Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Does your practice utilize the Finish Note task in Allscripts Enterprise EHR^TM? 

If you answered yes, then this blog is for you.

In this article, I wanted to show you two possible outcomes when working in your  v11 Note. You will notice that there are two similar workflows to add and commit clinical data in the note that will impact how a Finish Note task appears in a user’s task list.

While you will find that these two workflows are scaled down to be very basic and generic, I wanted to limit them to clearly demonstrate the difference between the two.

Workflow #1: Committing data while saving and closing the v11 note

In this workflow, we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Select “Save and Close” in the Note window
4. Select “Save and Continue” on the Encounter Summary
5. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- One Active Finish Note task

So in this case, using the Current Patient – All or Current Patient – Active task views, you will see that just one Finish Note task has been created in an active status.  The task indicates that the note has been created and saved.  Keep in mind, at this point, that the commit action occurred while the user selected Save and Close in the Note. In this workflow, the system only reviewed the data once.

Workflow #2: Committing data prior to saving and closing the v11 note

As we did in the first workflow, here we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Click the Commit button
4. Select “Save and Continue” on the Encounter Summary
5. Select “Save and Close” in the Note window
6. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- A Complete Finish Note task and an Active Sign-Note task

If you use a task view that simply shows Current Patient – Active, you would not typically see the Finish Note task in this instance, but instead the Sign-Note task.  This means the note has not been signed and might not be the task you expect to receive if you seek the Finish Note task.

While a Finish Note task has been generated and marked as Complete, there may yet be information to add to the note.  The logic behind this workflow is that the second action of “Save and Close” is the second review after having hit “Commit”, and therefore results in the outcome we see here.  In this case, the system has reviewed the data twice, and the Finish Note task in regards to this note is completed and the active Sign Note task is automatically generated.

My advice in this situation is to follow Workflow #1 when working in a v11 Note. If users are creating a note and adding clinical data, but need a provider or second user to receive a Finish Note task and add additional items to the note; use the first workflow.   This way, the Finish Note task will be assigned and visible to the correct person, and users will be trained in such a way that ensures the success of this workflow.

Please don’t hesitate to leave your feedback below or Contact Galen Healthcare Solutions should you have further questions!

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, Galen Webcast Series, Tasks, TouchWorks, v11, v11 Note

Super-users are integral to an organization’s ability to be successful before, during and after an EHR implementation.  They serve a number of purposes, which include assisting during go-lives, being a first line resource to end users post go-live and helping to identify gaps in workflow. In order to provide the level of support needed, they also have a higher level of training than the typical end-user.  This training is often role specific and consists of:

• Monitoring the print queue
• Unlocking notes
• Troubleshooting basic EHR issues (e.g.  can’t get something saved, note attached to wrong encounter, etc…)

The selection of super-users plays an even bigger role in the overall EHR lifecycle.   Unfortunately, figuring out how to choose the “right” super-users can be quite challenging for many organizations.   The natural tendency seems to be to select office managers, people who are “good” with the EHR and/or long-time staffers, but this method often yields poor results for the following reasons:

• Office managers are not consistently actively working in the system.  There are exceptions to this rule however.
• End users who are “good” at using the EHR, may not be “good” at teaching others and/or troubleshooting issues within EHR.
• Long time staffers may know their job and the clinic well, but they also may not be the best teachers or be the most knowledgeable about the EHR.

Figuring out how to select the finest super-users can be as simple as following the process below.  You can be comfortable in knowing that this process has been followed my many organizations across the country (large and small) and far exceeds the alternative of figuring it out as you go, or figuring it out after the fact.

• Ask for volunteers.  Make sure to explain the position and the expectations clearly so that potential super-users can make good informed decisions.  People who WANT to take on the extra responsibility will undoubtedly do a better job than those who are forced into it.
• Recruit at least one front office and one back office super-user.  It would also be worthwhile to have back up super-users to account for vacations and sick days.
• Recruit those individuals who are well respected among their peers.
• Use people who not only have great computer skills, but who have great people skills, patience and who are good problem solvers.
• Always recruit people who actively use the system on a day-to-day basis.

Following the recommendations as outlined can help your organization achieve the best possible outcomes, while also providing  a more positive EHR experience to  end users overall.

-Litisha Turner, MS, BSN, RN

Clinical Consultant

Tags: Allscripts, EHR, Implementation, Super-users, Training

This week, the world lost one of the most innovative people of our time. Steve Jobs, co-founder of Apple Computer, passed away leaving behind quite the legacy. I feel obligated to honor Steve Jobs this week and reflect on how he affected technology in health care.

It is amazing to reflect upon the history of Apple computers. It seems not too long ago, I was learning how to use a Macintosh computer playing Number Crunchers and Oregon Trail in Elementary school. Back then, the idea of a computer with a mouse was relatively new technology! Twenty years later, Jobs’ vision has evolved technology well beyond that grey box, keyboard, and mouse.

Take this timeline for example:

• May 1984 – Macintosh was released using a graphical user interface controlled by a mouse (courtesy of Xerox technology)
• April 2010 – Apple releases the first iPhone, optimizing a user interface that would pave the way to the iPad and an extensive library of applications that remains the most popular OS to developers today.

What an advancement in technology in twenty six years! So while the only Apple product I own is an iPod, I remain deeply amazed at the technology Apple offers and how much its technology touches our lives. Apple products remains as probably the most popular choice for mobile computing in the United States.

Business Insider published an article in July 2010 titled “10 Ways The iPad is Changing Healthcare”.  While it’s a quick click through the list, you certainly get a feel for the opportunities the iPad has presented to healthcare. Examples included “Going Green”, cost savings, and information consolidation. All this was made possible with the vision of Steve Jobs.

Did you know?:

According to Wikipedia on Steve Jobs:  “Jobs is listed as either primary inventor or co-inventor in 338 US patents or patent applications related to a range of technologies from actual computer and portable devices to user interfaces (including touch-based), speakers, keyboards, power adapters, staircases, clasps, sleeves, lanyards and packages.”

Being in the Electronic Healthcare Record industry, I want to share a couple examples that resulted from Jobs’ technology.

Thank you to the iOS software and the work by developers at Allscripts^TM, there are two applications that Allscripts^TM offers that can be utilized using an iPad or iPhone.

ePrescribe:

This application allows providers to use their iPhone/iTouch to view patients from their Practice Management System.

Features:

• Summary page that identifies and presented problems, allergies, unprocessed medications, and any active medications
• Allows providers to write prescriptions using an excellent, user-friendly design
• Displays formulary indicators and DUR
• Can submit Rx’s direct to Pharmacy, Send to Mail order, and send to a printer

For more information on Allscripts^TM ePrescribe, visit their webpage to learn more.

Remote EHR:

This is another excellent application that is utilized by healthcare facilities using the iOS software that allows providers to remotely control their AllscriptsTM Electronic Health record from any location.

Features:

• Provides real-time access to patient summary information
• Includes ePrescribing to the patient’s pharmacy
• Integration with Charge capturing and attaching diagnosis codes to scripts
• Compatible with Allscripts^TM Enterprise EHR v11 (among other Allscripts products!)

For more information on Allscripts^TM, visit their webpage to learn more. Additionally, Galen Healthcare Solutions offers a Wiki page with more information regarding Remote EHR.

So, thank you Steve Jobs for making such applications possible. Remote EHR and ePrescribe are two examples of the results of Jobs’ achievements and have allowed for better patient care.

Share your thoughts! Give us your feedback on how you’ve used this technology in healthcare and how you see its benefits or contributions.

As always, do not hesitate to contact Galen Healthcare Solutions for more information.  Galen is a Preferred Platinum Partner of Allscripts^TM .

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, ePrescribe, Healthcare IT, iOS, Remote EHR, Steve Jobs, v11

Technology in healthcare is taking a huge step forward. Wellpoint, Inc has announced that they will be using a commercial version of IBM’s Watson supercomputer.

Not too long ago, a room full of computer hardware once computed at a power less than what our cell phones currently do. Now, a room full of computer hardware will equate to a computing entity with the intelligence to assist physicians with medical decisions.

You may know Watson best for its performance on the Jeopardy game show. Watson demonstrated swift decision making after indexing over 200 million pages of data. Watson would only answer if the system crossed a certain confidence threshold.  The confidence threshold was a predefined percentage set inside the system. When Watson referenced the data, it determined the percentage to which it was sure the top three answers were correct. If the percentage of the top answer crossed the confidence threshold, Watson would signal for the answer. The IBM machine proved itself successful against two humans competing in the game show by winning both rounds.

Certainly physicians and members have much to gain from the assistance of a machine that can reference millions of pages of data to ascertain a diagnosis or treatment.  While physicians may always hold the upper hand to interpret the context of the situation for a presenting patient, Watson’s assistance can certainly supplement any decision using vast amounts of data in a quicker time frame.

In an article posted by EMR and HIPAA, it noted that “One of the keys in the AP article above and was also mentioned by Dr. Nick from Nuance was that the Watson technology in healthcare would be applied differently than it was on Jeopardy.  In healthcare it wouldn’t try and make the decision and provide the correct answer for you. Instead, the Watson technology would be about providing you a number of possible answers and the likelihood of that answer possibly being the issue.” The article later went on to state:  “Saying that perhaps 25 percent of all healthcare errors are errors of diagnosis, Kohn [IBM Chief Medical Scientist Dr. Marty Kohn] noted how getting the diagnosis right can prevent all kinds of unnecessary complications and spending. “Of course, if you’ve made the wrong diagnosis, picking the right course of treatment becomes a challenge,” Kohn said.

So how might this affect the EHR world? The electronic EHR would be used as a reference for the Watson system. Previous prescriptions, orders, lab results, presented problems, among others, would all contribute to Watson ascertaining a confidence threshold.  Once a confidence threshold is reached or passed, the system would suggest a route of possible treatment, or determine a possible diagnosis.

With the advances in accuracy, these decisions can come back to the EEHR and certainly provide more efficiency and cost savings for the practice. The technology undoubtedly proves to be a win-win situation for all players in the healthcare industry.

 What do our readers think?

Tags: Business Intelligence, EHR, Healthcare IT, IBM Watson

This morning, Shahid Shah over at the The Healthcare IT Guy blog, published an article outlining why medical device data is the best way to fill meaningful use EHRs and conduct comparative effectiveness research (CER). What was of particular interest to me is the way in which Shahid elegantly broke down how unstructured and structured data is “sourced” today (scroll down in the blog article for the graphic).

As is evident by the table above, many of the existing MU incentives in Phase 1 (patient reported and healthcare professional entered especially) promote the wrong kinds of collection: unreliable, slow, and error prone. Accurate, real-time, data is only available from connected medical devices and labs / diagnostics equipment.

Given that meaningful Use and CER advocates are promoting (structured) data collection for reduction of medical errors, analysis of treatments and procedures, and research for new methods it’s important to see that we’re not going to get real gains until the medical device vendors are fully connected and providing data directly into EHRs or clinical data warehouses.

Shahid’s article brings to light a larger issue within the industry – a lot of meaningful data is captured in an unstructured fashion. Dr. John Halamka brought this to light in a blog article earlier in the year which addressed “Freeing the data.” In this article, Dr. Halamka suggests that businesses will always have a combination of structured and unstructured data and that businesses must find ways to leverage this unstructured data:

In healthcare, the HITECH Act/Meaningful Use requires that clinicians document the smoking status of 50% of their patients.   In the past, many EHRs did not have structured data elements to support this activity.    Today’s certified EHRs provided structured vocabularies and specific pulldowns/checkboxes for data entry, but what do we do about past data?   Ideally, we’d use natural language processing, probability, and search to examine unstructured text in the patient record and figure out smoking status including the context of the word smoking such as “former”, “active”, “heavy”, “never” etc.

The value of unstructured patient narratives was addressed in detail in one of last year’s Health Management Technology articles – specifically the section which addressed Mining unstructured data:

As EHRs become increasingly widespread due to the billions of dollars in federal stimulus incentives, harnessing unstructured clinicians’ notes gives us the power to yield valuable patient data. With each year of data, more information will be gathered that could be used to find predictors for diseases or adverse effects of treatment that would otherwise have gone unnoticed by most traditional research studies. Though challenging, capturing and delving into this data will be worth the effort, and could potentially help healthcare institutions meet requirements for CMS reporting and for meaningful use, access funding and, most importantly, improve the health of entire populations.

At Galen, we have developed a solution that addresses current limitations with regards to extraction of structured note data within built-in Allscripts Enterprise EHR functionality. Galen’s NoteXML solution is designed to facilitate the querying of data contained within Allscripts Enterprise EHR v11 Structured Notes. These notes are not stored inside the EEHR as discrete data, but rather as XML documents that aren’t easily query-able. The solution has helped our clients extract pertinent MU reportable data that otherwise would not be discretely available.

Again, the aforementioned solution does not facilitate data mining of unstructured note data. However, companies such as Nuance are engaged in “‘unlocking’ unstructured clinical documentation, sometimes referred to as the ‘narrative blob’” Nuance’s NLP solutions assist in collecting and reporting on various diagnostic, quality and safety measures. I have yet to see this integrate directly to the Allscripts product line, but anticipate this possibility in the future months.

I’m curious as to how other groups and organizations are addressing the gap between unstructured data capture and discrete data extraction for MU and quality reporting? Are organizations relying on third-party solutions such as that offered by Nuance?

Tags: Data Mining, EHR, EHR Unstructured Data Mining, Extensibility, Meaningful Use, MU, Natural Language Processing, NLP, Reporting, UNstructure EHR Data

This is the first (in my humble opinion) controversial article to be published on the Galen blog and was inspired by the challenge issued  by John Lynn over at EMRandHIPAA.

I personally like to call it blog sparring. Basically, you take someone else’s post and provide the opposing perspective or at least you add to the conversation that they started. I love these types of interactions with other bloggers. Plus, I love the deep dive into a specific topic that happens when you do this type of blogging. As a reader, I think it’s fun to read the various blogger’s perspective on the topic. So, on that note, I’m going to make the next week, Blog Sparring Week.

Let the parallels between the EHR and the ATM, and between patients safely visiting the hospital and flying in a plane stop here. I find it interesting that humans natural gravitate towards drawing comparisons on past experience. It’s a lot like how the federal government based the model for Regional Extensions Centers (RECs) on the model for US agriculture, which was intended to disperse new info to the family farm. Alike agriculture, the goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation. Yes, it’s true that there are lessons to be learned from other industries, but as Keith Boone of at the Healthcare Standards blog recently pointed out, it must be done thoughtfully.

Recently, Brad Waugh, CEO of Navinet, brought up another Healthcare IT analogy – that of Air Travel and Interoperability – on the Navinet Blog:

The patient in the National Journal article, after being sold a flight departing months past his desired travel date, after he is required to fax in a consent form, and after he must call a separate company to handle his baggage, informs the customer service representative that in a modern system, he would be sold “a safe round-trip journey, instead a series of separate procedures. It would have back-office personnel using modern IT systems to coordinate my journey behind the scenes. The systems and personnel would talk to each other automatically. At the press of a button, once I entered a password, they would be able to look up my travel history. We’d do most of this stuff online.” He’s describing the way most industries operate today, from air travel to banking to freight transportation, all of which are able to successfully communicate between systems, companies and types of data.

While it’s true we often wish that the healthcare industry was as efficient and safe as the aviation industry, the fact of the matter is, patient safety is harder and will require more effort as Jeff Terry, Managing Principal, Clinical Operations, asserted on the GE Healthcare Quality & Safety blog.

Why is patient safety harder? You be the judge:

1. On any given day in the United States, there are about 800,000 inpatients and many more outpatients. By contrast there are about 30,000 flights per day.
2. The major US airlines fly about 25 different types of planes. By contrast, the ICD-10 lists 12,420 diseases. Each plane, like each disease, requires different protocols to manage.
3. There are 2.5M nurses compared to 200,000 pilots

And that brings us to the recently asserted Boone’s Law, first published on Keith’s aforementioned blog:

Boone’s Law

It’s very similar to Godwin’s law, but related specifically to Health IT.  In any sufficiently long discussion of Healthcare IT, the probability of a comparison being made to the financial sector approaches unity. Keith’s corollary is that that in any sufficiently long discussion of patient safety, the probability of a comparison being made to the aviation industry also approaches unity.

Key points:

1. Transaction payload – Single pieces of data are not being transmitted in the payload with healthcare. Conversely, financial transactions however are very small (include account holder identity info, merchant identity info, and a transaction amount.
2. Business model – in financial transactions, there’s a payment model already built in, who would pay for it in healthcare transactions and why?
3. Regulation, Trust and Security – The financial industry deals with audit trails, logging and security, but again, back to point #1, single pieces of data aren’t in the payload, there are instead hundreds or thousands – especially with imaging studies.

I’ll leave off the debate with an article I read while taking the train home last evening –  “Point to Ponder” written by Greg Gillespie, Editor in Chief, Health Data Management.

Aviation experts quoted in a Wall Street Journal article predict the accident will result in a shake-up of pilot training over concerns pilots have abdicated too much responsibility to computer aids and, when those aids malfunction, can’t handle emergencies because of rusty piloting skills.

Not sure anyone would argue the health care industry is in any immediate danger of being over-automated, but the question of whether automation serves the user, or vice versa, is an important one. Industry gurus typically point to aviation as a model for medical reform, and there is absolutely no question that automation has increased aviation safety. But automation shouldn’t lead us to a point where a pilot stops being a “real” pilot, or a clinician a “real” clinician.

Well put Greg. As much as computers aid our decisions, we should never completely remove or undervalue the human element.

Tags: Air Travel, ATM, EHR, Financial, Healthcare IT, HIPAA, Integration, Interoperability, Patient Safety, REC, Regional Extension Center, Security

Galen Healthcare Solutions was founded on the belief that the Allscripts Enterprise EHR is the premier ambulatory electronic health record and the conviction we could add more value to the community by focusing on client side implementations.  Over the past 5 years, we have watched that dream become a reality in many ways.  We are currently working with hundreds of clients and have over fifty experts working on our team in a variety of roles.  Our vast expertise is a critical component of facilitating our partners’ successful deployments and advancements of the electronic health record. 

At Galen, we believe strongly in sharing our success and giving back to our community.  One of our driving tenets internally is to “Perpetually Learn and Share”.  As a team member at Galen, it is not simply an expectation to further one’s knowledge of new and evolving areas of the application and stay current with the latest releases but a requirement. Furthermore, we foster a collaborative environment where this experience and knowledge are communicated to the entire team.  This has been instrumental to our success and ensures that when you work with a Galen team member you are getting full access to the resources that define our organization. 

This goal is not just an internal method for us to keep up to date and deliver value to our clients; it is also our philosophy to share this knowledge with the community for free.  We have established many forms of knowledge sharing for the community and our hope is that we are able to further educate the entire industry by doing so.  Throughout the years, we have actively expanded our roster of free guidance and I’m proud to affirm we now have three ways to share this knowledge:

The Galen Wiki – This houses the industry’s largest source of free Enterprise EHR information.  We currently have many customers, competitors and colleagues that use this repository on a regular basis to research and share information.  The Galen Wiki also allows you to sign up for an account if you’d like to share information.  If you haven’t accessed this site, we hope that you’ll take a minute to see what we’ve shared.  (http://wiki.galenhealthcare.com/Main_Page)

Galen Webcasts – Many groups utilizing the Enterprise application have benefited from the various webcasts that we have offered to date.  Our team offers a few sessions each month to cover various topics, including technical and functional based sessions.  The overall feedback has been remarkably positive and we feel this has been a great forum to educate the community and share some of the experience we’ve gained.  These webcasts are free to join and are announced on our website.  If you haven’t attended a session, we encourage you to register for one of the upcoming events!  (http://www.galenhealthcare.com/calendar/)

Allscripts Interface Developers Network – Most recently, we launched a new forum dedicated to the Allscripts interface developers community.   This is meant to assist with questions and advice for interface developmental needs.  As the content and usage grows, our hope is that this will become the primary place to research interface advice or post a question with the challenges you are currently facing.  If you are an interface developer or work with interfaces on a regular basis, we suggest that you check it out and post questions or suggestions you may have.   (http://interfaces.galenhealthcare.com/)

These forums are our way of giving back to the community that has supported us throughout the years.  As we continue to grow and identify further needs, we expect these to continue to grow as well.  We hope that each of you is able to gain valuable insight from each of these resources and cultivate your own expertise so you can in return perpetually learn and share.  Together we will conquer the challenges universally faced within health care today and ensure that everyone in the community is well prepared to implement and deploy the Allscripts Enterprise EHR.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, EHR, Galen Webcast Series

Were you aware that the moment the IS staff plugs a USB connector into a medical device to send data from it to another device, the organization could become the manufacturer of a completely new medical device and subject to recently announced Medical Device Data System regulations from the FDA? Were you aware that devices that collect and store data from a blood pressure cuff for future use or that transfer thermometer readings to be displayed at a nursing station for future use are considered an MDDS product and thus governed by the FDA?  Well if you didn’t know, you are not the only one as neither did I until attending the latest New England HIMSS (NEHIMSS) Monthly Event and Social Tuesday evening at the Papa Razzi in Wellesley, MA.  Rick Hampton did a phenomenal job of running through the rules and regulations surrounding “Integration of HIT & Medical Devices.”  Rick is a Clinical Engineer who has helped write several international standards, including the latest on risk management of integrated HIT and medical networks.  He works for Partners HealthCare as their Wireless Communications Manager.

Rick outlined the trend in increasing attention being paid to HIT integration efforts over the past few years.  The latest are new FDA rules from February 15, 2011, which specified “Medical Device Data Systems are off-the-shelf or custom hardware or software products used alone or in combination that display unaltered medical device data, or transfer, store or convert medical device data for future use, in accordance with a preset specification.”  He then discussed how the new standard, IEC 80001-1, was written to help hospitals perform proactive risk management when creating these integrated systems.

Currently, Electronic Health Records (EHRs) are granted an exception from being considered a medical device, however one might anticipate the day when they are considered as such and are regulated the same as a Laboratory Information System (LIS) or Radiology Information System (RIS). For an interface analyst such as myself, the implications are that there will be liability in the exchange of unsolicited results (for instance) between the LIS and the EHR. For those Allscripts users, this also brings into question the applicability of the regulations on the Allscripts Universal Application Integrator (UAI), which provides Allscripts Enterprise EHR the ability to interface with third party applications. An example would be a Welch Alynn Vital device.

A great question was posed from a HIT project manager in the audience who inquired about where this all fits in the scheme of all of the potentially competing projects in the enterprise (HIPAA 5010 EDI, ICD10 and MU come to mind), and also, where does it come into play in terms of the project to get the necessary departments together to discuss compliance? Often times the clinicians, end-users or decision-makers have already procured the software/solution/system and simply hand-off to IT to implement, and unfortunately it is too late by that point to perform the necessary risk assessment and ensure compliance.

Additionally, Rick provided a great link for organization’s to participate in the AAMI/ACCE/HIMSS Risk Analysis Survey to ensure compliance. This survey is intended to obtain baseline information from healthcare delivery organizations about the application of risk management during the healthcare technology life-cycle (eg. acquisition, deployment, use, modification and retirement).

On a side note, this was my first NEHIMSS meeting which I attended as a member. The group has historically been very gracious in allowing non-members to attend free of charge, but to me it made sense to invest $30 for a chapter membership (essentially a drop in the bucket). Not only do I get great exposure to topics and presentations I normally wouldn’t have access to, but I also get the opportunity to network and form contacts with fellow members of the HIT industry.  To me, that is a $30 well spent (by Galen of course .

Lastly, for those project managers out there, be sure to register for the 5^th Annual New England HIMSS/PMI-NH Project Management Symposium, hosted at the Sheraton Portsmouth Harborside Hotel in Portsmouth, NH. There are some great speakers presenting who will surely offer valuable insight into their experiences with initiatives that directly impact the healthcare organization today (Patient Portal, PM’s role in an EMR implementation, Project Managing a 5010 and ICD-10 upgrade, and HIE implementation to name a few). CPHIMS Credits will be offered for this event as well!

Tags: Allscripts UAI, EHR, FDA, IEC 80001, Integration, Interfaces, Interoperability, LIS, MDDS, Meaningful Use, Medical Device, NEHIMSS, New England HIMSS, Partners, RIS, Universal Application Integrator

Last Wednesday I attended the VITL Summit ’10 in Burlington Vermont.  VITL is non-profit “public charity” that operates as a partnership between the public and private sectors; VITL receives funding from the federal and state governments, as well as the Vermont Health IT Fund.

As part of the HITECH Act (Health Information Technology Extension Program) VITL became a Regional Extension Center (REC) and received $6,762,080 in Round 1 funding from the ONC.  RECs provide: training and support services to assist doctors and other providers in adopting EHRs, information and guidance to help with EHR implementation and technical assistance as needed.

The Summit Key Note speaker was Dr. David Blumenthal, the national coordinator for health IT.  Vermont Governor Jim Douglas was also there to emphasize how important the topic is to the state.  Dr. Blumenthal’s speech touched on a variety of topics and as expected, stressed how important the adoption and use of EHRs is to the future of how doctors practice medicine.  An interesting personal note Dr. Blumenthal shared was about his daughter who is currently in Residency.  Her current rotation had her moving from a practice that used an EHR to a practice that did not.  Her immediate response… ‘how could someone possibly be affective without an electronic system in place?’; an opinion father and daughter obviously share.  Along those lines, he suggested that new doctors, fresh out of medical school, would know nothing other than an electronic practice.

Additional notes from Dr. Blumenthal’s remarks;

• Dr. Blumenthal is an self-proclaimed “non-geek”, with a house in South Pomfret, VT.  He believes Vermont serves as a model for how EHR/HIE programs could be designed and thinks VT has a unique, competitive edge because of its collaborative spirit and natural desire to exchange information.
• Some reasons he thinks EHRs develop better doctors;
  • 24/7 Information access – problems, meds, history, etc
  • “See” what’s been done – even if you weren’t around when it happened
  • Knowing/receiving result more quickly
  • Decision support
  • Interaction checking – allergies, meds
• The big benefits of adoption – (most, if not all are oft repeated by those in our industry)
  • Reduce costs – an important point for many of the individuals participating in the conference.  Short term improvements in terms of reducing operational costs of a practice (efficiencies), longer term.. see next bullet.
  • Increase the quality of care – this was a point he expressed a number of times.  He pointed out that perhaps not in phase 1 of MU, but long term (phases 2 and 3), this was the ultimate goal.  I.e. EHRs would improve patient outcomes, remove redundancies and ultimately affect overall patient health.
• 3 Barriers of EHR adoption (+1 more)
  1. Financial
  2. Logistical/technical – especially for smaller practices.. there is a tendency to think it’s too difficult or time consuming
  3. Sharing – Will sharing patient data be accepted?  Will it actually hurt my practice?
  4. Trained workforce – Dr. Blumenthal mentioned that many more colleges and universities are now developing disciplines in Healthcare IT (including some in Vermont!)
• Meaningful Use will be here before you know it…
  • Practices will have 2 years, from Oct 1^st , to pick an EHR and meet MU requirements for reimbursement.  DO NOT wait.  Time will pass quickly and inevitably a bottleneck will develop.

In a separate presentation, VITL’s HIE offering was discussed.  Connection to an Exchange like this one will eventually be a requirement for all those participating in the MU program.  VITL’s exchange is run by GE and like other HIE’s, employs a hub and spoke model to connect practices and make the exchange of patient data possible.  Besides the physical network making the connections and the software platform running the exchange, HIE policy will play a large part in how information is shared.  Whether individual patients choose to participate, what privacy rules are in place and how security is managed will all play a central role in an HIE.

An interesting part of the Summit was the presence of all the big vendors; GE, McKesson, Greenway, NextGen, Athena, Cerner, Medent, eClincalWorks and of course Allscripts.  The interesting part came from being able to go from both to both and see one application after the next.  Seeing and feeling the dramatic differences in how they each work, look and perform.

This year’s event was sold out and overall seemed like a big hit with everyone in attendance.  Great job VITL!

Tags: EHR, EMR, HIE, HITECH, REC, VITL

The Path to Meaningless Use:

As many of you know the ACE 2010 event just took place last week. As I was pouring through some of the handouts I couldn’t help but be drawn into the “Handy Trail Guide” which Allscripts has touted as “The Path to Meaningful Use” This is a great high level guide to reaching Stage 1 of Meaningful Use – Capture and Share Data.

The more I read through this the more I thought of how clients will be looking at this with an eye to the shortest path to receiving their stimulus check, and rightfully so – every group should be looking to take advantage of this, from the largest hospital to the smallest single-doc practice. However, I wanted to make sure we don’t lose sight of the forest from the trees here and bring this trail guide back to the true reason for the stimulus – improving patient care! Hence the genesis of this article, The Path to Meaningless Use.

There are a couple of main points I’d like to highlight before dissecting the step by step approach.

1. Sell benefits of the EHR – I feel like this process is woefully underappreciated. In order for your rollout to be a success you absolutely need buy-in from all end-users, including physicians, nurses, data-entry folks and really any person that will touch the EHR on any level. How is this product going to improve their productivity? Make their job easier? Make their work experience more enjoyable?
2. Change is a good thing – Change is the process by which innovation and improvement are instilled. I know that people are comfortable with the status-quo and yes, change for change sake is useless, but there’s a reason for change here, I promise! Challenge your co-workers to look at everything objectively and really question if the products and processes currently in place really make sense or if there could be a better way.
3. Make concessions, don’t over-customize – The product is designed to work best when used in an out of the box capacity, sans customizations. The reality is that you probably aren’t going to be able to sell the idea of changing every workflow to fit the product, but that doesn’t mean you shouldn’t try. Ultimately in the long term the stability of the system is most closely tied to how close you stay to it’s intended use, therefore fight for those process changes to model the system, there’s a reason the EHR was designed the way it was! This point goes back to selling the benefits, be able to show how using the new workflows will actually improve the end-user experience!

With those main points made here are a few comments on the step in the Path to Meaningless Use, enjoy!

1. Understand Stimulus – Don’t just aim for the stage 1 level of capturing and sharing data, yes this can improve productivity but don’t lose sight of the true end goal, improving patient care.
2. Assess Gaps – Be honest with yourself. Are the tools you are using as efficient as they could be? Don’t keep old processes and tools in use just because people are “comfortable” with them, if there is a better tool out there, use it! Sometimes taking people out of their comfort zone is exactly what is needed to promote healthy growth.
3. Design New Workflows – Don’t be unwilling to change workflows simply because that’s the way it’s always been done. Be prepared to pitch workflow re-design to physicians with benefits for them in mind.
4. Upgrade EHR & Stimulus Set – Don’t rush this upgrade. There are many factors that go into an upgrade (depending on how many versions you are jumping) and simply upgrading for the sake of getting the stimulus approved version may end up biting you if you haven’t correctly re-worked process flows to use the EHR in a meaningful way.
5. Rollout – During training stress benefits to end users, a 3 day crash course on the new EHR system is great but if you can’t prove to your end users why the new product and workflows make sense you aren’t going to receive full buy in and consequently won’t get the most out of the product.
6. Begin 90-day Meaningful Use – Metrics should be kept on an ongoing basis, not just for 90 days. It’s great to hit the 90 day plateau to receive the stimulus check but the true purpose of the EHR is to improve patient treatment, and you can’t improve what you don’t measure.
7. Report & Claim Stimulus – Nothing meaningless about this step, claim the money and move on to the next stage!

Tags: Allscripts, EHR, Meaningful Use, v11 upgrade