Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Last Friday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 2 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference.

Keynote from the Surgeon General – Vice Admiral Regina M. Benjamin

• She covered how Hurricane Katrina affected her community in Alabama and the fact that due to the natural disaster, they were reliant on pharmacy chains to provide a record of what medicine the patients were taking.
• She also touched on a story of how members of her clinic were drying out the patients records after Hurricane Katrina and after they had them completely dried; a fire burned the entire clinic down. This brings to light the need for disaster recovery and collocation in some circumstances. Galen Healthcare Solutions proudly offer a downtime solution in its VitalCenter product.
• After the fire, Bentley college students came down to assist and one of those classes contacted the president of e-ClinicalWorks and convinced him to donate the EHR – integrated with both labs & referrals
• She stressed that prevention is the foundation to the National health System and as such we should be incentivizing prevention.
• She also mentioned how the EHR played a major role in prevention of errors

Getting Clarity – Developing Effective Health IT Policies and Standards

• Need to integrate claims and clinical data to provide total model for exchange
• 15 cents of every dollar in healthcare goes to administrative overhead
• Two key issues for data exchange – identity and consent
• Public Health entities currently receive data, however not every public health entity has the infrastructure to receive data
• How do we pull quality measures out of unstructured text?
  • Analogy of querying for alcoholics, but free text match is returned about using alcohol to swab skin before applying needle.
• The tough part of concerning clinical quality measures is the balance of structured and unstructured data
• Healthcare delivery is complex in that there is heavy fragmentation – 80% are solo or two physician practices
• Dr. John Halamka mentioned that we are the stewards of our own data and architecturally that is the design of the system

Jobs, Jobs, Jobs – Health IT, Business Opportunities, and Job Creation

• Healthcare workers do not have not enough IT in their educational curriculum
• Howard Messing, the President of Meditech mentioned that in Massachusetts in particular the cost of living is a barrier – Meditech actually has commuters from Atlanta.
• Girish Kumar Navani, CEO of e-ClinicalWorks indicated that they currently employ greater than 1000.
  • He anticipates hiring 500 new workers over the next 2 years for programming and business analyst positions
  • He also mentioned the analogy of the electrical socket – broadband network need to be as irreplaceable in physician office as the electrical socket.
  • He believes there is a need for a  new type of worker, the knowledge worker, who understands workflow and is able to analyze and make better decisions about population health
• Richard Reese, Executive Charmain of the Board, Iron Mountain, anticipates helping hospitals clean up paper mess.
  • He mentioned non-compliance in healthcare IT to storage and backup standards
  • Lesson in compliance can be drawn from Wall Street years ago and that healthcare organizations must design for workflow, but compliance as well
• Brad Waugh, President & CEO at Navinet, indicated that the network his company providers connects payers and providers, saving $800 million per year.
  • They currently require Microsoft .NET certified engineers and have over 30 openings
  • He indicated that the educational system must produce the folks needed in healthcare IT and currently it is just not doing so domestically
• This discussion brought to light a deeper seeded issue in American society in that as a society we are not pushing computer technology anymore as it is no longer the glamorized industry.
• There is a major need for qualified issues and it is a supply versus demand issue with the roots in education and society.
• One member of the audience mentioned that the goal of healthcare reform is to eliminate costs and the irony is that in a sense we are creating jobs to eliminate jobs
• Another member of the audience commented on the arrival of programs for night healthcare professional courses, much like it was the trendy thing to get a night MBA in the 90s
• Finally the point was made that by the middle of the current decade, we will be facing baby boomers hitting Medicaid and the amount of care they need is incredible. With less dollars, we will need to re-engineer the system and what could come as a result is care rationing

Panel: Successful HIEs – How They Did It and How It Helps

Fallon Clinic HIE

• Emergency care was the highest reason for HIE usage
• Some quotes from physicians on the value the HIE provided
  • “Importing the CCD expedited documentation”
  • “Reduced need to ask patients questions”
  • “Expedited verification of medication and allergy list”
  • “Saved time”
  • They estimate phone calls were avoided for 75% of hospitalist and were extremely beneficial for new patient visits
  • They estimate they spent 3 years and $3 million learning and developing “trust” and $1M in building and implementing in the final 2 years
  • Lesson learned:
    • They pre-registered all of their patients in the community (bulk-load) and this helped with performance as they didn’t have to query the state
    • They felt the key to sustainability was to reduce operating expenses
    • Each organization in the HIE was responsible for server maintenance – ends up being $2000/year/organization which represents rounding error in most healthcare IT budgets
    • Key points – earn trust – utilize real-world workflows – value of low cost

Indiana Health Information Exchange

• Federated data model – 62 hospitals – 3 billion structured results – doubling time of 4 months
• They meet the providers where they are whether it be delivery of data to the EHR or physicians receiving data as PDF or view into a portal
• They view sustainability in the sense of funding via offering services
  • work with public health services for syndrome surveillance and track immunizations
  • Their business model for sustainability is such that scale is needed and again they emphasized avoiding grants for operational costs.

NEHEN

• Their sustainability model is such that their organization provides governance – decide what has value – much as a board of directors would
• Federated model works better than centralized – more accepted in the marketplace
• Lessons learn include integrating processes across the enterprise
• The case of the transfer of information to public health is needed to sustain HIEs as well as the capability to sell other products within the network.

Tags: Adoption, Business Continuity, HIE, HL7, Immunizations, Integration, Interfaces, Interoperability, Meaningful Use

We here at Galen have seen a greater influx of requests to be able to integrate client’s EHR environments with 3rd party applications and/or internet websites.

I’ve created a few examples that I’ve added to our Wiki page.

1. http://wiki.galenhealthcare.com/Patient_Portal_Integration

With this case study Galen had a client who has implemented a patient portal application whereby patients are able to send messages to their doctors regarding tests, results and general questions. The client was looking for a way to have the provider be able to integrate this application directly into the EHR. With RelayHealth’s help we have succesfully built a prototype whereby a provider can seamlessly communicate with a patient in the most efficient manner possible!

2. http://wiki.galenhealthcare.com/images/5/57/Add_new_Web_framework_documents_to_the_EHR.pdf

In this example a client was looking for a new link on their vertical toolbar which would allow them to display any website in their current workspace (the main viewing pane of the EHR). This one example integrates the website directly into the EHR window without having to navigate through a new tab or window, showing a FRAX calculator. The other tab actually has the ability to take in patient context (height, weight, blood pressure, etc.) and pass it into a form automatically populating fields to save physicians valuable time. This article goes through the steps involved in setting up new vertical toolbars, horizontal toolbars, and workspaces to set up these outside websites in the EHR. The actual code to populate patient context is fairly complex but definitely something Galen would love to help out with!

Tags: Allscripts, EHR, EHR Implementation, HL7, Integration, Successful EHR Implementation, Technical

Last Thursday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 1 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference and look for a recap of day 2 of the conference on the Galen blog this Wednesday.

Keynote Address: The State and National Vision for Health IT and HIE

Dr. David Blumenthal, National Coordinator for Health Information Technology – U.S. Dept. of HHS,  presented his own anecdotal experiences with the EHR, namely a story of how he was going to prescribe a patient a drug containing sulfa, yet the clinical decision support software in the EHR flagged him for a drug-to-drug interaction. If CDS tools within the EHR not available, would the pharmacist have caught this? Could the patient potentially been adversely affected?

Dr. Blumenthal then elaborated on two key components to which he felt would impact behavior via policy: writing regulations and spending money.

Regulations

• There have been 2000 comments received on the Interim Final Rule, with the publication of the final regulation anticipated by the end of the spring
• No comments questioned the conceptual framework nor the direction of Meaningful Use.
• The framework of Meaningful Use consists of 5 domains – quality, efficiency, patients & family, coordination of care, protection and security
• In speaking of the Interim Final Rule, Dr. Blumenthal utilized the analogy of an escalator – allow providers ease of introduction and steps for clear path of usage while lowering barriers to entry.
• Information Exchange – infrastructure is poorly developed for information to follow the patient and thus policy needed to address this. Certification will be the key to interoperability and with tighter standards, HIX should be more interoperable.
• CLIA (Clinical Laboratory Improvement Amendments): Currently, legacy regulations are being addressed such that the barriers to LDX (Laboratory Data Exchange) can be removed.
• Privacy & security: Providing authorities with the means of penalizing individuals and organizations for violations to ensure controls, access, protection

Spending money

• Regional Extension Centers (RECs) are currently modeled after US agriculture, which was intended to disperse new info to the family farm. The goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation.
• Focused on <10 provider practices such that the full benefits of HIT can be reaped by the practice. Facilitation of re-design of work flows and mobilization of information for quality and efficiency improvements
• 50 states have been funded to promote RECs.
• Different localities will have different solutions for health information exchange (HIX)
• 70 community colleges were funded for workforce training and it is anticipated this will facilitate staffing of RECs

Next Year: Direction

• Implementation
• Finalize requirements for Meaningful Use
• Beacon Community Program – Fund 15 communities around the country directly through a grant program with the intent to offer a source of lessons and inspiration. There have been over 130 applicants to the program thus far.

F/U Questions/Concerns

• Physicians are worried that HIT happens to them, not with them and that users not intimately involved with the design

Panel – Consumer-Centric: The Role of the Patient in Health IT and HIE

• John Moore from Chilmark Research introduced term the term “citizen” as the term patient can often be paternal. He mentioned a John Halamka quote – “automating bad processes will not lead to improvement”.
• David Szabo, a partner, Edward Angell Palmer & Dodge brought up the point of how do we go about engaging citizens and brought up some serious concerns over privacy, especially in regards to patient portals. The topic of behavioral advertising in PHRs was brought up and it was mentioned that  FTC may provide governance to this regard.
• A question was posed about those surveyed and focused on in regards to Healthcare IT in that they are predominately affluent and white. John Moore responded with mobile health technologies being the enabler to reach all demographics and minorities.
• A comment was made concerning the power of secondary data to pre-populate EMRs. Barbra Rabson, Executive Director, Mass Health Quality Partners, provided a response and brought up a cautionary tale in the highly publicized case of e-patient Dave as published in the Boston Globe.
• To touch on concerns about patient security and privacy in regards to the Personal Healthcare Record (PHR), John Moore also brought up a really cool Massachusetts company called “Patients Like Me”  and highlighted the fact that through this vehicle,  “citizens” currently share their healthcare stories and experiences.

Regional Collaboration Meetings (CT, ME, MA, NH, RI, VT)

Later in the afternoon a breakout session allowed public officials to meet with neighboring states to discuss current plans, areas of concern, regional interoperability and opportunities for collaboration.

• NESCO (New England States Consortium Systems Organization) represents a business model built around collaboration and their Deputy Director, Nancy Peterson, acted as the facilitator.
• The idea of health delivery system reform was immediately brought up in that the system incentivizes and currently pays for sickness instead of for health via preventative and behavioral care.
• The model of the state of ME was addressed. Currently they have an operational provider-only HIE available to facilitate treatment improvement and representative of six of the largest healthcare systems in the state. The HIE, established in 2004 and live as of the summer of 2009, covers 50% of the hospitals 46% of ambulatory care.
• Some of the questions and comments posed by the audience included the following
  • How do we bridge between standards?
  • The business case needs to be established as this will drive investment. We need to clarify a vision and clearly express the financial incentive model.
  • Challenges with the business case in that savings on one side put costs on another.
  • We need to attack some of the low-hanging fruit first by implementing a common consent framework.
  • Ownership of the data: Who owns the data? The patient?
  • HIEs need to be consumer-driven.
  • Are we focusing too much on the standards with meaningful use, whereas we should be focused on the transport and the “network”?
  • Where are the interconnections in healthcare delivery that have the highest yields in terms of clinical data?
  • We face the underlying competing entities in clinical standards versus claims standards. Integration of the two needs to be addressed.
  • We are up against perverse incentives as there are many other resistive forces towards HIE, namely disincentives, in the health system.

Tags: EHR Implementation, HIE, HL7, Integration, Interfaces, Interoperability, Meaningful Use, RHIO

Galen Healthcare Solutions will be hosting a series of free webcasts covering ConnectR interfaces.  The purpose of these webcasts is to provide insight into advanced troubleshooting methods as well as advanced design and configuration options within your ConnectR environment.  We will cover various aspects of interface design, development and maintenance as well as best practice techniques.

These will be structured in a similar format to university courses – the initial three classes will be at 100, 300 and 500 levels.  The list of the webcasts and their times may be found below.

100 Series – Configuration and Deployment of Imagelink: Overview of Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

• Wednesday, May 19th, 2010 at 2:00pm EST

300 Series – Advanced Troubleshooting: Error analysis and resolution as well as custom techniques for error remediation

• Wednesday, June 23rd, 2010 at 2:00pm EST

500 Series – Advanced Design: Interface filtering techniques and interface-driven tasking

• Wednesday, July 21st, 2010 at 2:00pm EST

To attend, please contact Justin Campbell, justin.campbell@galenhealthcare.com.You must be an existing Allscripts Enterprise EHR client to attend.

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, Allscripts Enterprise EHR, ConnectR, Database, Galen Webcast Series, HL7, Integration, Interfaces, Interoperability, Meaningful Use, SQL Server

The benefits of Health Information Exchanges (HIEs) are quite profound. Recently we were able to assist one of our clients in exchanging data  from the Electronic Healthcare Record (EHR) with their state’s HIE network – specifically registrations, radiology results and documents. The biggest challenges we faced in integrating the EHR and the HIE included the following:

• Patient identifiers – these can be different between driving system (Radiology Information System (RIS), Laboratory Information System (LIS), and EHR. Consistency with the Master Patient Index (MPI) across all interfaces is the desired outcome.
• Filtering – mental health document types, “celebrity patients,” preliminary documents, unverified results – the list goes on and on. Knowing the gamut of different options of configurability is helpful in deciding which filtering should take place.

These interfaces were built in the ConnectR interface engine utilizing the existing Application Programming Interface (API) to the Allscripts Enterprise EHR (AE-EHR) – inbound and outbound stored procedures. It should be noted that the ConnectR interface engine is used as the standard interface engine by Allscripts to facilitate the communication between healthcare systems, however there are alternatives.

This approach is not entirely desirable in that it requires customization of the interfaces to the particular vendor/client based upon their underlying data exchange implementation architecture. In an ideal sense, the data exchange would facilitate a “seamless” plug-in to existing AE-EHR users and HIEs. This is certainly what the industry is driving towards.

As Dr. Halamka alluded to in his blog posting yesterday, the ideal scenario is one in which CDA/CCD documents are used to exchange data between the EHR and the HIE as they offer a complete set of the patient record. HITSP (Health Information Technology Standards Panel) standards describe these transactions  as there are thirteen original Interoperability Specifications (IS) into an EHR-centric view to facilitate alignment with Health Information Technology provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). For more information regarding Health Information Exchanges (HIEs) and “real-world” implementations and their utilization of HITSP products see the following HIMSS webinar. In the interim, for those Allscripts clients looking to get ahead of the game with meaningful use, we are left to develop interfaces within the framework of the existing API to/from the AE-EHR.

In closing, be very aware of the possibilities as the HIE landscape is changing. For example, Navinet now offers subsidization of HIE implementation costs. However, the challenge remains in determining the best business model to fund the exchange going forward.

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: EHR, HL7, Integration, Interfaces