Archive for the tag 'Meaningful Use'

Engaging your patients……and their smartphones

Last week, Jamie Verkamp of (e)Merge wrote a terrific piece as a guest blogger for EMR & HIPAA about looking beyond the simple patient engagement measures required by Meaningful Use and focusing more on patient involvement and education. In her piece, she mentions a TeleVox study that revealed 83% of Americans don’t follow treatment plans as prescribed by their physicians, and that 42% of those surveyed felt a form of motivation would help them follow their care plan. With Meaningful Use measures driving the adoption of patient portals, practices need to look at this investment as not another MU hurdle, but an excellent opportunity to interact with their patients. One of the suggestions mentioned in Jamie’s piece is the idea of making sure your patient-facing staff is well educated in accessing and navigating the portal in order help answer any of your patients’ questions. She also mentions that educating your patients on maneuvering around the portal is a simple way to increase patient engagement.

Along the same lines of patient engagement, the HIT industry received exciting news when Apple, during their Keynote presentation at the 2014 WWDC, introduced Health and HealthKit for their iOS 8 mobile operating system. When I watched the keynote, my first reaction was not “wow!” but “about time”. The mobile health app market has been around for a few years now, but so were mp3 players before Apple introduced the iPod back in October of 2001. While I don’t want to come across as an Apple fan boy, you can’t help but appreciate Apples ability to re-energize an industry and get people to rally behind their vision. In a generation where everyone is glued to their phones (waiting to see the “Head injury due to walking into street post while patient on their smartphone” ICD-10 diagnosis), it was only a matter of time that the mobile health market got it’s opportunity to take-off (Let’s just hope this isn’t another Spruce Goose).

Like!

“Like!”

Even though there are plenty of great running, exercising, diet/calorie tracking apps already in the market, Apple’s hope is that these apps, along with new ones entering the market, will have the ability to easily to integrate with and transmit information to an individual’s healthcare provider. With that said, I say “Good Luck.”

Fortunately, Galen has already recognized the need for a simple, educational, integrated care-management mobile application. Back in August 2013 during ACE, Galen introduced Dragonfly, a remote patient monitoring and chronic disease management app. Dragonfly lets a provider prescribe a patient self-management plan from their EHR, allowing the patient to capture the necessary vital measures for their specific care plan through the Dragonfly app. If the patient records a vital sign, such as a blood pressure reading, outside a reference range set by the provider, Dragonfly will alert the provider and their staff of the result in the EHR. You can learn more about Dragonfly and it’s other great features by visiting our website.

New TWUser Admin Preferences in 11.4.1

There are a few new enhancements available for Allscripts TouchWorks EHR (formerly Enterprise EHR) beginning in version 11.4.1.  The first feature allows you to assign all sites or specific sites to a user’s primary organization while establishing a default site for each.  This is an ideal feature for users that do not need access to all the sites for whatever reason your organization may decide.  Be aware that post upgrade, all users are assigned to all sites at all organizations by default.  This would apply to any new users created as well.  To configure any changes needed for users there is now an Assigned Sites section within TWUser Admin>User Admin.  Previously the controls for changing sites were located in the User Details section.

You can see by the screen shots below that you can select “All Sites” or un-check the desired sites as needed in order to limit the choices that the user will see.  Be sure to select a Default Site as well which will automatically be the choice if only one site is selected.  Notice that when Western Colorado Pediatric Associates unchecked, it is no longer an option for the user within Site Selector.

 

Site_Selector_001

 

Keep in mind that if  there is only one site assigned to a user, the user bypasses Site Selector even if  the Always Present Site Selector preference is set to Y.

 

The next new feature available within User Admin is the ability to add multiple licenses and ID’s previously not supported in earlier versions of Allscripts TouchWorks EHR.  The new Licenses/ID’s Section offers enhanced tools for defining provider licensing information, including support for multiple Drug Enforcement Administration (DEA) registrations.   When a provider has multiple DEA numbers, the application selects the correct DEA license for a controlled substance prescription based on the prescribing location (Site).

You can add multiple licenses and ID’s for users in specific states or sites, or for use at all sites as well.   These are  used for enrollment, prescription routing, prescription eligibility, and prescription history transactions.  Also be sure to enter applicable information for any users who enter orders for Physicians.  Clinical Quality Measures for Meaningful Use Stage 2 require that for an order to count towards an encounter provider’s computerized provider order entry (CPOE) measure, the user entering the order on behalf of the physician must be certified.

Licenses_ID's

As always, be sure to test any new features and enhancements first to ensure they are working as designed and are appropriate for your organization.

To learn more about 11.4.1 features and enhancements,  be sure to visit  http://www.galenhealthcare.com/events/ for upcoming free public webcasts.

  • References
    Enhancement Supplement Prescriber, Site, and Pharmacy Setup Changes for Electronic Prescribing- Available on Client Connect
    Enhancement Supplement Assigned Sites- Available on Client Connect

YES! Attaching Documents to Orders as Results

The Allscripts TouchWorks EHR 11.4.1 upgrade for Meaningful Use Stage 2 reporting contains a new feature which allows a document to be attached to an order as a result or as additional information.

This article is going to focus on attaching documents as results. For organizations that have paper results returned for lab and/or imaging orders this new feature will improve the workflow for verifying results, completing the orders, and support compliance with meeting MU2 Core Measure 10 and MU2 Menu Measure 3. Scanned results attached to orders will be documented in the patient’s chart like electronic results and will no longer be hidden in a list of scanned results.

Prior to the introduction of this new functionality, verifying results and completing the orders with scanned results usually followed one of two processes:

1.    The provider verified the result by signing a paper copy of the result, and then the result was scanned into the TouchWorks EHR and tied to the appointment encounter within which the order was placed. The order was then manually completed.

2.    The paper result was scanned into TouchWorks EHR, tied to the appointment encounter within which the order was placed, and a Review Document task was sent to the ordering provider. The order was then manually completed.

Attaching a document to an order as a result solves many inefficiencies in the order completion process. Now, when the provider verifies the result, with the same workflow used for electronic results, the order automatically completes. The order also automatically completes when the document attached as a result does not require provider verification.

Changing your current workflow to include attaching a document to an order as a result requires consideration for scanning processes, who will attach the result document to an order, and when will this work be done during the course of patient care. Not everything needs to be changed; for example, the question of who performs the scanning can remain the same with this new workflow, whether the scanning is done by a central scan center, a medical records team, clinical staff, or whomever else a clinic utilizes.

The following is a suggested workflow with these considerations in mind:

All result documents that are scanned into the system need to generate the same task type from scan. If an organization does not receive tasks from a transcription center, the best option is to use the Review Document task because this particular task is not presently utilized by other defined workflows within the Allscripts TouchWorks EHR. The Review Document task should be set to delegated and then filtered into a task view that is worked by the person or team that will be attaching results to orders.

The biggest challenge for implementing this new workflow is deciding who will be taking on the job of attaching the documents to orders. The process involves not only going into a patient’s chart to find the corresponding order, but also the time to enter at least one discreet result data item to make the result count for the MU2 measures. The time taken to implement this workflow will replace the time taken to manually complete orders and may or may not involve the same people.

There are many benefits and efficiencies to be gained through this new workflow:

·         Scanned result documents, attached to orders, can be viewed in the same Chartviewer locations where electronic results are viewed.

·         Results are no longer separated from the order and buried in a list of scanned documents that are difficult to locate and associate to the correct order.

·         Providers receive a Result Verification task in the same manner as an electronic results.

·         Scanned results can be cited into a note.

·         The orders with attached results are displayed in flowsheets.

·         The orders are included in duplicate checking and are used in order reminder calculations.

Configuration Requirements for Attaching Documents to an Order

Document Type Dictionary
If your organization is able to use the Review Document task from scan, set Workflow for all scanned result document types to “Non Electronic”. This controls scan sending a Review Document task as opposed to a Verify Doc or Sign Note task if “Electronic Verification” or “Electronic Signature” are selected.

Documents may be specified as “Is Result”, but other types of documents may be attached. The only documents that cannot be attached are enforced types: Encounter Form, CED-Automatic Export, CED-Import from External, CED-Manual Export, Result, Audit and invalidated documents.

If the document type is specified as ‘Has Image”, and the orderable item and image are included in Meaningful Use reporting, the attachment is included in Meaningful Use reporting.

User Requirements
Users attaching documents to orders need Chart-Edit and Results-Edit security.

The user role that attaches documents to orders will need the Documents tab on their clinical desktop, with the delegated Review Document task as the default view.

Order Requirements
Orders placed in Allscripts TouchWorks EHR must be in an Active or In Progress status to enable the functionality of attaching a document as a result to an order.

The order must be associated with a resultable item and the ‘Enable Documents as Results’ checked. This option is selected by default after the 11.4.1 upgrade.

All orders can have documents attached as results except Clinical Findings.

Task Requirements
Delegate the Review Document task and define a view that is given to the users that will be attaching the results to an existing order in Allscripts TouchWorks EHR.

Meaningful Use Stage 2 Requirements
Meaningful Use Stage 2, Core Measure 10 – Lab Results, requires at least one result entered as discrete data, in addition to attaching the paper lab result to the order. To meet this requirement an organization needs to decide which discrete value will be entered for each lab order with paper results. If a complete set of discrete results values are entered, than the scanned document can be attached as additional information instead of as a Result.

Meaningful Use Stage 2, Menu Measure 3 – Imaging Results, requires checking “Image Accessible for MU Reporting” in the Orderable Item Dictionary Behavior section for imaging orders that have a resulting image scanned into TouchWorks EHR and attached to the order as a result.

 

Workflow for Attaching Scanned Results to Orders

There are different ways to attach a scanned result to an existing order in the system. This workflow assumes the result document is scanned into the system before it is verified, and a delegated Review Document task is automatically generated.

In addition, this workflow design requires providing the Documents tab to the users attaching the results to orders, with the default view set to the delegated task view containing the Review Documents task.

1.    Go to the Documents tab and select the document from the task list

2.    Select ‘Attach To Result’

3.    Highlight the correct order on the list

4.    Click the beaker icon next to the order

5.    Click ‘Save”

6.    Click ‘Done’ to complete the Review Document task

If the order is set to require verification, the ordering provider automatically receives a Verify Result task. Once the result is verified, the order will complete.

In the perfect world, providers place orders during the patient visit when it’s decided the order is needed. However, there are times when an order has not been placed in TouchWorks EHR and is not available for attaching the corresponding result. If protocol allows, a retrospective order may be placed by clinical staff during the result attachment process.

1.    In the ‘Order Selection’ dialog box, click ‘New Order’.

The ACI opens with the Lab Orders tab selected by default.

2.    Create and save the new order

3.    Close the ACI, returning to the ‘Order Selection’ dialog box

4.    Attach the document to the new order

5.    Click ‘Commit’ on the Clinical Toolbar

6.    Click ‘Done’ to complete the Review Document task

Meaningful Use Stage 2: Hesitation could be costly

We often expect something we experienced before to be not as hard the second time around.     We are encouraged by software companies to not to think about MU2 until after we get the latest compliant version of the software installed in our system.       There are promises that if we have the software in place on day one of reporting that we will be able to attest.

Yet,  Meaningful Use Stage 2 has the potential to be the perfect storm.    

I have been on many calls and talked with other Meaningful Use SMEs (Subject Matter Experts) that are not just helping their clients through configuration, but working at warp speed both bailing the water and battening the hatches.   We can do it, we are great at it…but the frustrating thing is that we don’t have to let it get to this point.

Meaningful Use Stage 2 has a broader and deeper scope than Stage 1.       Many measures that at first glance look the same as last time around are actually much more specific in ways that affect how you organize your data and workflow – Computerized Provider Order Entry is a great example of this.   In Stage One, Providers just needed to be placing orders electronically, 90% of our clients were doing this so we were good.   In Stage 2 it becomes more specific about the types of orders and will be reporting a percentage for Medications, Labs and Imaging orders.     This means that we need to review those dictionaries and ensure that all Labs and Imaging orders are in the correct parent class and that there is nothing extraneous there that might alter our numbers.

“We’re not going to talk about MU2 until after the upgrade”    I have heard this from clients as well as software reps, and it’s maybe the most dangerous attitude that anyone on the team could present.    We are at a stage in this process that every Organization should have a Meaningful Use SME that they can call when implementing anything new and just ask “Is there anything I am missing here, what should I be thinking about in regards to MU?”

For MU Stage 2 specifically, we know that there is work to be done that is not dependent on the latest and greatest version of the software.   Dictionary updates, cleaning up the referring provider dictionary,  LOINC & SNOMED updates, identifying & thinking through the gaps between the present day workflow and future state workflow are among the items that can be done well in advance.

Most importantly, don’t rely on software timelines to drive your project.    MU2 work should start a full three months prior to the quarter that you want to attest, regardless of infrastructure timelines.     If you are planning on reporting in Q3 of this year, you should be looking at all of the measures and reporting requirements now.    If you are planning on reporting in Q4, then you should start your review no later than July first. If you doubt the need to start reviewing and configuring now, take a close look at the measure for closing the referral loop.  That should get you and your staff motivated to begin as early as possible.

 

HIE is here to stay

Galen Healthcare Solutions announced its strategic partnership with Orion Health in a past January article. Since then, Galen has been heavily involved in the recent boom of Health Information Exchange (HIE). What’s an HIE? In a nutshell, HIE is the “secure health data exchange between two or more authorized and consenting trading partners” (HIE Implications in Meaningful Use Stage 1 Requirements). On one end is the data supplier; on the other end is the data receiver. A third party – in this case, Orion Health – facilitates the data transfer to ensure quality control and necessary HL7 specifications.

I’ve spent the past few months working with two promininent HIE projects: hundreds of hospitals in each state sending demographic information, clinical documents, laboratory results, radiology reports, and immunizations to the state’s data repository. Providers from those hospitals are then able to access a portal that can display a patient’s full medical history from multiple hospitals on one profile.

Engaging in an HIE is one way for a hospital to meet Stage 1 Meaningful Use objectives. HIE engagement will only grow in the future as Stage 2 and Stage 3 Meaningful Use requirements are initiated. At its core, Meaningful Use is using EHR technology to promote patient engagement, care coordination, and health security. A breakdown of the 3 stages are as follows:

An important criteria for Stage 2 is that providers who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria to continue collecting government incentives. As eligible providers move into the next phase of meaningful EHR utilization, we can expect the trend of HIE to continue, with increased attention on advanced clinical procedures.

Next Page »