Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

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

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