Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Last night, my colleagues and I attended a New England HIMSS event in Wellesley, MA covering Mobile Health. After battling through brutal traffic commuting from Boston to Wellesley during rush hour, we arrived and were all equally impressed with the night’s speaker -  Robert Havasy, Business Analyst at the Center for Connected Health in Massachusetts. I particularly liked the presentation technology used for his pitch – Prezi - a web-based presentation application and storytelling tool that uses a single canvas instead of traditional slides.

Some key takeaways from the presentation:

• Will the FDA regulate smart phones or mobile devices and treat them as medical devices?
• Patients are unencumbered by the regulatory process
• Two focus areas for mobile health technology
  • Capturing Data – vitals, blood sugar, etc
  • Coaching – guiding patients to make better choices
• Sunscreen adherence using mobile technology
  • Electronic monitor used to accurately measure usage of sunscreen
  • Reminder texts sent to mobile phone
  • After six weeks adherence rates for the reminder group were almost double that of the control group who did not receive reminder texts: 56 versus 30 percent.
• Utilizing text messaging to influence patient behavior -Center for Connected Health – project in Lynn, MA.
  • Two areas of focus: Opiate addiction and Teenage pregnancy
  • Localization is important – mention people by places and name
  • Who the message was from (especially doctor) meant more to patients that if it were personally addressed to them
  • Barrier to participation – cost – patients were afraid they would have to pay for the additional text messages
  • Unleash the nurses – nurse evangelist sells benefits to non-physician staff
  • Offset workflow changes in offices – take administration off of practice
  • Sustainable reimbursement structure – engage carriers – CMS – insurers – alternative quality contracts
• Northeastern University, working in collaboration with industry players, announced an incubator program for mobile health technologies. Contact Dan Feinberg, Director, Graduate Health Informatics Program at Northeastern University, President at New England Chapter of HIMSS, for more information

Tags: ehealth initiative, Extensibility, Integration, Interoperability, Meaningful Use, mHealth

The requests for reports that we get runs the gamut. Most of the time, clients are looking to modify the existing canned reports that Allscripts offers with the Allscripts Enterprise Electronic Health Record (AE-EHR). Other times, clients envision a custom report that is unlike any of those currently offered and is unique to their particular organization. And still further, some organizations wish to fulfill reporting metrics to receive monetary incentives from initiatives such as the Physician Quality Reporting Initiatives (PQRI) and P4P (Pay for Performance) .  Given the commonalities in the requests we receive, with our reporting solutions store, we have attempted to pick the most popular reports requested from clients and offer them via on-demand payment, download and installation.

We also receive a substantial amount of inquiries from clients as to what exactly goes into customizing existing reports and creating new reports. Clients are often curious as to what types of skill sets are needed. These organizations may feel that they are better suited to have their own personnel develop custom reports. For instance, the organization may have performed an return on investment (ROI) analysis and determined it makes the most financial sense to train their own staff to supply the multitude of administrative and “print” reports they require in the coming future.

That said, let’s get to answering the question of what goes into developing custom reports for the AE-EHR:

1. AE-EHR Clinical Database Stored Procedures: These are used to extract data out of the database to render in the report. The stored procedures can be thought of as a “middle-man” between the database and the Crystal Report. More information on the basics of stored procedures can be found via the following link.
2. Crystal Reports: Most AE-EHR reports are developed using Crystal Reports. Crystal controls the how the data extracted from the stored procedures renders in the final report. Crystal offers functionality for pivot tables, summary of data fields, grouping, custom formulas, suppression based upon data values, etc. For more information on Crystal reports tutorials, follow this link .
3. Insert Scripts:  There are several places that reports can be installed within the context of the application’s user interface (UI) – these are called “Calling Points.” Reports can be printed from the administrative workplace, and also added to the UI for the traditional “print documents” – immunization or results “calling point” for instance.

The most important ingredient to custom AE-EHR report recipes comes in the experience – specifically knowledge of the database schema. Knowing what tables to pull from, how tables are related, and what functions, stored procedures and existing custom reports can be utilized so as to not re-invent the wheel. Knowledge of advanced SQL querying is invaluable as well. If you would like to learn more, Galen is offering free EHR Reporting webcasts.

Let us know if we may assist your organization in developing and delivering custom AE-EHR reports. In addition to the reporting solutions store, we also offer training courses and reporting services for the Allscripts Enterprise EHR database, ETL database, Analytics and the ConnectR  database.  Please contact sales@galenhealthcare.com for more information regarding these courses and our reporting services.

Tags: Allscripts Enterprise EHR, Crystal Reports, Custom Reports, Extensibility, Reporting, SQL Server, Technical

In light of the highly publicized widespread outbreak of the Swine flu, it is certainly pertinent to touch on how organizations may utilize an Electronic Healthcare Record (EHR) data exchange from the EHR to an immunization registry to contribute in the effort to control this pandemic. Resolutions by the American Medical Association (AMA) and the American Osteopathic Association (AOA) note that the “lack of accurate immunization records represents a major reason for missed opportunities to vaccinate” and “immunization registries offer a cost-saving solution that ensures access to accurate immunization records at every visit.”

It is well-documented that registries can save health care provider money by drastically reducing the time it takes to pull a child’s medical record, review his immunizations, enter the new shots, and re-file the record. However, a stand-alone registry application requires duplicate data entry in the case where an EHR acts as the practice’s clinical data repository. In situations where a stand-alone immunization registry solution is already instituted in a practice, productivity increases of 30 to 50% can be realized by integrating the clinical repository system, namely the EHR, with the state registry via a data exchange.

Introduction

An immunization data exchange facilitates the share of data between the immunization registry and the EHR by bringing registry information into the EHR and also sending data to the immunization registry with every administered immunization. Integrating the EHR with the immunization registry offers the capability of sustaining high immunization rates and low disease levels via sharing of clinical data. As a result of these immediate benefits, providers will also realize many long-term benefits such as a reduction in paperwork, staff time and costs associated with immunization related activities. Most importantly though, are the direct patient outcomes in that the immunization data exchange prevents unnecessary (duplicate) immunizations.

Benefits

• Compliance – On average, less than 80% of shots given are entered
• Data Accuracy – Over 15% error rate when completed by clinical staff
• Data Availability – 50% of 2 year olds have 2 or more providers
• Provide record consolidation of immunization information
• Facilitate management of immunizations so that children receive only the vaccines they need within the appropriate time-frames
• Decrease time spent by office staff seeking immunization histories
• Generation of timely immunization reports to assist with reporting requirements and other quality improvement initiatives.
• Elimination of redundant entry of patient data in both EHR and registry application
• Immediate availability of immunizations to the enterprise.
• Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc)
• Custom reports can also be created and deployed to supplement current paper processes for documentation of immunizations (for instance a summer camp requires all medications, immunizations, allergies be documented)

And perhaps the biggest benefit is that many groups are able to negotiate with the immunization registry to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view – the practice actively contributes to the patient immunization record via a data exchange from the EHR to the registry – the registries are often happy to provide financial incentive for practices to participate in an electronic data exchange.

Cost Savings

A study published in the American Journal of Preventative Medicine found that the annual cost for a practice to participate in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $.65 to $7.74. It was noted in this study that annual per-patient costs were lowest in the sites that used an automated data-entry interface. The main conclusion reached from this study was that ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Implementation of an interface to accept and send electronic transfers of records avoid duplicate data-entry tasks and decrease provider costs.

For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service

Tags: Allscripts Enterprise EHR, Extensibility, H1N1, Immunizations, Integration, Interfaces, Swine Flu

In IT, the term for a software application’s ability to be “tailored”, without making core code changes, is Extensibility.  Extensibility is what allows us to have:

• “Toolbars” in Internet Explorer and FireFox, like the Yahoo and Google toolbars
• Mac Dashboard Widgets, and Sidebar Gadgets in Vista
• Customized Homepages, like iGoogle

The Allscripts Enterprise EHR does not have an extensibility model for its UI.  This doesn’t mean that there aren’t requests to tailor the AE EHR.

What it does mean, though, is we have to be careful when changes are made.  It means we do have to customize the application’s software code while not breaking the software and ensuring things won’t fall apart during the next upgrade.

The first thing that we need to do is ensure that it’s worth making the change.  John Halamka has a good article regarding Removing Complexity from IT, in which he comes down pretty hard on customizing commercial software products.  I cannot tell you the hard and fast rules on determining whether to make a customization, but I can tell you that it will:

• Add complexity to your application
• Require additional coordination and testing during upgrades
• And, customizations will not always be able to be carried forward to the latest version

What we have done at Galen to help ensure that a customization causes as few headaches as possible and provide the value that our clients hope for is:

• Documentation – clearly document all of the files, database objects, etc that are affected, providing both plain English descriptions for non-technical folks (e.g. a project manager) and the technical detail required by our programmers and technicians.
• Testing – test the changes thoroughly ourselves, and work with our clients to build robust test plans for the initial install, and to use during each upgrade.
• Tracking – encourage our clients to track each customization that we make, and we also add those customizations to the Allscripts CRM, the same place where Allscripts technicians track their customizations.

So far, we have been successful working with our clients to keep their systems running well with the customizations that we’ve made together.

We hope that our work to mitigate the risks of customizations will allow us to continue to be successful in this area!

Tags: Allscripts, Allscripts Enterprise EHR, Extensibility