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

 In this demo, we will present Allscripts Enterprise EHR and RelayHealth Portal integration capability. This solution facilitates seamless integration between the two applications, offering single sign-on, messaging between provider and patient,and patient online indicator functionality.

Contact us today so your organization can realize the compelling benefits of Enterprise EHR RelayHealth Portal integration.

Tags: Allscripts Enterprise EHR, Allscripts Patient Portal Integration, Application Integration, EHR Patient Portal Integration, Enterprise EHR, Extensibility, Integration, Patient Online Indicator, Patient Portal Integration, RelayHealth, Single Sign-On

CMS released a couple of updates last month regarding Meaningful Use and the EHR incentive program. I wanted to pass this information along to our readers.

In their December 7 update, CMS indicated that “HHS announced its intention to delay the start of Stage 2 meaningful use  for the Medicare and Medicaid EHR Incentive Programs for a period of one year for those first attesting to meaningful use in 2011”.  The reason as such, according to them, is that the current schedule for compliance to Stage 2 could be a challenge for those that attested in 2011. The decision also was in consideration for vendors and practices.

 The CMS update identified some benefits from the proposal:

• The delay could provide vendors more time to develop their certified technologies for Stage 2
• The delay could also provide providers more time to implement the new software to meet Stage 2 requirements
• Expectations remain current so that providers attesting in either 2011 or 2012 begin Stage 2 in 2014
• And while 2011 has passed, CMS believed this idea would provide added incentive for providers to attest in 2011.

While I am sure there is a group of people out there that is ambitious enough to keep pace for this process, I am certain that we all can stand to benefit from the proposed delay.  The benefits from the added amount of time for both the vendors and practices/providers seem more appealing, in my opinion.

Back on December 1, CMS also announced a new tool to help Eligible Professionals (EPs) through the phases of Meaningful Use.  This tool is an eighty-five (85) page PDF file, dubbed as a “Beginner’s Guide”. This file provides a thorough, interactive walkthrough of Meaningful Use.

Among the items of information provided are:

• EHR Incentive Program basics
• How to participate (determining eligibility and registration)
• Meaningful use and choosing measures
• Attestation
• Helpful resources on the Medicare and Medicaid EHR Incentive Programs

Lastly, they also provided a link to their Educational Materials page for the EHR Incentive Program. This link offers an extensive array of files and tools regarding the EHR Incentive Program.  This is definitely a link to bookmark, as well as the guide previously mentioned.

If you haven’t already done so, visit the CMS EHR Incentive Programs webpage and register to receive their email notifications. 

Contact Galen Healthcare Solutions for any additional questions regarding Meaningful Use and Allscripts Enterprise^TM EHR.

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

With the release of version 11.2, Allscripts Enterprise EHR^TM has the ability to define acceptable ranges for vital sign readings based on age and gender. Once this range is defined, when a vital sign is input and falls outside the defined range, users are alerted that this value is an abnormal result.  The alert is shown as a red beaker, displayed next to the value in either the Health Maintenance Plan (HMP) or as bolded, red text in the Note Authoring Workspace (NAW).

While four vital signs (Systolic Pressure, Diastolic Pressure, Heart Rate, and Respiration Rate) are pre-delivered with ranges, clients can create their own ranges for any other vital sign, such as Weight.  These ranges are defined solely using the SSMT tool using the RID – Reference Range content category.  This means that clients do not define these ranges anywhere inside the Enterprise^TM application, instead, are only able to be defined using SSMT.

Tip:  The four pre-delivered vital signs will need additional values populated as the user configures the reference ranges.

First and foremost, the organization needs to ascertain what the actual ranges will be.  The NIH Clinical Center provides their guidelines of vital sign ranges. One example of guidelines they provide is Pediatric resting values.  The organization should be aware of the resources should determine which guidelines to follow, whether it is the American Heart Association or NIH Clinical Center.

Once the decision has been made for which data will drive the decision to move forward and be used by the organization’s EHR, the System Administrator can begin to use those decisions to load the data to the system.

Now let us explore the basic fundamental steps to set up the Vital Sign Reference Ranges.

1. First be sure to backup any data prior to making changes in SSMT.
2. Access SSMT and extract the data from the RID – Reference Range content category
3. Copy the data to a spreadsheet that has the cells formatted to “text”
4. Edit the spreadsheet; the following are the applicable column headers:

• [A] HDRResultable Entry Code: value from the Code field in the Resultable Item dictionary
• [B] Resultable Entry Name: value from the Name field in the Resultable Item dictionary
• [C] Where Performed: can be a null value – if populated the range will apply to the resultable item specific to that preforming location
• [D] Reference Range Type: must be set to Numeric
• [E] SEX: leave blank if using for both genders, otherwise M for male and F for female
• [F] Lowest value: lowest allowable value for the vital sign to be considered normal
• [G] PanicLowValue: needs to be a unique value and at least one more than [F] and less than [H]
• [H] LowNormal: needs to be a unique value and at least one more than [G] and less than [I]
• [I] HighNormal: needs to be a unique value and at least one more than [H] and less than [J]
• [J] Panic High Value: needs to be a unique value and at least one more than [I] and less than [K]
• [K] Highest Measureable: highest allowable value for the vital sign to be considered normal
• [L] Reference Text: This can be set to indicate the text to be displayed in the Results Entry dialog screen indicating the range. So if the range from [F] to [K] is 40-90, indicate such in this field.
• [M] Answer: This field is left null.
• [N] Abnormal Flag: Does not need to be set to any value
• [O] Is Inactive (Y/N): Set to Y if setting an item to be inactivated, otherwise set to N
• [P] Create (Y/N):  Must be set to Y if creating a new entry, otherwise set to N
• [Q] Age Min: beginning point for the age range; the lower number
• [R] Age Max: ending point for the age range; the higher number
• [S] Age Units: units of the age range; ex: Days, Months, Years

1. Save the spreadsheet
2. Be sure to clear the text box field in SSMT
3. Copy all applicable rows of data from the spreadsheet and paste into the SSMT box (do not copy the header row)
4. Load the data
1. Return to the Enterprise EHR^TM application and validate using a test patient the applicable vital(s)

While these are basic instructions to successfully set the reference ranges, the steps should provide success in loading the reference ranges.  There are a few main points to reiterate in this process:

• Please back up any data prior to using SSMT.
• Pay close attention to the bullet steps for the column headers indicated above. Certain columns require certain information.
• Ensure the Resultable Item information is reflected in the spreadsheet as it is in the RID
• Keep in mind that columns [F] through [K] must be populated with unique values, that are not 0. [F] must be the lowest acceptable normal value, while [K] must be the highest. The numbers in between CANNOT be the same value!
• Set [P] to a value of Y when creating new values
• Try loading one line to begin – to ensure set up is correct.

 It is important to note that this enhancement has no direct effect on Meaningful Use Core Measure 8 – Record Vital Signs. The Record Vital Signs Objective states: “Record and chart changes in the following vital signs: (A) Height (B) Weight (C) Blood pressure (D) Calculate and display body mass index (BMI) (E) Plot and display growth charts for children 2-20 years, including BMI”. The measure being “for more than 50 percent of all unique patients age 2 and over seen by the Eligible Professional, height, weight, and blood pressure are recorded as structured data”. In reviewing the measure documentation, there was no mention of measuring whether or not the vitals being recorded are being flagged as abnormal.

Allscripts Enterprise EHR^TM version 11.2 offers a plethora of excellent features and this functionality certainly allows users to optimize the system and how charts are viewed. The return from defining these ranges is to provide the visual indicator that certain recorded vitals are abnormal for the patient in context.  So, while there may no added benefit from a Meaningful Use standpoint, there is certainly clinical benefit to utilizing this functionality.

Tags: Allscripts, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, v11

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

The system is upgraded to Allscripts Enterprise EHR^TM (AE-EHR) version 11.2.x- now what to do? Evaluation of current workflows and deciding on the Meaningful Use measures the organization will be using are the next steps. This article will cover some basic key concepts of Meaningful Use as it related to the application and processes as well as examples to provide the foundation to move forward and build. Ideally, obtaining a baseline of the workflows currently used today in each site/clinic prior to the upgrade itself is the recommended approach. This article will highlight at the end the recommended timeline and priority items to provide the best success of not only the upgrade but more importantly capturing meaningful use.

Step 1- Evaluate current state workflows of each site and the role of the end user population

Even if the site recently went Live or had training- end users continuously find new ways to use the application. AE-EHR version 11 in general provides multiple ways to enter information and despite the best training and/or trainer, an end user may change their behavior over time.  Not only will a potential different workflow result in inaccurate testing of what is believed in the workflow; it may potentially allow for an area of missed training when moving to version 11.2. Here’s a great example, suppose clinical staff were not trained to enter problems, however over time the providers and office managers of a site have asked clinical staff to enter the problems for physicians. This would have an impact on training for meaningful use. Or, perhaps the staff is trained to enter smoking status on the social history but behavior has recently changed by the end users and they started capturing it in the comments field in vitals because the end user thought it would be quicker.

The best approach is to go to each site and evaluate each role on what they currently do in the application, as well as how they document in the application. This will allow the testing team to accurately test the role based workflows as well as train as appropriate on workflows. Once the current workflow is established then the foundation for configuration and re-training can begin.

Step 2- Decide which of the Meaningful Use Measures will be used by the organization.

The 15 Core measures will be required by all eligible providers, however only 5 of the 10 menu sets are required.   Additionally, of the 44 Clinical Quality Measures, three of the Core or Alternate Core will need to be used and three of the remaining Clinical Measures will need to be decided upon in order to have a total of six Clinical Quality Measures.

This step can be quite a task depending on your organization. Here are some sample questions to ask:

• Who will be the lead decision maker?
• What teams need to be informed of the Meaningful Use objectives- Business Admin, Executive, Physician Core team?
• Are there multiple teams that will make decisions on different aspects (clinical versus business versus administrative)?
• Do those key decision makers know about Meaningful Use and if so at what level – high-level or detailed?
• Will basic ARRA- Meaningful Use training be required?
• How will government incentives be paid out (to the organization, to the physician, to the site)? This will be asked at meetings and better to be prepared when instituting workflow change.
• What providers are eligible in the organization?
• Will the eligible providers report for Medicare or Medicaid?
• Who is responsible to enroll each provider with CMS?
• Does an analysis of potential eligible providers need to be assessed to make the decision of MU reporting?
• Does an analysis need to be done, and what patient population and/or diagnoses are seen by eligible providers to select the appropriate Clinical Quality Measures?
• Will eligible providers have a choice on whether to participate in MU reporting or will it be decided by the organization?
• Will each site, specialty, or provider select the measures (MENU and Clinical Quality Measures selections) or will it be directed from the organization?
• Will there be a team dedicated for Meaningful Use?
• Who will track the user’s behavior to ensure the necessary information is obtained?

These basic questions will allow the core Upgrade/Meaningful Use team to be prepared for configuration, workflow re-design, testing, and end user training. Each item can have a direct affect on one of the aspects of the upgrade/MU project. For example, if all eligible providers will be allowed to decide which measures they will select for reporting then the configuration team will need to configure to all CORE, MENU, and all 44 Clinical Quality Measures. In addition, if each provider selects their own measures ideally the training would be tailored around the measures for that eligible provider. Training all providers on all 44 Clinical Quality Measures or all 10 MENU items that may not pertain to that provider will not increase retention of the information and workflow change and likely decrease the MU reporting success.  Another example, from the above proposed questions is Medicaid provides a greater financial return if the measures are met however what if no one meets the necessary 30% of patients? Does it make sense as an organization to increase an eligible provider’s percentage of Medicaid patients to capture the higher value and if so who makes this decision and how does the front office staff know to direct more new patients of a certain insurance to a certain provider?

Step 3- Workflow Redesign for Meaningful Use

Once the system is configured and reviewed by the implementation consultant during the upgrade process, the workflows will need to be re-designed to meet the Meaningful Use Measures to guarantee success! A workflow is not just the use of the application but also the process in place for monitoring the Meaningful Use within the organization. At this point, the system has been configured by the organization configuration team (system analyst) based on Steps 1 and 2.  However, unless the users actually change behavior Meaningful Use will not count. Here are some examples below that will need to be considered based primarily on the CORE, MENU and Clinical Quality Measures.

• CORE EXAMPLE:  Suppose that currently the organization doesn’t allow clinical staff to enter and/or update problems or medications on patients, however the providers have not been keeping these lists up to date. Will the organization allow the clinical staff to begin to perform these tasks? Does configuration need to change to allow for retrospective/prospective authorization? Does enable verification of problems need to be added? Do clinical staff need to be trained how to do this item?

Remember there are many new alerts for Meaningful Use however everything doesn’t have an alert and likewise an end user can ignore an alert.

• MENU EXAMPLE:  Providing a Summary of Care Record to the patient and Patient Education. First, who will be responsible for providing the Summary of Care Record- clinical staff or providers? Will the Clinical Summary provided by Allscripts be used or will it print out from the v10 or v11 note? If the patient is a portal patient and you don’t want to provide a Clinical Summary or a non-portal patient how will the provider state if no Clinical Summary is to be provided? What/Who/How is the workflow to be defined, tested, and trained? Regarding Patient Education, will there be a standard developed if not already implemented such as every new medication prescribed by the provider the patient will receive the Drug Ed for that medication? How will the patient instructions be populated and printed?
• Clinical Quality Measure EXAMPLE:  Adult Weight Screening and Follow Up- many sites may already obtain the patient weight today and this may appear as an easy Clinical Quality Measure to capture. However, there are a couple of items to consider, by adding a free text box for comments to document if a patient denied obtaining their weight and if used would count for Meaningful Use. Is this configured already and/or do end users know to enter this information to count for Meaningful Use? In addition, to meet this measure the BMI of the patient needs to be evaluated and based on the patient’s age and BMI an additional workflow must be completed. Part of that measure states if the BMI is greater than 25kg/m2 a follow up plan must be in place. What will that plan be if not already used by an organization/site/provider? Will there be a dietary consultation or a BMI Management Follow Up Order? Will the end user be able to select from any of the potential recordable actions: Dietary consult with the appropriate SNOMED or the BMI Management Follow Up order with the appropriate CPT code? Will the clinical staff perform this action at the time the vital is taken or will the provider be responsible for adding this item on the patient.

These are some examples of Meaningful Use and all the decisions, configurations, and workflow changes that could be affected. This article is not all inclusive, rather, it is intended to begin the process for the team to meet the Meaningful Use objectives.  Please feel free to contact Cary Bresloff, Cary.Bresloff@GalenHealthcare.com, for further questions, guidance, or consultation on Meaningful Use and the impact to an organization.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Meaningful Use, v11

In an effort to improve the way patient data is accurately maintained, the Health Care Industry is undergoing a historical transformation.  The initiative is fueled by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Reinvestment and Recovery Act (ARRA) of 2009.  There are certainly a lot of preparations in the works to make this movement the next big shift in how medical care is provided.  With that comes advances in health technologies and the computer systems we incorporate to make it all happen.

The standard now has become an advanced network of cloud technologies, interfaced labs, pharmacies and networked providers all at your fingertips.  One would need a full team of dedicated professionals to navigate through the bests tools available to be ahead of the game, or a specialized group now called, the Upgrade Team.  A team of technically advanced, inquisitive and dedicated people to spend tireless hours scouring through new developments and documentation, who choose the proper tools and encourage you to set up your organization to succeed. 

The next best thing for an organization has now become Allscripts Enterprise EHR^TM version 11.2 (AE-EHR).  Because many clients have not yet participated in an upgrade process, but have instead experienced a net new implementation, service pack update or simple hot fix, we want you to be as prepared as possible. 

To begin, you will be assigned an Upgrade Team from the vendor which will include a Project Manager, an Upgrade Technician, an Upgrade Consultant and an Interface Analyst.  Your internal team should have representation for those same roles,  and in total your team should have at least 8 to 10 resources.  In addition to this core team, a group of Physician champions, super users, testers, trainers and help desk personnel is recommended to help run the command center and support each other during the actual Go Live week.

When the process begins, we hope that you take time to review all documentation available to you. Please refer to the Galen wiki and various Webcasts, Sales Force, and Client Connect.  You will be instructed to partake in the Allscripts eLearning courses, as well as an 8 hour instructional guide to the process by your Upgrade Consultant.  The Upgrade Team will introduce you to all the new functionalities in AE-EHR version 11.2, the Meaningful Use attestations, and will assist you in building your system to work seamlessly with your organization.  Part of the process will also incorporate the newly released Stimulus Set to the base AE-EHR version 11.2 application.  You will be responsible for attesting that your system is set up correctly to handle all the new requirements.  For this, you will need to allow various members of the Technical Team access to analyze and report how you have organized, mapped and set up your data.

To make sure the project stays on track, two weekly meetings will be held over the course of your 19 week upgrade.  The Project Manager will coordinate all resources for their action items and responsibilities, while the Upgrade Consultant meets to discuss the application, testing and build stages of the upgrade.  The Upgrade Tech and Interface Resource are invaluable pieces to the puzzle that will help you throughout the process, and will be available to you in addition to these meetings.  To start, a copy of environment is created to mirror your live system and is then upgraded to the new 11.2 version.  To personalize this base and to utilize the application, we need to configure the new parts to their full potential.  Many of the new functionalities in AE-EHR version 11.2 are in the areas of Security, Preferences, and new Tasks that all have been designed to help you meet the Meaningful Use criteria. 

As the go-live date approaches, testing has been as thorough as possible and all training has been passed along to your end users, we encourage you to prepare everyone for the new version.  It is recommended to provide reference materials for all users to avoid high traffic through your call center on go live Monday.  We also recommend an organized ticketing system to track the concerns that may arise, and a resource that may be available to uninstall and reinstall controls for various computers, tablets and devices that may not have been updated.  Your Upgrade Consultant will be with you throughout the entire go live process remotely, and host an open bridge screen share to walk you through the build process, testing concerns and later onto issue resolution.  You may request that the consultant be on site for this and an additional contract will have to be submitted.  Either way, the entire team will have constant contact with you throughout the first week of your live system.  Post upgrade, the one week transition period will help all team members decompress from the previous 19 weeks.  We will hold meetings to review our outstanding issues that came from the go live weekend as well as any outstanding Sales Force tickets that could be considered critical to your success.  Once we have transitioned past this first week, all outstanding minor concerns will be processed by the Allscripts post live queue and closed appropriately. 

For those of you who may be taking the Stimulus Set component after your go live with AE-EHR base version 11.2, you will once again be in contact with your Project Manager and Upgrade Consultant to repeat the process in building the set and moving forward successfully in attempts to use your Electronic Health records in a Meaningful Way.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Upgrades, v11

Client – UMass Memorial Health Care

Project:  UMassMemorial V11.2 Upgrade

Project Timeframe:  February 7, 2011 – June 13, 2011

Client Contact: Emily Lazaros, Allscripts Application Manager

“I would like to take this opportunity to tell you of our experience with our Galen upgrade team.   Troy Forcier and Kristie Gilbert are, in a word, fantastic.  They are professional and knowledgeable, and have been with us on this upgrade every step of the way.  Kristie’s project management skills and proficiency with the application are exceptional and Troy is about as calm a person as I have ever come across.  This gives us, the client, a real sense of comfort.  And as the IT Ambulatory EHR lead for this upgrade, in an organization of this size, that is invaluable.

….

Last, but not least, we have had lots of laughs and fun together through this process.  Thanks to them and Galen for helping to make our 11.2 upgrade a success.”   –Emily Lazaros, Allscripts Application Manger at UMass Memorial Health Care

 UMass Memorial Health Care is the largest health care system in Central and Western Massachusetts, and the clinical partner of the University of Massachusetts Medical School. The Medical Center has a total of 12,350 employees with approximately 1,700 physicians and 3000 registered nurses representing clinical expertise in Cardiology, Orthopedics, Oncology, Emergency Medicine, Surgery, Women’s Health and Children’s Medical Services.   UMass, on the cutting edge of technology, utilizes Allscripts Enterprise Electronic Health Record^TM (AE-EHR) as a means to help with continued excellence in clinical care and patient service.  Over the last several months UMass has worked, very successfully, with Allscripts and Galen Healthcare Solutions to upgrade their AE-EHR product to version 11.2.

The underlying motivation for this version upgrade was of course, Meaningful Use.  While there are incentives for moving to the new version, the idea of having to implement new functionality with potential workflow impact is regarded with dread.  There are dozens of models for how to complete an upgrade, most of which are painful.  The vendor and we, as your consultants, must take ownership over finding the best model for your practice to reduce the pain of upgrading.  Since Meaningful Use is the ‘next big change’ in healthcare, this change needs to happen for all medical practices across the US.  So the question remains, how do you increase your chances of success? Your Galen consultants will help lead the way.

The duration of this particular upgrade project was a brief 19 weeks, leaving us little time to configure the new AE-EHR version 11.2 functionality and guide UMass towards decisions that would qualify them for all Meaningful Use criteria.  In addition to a rapid project timeline we encountered other challenges: the release of process documentation simultaneously to the stages defined in our plan and shifting resource allocation as priorities changed.  Throughout the entire process, though, we were able filter the information, analyze the functionality, provide appropriate guidance, and enjoy the camaraderie of a great group of UMass team members!  We can now take great pride in knowing we were helping thousands of people use their version 11.2 AE-EHR product in a Meaningful Way.

A week after UMass has transitioned to end users, the real challenge of analyzing their data and incorporating their new configuration into their daily lives will prove to be a reality once the Galen team returns to assist with the Stimulus Set.  I know we are all up for the challenge!  Our willingness to help our clients, to test our knowledge of the latest cloud technologies and data reporting and to pass it along will be a very rewarding journey.  If the final product can be as great as the first steps in helping UMass upgrade their base AE-EHR version 11.2, then sign us up…Galen is ready to go! 

UMass was a fantastic group to work with and we look forward to helping them implement the Stimulus Set.  Congratulations to the staff at UMass for a successful upgrade!  We also appreciate the positive feedback from UMass and plan to make the same impact with other clients.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Meaningful Use, Successful EHR Implementation

Galen has recently helped several Allscripts Enterprise clients work through a specific charge issue related to billing for ancillary visits originally scheduled under a generic provider. This is a common registration/scheduling practice, and we thought it would be good to share the issue we found and how to address it.

An example of this type of scheduling would be a setting where a patient sees a rotating nurse for an EP device check. Appointments might be scheduled for a generic provider named Pacemaker NP. This schedule is then worked by the NP on duty that day and billed by the attending physician.

 From the standpoint of the EHR, there is an appointment scheduled for a non-billable provider, an order performed by a separate non-billable user, and then an encounter form billed by the attending physician. When an appointment for a non-billable provider is arrived, the EHR creates an encounter form but leaves the Billing Provider field blank. If this is not updated before charges start dropping to the encounter, problems arise.

If the ancillary staff places the order in the name of the attending provider, a separate encounter form is created for a Med Admin Encounter. This new encounter form is active under the name of the attending provider, but the original visit encounter form is still active with no billable provider. Two encounter forms for a single encounter.

Here’s an explanation of the flawed workflow and the solution we found.

Flawed Workflow:

1. Patient is scheduled for a visit with a non-billable provider. For instance, “Clinic,Provider”.
2. Ancillary staff monitors the Clinic,Provider schedule and clicks on current patient.
3. Ancillary staff places a med admin order. Sets “Ordered By” to the name of the attending physician.
4. This action creates a separate med admin encounter form for the ordering physician but also leaves the original encounter form linked to the non-billable provider appointment active.
5. Confusion occurs as there are now two encounter forms for a single encounter. Potential for both double-billing and lost encounter forms.

Corrected Workflow:

Prerequisite: Ancillary staff personalizes the Daily Schedule so that double-clicking on appointment takes the user to the MD Charges screen. This only needs to be done once.

1. Ancillary staff double-clicks on patient appointment from schedule. This takes the user to the Encounter Form.
2. Ancillary staff changes the Billing Provider from non-billable provider to the attending physician.
3. Staff navigates to the clinical desktop and places a med admin order.
4. Staff selects the attending physician as the ‘Ordered By’ provider in the order details.
5. Now the charges are dropped to the recently updated appointment encounter form.
6. Appointment encounter form is submitted to biller for review.

The basic idea here is that the encounter form needs to be updated before the order is placed. Automatically navigating certain users from the daily schedule to the encounter form is a good way to remind and encourage them to follow this workflow. This issue can occur anytime appointments are scheduled for non-billable providers. It applies most commonly with med admin appointments but can also come into play with other ancillary workflows depending on how they are designed. Without this correction, you can end up with piles of incorrect encounter forms that will need to be sorted out.

Tags: EHR Charge Workflow, Enterprise EHR

Introducing the Galen Clinical Conversion Toolkit, a solution and process designed to guide clients through converting from legacy systems and existing EHRs to the Allscripts Enterprise EHR. As Managed Service Organizations (MSOs) seek to expand their footprint through acquisitions, conversions to consolidate to a standardized system are often desirable to avoid the Healthcare Information System Mosaic.  Leveraging experience gained from previous clinical conversions, the Clinical Conversion Toolkit streamlines the process and provides a means of converting clinical data safely and efficiently. It should be noted that while conversions can be extremely useful in the sense that they save duplicate data entry, clients need to exercise caution in that any conversion data should be reviewed.

Discrete Conversion Types

Process Overview

• Data Extraction

• Data Analysis: Cross-Referencing

• Design: Data Filtering, Matching (Provider, Patient Item), and Exceptions/Errors

• Testing

• Go-Live

Data Extraction

Whether the historical system is an EHR such as NextGen, Greenway or eClinicalWorks, a PM such as GE Centricity, or a legacy in-house clinical information system, one of the most important aspect of the conversion will be acquisition of the data. Often times, this will require assistance with the current vendor to trigger a bulk-load export of the data. The preference is to output to flat-file, thus facilitating an intermediary step of data analysis and cross-referencing to prep the data before it is loaded into the EHR.

Data Analysis – Cross-Referencing:

The most important part to cross-referencing is to ensure that the corresponding AE-EHR dictionary dependency exists in the dictionary. If starting from a “blank-slate,” it is prudent to extract the compendium information for the exported data file from the source/reference system. In the case that dictionary entries already exist in the AE-EHR (for instance, in the scenario of a client that is an MSO, multi-org, and single EHRDB), it will be important to setup cross references so that the codes in the reference system match up to the corresponding values in AE-EHR. This is often realized through deployment of translation tables within the Clinical Conversion Toolkit.

• Provider code – Recommendation to use default “dummy” provider to identify clinical items loaded from conversion
• Document type
• Allergy code
• Immunization name, provider, route of admin, body site and manufacturer
• Problem and procedure codes
  • These codes will need to be cross referenced with the more-granular Medcin nomenclature.
  • This presents a challenge in that an ICD9 or CPT code could have a one-to-many relationship with Medcin.
  • The Clinical Conversion Toolkit provides a translation tool utilized in previous problem conversions to assist in the cross-reference.
• Vital sign names
• Order/Result Item Codes

Design – Filtering:

Filtering can be performed up-stream as part of the source/reference system extraction process, or it can be realized within the Clinical Conversion Toolkit logic. Typical filtering options include the following (but are not limited to):

• Items that have been entered in error in vendor system
• Allergies – NKA and NKDA entries are typically excluded to avoid incorrect reporting of NKA and NKDA
• Exclusion of non-finalized documents or results

Design – Matching:

Patient Matching: Patient matching is crucial to the exchange of clinical information between systems.  The Allscripts Enterprise EHR has strict matching criteria – in summary, matching on three of the four of the following: Name, Date of Birth, Medical Record Number (MRN) and Social Security Number (SSN).  As there is a move away from using SSN, by patients at least, this leaves us with only three fields to match on for many patients: Name, Date of Birth and MRN. In certain cases, more advanced options for patient matching can be deployed such as fuzzy matching as previously described on our blog.

Provider Matching: Clinical items will need to tie back to the provider who originally entered, ordered or authorized.  Typically, a short numeric or alphanumeric identifier is used to link a provider entry in the Other Vendor’s system to the provider entry in the EHR.  The current trend is to use a provider’s National Provider Identifier (NPI) as the identifier that the two systems exchange.

Design – Exceptions:

Not all of the data will load to the EHR without error. Some records will require manual assistance via add-on tools such as Allscripts Patient Bridge, while others may require more advanced troubleshooting and re-file. The Clinical Conversion Toolkit takes care of logging those transactions which generated error for future reference.

Contact:

Please contact sales@galenhealthcare.com if you or your organization would like to learn more about Galen’s Clinical Conversion Toolkit for the Allscripts Enterprise EHR.

Tags: Acquisition, Allscripts Conversion, Allscripts Enterprise EHR, Clinical Conversion Toolkit, Data Conversion, Enterprise EHR, Integration, Interfaces, Interoperability, MSO, Multi-Org, Technical