Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Over the past year we continued to experience tremendous change as a company, an Allscripts community and as an industry.

As a company we can point to our proficiency with the Allscripts PM and Professional products. Prior to 2010, our Technical Services team had been involved with a handful of interfaces with Allscripts Enterprise PM, primarily the standard interfaces with the Enterprise EHR. In 2010, however, the team took its knowledge of PM interfaces from elementary to expert as demonstrated in the PM Integration article in this newsletter. The team became experts in inbound demographics conversions, customized outbound registration and scheduling interfaces, and began to explore the world of general ledger interfaces. Additionally, the company performed its first conversion of an Allscripts Professional EHR system – splitting a single environment into three as part of a four-party acquisition. Galen also had the fortune of bringing on a handful of experienced Allscripts PM Implementation Professionals in 2010.

It wouldn’t be entirely fair to categorize 2010 as the year of Allscripts PM and Professional at Galen. Our advancements in these areas simply showcase the organization’s willingness to embrace change. Our commitment to learning and, more importantly, sharing what we learn requires us to constantly move into unexplored territory as we strive to add measurable value to our clients. We share our experiences and newfound knowledge within the industry via the Galen Wiki and the Galen Blog. We also see the Allscripts community sharing its knowledge through the Regional User Groups, the AmberSight forums and at ACE each year.

The upcoming year promises to bring even more change to all of us in Healthcare IT. Many groups are aiming to achieve Stage 1 Meaningful Use in 2011. This means an upgrade to Allscripts Enterprise EHR version 11.2. It means capturing new data, like smoking status and language. It means new interfaces, including lab and immunizations. New workflows. New reporting. We all have a lot to do.

At Galen, we began our journey towards Meaningful Use in earnest in 2010 following the release of the Interim Final Rule. Our Meaningful Use Committee began meeting bi-weekly to discuss the rules, their impact and how we can quickly and effectively assist our clients to meet MU in 2011. Galen’s Upgrade Team will be performing nearly 20 upgrades to v11.2 this summer, ensuring the systems are there for our clients to achieve meaningful use in 2011. Additionally our Interface Team has been furiously working the past 12 months on interfaces that aid in achieving Meaningful Use, and will continue to do so over the next two years.

At Galen, we welcome the opportunity of another year working with some of the best health care providers in the nation. We look forward to overcoming the challenges that will come with implementing the software, workflows and procedures necessary to achieve Meaningful Use.
We will stay the course of learning and sharing – with our colleagues, with our existing clients and with the broader Allscripts community.

Mike Dow

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Interfaces, Meaningful Use

Our clients environments are both sophisticated and complex, often times with different vendors in the fold for the different healthcare information systems that are utilized by the organizations. For those clients that are Managed Service Organizations (MSOs) or have different sub-entities, this is even more pronounced. Consider for a moment a scenario where an Integrated Delivery Network (IDN) consists of four physician groups under its umbrella. Some of these physician groups were added via acquisition – and as such were using existing systems such as EHRs or PMs from vendors different than those of the organization they were joining. The following mosaic illustrates such a case:

Given the graphic above, one can appreciate the complexity involved with the following core enterprise organizational functions:

• Interoperability – Most systems do not easily interoperate with one another and thus require interfaces to be developed to facilitate communication between the systems
• Patient Matching – uniquely identifying a patient across the enterprise in a system-agnostic fashion.
• Reporting and Analytics – Each of the systems may have different database technologies at their core, and additionally the structure of the data is sure to be different.  This creates a challenge in reporting metrics to exhibit adherence to meaningful use criterion for instance or to
• Trust – Which patient data should be shared across which systems?

A recent presentation at a NEHIMSS last month illustrated these points above and did a great job of communicating how Partners Healthcare is addressing the Healthcare Information System (HIS) mosaic via their COMPASS project. The COMPASS project is an aggressive initiative which implements a common administrative system and processes to streamline revenue cycle management and help manage costs through a “holistic, patient-centric, workflow-driven approach.”

The efficiency of the mosaic of systems (ala Claude Shannon for those EE nerds out there) is subpar at best. But this is the environment organizations find themselves. The alternative would be to consolidate to utilize one vendor across all systems ala the COMPASS project. However, some vendor systems are better at functions than others and the cost for conversion may be prohibitive or in some instances not feasible. For those organizations seeking out advice or recommendations for healthcare information systems, check out the folks at Software Advice as they offer great resources.

Contact us today if your organization seeks assistance with data conversion or integration of healthcare information systems.

Tags: Data Conversion, IDN, Integration, Interfaces, Interoperability, Meaningful Use, MSO, Multi-Org, Reporting

A recent article in Health Management Technology – Poised to touch all things -  highlighted the importance of Picture Archiving and Communication System (PACs) and offered the opinions of where PACs is headed from various leaders within the industry.

Additionally, as presented in a recent article in Health Data Management -  Is a Picture Worth a Thousand Interfaces?: “integrating imaging workflows – and images – in EHRs can be costly. But the benefits keep many trying.”

Many organizations utilizing Allscripts Enterprise EHR are unaware that image integration capability exists, and those that do figure it is too costly to implement.

In this demo, we will present Allscripts Imagelink capability. Imagelink is an Allscripts add-on that can be used to integrate outside systems with Allscripts Enterprise EHR.

More specifically, Imagelink provides organizations access to images and other documents associated with a result from a variety of different systems that have a web-based image viewer - from within the EHR.

With this solution, users of the EHR are presented with the clinical data they need to interpret, comment on, review or validate a particular result – without leaving the EHR application.

Just a few of the vendors we have experience in integrating to the Enterprise EHR via Imagelink include (but not limited to):

• NovaRad
• Stryker
• SCImage
• GE

Be sure to look out for one of our upcoming free webcasts covering Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

Contact us today to see if your organization can realize the compelling benefits of Enterprise EHR Imagelink integration.

Tags: Allscripts Enterprise EHR, Demonstration, Enterprise EHR, Extensibility, Imagelink, Integration, Interfaces, Interoperability, Meaningful Use, Results Interface

Integrating other web applications into the EHR is a dream for many.

Here, we take the risk calculator built based on the Framingham Heart Study, and integrate it into the Allscripts Enterprise EHR.  With the integration from Galen, the EHR sends the required fields into the Framingham Risk Calculator, like patient age, blood pressure and cholesterol, reducing the data entry and number of clicks for the clinician.  

Now’s it’s as simple to calculate the patient’s risk of heart attack, as it is to view their chart, all while in the EHR.

As we mention in the video, the Framingham Risk Calculator is just one example of integrating a website or web application into the EHR.

Galen has worked with groups on many types of EHR to web application integration – what would you add to the EHR, if you could?

Tags: Extensibility, Interfaces, Interoperability, Meaningful Use

One of the “Menu Set” CMS Final Rule Meaningful Use Stage 1 objective and measures specifies that “at least 40% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.” Additionally, the Certification Commission for Health Information Technology (CCHIT  - certifying body for EHRs) indicates via IO-AM 07.02 that “The system shall provide the ability to receive and store microbiology laboratory results with organisms recorded as free-text. (Not MU).” This brings to question the handling of interfacing microbiology results into the EHR.

Microbiology results are often longer, textual results including sensitivities. Additionally, microbiology results can have 3 levels of hierarchy:

1. Orderable item(s) (Urine Culture)
2. Culture(s)/Organism(s) (Light Growth Escherichia Coli)
3. Susceptibility(ies) (Amplicillin)

The problem is that most EHRs are not well-suited to rendering interfaced results with three-levels of hierarchy; rather, the EHR is suited for just two levels of hierarchy:

1. Orderable(s)
2. Resultable(s)

When the interfaced result is sent by the vendor as a “discrete” result, the result likely will not render in the EHR properly:

To accommodate for this, most vendors have the capability of sending the interfaced result as “non-discrete,” or in other words, sending a free-text version of the result.  However in an instance where the vendor is able to send “discrete” microbiology results only, the interface analyst is charge with developing a interface customization to translate the “discrete” result to file into the EHR as a “non-discrete”:

The disadvantages of filing the result as “non-discrete” include the likely lack of ability to aggregate or report on these types of results.

For reference the original printed report from the Laboratory Information System (LIS) for the example above (recall that if an interface is not setup, this is the report that is usually provided by the LIS via fax).

Please contact sales@galenhealthcare.com if you or your organization would like assistance in interfacing discrete/non-discrete results to your EHR.

Tags: Allscripts Enterprise EHR, CCHIT, Certification Commission for Health Information Technology, ConnectR, Database, Enterprise Order, HL7, Integration, Interfaces, Interoperability, Laboratory Information System, LIS, Meaningful Use, Microbiology Results

Organizations exploring Computerized Physician Order Entry (CPOE) might first pursue low-hanging fruit and implement an electronic workflow for results and keep a paper workflow for orders. Often times, electronic order entry can be cumbersome for end users and cause longer workflows.  As alluded to in a previous blog article, the benefits of implementing a solicited result interface are compelling – reducing paper and scanning, and offers the capability for automated result tasking.

In the Allscripts Enterprise EHR (AE-EHR), results can tie back to existing orders, facilitating completion of the order. This functionality is enabled and configured within the results interface deployed at a particular group and can be achieved in one of two ways:

• Order Number: the Order Number EXT generated from Allscripts is sent back with the results. The Order Number is tied directly to a specific order – a specific CBC order in a patient’s chart.
• Requisition Number: the Req Number EXT generated from Allscripts is sent back with the results. The Requisition Number is tied one or more orders – all orders on a single requisition. A requisition is defined by the Patient, Encounter, Performing Location and Ordering Provider.

For some organizations, a paper order work flow may be utilized, in which a paper requisition is presented to the lab instead of an electronic order. However, the Laboratory Information System (LIS) may not allow for discrete capture of the Allscripts-generated order number or requisition number. For that matter, the LIS also may not have the capability to send back this number in the result interface (typically a HL7 ORU result message).

Additionally, most organizations encounter a percentage of solicited results that do not complete the order. In the latter scenario, a lab may manually enter the order introducing the possibility for human error and can cause issue with not only reconciliation of the order, but potentially patient or provider matching.

Furthermore, if a lab has to change an order for any reason (for instance, changing the orderable item), the corresponding result will likely not reconcile the order (with the AE-EHR, the correct protocol would be to cancel the order and place a new order with the desired changes).

This situation can cause nightmares for organizations that are trying to gain semblance as to where lab vendors stand in terms of order fulfillment.  Additionally, order reconciliation reporting will likely be inaccurate.

This is especially pronounced in v11 AE-EHR, in which solicited results that are unable to reconcile to the original order create a “reported order.’ The original order is left unreconciled and a “duplicate” order renders in the patient chart:

We have resources available on our wiki to guide an organization through interfaced result-driven order reconciliation and can assist those organizations looking to gain control of order fulfillment and reconciliation. Please contact sales@galenhealthcare.com for more information.

Tags: Allscripts Enterprise EHR, CPOE, Crystal Reports, Custom Reports, Integration, Interfaces, Interoperability, Meaningful Use, Order Interface, Reconciliation, Reporting, Requisition, Results Interface

Tags: Allscripts Consultants, Allscripts Demo, Allscripts Enterprise EHR, Data Conversion, EHR Implementation, Enterprise EHR, Extensibility, Integration, Meaningful Use, ScanMD

Currently, exchange of clinical data in and out of the Allscripts Enterprise EHR is facilitated via stored procedures. This  application programming interface (API) approach certainly comes with its downsides. In this article, we propose a re-design of the API to segment out the data and the configuration components of clinical data exchange.

At the outset of an interface project where there has been precedent set (existing Quest or LabCorp <-> AE-EHR order/result data exchange deployments), we almost always get the following questions from the vendor:

• Shouldn’t the interface be the same from client-to-client?
• Why do we need to pay Galen (vendors will often times subsidize the cost of interfaces) to design a known interface deployed across hundreds of clients?
• Why do we need to reinvent the wheel?

Now these are very valid questions. And the response is as follows: Due to the approach utilized with the Allscripts interface API, an interface designer must take care in translating data extracted from outbound stored procedures into a valid, compliant HL7 message the vendor can accept (ORM for orders) and also take care in translating an HL7 message from a vendor (ORU) into a stored procedure call which sets both data elements and configuration options. To help guide the client and vendor through design decisions, Galen provides interface-specific (document, result, immunization) questionnaires.

Back to our proposed re-design: segmentation of the data elements (patient first name, provider ID, order item code) and configuration settings (enable tasking, utilize NPI for provider matching, utilize EntryCode for item matching – setting the traditional form parameters of the inbound stored procedures). With this approach, the vendor is responsible for providing the data elements as they normally do in the HL7 message (ORU for results), and the client sets the configuration settings via a workplace within the TWAdmin context in the AE-EHR – much as they do to set application preferences:

We have covered AE-EHR inbound interfaces quite well, so let’s address proposed re-design for outbound interfaces. Instead of each client requiring a site-to-site VPN and individual interface deployment, what if Allscripts chose some of its top vendor partners (Quest, Labcorp) and offered the capability to exchange out of the box, without the need for one-off interfaces? This approach is somewhat analogous to that of Surescripts acting as the hub and router for electronic prescriptions. In the case of outbound interfaces (orders for our example), there would still be the need to segment data (patient, provider, item) from configuration settings (a setting to enable or disable sending insurance information – IN1 segment of an HL7 ORM order message).

In conclusion the Allscripts clinical data exchange API serves its purpose quite well, but it could do a better job. Much of the functionality is derived from legacy, antiquated methods. Our hunch tells us that in promoting themes of Community Exchange and Connecting, the “new” Allscripts will be addressing this in short order.

Tags: Allscripts Enterprise EHR, ConnectR, Database, Enterprise EHR, Enterprise Order, HIE, HL7, Integration, Interfaces, Interoperability, Meaningful Use, Results Interface, Technical

The Path to Meaningless Use:

As many of you know the ACE 2010 event just took place last week. As I was pouring through some of the handouts I couldn’t help but be drawn into the “Handy Trail Guide” which Allscripts has touted as “The Path to Meaningful Use” This is a great high level guide to reaching Stage 1 of Meaningful Use – Capture and Share Data.

The more I read through this the more I thought of how clients will be looking at this with an eye to the shortest path to receiving their stimulus check, and rightfully so – every group should be looking to take advantage of this, from the largest hospital to the smallest single-doc practice. However, I wanted to make sure we don’t lose sight of the forest from the trees here and bring this trail guide back to the true reason for the stimulus – improving patient care! Hence the genesis of this article, The Path to Meaningless Use.

There are a couple of main points I’d like to highlight before dissecting the step by step approach.

1. Sell benefits of the EHR – I feel like this process is woefully underappreciated. In order for your rollout to be a success you absolutely need buy-in from all end-users, including physicians, nurses, data-entry folks and really any person that will touch the EHR on any level. How is this product going to improve their productivity? Make their job easier? Make their work experience more enjoyable?
2. Change is a good thing – Change is the process by which innovation and improvement are instilled. I know that people are comfortable with the status-quo and yes, change for change sake is useless, but there’s a reason for change here, I promise! Challenge your co-workers to look at everything objectively and really question if the products and processes currently in place really make sense or if there could be a better way.
3. Make concessions, don’t over-customize – The product is designed to work best when used in an out of the box capacity, sans customizations. The reality is that you probably aren’t going to be able to sell the idea of changing every workflow to fit the product, but that doesn’t mean you shouldn’t try. Ultimately in the long term the stability of the system is most closely tied to how close you stay to it’s intended use, therefore fight for those process changes to model the system, there’s a reason the EHR was designed the way it was! This point goes back to selling the benefits, be able to show how using the new workflows will actually improve the end-user experience!

With those main points made here are a few comments on the step in the Path to Meaningless Use, enjoy!

1. Understand Stimulus – Don’t just aim for the stage 1 level of capturing and sharing data, yes this can improve productivity but don’t lose sight of the true end goal, improving patient care.
2. Assess Gaps – Be honest with yourself. Are the tools you are using as efficient as they could be? Don’t keep old processes and tools in use just because people are “comfortable” with them, if there is a better tool out there, use it! Sometimes taking people out of their comfort zone is exactly what is needed to promote healthy growth.
3. Design New Workflows – Don’t be unwilling to change workflows simply because that’s the way it’s always been done. Be prepared to pitch workflow re-design to physicians with benefits for them in mind.
4. Upgrade EHR & Stimulus Set – Don’t rush this upgrade. There are many factors that go into an upgrade (depending on how many versions you are jumping) and simply upgrading for the sake of getting the stimulus approved version may end up biting you if you haven’t correctly re-worked process flows to use the EHR in a meaningful way.
5. Rollout – During training stress benefits to end users, a 3 day crash course on the new EHR system is great but if you can’t prove to your end users why the new product and workflows make sense you aren’t going to receive full buy in and consequently won’t get the most out of the product.
6. Begin 90-day Meaningful Use – Metrics should be kept on an ongoing basis, not just for 90 days. It’s great to hit the 90 day plateau to receive the stimulus check but the true purpose of the EHR is to improve patient treatment, and you can’t improve what you don’t measure.
7. Report & Claim Stimulus – Nothing meaningless about this step, claim the money and move on to the next stage!

Tags: Allscripts, EHR, Meaningful Use, v11 upgrade

As many of our loyal blog followers know, the Allscripts Client Experience (ACE) is Allscripts annual user conference, and a huge event for Galen. It’s a time for us to reconnect with clients, Allscripts contacts, and build new relationships. The theme of this year’s conference was “GO” – the time is now to implement an EHR, and ensure groups are setup to exhibit Meaningful Use.

Some of my own key highlights and takeaways from ACE:

• “The Path to Meaningful Use”
  • Allscripts offered a handy trail guide for ACE:

• The theme of “Community”
  • Our CEO, Steve McQueen, exhibited some pre-conference foresight in lending his own insight into Galen’s community
  • MyAllscripts - client portal for all Allscripts products facilitating collaboration via discussion forums, enhancement idea exchanges and blogs.

• Analytics
  • Dan Mingle, Chief Physician Execute from Maine MSO and Dan Reber, Lead Product Architect at Precision BI led an informative session on the Analytics product, touching on the correct process to implement Analytics as well as using the cross-tab analysis and linked group analysis.
  • I was unaware of its existence, but a user group community has been established for analytics
  • Precision BI has a roadmap for several improvements

• Aternity – an Allscripts performance monitoring solution
  • The ideal tool is non-invasive, comprehensive, accurate and provides an aggregated analysis
  • Facilitates user-centric proactive IT management
  • Yields performance by location, variation by site, and performance over time

• Allscripts Product Portfolio Roadmap – Jon Zimmerman, Allscripts Senior VP Solutions Management
  • Revenue Mix Changes:
    • Today: Fee for Service and Bonus Payments
    • Tomorrow: Fee for Service, Bonus Payments for Savings, Contract per Patient per Month, and Other P4P
  • Systems Evolution
    • Paper Health Records -> Electronic Health Records -> Electronic Health Systems -> Intelligent Networks
  • Connectivity Blueprint:
    • Allscripts HUB: Connecting commercial lab, hospital, pharmacy, payer, HIE, government registries, and sate RHIO
    • Services Framework: EntEHR, PM, ProEHR, MyWay

For more information regarding the topics touched on above, be sure to visit MyAllscripts to view presentations from ACE.

Thanks again for everyone who stopped by our booth to say hello. It was both great to see old friends and establish new relationships. And a special congrats goes out to Melissa Singh, Analyst at NSLIJ, for winning the grand prize – an Apple IPAD – in our “Spin and Win” drawing.

Tags: Allscripts, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, Meaningful Use