Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

—Discrete Clinical Data Elements as the building blocks to a Connected Health Platform—

Broken down to its basis, any vision of a truly connected Health Network will be reliant on the ability to pass, and ultimately present, discrete data elements.  Although the audiences for the information will be diverse, and the front-end systems will vary, the foundation of the information is the same.  In order to unlock the value that lies in the data being captured every day, an organization must have solid planning and execution. 

Each organization we work with is unique, but overall themes are constant: Reporting for Meaningful Use, Optimizing Health Care Decisions with Analytics, and Growth through Acquisition or Partnership.     

If we consider Clinical Data as building blocks that will be used, in whole or part, to support these efforts, we need to ensure both the ease of access and integrity of that data.  Galen has leading expertise and insight on conversions, reporting, and interfaces that can help you down this path. 

So how do you take the first steps in creating solid building blocks?  We would recommend to:

Define and establish consistency in electronic documentation and workflow.  This starts by understanding the EHR build and configuration decisions that will impact both availability and integrity of the data.   This consistency will also pay dividends to the organization by making the support of the Enterprise EHR system more predictable and efficient. 

Independent of your organization’s current state, Galen has the breadth and depth of expertise to help achieve your vision.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Clinical Conversion, Data Conversion, EHR Implementation, Enterprise EHR, Healthcare IT, Interoperability

As seen in the trend from past newsletters, Galen continues to grow not only as a company, but as a presence in the Healthcare IT industry.  Galen’s success continues this quarter with the help of those from within; those that help propel us forward. While we could recognize the talents and valuable contributions of the entire staff, we are pleased to recognize two individuals in their promotions.

 Troy Forcier, Team Lead – Upgrade Technicians

 In the time since our last Spotlight article, Troy was promoted to Team Lead of the Upgrade Technicians. In this role, Troy serves as the front man for his team’s education, client relations, and resource planning. Troy continues to perform assessments and training on effectively maintaining Allscripts server environments, also drives the webinar schedule for the Technical Team’s topics. Since his arrival in 2008, Troy has continuously found ways to work efficiently within his group and will continue to help shape the direction his team as the IT group evolves moving forward.

Join us as we congratulate him stepping into this new role as Team Lead!

 John Buckley, Senior Consultant

 This month, John not only celebrated his fourth year with Galen, but he also was promoted to Senior Consultant. He has been a powerful asset working with clients such as North Shore – Long Island Jewish and Mercy of Maine. Early in his career with Galen, John worked as a technical resource with the upgrade team and continued to grow his working knowledge of the various components of the Enterprise EHR^TM program. In addition to his assignments, he contributes to the Galen Newsletter, Blog, and assists with other internal technical projects. John is very motivated and serves as an excellent role model to others in Galen.

Congratulations John with your promotion to Senior Consultant!

Tags: Allscripts Consultants, Healthcare IT

Are we in an EHR bubble? Evan Steele, CEO of SRSsoft, predicts that much like the dot-com era, the EHR market is in the midst of a bubble which is soon to burst. He foresees a shakeout in which consolidation of the current 472 EHR vendors takes place. Steele envisions causes of the popped bubble to be attributable to missed growth projections, government money drying up and physician dissatisfaction with existing vendors, ultimately resulting in a survival-of-the fittest among the EHR vendors.

Several industry leading bloggers have made bold predictions to this same point. John Moore from Chilmark Research offered the following:

Bloom is Off the Rose, EHR Market Plateaus
Going out on a limb, we see 2012 as the year when we start talking of the post EHR-era. Yes, there will be plenty more EHR sales in the year to come but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4’12. You heard it here first folks, it is time to collect your EHR winnings and seek new places to invest.

iHealthbeat had its own 2012 predictions for the outpatient EHR market:

• The use of cloud computing;
• The use of mobile devices; and
• Vendor consolidation.

Over the past several months, Galen has seen quite a bit of consolidation in the industry specifically with conversions in support of acquisitions. We have converted groups to the Allscripts Enterprise EHR from a number of legacy vendors – among them AmazingCharts, eClinicalWorks, Greenway, GE Centricity, SRSSoft, SAGE, MedManager – in support of these groups absorption by larger organizations and Integrated Delivery Networks (IDNs).

We continue to see an increasing amount of conversions on the horizon, supporting the claim made by Mr. Steele regarding consolidation in the industry. Organizations are certainly in acquisition and consolidation mode – will the same hold true for vendors? Will we see more mergers and acquisitions in the outpatient EHR space in 2012? I think it is a safe bet to expect activity from those vendors that own most of the market share. The following is a recent ambulatory market share analysis as offered by American EHR:

Tags: EHR Acquisition, EHR Market Analysis, EHR Merger, EHR Predictions, EHR Vendor Consolidation, Healthcare IT, Meaningful Use

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

This piece is the second of a two part series discussing the transition to ICD-10.

As I mentioned before, the healthcare industry is rapidly moving closer to the October 1, 2013 compliance date for ICD-10. As that date draws closer, organizations will need to actively take action to successfully be compliant.  The Centers for Medicare and Medicaid Services (CMS) is actively providing resources to assist in achieving this success.

Before I share another tool that CMS is offering as support to the transition, I wanted to reflect upon some rather humorous information regarding the new ICD-10 codes. Last week, I read a blog from EMR and HIPAA that made me aware of the fact that the ICD-10 code volume has expanded and now includes some “off-the-wall” codes.

One example the article shared was “V91.07XA, “burn due to water-skis on fire”. I would say that’s fairly specific!  After reading this, I was encouraged by curiosity to dig for more interesting codes. After browsing the ICD10 code listing, I did manage to find some more codes that amazed me.

In tribute to the Southeast United States:

• W5803XA Crushed by alligator, initial encounter
• W5803XD Crushed by alligator, subsequent encounter
• W5811XA Bitten by crocodile, initial encounter
• W5811XD Bitten by crocodile, subsequent encounter

I come away from those codes wondering what the actual number of times the code W5803XD will be used.

The fact that these codes have increased in volume and in specificity, to me, seems to have far more benefit than harm as we transition to using ICD-10 codes. But before we see the end result of this transition, we have to endure the transition and arrive to October 2013 with only success. One tool CMS is offering to assist is the Implementation Widget.

Implementation Widget

CMS offers a “timeline widget” that users can download to their desktop of mobile device.  Once downloaded by a user, that person can share the application through email, social media, or post in a website. The purpose of the widget is to “identify and take action on the benchmarks you will need to ensure smooth transitions to” the ICD-10 compliance date. HIMSS News summed it up perfect indicating that it would help organizations:

• Understand what should be done right now to prepare for the switches to 5010 and ICD-10
• Know the steps needed to take in the future and when
• Stay on top of approaching transition deadlines to help manage the implementation process

The widget first prompts for a selection among four choices: Vendors, Payers, Large Providers, or Small Providers.  Each category differs in the output of the timeline, benchmarks, and necessary actions suggested by CMS to act upon.  A full timeline can be downloaded in each category. The timeline, viewed as a PDF file, indicates the suggested immediate actions/goals, then broken down by quarter up to the deadline. However, users can step through the timeline using the widget, making the experience more visually appealing as it breaks down the timeline piece by piece.

The goals and action points are clean, concise bullet points set to guide the organization in the direction of a successful compliance. Here’s an example of the bullet points for Venders listed of Actions to take immediately:

• Identify staff to receive training and develop training materials (5 months)
• Establish organization’s implementation chart (6 months)
• Determine product requirements (8 months)
• Estimate budgets.  Budgets should include all costs associated with implementation including software, software licensing, hardware procurement, development, and staff training costs (8 months)
• Conduct product re-engineering analysis (6 months)
• Start product/solution development (9 months)

Each action point has a timeframe given. That timeframe is the estimated total duration needed for that action point.

The information presented in this tool should prove to be a valuable resource to organizations. I am interested to hear feedback from organizations whether they are using this tool or not, and if so, how the information is helping steer them successfully to compliance.

Another key ingredient to the October 2013 compliance date will be the incorporation of the ICD-10 codes to vendor systems. This will certainly affect systems such as the EHR and PM systems. Hopefully soon, the various vendors will begin (if they haven’t already started) to incorporate plans to swap the ICD-9 codes to ICD-10. Organizations will need to pay close attention to any vendor communications, as vendors will surely indicate release dates and material that correspond to the ICD-10 implementation.

As we move closer to the deadline, CMS will certainly provide more information on the ICD-10 transition. Visit their Latest News page to sign up for notifications, industry updates, attend teleconferences, and obtain other valuable resources.

One common and important theme from the CMS resources is training.  Proper and well established training inside each organization will prove to be a crucial step to ensure a smooth transition to using ICD-10 codes.  Training is the most powerful force behind deciding the level of success to using any new or updated information and procedures.  An organization that chooses to invest more in training will certainly have a higher return on that investment.

Galen Healthcare Solutions offers project management and training solutions. Contact us to find out how Galen might assist in the ICD-10 transition.

Tags: Centers for Medicare and Medicaid Services, Clinical Conversion, CMS, Compliance, Data Conversion, Galen Healthcare Solutions, Healthcare IT, ICD-10, Implementation, October 2013

This piece is the first of a two part series discussing the transition to ICD-10. The ICD-10 transition should be a high priority concern in healthcare.

Today, the healthcare industry is rapidly moving closer to the compliance date for ICD-10. That date is October 1, 2013.  As that date draws closer, organizations will need to actively take action to successfully be compliant.  The Centers for Medicare and Medicaid Services (CMS) is actively providing resources to assist in achieving this success.

FAQ Fact Sheet

CMS posted a downloadable PDF FAQ “transition basics” fact sheet indicating sixteen question and answers.  This tip sheet gives an excellent and informative overview to the transition to ICD-10.

Among these Q/A’s are:

• What does ICD-10 compliance mean?
• ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are able to successfully conduct health care transactions on or after October 1, 2013 using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after this date
• What is the transition to ICD-10 happening?
• The transition is occurring because ICD-9 codes have limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated and obsolete terms, and is inconsistent with current medical practice.
• Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.
• A successful transition to ICD-10 will be vital to transforming our nation’s health care system.
• What type of training will providers and staff need for the ICD-10 transition?
• Training should take place in late 2012 or early 2013 for most staff. Training needs will vary for different organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding.
• Look for specialty-specific ICD-10 training offered by societies and other professional organizations. Take into account that ICD-10 coding training will be integrated into the CEUs that certified coders must take to maintain their credentials.
• ICD-10 resources and training materials will be available through CMS, professional associations and societies, and software/system vendors. Visit http://www.cms.gov/ICD10 regularly throughout the course of the transition to access the latest information on training opportunities.

As we move closer to the deadline, CMS will certainly provide more information on the ICD-10 transition. Visit their Latest News page to sign up for notifications, industry updates, attend teleconferences, and obtain other valuable resources.

The second part of this series will discuss implementation and producing results.  Look for that piece next week!

Tags: Centers for Medicare and Medicaid Services, Clinical Conversion, CMS, Compliance, Data Conversion, Healthcare IT, ICD-10, ICD9, October 2013

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 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