Archive for the tag 'Extensibility'

eCalcs – How to video

We have received a warm response to eCalcs, Galen’s latest bolt on for the Allscripts Enterprise EHR.

We have received a lot of compliments along the way – integrated health calculators are much needed, that Galen put out a thoughtfully crafted product, and even that we finally listened a built this type of add-on tool that makes providers happy. That last one is my favorite – it’s a tough time for providers with the rush to Meaningful Use and now to ICD-10, many feel that they are taking on more work with lower results. If we can provide a “cool tool” that makes life easier, I couldn’t be happier.

What we have also received are plenty of questions about how it works. You can cite the scores into a Note? How are the scores stored in EHR – as Results? Questions like those.

This How To video will help answer those questions. It’s just under three minutes long and covers the major functionality within eCalcs and its integration with the EHR.

Our marketing firm also sent over a concise and rather visually pleasing brochure for eCalcs. Thanks guys!

Allscripts Enterprise EHR and RelayHealth Portal Integration

 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.

Top 3 EHR Data Integration Challenges

 

In response to a guest post on EMRandHIPAA, we take a look at the top EHR data integration challenges faced today:

Technology

Proliferation of point-to-point interfaces instead of using a hub-and-spoke type of model (like that which Surescripts utilizes with electronic prescribing). Unfortunately, most organizations which exchange data in and out of the AE-EHR utilize highly-customized point-to-point interfaces for orders, results, documents, etc. The point-to-point model is highly inefficient and does not adhere with a “plug and play” model that so many organizations desire.

We’ve seen Allscripts make an effort to move away from this by introducing capabilities to automatically send immunizations to state registries via the Allscripts Hub by  simply modifying configuration setting (with the caveat that Allscripts has worked with the state to develop the intergration).  We’ve also witnessed companies like Medicity and its Novo Grid technologywhich offers electronic communication between physician practices, hospitals, and other health care providers. Novo embeds agents (small but powerful Java programs) in hospital data centers, physician practices and other locations. The grid component is an object oriented system that can replicate an object to multiple agents and keep it in sync across locations.

 Standards

As outlined in the EMRandHIPAA post, there are no mandated standards for EHR vendors to follow, thus making it difficult to coordinate data sharing between medical devices and other systems. Allscripts does offer the Universal Application Integrator (UAI),  which facilitates extendibility to other applications and devices. However, there is a certification process that needs to be pursued. In terms of the point-to-point interfaces previously mentioned, the Allscripts proprietary (API)  Application Programming Interface(which consists of inbound and outbound stored procedures to their primary clinical DB) does not segment out the data and configuration components of clinical exchange, something touched on in detail in a previous Galen Blog post.  Lastly, most vendors have their own specifications for HL7 message definitions. For instance, Quest may send ordering provider in OBR-16 in an interfaced result ORU message while LabCorp sends this in ORC-12. Another example is communication of “Ask at Order Entry” questions – something Quest expects to receive in repeating OBX segments while LabCorp expects this across Z-segments in an interfaced order ORM message.

Adherence to HL7, proprietary approaches.

Cost

John Halamka bravely predicted that when health IT vendors and providers began adopting new standards, the cost for interoperability would plummet: “We know that we won’t get precisely plug and play—this is a journey,” Halamka told Government Health IT. “But each year, we will get more constrained. We are going from a $20,000 -$30,000 venture hopefully to $5,000-$10,000.” Unfortunately the numbers quoted are accurate – and provide a high barrier to entry for smaller groups looking to electronically exchange data. There is the flip-side to cost and that is the ROI, which could include reduction in direct annual labor costs, elimination of non-billable tests, and elimination of lost charges.

Summary

The benefits of health information exchange are well documented. As outlined in the EMRandHIPAA post, there is a need for a “consistent, secure and reliable way to capture and share patient data among all systems and healthcare providers,” especially given that benefits in improved coordination of care and reduction of medical errors.

EHR Unstructured Data Mining

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?

Allscripts Interface Developers Network

Introducing the Allscripts Interface Developers Network – a forum for Allscripts integrators by Allscripts integrators. The site is intended to facilitate knowledge-share and collaboration within the Allscripts integration community.

Too many of us live in silos and don’t have the means necessary to collaborate and exchange knowledge and IP instead of reinventing the wheel. Our hope is to enable our clients and the community to produce integrations that conform to best-practice principles and are efficient and safe in the transfer of critical patient clinical data. The scenarios for collaboration are vast, with just a few examples listed below:

  • Design: When designing an interface, an integration analyst may not have the necessary documentation they need concerning the functionality of the API, a list of configuration options, or a template to work off of.
  • Scripts (both interface engine and database): Additionally, there may be a need for custom scripts, and perhaps another member of the community has already developed said script.
  • Error Remediation and Mitigation: Perhaps an analyst has encountered an error that they have not seen before, yet another group has and has a process for mitigation
  • Performance Optimization: We recently encountered a scenario where clients were experiencing performance degradation in their live environment – namely results were taking upwards of three minutes (!!!) from when they were first received in the source system to the point where the processed and filed into the EHR. With a Cached Lookup solution, the client was able to get the processing time back down to a more reasonable value.

You’ll also notice that the forum contains quite a bit of content already. We recently conducted a “soft-launch” of the forum, reaching out to our strategic partners, and got phenomenal response. A special thank you and congrats goes out to Ray Lape, EHR Application Manager at Medisync Midwest. His contributions and collaboration have been outstanding thus far. We know there are more like Ray out there, so please register and begin participation today!

So, as integration questions arise, instead of – or in addition to – emailing to a corresponding interface vendor representative, please post on the forum. Create or branch threads where appropriate. Also note that RSS capability has been enabled on the forum to offer ease of subscription.

Lastly, feedback is certainly important and if there are ways we can improve the site, especially in regards to the forum categories, it is certainly appreciated. In fact, there is a separate forum category that addresses site feedback.

 

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