Galen, we look to find the most efficient and effective ways to assist our clients in accomplishing their goals as they transition from fee-for-service to pay-for-performance models.  In an effort to help our clients find a care coordination solution that results in better care, better health, and lower costs, Galen made the decision to collaborate with PinpointCare.  The purpose of the PinpointCare solution is simple – develop a cutting edge platform to connect all of a patient’s care providers.  Together, PinpointCare and Galen have implemented a powerful solution for clients who participate in the Medicare Bundled Payments for Care Improvement initiative (BPCI), organizations who participate in bundled payment initiatives with private payers, and organizations seeking to better manage episodic events, chronic diagnoses, and wellness care plans.

The PinpointCare platform allows the care team to work with a patient to create a personalized, but dynamic care plan to support the patient through all phases of care.  An intuitive dashboard gives the care team the ability to closely monitor adherence to the care plan and make the necessary adjustments along the way.  The web-based platform that is available anywhere, anytime, allows real-time collaboration around the patient’s care in the acute setting, ambulatory setting, rehabilitation, skilled nursing facility, home health and outpatient physical therapy.  The care plan truly follows the patient throughout the entire span of their care, so at any point, if a patient is off-plan, immediate real-time adjustments are made to better care for the patient.  A patient’s involvement in their care plan is key.  With PinpointCare, the patient is involved from start to finish in developing the appropriate care plan to best meet their needs.  See how one patient was able to keep herself on plan when things went off course: Penny’s Story.

Whether the need is to track patients through a particular surgical or medical episode, through diagnosis and treatment of a chronic condition, or to track patients on a wellness care plan, PinpointCare is the solution.  The results PinpointCare have enabled are real.  A single organization utilizing the PinpointCare solution has seen a 14% reduction in hospital readmissions, a reduction of cost per DRG of 18%, and savings of over $3 million dollars – and those results are from a single year alone!  The agility of the easy-to-use platform, along with connecting the patient and the patient’s entire care network, truly allows for better health, better care, at a much lower cost.

Galen’s implementation methodology ensures that the execution of PinpointCare is very low impact to any organization.  Within a few months, Galen will configure the system, build necessary integrations with existing ancillary systems, develop customized care plans, train end-users, and launch the new platform for immediate use and cost savings.

The need to depart from an antiquated fee-for-service model is real and upon us.  The PinpointCare solution sets your organization firmly on the path to value-based care and puts the goals of the Triple Aim within reach.

Interested in seeing how PinpointCare helps move us into the new world of pay for performance AND helps achieve the Triple Aim by coordinating care by design?  Contact me at erin.sain@galenhealthcare.com

Clinical Data Conversion Testing, Client Roles and Responsibilities

Clinical data conversions are an everyday topic at Galen Healthcare Solutions.  As many hospitals and clinics settle into their EHR choices, we are seeing more and more groups begin to rethink their original selection.  Organizations and providers now see the benefits and subtle (or sometimes not so subtle) differences in functionalities between EHR applications. They are able to examine their EHR with more experienced eyes and evaluate whether the system meets their organization’s goals, how well it with other systems, the vendor’s stability, and ongoing EHR-related costs.  In addition to turning away from their legacy systems, many organizations are merging with or acquiring existing clinics, increasing the necessity and demand for clinic data conversions.

Galen Healthcare Solutions often helps clients with their clinical data conversion.  During these conversions, one area that is often overlooked is client involvement in validation.  Partnering with your conversion team for validation and testing of this clinical data is equally as important as it was with your initial implementation.

Who should be testing?

Your conversion team will need to test the clinical data that they are bringing over to your new system.  Our Galen conversion teams have clinical analysts who test and test and then test some more, stepping through your current and future workflows as provided.  Their clinical backgrounds allow them to be familiar with not just what the data should be, but how the data should look and how it will be used in your new system.

It is also essential that the client allow for sufficient resources with dedicated time to complete end user testing to avoid issues later on.

End user testing is usually performed by clinicians and other end users and is even more focused on identifying whether the converted data is working to meet the organization’s needs.

What are you testing?

Your structured data conversion is highly customized based on your needs. End users should test all the various workflow scenarios based upon the agreed functionality to ensure that the data not only has been entered into your new system accurately, and also that it is clinically sound and functional.

Beyond testing that the data appears correctly in the new system, you should also make sure that the workflows using the data are functioning as expected.   It is important that the target system display vital signs from the legacy system’s last patient visits, but can you also refill a medication based on the height and weight entries that are present? Are you able to trend the results being brought in from your A1C tests in your source system flowsheets?  Is your last colonoscopy date being brought in to trigger a reminder when your next one is due?  Can you report on the converted data sufficiently to meet Meaningful Use requirements?

Provide adequate feedback

Clients are responsible for verifying the correctness of the end user tests and reviewing the results with the conversion team to decide what needs addressing.

Galen’s resources can help facilitate a client with their testing, but it is important to be as specific as possible when providing your results.  We need to know how an error occurred and what steps were taken to create this problem.  You will need to provide patient identifying information, incident date/time details, a replicable error, and even screenshots when possible.  Without these details, it can be nearly impossible to duplicate or identify the issue.  Ultimately, a client needs to take part of the responsibility for ensuring that the clinical data entering their new EHR application has been thoroughly tested and meets the needs of the organization, providers and patients.

Galen Healthcare Solutions helps guide our clients through this end user testing phase with tools such as test scripts, organizing and leading testing sessions, results compilations, and even end user training on the system itself.  Galen takes pride in our many successful system conversions and our professional and technical service teams can help assist your conversion every step of the way.Check

Custom Reporting

“Allscripts TouchWorks is a great EHR, but is lacking in reporting.”  This sentiment has been expressed over and over by the people who use it daily. There are a thousand and one reports needed to deal with the wide variety of measures, and the differences between the reports can be subtle enough that a single canned report won’t cover many scenarios.

When it comes down to it, the EHR is meant to assist in the delivery of care; reporting, while useful, is a secondary consideration. That’s not to say that reports shouldn’t be included in the EHR, because a lot of value can be derived from them. They are useful in a multitude of ways, from simple reports such as problem-based patient populations, to reports on scheduled appointments or charges. Still, reporting often requires a finer level of detail than a canned product can provide, and even input parameters may not allow for that necessary level of control. Often, small differences in workflows cause data to be found in different fields, making out-of-the-box reports less practical. As requirements evolve, the complexity of even a simple report can multiply, and the reporting logic should have the adaptability to accommodate these changes.

In today’s data-centric environment, custom reports are incredibly useful in tracking progress on both external measures, such as HEDIS or PQRS, and internal organizational initiatives. There have been many variations of referral reports, such as the one Acton Medical Associates uses to analyze their internal vs. external referrals. Sunny Herguth, the Clinical Director at Acton, had this to say about their report:

The referral tracking report is used all the time to track referral trends and to use to see who we do not receive reports back from once a patients sees a specialist.

This is a great example of a custom report used for internal purposes. Knowing where referrals are going, and from which providers, can give an organization insight into areas that might be improved.

Another example, from OrthoVirginia, addressed the issue of providers not signing notes. Rhonda Coor, COO, explains how they use the report:

When my group decided to more closely monitor the signing of notes, I turned to Galen to write a custom report so I could track my physicians’ compliance.  The report is the only way I can stay on top on how the physicians are timely dictating and signing their notes.

This particular report was used to guide providers to complete their charting, though other reports have been used as a carrot rather than a stick incentive.

Custom reporting also contributed to the American Medical Group Association’s (AMGA) Measure Up/Pressure Down program, an initiative to improve hypertension patient care and the general health of this patient population. Rather than a regularly run EHR report, this report was designed to pull percentages of patients who met certain blood pressure criteria. Baptist Medical Group collaborated with Galen on the necessary parameters for the patient groups, and Galen developed several queries to extract and compile this data. The AMGA and Baptist leveraged the data to deliver better care to their hypertension patients, with the end goal of building a healthier patient population and reducing healthcare costs for the organization.

I’d like to conclude with an anecdote from Tom Goodwin, manager of Clinical Systems and Clinical Data Quality at MIT Medical:

In this electronic age it is hard to tell an exciting story about a printed sheet of paper. But if the sheet of paper serves as many purposes as I am about to describe I think you would agree that it is at least worth a smile.

In order to provide a high level of service, MIT Medical, like every other healthcare organization, needs to collect a tremendous amount of information from our patients. This information feeds billing, supports Meaningful Use and Joint Commission initiatives, ensures patient safety, and most importantly helps to improve the patient clinician relationship.

The MIT Medication Worksheet is unique to the presenting patient and can be printed from the schedule in a batch for the day or on the fly from a number of spots within the chart. Based on information we already have in our electronic health record, the patient is asked to verify standard demographic information, to support Meaningful Use they are asked to verify race, ethnicity, preferred language, their smoking status, and if they would like a clinical summary. For Joint Commission they are asked about special needs. For safety they are asked to verify existing allergies, the medication list as displayed in the electronic health record, and they are asked to write down any medications prescribed by an outside clinicians as well as over the counter or herbal medications that are taken on a regular basis.

Using this worksheet gives our patients a sense of how well we know them. They are more active participants in the care they receive and they aren’t frustrated by being asked to newly produce the same information at each visit.

Our friends at Galen Healthcare helped to make this and many other enhancements to our electronic health system possible. We truly value our partnership with Galen.

Custom reports can provide tremendous value. They can expose workflow deficiencies, assist in clinical and administrative decision making, and provide necessary data to third parties for patient care or financial reimbursement. Let Galen help your organization make better use of your EHR data. For further information, please check out a sampling of custom reports on our website or contact sales@galenhealthcare.com.

Next Page »