Archive for the tag 'EHR'

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.

It’s All in Your Head

“We have some custom workflows and configurations but, it’s not documented anywhere.” These are challenging words for a consultant to hear. It should not be “All in Your Head”. Without documentation, resources must sometimes rely on several unfamiliar sources to gather pivotal information. This could unknowingly lead to time and effort spent on a futile process. With larger organizations, many departments function with complete autonomy and that can sometimes lead to fragmentation within an organization.  Consultants focus not only on the individual user role, but on the entire patient care process as is flows through the organization and each user role involved.

Having an accurate EHR Configuration Workbook (CW) to offer consultants, or even new vendor resources coming on board, may not only save all parties from performing redundant work, but also the some billable hours. When a client contracts a consultant to assists them with a project, one of the first things they are asked for is their EHR System “Configuration Workbook (CW)”. Unless the project is very refined or specific to one function, this is an invaluable tool to give to a new resource at the project kick off. As consultants, we are hired by clients to not only consult, but more often than not implement system changes that touch many aspects of the organization. One small change to a client’s current system configuration can affect groups of users, entire departments, and sometimes even teams that function outside of the CEHRT.  Because of the intricacies of each client’s organizational set up, it is important for onboarding resources to have a clear understanding of how all the pieces work together.

Examples of items that organizations could include in their CW in addition to the standard:

  • List of all moving pieces – The PM that is used, the various environments being maintained, server diagrams and lists, Patient Portal, HIE, etc.
  • A grid w/ Products version and status – Upgrades, Installs Patches or hot fixes, dates etc.
  • Organizational Hierarchy with high level process – Does your Org have a separate support team for the EHR, a Network team, an MU Team, a compliance department, or a separate training team?
  • List of ‘Go-to’ people for information – Who should be contacted and how for questions.
  • MU Status – What stage, which CQMs are being reported, are there any EPs that are exempt, etc.
  • Custom workflows or processes – Is there a call processing or triage team, do certain sites have POC lab testing, does the org use and follow the standard work/task lists?
  • Up to date user list – The list of users should be current with a process in place for on-boarding new users or inactivating user profiles and assuring that user EHR assignments are captured and reassigned as needed.
  • List all interfaces – What interfaces are in place and what department monitors these.  Does your org primarily use Quest, LabCorp, or a local hospital?

The scramble to meet imposed deadlines is a common denominator amongst clients and documentation that is not an obvious and immediate requirement may not seem like a priority. However, organization should maintain a current CW with managers and/or departments leads doing their part in keeping the information captured up to date. All organizations no matter what product they are running would find this a tool that could be used for many purposes as a whole and information extracted from for many reasons.

Lastly, it is important to have a department or team take ownership of this documentation and commit to maintaining its accuracy. Evolving governmental requirements have pushed the industry of EHR technology to develop and roll out new functionality at a rate most organizations struggle to comply with. Having an accurate Configuration Workbook for the organization both now and going forward will become an invaluable tool of reference not only for hired resources or consultant but most importantly, for the client’s organization.

Assess and Optimize

The Assessment and Optimization of your IT needs, although previously covered, is a topic that I believe too many organizations put on the back burner. Therefore, an organization that assesses both current and future needs while incorporating achievable goals and defined metrics will be a successful business. In the healthcare market these goals might be to meet Meaningful Use, Patient Centered Medical Home (PCMH), or ICD10 standards. They could also consist of achieving financial goals such as reducing days in A/R, claim rejections rates, or reimbursement analysis of your payers to make sure they are indeed paying per your latest contract. Many organizations only review the health/performance of their electronic health record (EHR) and/or practice management applications when issues arise or it is time to upgrade. However, that is not the best time to do an assessment of your processes and system health. We do our budgets annually but many organizations also do a 5-10 year budget. This is done to anticipate changes and plan for the future. In the realm of Healthcare IT, change is the only constant. Healthcare Reform stresses the importance for health prevention to improve efficiency and to lessen long-term costs. In order for your organization to operate at the highest efficiency, it may smart be tie to perform a check-up on your system to see what tweaks can be made to improve system or user performance.

Strategic thinking – Does your organization know of a new regulation or service that will need to be offered in the next 1-5 years? Let’s take ICD-10 as an example, which has been a long time in the works. Many organizations waited until the last-minute to finance and schedule their system upgrade/enhancements and to begin training staff on the new requirements. Had ICD-10 not been postponed, several organizations would not have been ready. Was your organization one of those scrambling? Is your organization wanting to add a service to their offerings in the next 3-5 years such as an imaging solution? Will it need to be integrated? Can your current architecture handle that additional interface? These are important questions to ask, on a regular basis. According to an article by Forrester, Inc.¹, the assessment ideology is outlined as follows:

  1. A repository of application data. Planning provides a common inventory of application data including costs, life cycles, and owners, so that planners have easy access to the information that drives their decisions.
  2. Capability maps. Forrester recommends using capability maps to link IT capabilities to the critical business processes they support. These software tools provide a graphical tool that clearly outlines how the business capabilities that IT provides to the business are linked to IT efforts. This can also be known as an IT Roadmap or technology roadmap.
  3. Gap analysis tools. Alongside capability maps, planning tools capture information about the future state of business capabilities as dictated by business strategy. Users leverage this functionality to identify the areas where IT capabilities need to be built, enhanced, or scaled back — driving IT strategy.
  4. Modeling and analytic capability. These tools enable planning teams to create a variety of plans, which can then be compared to one another to weigh the pros, cons, and risks of each. In addition, their impact on architecture and current initiatives becomes visible. This keeps plans relevant, provides teams with the foresight to plan holistically, and enables IT to communicate the plan clearly.
  5. Reporting tools. Reports guide the planning team’s decisions — for example, which applications have redundant capabilities, have not been upgraded, or are plagued with costly issues. IT strategic decisions are therefore more easily justified. the management process are used in business policy and each person are able to promote the policy of data feeds and how much process are able to know the process is build up in each and every process of management data.

After an assessment has been conducted and action items have been identified, the optimization strategy needs to be created. When doing so, make sure to prioritize the critical needs either by cost, time, or strategic incentives. It’s also important to note that there are different levels of optimization including design, build, compile, assembly, and source code. Optimization should start with workflow analysis and skill level of staff. Why does it take Mary 10 more minutes to check in a patient than it does Joan? Is it a skill level issue or are they using two different workflows? This could simply be a training need. Another common issue we see is that Dr. Smith closes his encounters within a 24 hour window, however Dr. Jones sometimes takes more than 72 hours to close an encounter. Again, this could just be a work ethic issue, but many times it is a workflow issue that we can fix with a little tweaking of Dr. Jones’s preferences or settings. Galen can assist clients with the assessment of needs both on the technical and professional service side of the practice. We can also help with an optimization of workflows and systems to get the most bang for the many bucks you have invested on implementing these products. There are also many customizations and tools that can be of great benefit and aid in the achievement of organizational goals.

You might be saying to yourself a few things; “we already do this,” “we can’t afford to have someone come in and do an optimization”, or “we can do this ourselves so why hire someone?” To this I ask you, how do you know that your optimization is being done to its fullest extent? Bringing in an outside consultant can be scary and nerve-racking, but it can be very beneficial. Galen’s consultants have worked with hundreds of different organizations and have learned the most efficient ways to bring positive improvements to different IT systems. Even when an organization feels as though their challenge is unique and overwhelming to solve, through our extensive experience we have been able to bring lessons learned from other organizations to resolve your specific concerns. The comment I hear most when discussing consultant options is “how can we afford this? ” Instead of focusing on the upfront costs, it should be looked at as an investment which you will recover overtime. One of the biggest investments in your practice is time. Staff time is precious, not only to your organization but to them personally. They don’t want to put in 10 – 12 hours days. They have life outside of work. If you can save money on time-saving adjustments to workflows, tools or simple changes to settings that is priceless . Would you not want to get an hour back in your day or reduce staff overtime? It is very possible to do so.

To discuss any of these topics with us please contact us here. We would be glad to share with you what we have done with other clients and what we can do for you. We are not cookie cutter, we tailor each client service to their needs as we know every one works just a little bit different.

Resources: Forrester Research, Inc 2010 Blog “Tools for IT Planning” by S. Leaver

What Do You Mean They Are Retired?!?

During recent upgrades to 11.4.1, clients have encountered a bit of a surprise: Retired Problems!  There are regulations that require IMO (Intelligent Medical Objects) to retire codes behind some of the terms organizations have diligently mapped to Medcin terms in the PMT (Problem Mapping Tool).  These changes do not affect the ICD-9 and ICD-10 codes, but rather the terms’ “behind the scenes” database codes. I’ve seen lists of retired terms on clients’ systems stretch anywhere from zero to a couple hundred lines long.  Some will be resolved through SYNC and by trickle down, so take a deep breath… it isn’t as bad as you might think.

Allscripts is continuously working to keep up with these retired problems and to find solutions to mitigate their impact, including a Retired Problem script that the Upgrade Tech can run.   Here are some tips to reduce your time with the retired problems and your end users’ time spent on problem conversions. Granted, some problems will need to be converted by the provider due to the specificity required, but for less specific terms, this will help.

Before the upgrade process begins, be sure that you have loaded the latest mapping files from Allscripts.  Do this by clicking the “Check for New Version and Download” button and then, if the “Apply New Version to PMT” button becomes active, be sure to apply that too.  Rerun your frequencies so you have the latest numbers, which will help you find the terms later in the process.  Review and approve the new Allscripts mappings (look for the green star), and be sure to complete and approve all terms that you want mapped.  Keep in mind that the PMT only picks up the approved mappings, and everything you haven’t approved will not be converted.  (If you need assistance with mapping, Galen can assist)

Ask your IC and UT about the Retired Problems list shortly after the Test/Pre-Prod system upgrade to allow more time to work this list.  The tech will take the files from the PMT and move them to the new system where the ATP (Allscripts Terminology Platform) is working.  This system communicates with IMO and will supply the latest active terms. After the UT runs the Retired Problem script, work your spreadsheet to find and remap the retired problems in your PMT.  Sorting by frequency will expedite the process, so ensure that you run the frequencies before the tech moves the files to the test system.   

Be sure to point your PMT to the Test/Pre-Prod environment before you start remapping.  This is where the active IMO terms will be available for use in your system.

Once you are done remapping, the UT can rerun the script to be sure you got them all.

I hope this little post has helped you to understand what to expect when it comes to PMT and your upgrade and will make the process a little less stressful.  For step-by-step instructions on how to work with the spreadsheet and PMT, see the Galen wiki.

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