Archive for the tag 'Meaningful Use'

You converted to a new EHR mid-year….now what?


 A few weeks ago, I had the pleasure of attending the Healthcare Analytics Summit hosted by Health Catalyst. As a data nerd, I attended out of interest for what is going on in the industry, specifically what initiatives health care systems around the country are currently involved in, and the challenges they are facing.

For the past few years at Galen, I’ve been performing data conversions for clients from one Electronic Health Record (EHR) to another. A recurring issue that I heard a few times during the Summit is that sometimes health systems need to perform mid-year data conversions from one system to a new system, which made year end reporting for quality initiative programs from the legacy system challenging. Some systems with their own Enterprise Data Warehouse (EDW) were able to incorporate the legacy data into their existing EDW, saving them hundreds of man hours of physically going through the records to find patients that meet the criteria.

But some of you don’t have the luxury of a fully functional EDW. And many of you are acquiring practices left and right. Incorporating the data from these legacy systems into your new or existing EHR is an exhaustive process in itself. Testing the data imports, managing timelines, training staff on a new system. It can be daunting.


Last year Galen performed many data conversions from a variety of source systems. The data that we extract as part of the conversion process is reportable and can be used for a number of reporting initiatives. Although they aren’t technically part of your hospital system, your conversion tech and conversion analysts know your data very well by the end of a conversion. We often work with staff in your hospital to understand workflows. We understand that specialty practices have different types of data and different types of needs than primary care practices. We work so closely with your data for months at a time that it sometimes feels as if we are actually employees of your health care organization.

The thought struck me during the Summit – why not utilize the data that was extracted for the conversion in order to assist in your reporting needs for your quality initiatives? Like I stated above, by the end of the conversion, your tech is going to understand your data really well, and most importantly, have access to it. For conversions, some of the most commonly extracted items include problems, medications, allergies, appointments, smoking history, vital signs, lab and imaging results, visit notes, health maintenance history and immunizations. On top of these items, we can also extract any items that you might need for quality initiative reporting at the same time that we are performing the extraction for the data conversion. For example, in the demographic extract, we can extract race, which might not necessarily be part of the conversion efforts, but something simple for us to add into the extract that will go a long way in helping you report for Meaningful Use.

We can help you. If you are one of our current or past conversion clients, contact us to see how we can work with you. Galen also offers archival solutions, de-migration and conversion services as well as a variety of reporting offerings to meet your quality initiative reporting measures as well as your own internal needs.

Discouraged Provider? Or Just Mislead?


Very recently, a provider that I have known and worked with for a long time informed me that he was leaving his practice.  He gave me a copy of an article from The Health Care Blog titled “How to Discourage a Doctor1” by Richard Gunderman, MD, and stated that the essence of this post is his reason for throwing in the towel.  The article itself was written by a doctor who appears very misled as to where certain drivers of policy and procedure originate.  It begins with the provider finding a document left behind in the hospital administration waiting room titled “How to Discourage a Doctor,” and takes a satirical view in detailing the many bureaucratic challenges facing physicians.  The article identifies the “most important driver of costs in virtually every hospital will be its medical staff.”  To maintain a favorable balance sheet, administrators must “gain control of their physicians,” which can be accomplished by “transforming previously independent physicians into employees” and “tying physician compensation directly to the execution of hospital strategic initiatives,” which thereby increases “hospital influence over their decision making.”  Finally, it cites the mandated use of technology, evidence-based care guidelines, and payer reimbursement structures as hospital-driven tools used to discourage physicians.

Having worked for independent physicians, for hospital-employed providers, for the hospital itself, and currently as a Healthcare IT consultant, I feel I have had adequate exposure from all sides of the fence to give an objective evaluation and break down the flaws in the highlighted assumptions.  Yes, hospitals have to put some constraints on providers to control costs and balance budgets, however those budgets and strategic goals are not dreamed up by hospital executives or other stakeholders trying to drive the market.  We are part of a culture driven by a broken economic system, and in trying to correct this, have grown dependent on payments from the insurance industry to sustain our practices.  Some of the comments regarding the article came from providers that have escaped this cycle by opting to do a cash-only business, but let’s face it, most consumers cannot afford to pay out-of-pocket for healthcare.  Additionally, the cost of healthcare has risen in part due to the need for providers to protect themselves from claims of malpractice.  As I break down a few other facilitators, it becomes evident that while there are discouraging drivers within the medical community, many extend far beyond the hospital’s control.

First – the Government

Ahh, we love the alphabet soup: MU, PQRS, PCMH, ACO, CCJR are just a few, and of course Healthcare Reform as a whole.  Let’s assume we all agree that communicating between entities regarding patients’ healthcare is a great idea.  At a provider level, if all systems could talk, a click of a button could show that your patient was admitted to the ER the night before, is seeing multiple providers, or was prescribed meds unbeknownst to you.  All of this information helps tailor a treatment plan accordingly to a patient’s needs.

Taking the same philosophy at a macro level, if the CDC or FDA could aggregate data and identify an emerging epidemic or a pattern of complications from a specific drug usage, why would we not want to support that?  Large sums of money are spent on medical research to cure diseases such as cancer, MS, or ALS, but imagine if researchers had access to the aggregate health data of hundreds of thousands of patients.  How would that expedite the progress of developing cures for horrible afflictions? The potential to avert a disaster and better patient health outcomes drives the need for enhanced interoperability between systems and regulations for EHRs, hence all the Meaningful Use, PQRS, CQM and many other buzzwords you hear about today.  Hospital executives do not make these requirements, however, if they want to see patients and get paid, they have to comply and they cannot do it without support of providers.

Second – Malpractice

Many people may not be aware of how much it costs an individual provider to carry malpractice insurance for one year.  Despite the tort reform that has been passed in recent years, there are still many states that have extremely high liability costs.  Below is an example of three specialties in three different states.


With other overhead costs continually rising and payment from health payers decreasing, it is difficult for a provider to survive with the cost of medical liability coverage, and many have been known to reach out to hospital-based provider networks where they can join in on a group coverage to help defray this expense.  To contractually qualify for this group coverage, the provider or his practice has to be affiliated with the hospital network.  Many times, this will require an employment agreement of some fashion.  Of course with an employment agreement, the physician is then required to abide by all the regulatory obligations of the contract.  In this instance, this is a financial benefit to the provider and not a control game played by the hospital system.

Third – Insurance Payers

Have you ever examined your Explanation of Benefits and seen how much of a write-off your provider/hospital is taking?  Take for example a patient who receives an outpatient procedure where the physician’s bill for the service is priced at $900.  Insurance pays nothing because the patient had not met their deductible, so the provider is forced to write off $750 due to contractual obligation, leaving the patient with a $150 balance. This is a very typical example of contractual write-off between health plan and provider.  Nowhere did the hospital executive dictate to my provider what was paid (or not paid in this case) for the services performed.  Believe me, as an employer of that provider, I am sure they would have much rather received even a portion of that $750 than have written it off as uncollectible.

It has been my experience that hospitals and provider networks are trying to work together as a group to meet insurance payers’ requirements for increased reimbursements.  Many payers are paying incentive bonuses when a facility meets a goal such as PCMH accreditation, quality of care guidelines or measures, and some readmission or emergency care goals.  Blue Cross and Blue Shield states “member plans saved more than $1 billion through programs that ‘emphasize prevention, wellness and coordinated care while reducing costly duplication and waste in care delivery2.’”  CMS provides the following background for their Bundled Payment for Care Improvement plan.

Traditionally, Medicare makes separate payments to providers for each service they perform for beneficiaries during a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. It also rewards the quantity of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – allowing them to work closely together across all specialties and settings3.  

Everyone in the healthcare industry knows that CMS dictates the trends, and other payers shortly follow. Managing hospitals and provider groups develop policies and protocols to meet these objectives so that they can receive more reimbursement for their services, while simultaneously managing their patient populations more effectively.

We can’t direct all our frustrations with the challenges of today’s providers towards the hospital executives, as there are obviously external forces driving these regulations.  Players across the entire healthcare spectrum need to come together and find resolutions for each obstacle, and Healthcare IT organizations like Galen Healthcare Solutions exist to facilitate synergistic change.  We should not discourage our providers out of practicing, but instead strive to make them partners in the future of healthcare.  Contact us to let Galen help you with your challenges, whether it involve migrating to a new system, custom reporting for incentive programs, or optimizing your portfolio of applications!


Are Medical Scribes For You?

picjumbo.com_HNCK3323 (2)

A role gaining popularity in the ever growing electronic healthcare industry is the medical scribe.  Scribes perform the data entry in the EHR so that the doctor can focus on the patient. They’re clerical in nature, don’t communicate directly with patients, and don’t perform clinical procedures or administer medications.  We’ll examine the pros and cons of using medical scribes in today’s dynamic healthcare field.

These positions are very competitive to obtain, which ensures that only strong candidates are selected.  They’re typically filled by pre-med students pursuing a career in healthcare, often during a gap year, as the idea of real provider-patient interactions appeals to many.  Observing providers as they diagnose and treat patients is an invaluable real-world learning opportunity that can’t be paralleled in a classroom.



Refocus attention on the patient: Scribes manage the majority of the data entry for the physician, affording the provider the freedom to listen attentively and focus on the patient’s needs.  In one example, “An American Journal of Emergency Medicine study found that emergency physicians spent 43% of their time entering data into a computer, compared to only 28% of their time spent talking to patients

Real-time documentation: While the physician examines the patient, a scribe can enter all relevant findings in real-time.  The result is more comprehensive and accurate documentation with fewer incomplete notes for the physician to circle back to at the end of the day.

Reduced Visit Durations: By minimizing the physician-computer interaction during the actual patient encounter, the time required to document a patient visit is significantly shortened.  This leads to decreased patient wait times and ultimately, increased patient and physician satisfaction.

Increased Revenues: Along those lines, practices stand to see potential long-term revenue improvement on two fronts:

  1. They can schedule a higher volume of daily appointments since patient visits are shortened, while maintaining high levels of accuracy and face-to-face interactions
  2. From a billing aspect, claims submissions should be more efficient since the documentation is completed in a quicker and more accurate fashion. This is especially important with the ICD-10 cutover less than 2 months out, but also very beneficial for incentivized programs.

Provide adaptability for incentive programs: Practices and physicians are constantly challenged with new regulations, and it is imperative that proper documentation accompanies each visit.  Scribes can alleviate some of the stresses by expediting the documentation process for initiatives such as Meaningful Use or PCMH, and capturing the added details required by the move to ICD-10.



Provider Responsibility: Regardless of how a visit is documented, the provider is liable for their notes, and is required to review all scribed documents for accuracy before signing off.

Loss of alerts and decision support functions: Providers will not see the alerts and decision support prompts if they are not personally navigating through the EHR.

Initial Investment: Scribes may increase revenue over time, however the initial investment shouldn’t be overlooked.  The additional compensation is an obvious consideration to account for, but using scribes also requires a workflow overhaul which may disrupt daily throughput (as any workflow change might).

Learning Curves: Other costs to consider are the associated learning curves.  Scribes require training in multiple areas – the application, HIPAA, medical terminology, etc. – and the adjustment periods between the providers and scribes could hinder workflow efficiency.  Practices must factor all of this, including the high turnover rate of pre-med students heading off to medical school, in their evaluation process.

Big Data: The need for structured, reportable data is greater now than ever before as pay-for-performance initiatives that leverage EHR reports are taking off.  Moving forward, it’s not only important that a patient visit gets documented, it’s also important how it gets documented. As part of the initial onboarding, organizations must train their scribes to document in the appropriate fashion to ensure their providers get the full credit for each patient encounter

Patient Comfort Level: Patients may not be comfortable with other non-clinical personnel in the exam room, which could lead to them being less open about relevant healthcare information.  Sensitive or embarrassing conversations necessary for accurate diagnosis and treatment may be omitted in certain scenarios.


There are definitely lots of discussion points when considering medical scribes. The cost/revenue analysis will differ at each practice. Patient and physician satisfaction are likely to improve, but at the cost of alert and decision support functions.

Our recommendation before even considering medical scribes is to assess your EHR and note module to ensure they are optimally configured for your providers’ use and for all requirements (e.g. ICD-10, Meaningful Use, P4P initiatives).  We are all familiar with the additional work required of providers to document and order within the EHR, but often these efforts can be greatly reduced by streamlining the EHR’s configuration, especially the note forms, for ease of use.  At the same time, an optimization can improve the documentation and data required for ICD-10, Meaningful Use, and other initiatives. Under pressure to first implement EHRs and then to conform to Meaningful Use, many organizations have not had the time to perform such an assessment. Once your EHR, especially the notes, is optimized, you may find that fewer providers actually require a scribe.  For additional information and an example of an assessment, you can check out Galen’s complimentary Assessment & Gap Analysis for ICD-10.

Whatever decision you ultimately make, we always encourage our clients to define metrics and implement a pilot group before proceeding.  Determine what is important to your organization.  Maybe the focus is increased revenue, provider productivity, staff and patient satisfaction, accurate and timely documentation, or a combination of the above.  Either way, goals need to be established and measured to be able to track success.  Piloting a program on a small scale prior to enterprise-wide implementation could prove very insightful.  Changes in a practice are always difficult, so it’s important to research and obtain the necessary information ahead of any decision making.  For more information on medical scribes, EHR assessment & optimization, or Galen’s implementation methodology, feel free to contact us.




Top 10 Recent Quotes on Healthcare Interoperability

Much print has been dedicated to interoperability over the past several months. At issue is whether the government (ONC) should attempt to solve healthcare interoperability or continue the course and let the market solve it (or perhaps some in between). We will be discussing this issue with our partners at our annual GPAC event next week in Boston. To prime the discussion – and as part of our interoperability blog series – we present the top 10 recent quotes on the issue:

  1. Interoperability may not have gotten enough attention in the early days of Meaningful Use’s electronic health records (EHR) gold rush, but it’s now taking center stage as healthcare providers, government agencies, vendors, and committees consider how to support the exchange of data easily and securely. It’s very easy to point fingers at folks. People underestimate how challenging this work is,” Sawyer told InformationWeek. “I think the vendors are being cautious before spending lots of research and development money before a standard is more clearly defined.

    -Alison Diana, Information Week, “Healthcare Interoperability: Who’s The Tortoise?”

  1. If Big Data is the new oil in healthcare, clinical business intelligence is the refinery.

    -Brendan Fitzgerald, HIMSS Analytics, “Infographic: The future of clinical & business intelligence in healthcare”

  1. Congress doesn’t think that the marketplace has created the interoperability it thought it was mandating in the HITECH Act. The right question is: How do we ensure that patients, clinicians and caregivers all have read and write access to a patient’s longitudinal health record in real time? More generically, how do we ensure that the right information gets to the right person at the right time?

    -Flow Health Blog, “Beyond Interoperability”

  1. “information blocking” – I believe this concept is like the Loch Ness Monster, often described but rarely seen.   As written, the information blocking language will result in some vendors lobbying in new political forums (Federal Trade Commission and Inspector General) to investigate every instance where they are getting beaten in the market by other vendors.  The criteria are not objective and will be unenforceable except in the most egregious cases, which none of us have ever experienced. We are in a time of great turmoil in healthcare IT policy making.   We have the CMS and ONC Notices of Proposed Rulemaking for Meaningful Use Stage 3, both of which need to be radically pared down.   We have the Burgess Bill which attempts to fix interoperability with the blunt instrument of legislation.  Most importantly we have the 21st Century Cures Act, which few want to publicly criticize.   I’m happy to serve as the lightening rod for this discussion, pointing out the assumptions that are unlikely to be helpful and most likely to be hurtful

    -John Halamka, Life as a Healthcare CIO Blog, “21st Century Cures Act”

  1. The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connected health IT system, are we getting our 28 billion dollars’ worth?

    -HealthBlawg “Locked Down or Blocked Up? ONC Report on Health Information Blocking”

  1. The bill abolishes theHealth IT Standards Committee and proposes to have the work of developing interoperability standards contracted out though usual procurement channels, and reviewed and approved by NIST and the Secretary ofHHS in addition to ONC. It also requires attestations by EHR vendors as to their products’ compliance with the interoperability standard, and it calls for the creation of a federal website that will have full transparent pricing for every certified EHR (and its components and interfaces) 

    -David Harlow, JD MPH, Principal, The Harlow Group LLC, “Whither Interoperability”

  1. The U.S. healthcare stakeholders include patients and individual physicians. Unfortunately, these two stakeholder groups are seldom represented in technical standards organizations and, more importantly, have almost no purchasing power when it comes to electronic health records or health information technology. This contributes to the slow rate of progress and has created significant frustration among both patients and physicians. The beauty of patient-driven interoperability is that ancillary infrastructure is helpful but not mandatory. As with auto-pay transactions with your bank, directory services are not required and certificate authorities are already in place. Certification tests would still be needed but the the Internet provides ample examples of open tests and self-asserted certification that would bypass most of the delays associated with legacy methods.

    -Adrian Gropper, MD, The Health Care Blog, “Patient-Driven Interoperability”

  1. I believe that the sufficient conditions for interoperability include the following:
    *A business process must exist for which standardization is needed. As Arien Malec put it recently, ‘SDOs don’t create standards de novo. They standardize working practices.’
    *A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation.
    *A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose. The business purpose may include satisfying regulatory requirements, or meeting market pressures, or both.
    *A ‘network architecture’ must be defined that provides for the identity, trust, and security frameworks necessary for data sharing in the complex world of healthcare.
    *A ‘business architecture’ must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur.
    *A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed.
    *And almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard.

    -John Halamka, Life as a Healthcare CIO Blog, “Standards Alone are not the Answer for Interoperability”

  1. Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay

    Anne Zieger, EMR & EHR, “HHS’ $30B Interoperability Mistake”

  1. This is one of the most public and noteworthy conversations that has taken place on the issue of patient identification. It’s time that Congress recognize the inability to accurately identify patients is fundamentally a patient safety issue.

    Leslie Krigstein, CHIME Interim Vice President of Public Policy,  EMR & EHR News Blog,  “Patient ID Highlighted as Barrier to Interoperability during Senate HELP Hearing”


Allscripts Analytics Platform – Do You Have the Latest News?


As Meaningful Use, PQRS, and CPCI have developed over the past few years, so have their reporting capabilities.  The race to achieve MU-required goals as well as a pattern of late-in-the-year Final Rule updates from Congress have required vendors to rapidly update reporting algorithms.  For Allscripts, what began as the Stimulus Reporting Portal with v11.2.3 migrated to the more robust Allscripts Analytics Portal (AAP) in v11.4.1.

In keeping with the ever-changing landscape, AAP 15.2 was deployed to Production on June 9, 2015.  There are the usual logic changes, however at a higher number than seen in the past.  In fact, there were enough significant issues during UAT testing that this update was delayed for several few weeks.  This latest version brings numerous logic, value set, and even workflow changes – 21 pages of calculation changes to be exact!   Whenever there is an update to the AAP, every organization’s data will be recalculated, and this can take several days for the process to finish.  As of the date of this publication, Allscripts is expecting this process to be completed by the end of the week.  Remember that the dropdown for the 2015 reports will be unavailable until the data has reprocessed.

A major change to note is in workflow NQF 0028- Preventative Care and Screening for Tobacco User:  Screening and Cessation.  In 2014, physicians were credited if counseling was entered as an order, but for 2015, the order must also be in a “completed” status to count in the calculation.  The numerous updated measures will have a new section in the configuration document called “Changes from 2014 to 2015”.  The specific measures affected can be found here with helpful hyperlinks.

With the combination of increasing alternative payment model adoption and the impending code set change to ICD-10, it stands to reason that audits will increase.  It is has become increasingly important to not only have accurate reporting in place, but to also develop the contextual connection to that information.


  • Subscribe to the AAP Blog to automatically receive email updates
  • Run and validate reports regularly
  • Always export reports to excel and save them! This is important for audits, but perhaps even more important for validation testing processes.
  • Keep careful records of what a report represents for the organization. A detail as simple as a specific consistent naming convention helps delineate changes, and creates a defensible audit position.
  • Keep a calendar or diary of the changes applied, not only for audit purposes, but also for ease of knowledge transfer between team members. For example documentation should include Plan of Correction Actions taken for workflow changes and confirmation of changes to existing configurations.

The healthcare atmosphere requires careful balancing between the many competing objectives of healthcare reform.  If you have further questions or feel your organization could use the strategic insight and proven solutions that Galen Healthcare Solutions offers, don’t hesitate to contact us at


Allscripts Analytics Platform Documentation:

Allscripts Advisory Blogs:

Allscripts Changes 2014 – 2015 Announcement:

Next Page »