Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Client: MedNetworx – Azalea Orthopedics

Project: MedManager PM -> Allscripts PM Conversion

Project Timeframe: April 15^th – June 1^st (6 weeks from initial scoping to go-live)

Client Contact: MedNetworx – Mark Johnson, President and CEO.

Description: Azalea Orthopedics, located in Tyler Texas, has been providing orthopedic surgery, sports medicine & pain management in East Texas for the past 20 years. Azalea employs 130 including 17 physicians who are specialists in orthopedic surgery, physical medication and rehabilitation. MedNetwoRx, a healthcare application service provider (ASP), located in Dallas, Texas, hosts the practice management and electronic healthcare record applications for Azalea. Azalea looked to convert from a legacy PM system, MegManager, to Allscripts PM, as part of consolidating systems to the Allscripts product line. Partnering with Galen Healthcare Solutions, MedNetwoRx leverage their own in-house Allscripts product and physician practice experts as well as Galen’s deep experience with clinical and administrative data conversion.

To facilitate this conversion, flat-file extracts were obtained from MedManager for dictionaries, demographics and appointments. However, instead of using these extracts to import into Allscripts PM, an alternative approach was taken in which real-time appointment and demographic interfaces were deployed from the client’s existing Allscripts Enterprise EHR to the new Allscripts PM environment. This offered the flexibility of having the PM data populate real-time. Interfaces were also required from Allscripts PM to Allscripts Enterprise EHR. Thus as part of the go-live, existing reg/sched interfaces from MedManager to Allscripts Enterprise EHR needed to be deployed.

Utilizing existing data in the Allscripts Enterprise EHR as well as flat-file extracts from MedManager (for more complete insurance and referring provider information), a conversion of dictionaries, registrations and appointments was executed.  Care had to be taken to ensure that appointments loaded into Allscripts PM would be able to map to existing appointments in the EHR and update appropriately instead of creating duplicate appointments. The same consideration had to be made for dictionaries to ensure proper matching on codes.

All patients (inactive and active) and appointments for the previous 2 years as well as future appointments were loaded from the Allscripts Enterprise EHR into Allscripts PM. Since insurance information wasn’t being captured in the EHR, and update of patient’s accounts in PM had to be executed, utilizing flat-file output from MedManager. Additionally, the patient MRN seed in PM needed to be reset as to avoid contention, and insurance and referring provider dictionaries were updated using extracts from MedManager, since the extracts contained more complete data than the EHR.

Conversion Statistics:

Tags: Allscripts, Allscripts Conversion, Allscripts Enterprise EHR, Allscripts PM, Clinical Conversion, Data Conversion, Galen Clinical Conversion Toolkit, Integration, Interfaces, MedManager, MedNetwoRx, MSO, Multi-Org, PM Conversion, Practice Management Conversion

Introducing the Galen Clinical Conversion Toolkit, a solution and process designed to guide clients through converting from legacy systems and existing EHRs to the Allscripts Enterprise EHR. As Managed Service Organizations (MSOs) seek to expand their footprint through acquisitions, conversions to consolidate to a standardized system are often desirable to avoid the Healthcare Information System Mosaic.  Leveraging experience gained from previous clinical conversions, the Clinical Conversion Toolkit streamlines the process and provides a means of converting clinical data safely and efficiently. It should be noted that while conversions can be extremely useful in the sense that they save duplicate data entry, clients need to exercise caution in that any conversion data should be reviewed.

Discrete Conversion Types

Process Overview

• Data Extraction

• Data Analysis: Cross-Referencing

• Design: Data Filtering, Matching (Provider, Patient Item), and Exceptions/Errors

• Testing

• Go-Live

Data Extraction

Whether the historical system is an EHR such as NextGen, Greenway or eClinicalWorks, a PM such as GE Centricity, or a legacy in-house clinical information system, one of the most important aspect of the conversion will be acquisition of the data. Often times, this will require assistance with the current vendor to trigger a bulk-load export of the data. The preference is to output to flat-file, thus facilitating an intermediary step of data analysis and cross-referencing to prep the data before it is loaded into the EHR.

Data Analysis – Cross-Referencing:

The most important part to cross-referencing is to ensure that the corresponding AE-EHR dictionary dependency exists in the dictionary. If starting from a “blank-slate,” it is prudent to extract the compendium information for the exported data file from the source/reference system. In the case that dictionary entries already exist in the AE-EHR (for instance, in the scenario of a client that is an MSO, multi-org, and single EHRDB), it will be important to setup cross references so that the codes in the reference system match up to the corresponding values in AE-EHR. This is often realized through deployment of translation tables within the Clinical Conversion Toolkit.

• Provider code – Recommendation to use default “dummy” provider to identify clinical items loaded from conversion
• Document type
• Allergy code
• Immunization name, provider, route of admin, body site and manufacturer
• Problem and procedure codes
  • These codes will need to be cross referenced with the more-granular Medcin nomenclature.
  • This presents a challenge in that an ICD9 or CPT code could have a one-to-many relationship with Medcin.
  • The Clinical Conversion Toolkit provides a translation tool utilized in previous problem conversions to assist in the cross-reference.
• Vital sign names
• Order/Result Item Codes

Design – Filtering:

Filtering can be performed up-stream as part of the source/reference system extraction process, or it can be realized within the Clinical Conversion Toolkit logic. Typical filtering options include the following (but are not limited to):

• Items that have been entered in error in vendor system
• Allergies – NKA and NKDA entries are typically excluded to avoid incorrect reporting of NKA and NKDA
• Exclusion of non-finalized documents or results

Design – Matching:

Patient Matching: Patient matching is crucial to the exchange of clinical information between systems.  The Allscripts Enterprise EHR has strict matching criteria – in summary, matching on three of the four of the following: Name, Date of Birth, Medical Record Number (MRN) and Social Security Number (SSN).  As there is a move away from using SSN, by patients at least, this leaves us with only three fields to match on for many patients: Name, Date of Birth and MRN. In certain cases, more advanced options for patient matching can be deployed such as fuzzy matching as previously described on our blog.

Provider Matching: Clinical items will need to tie back to the provider who originally entered, ordered or authorized.  Typically, a short numeric or alphanumeric identifier is used to link a provider entry in the Other Vendor’s system to the provider entry in the EHR.  The current trend is to use a provider’s National Provider Identifier (NPI) as the identifier that the two systems exchange.

Design – Exceptions:

Not all of the data will load to the EHR without error. Some records will require manual assistance via add-on tools such as Allscripts Patient Bridge, while others may require more advanced troubleshooting and re-file. The Clinical Conversion Toolkit takes care of logging those transactions which generated error for future reference.

Contact:

Please contact sales@galenhealthcare.com if you or your organization would like to learn more about Galen’s Clinical Conversion Toolkit for the Allscripts Enterprise EHR.

Tags: Acquisition, Allscripts Conversion, Allscripts Enterprise EHR, Clinical Conversion Toolkit, Data Conversion, Enterprise EHR, Integration, Interfaces, Interoperability, MSO, Multi-Org, Technical

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 engagement with a large multi-specialty client gave some insight into increasing physician acceptance and adoption of the Electronic Health Record. It became apparent very early on during the rollout of ePrescribe and Call Processing, that easier accessibility equals higher acceptance. The physicians want to be able to access the EHR instantaneously while with the patient: order medications, input visit data, submit charges. This proved to be a difficult task when workstations were not available in the exam rooms. We discovered that the providers were less likely to exit the exam room at the end of the patient visit to print/send prescriptions and return to the exam room with the patient.

There are different options available to increase accessibility. Permanent workstations in each exam room provide the providers with the ability to access the EHR directly from the exam room and complete any tasks needed for the current visit: order medications, diagnostic tests, submit charges, input visit data. Tablet PCs give the provider the flexibility of moving around the clinic and working in different areas. They are able to access the EHR while in the exam room, in their office, or standing at the nursing station.

I have seen the use of both the Permanent workstations and Tablet PCs in different sized organizations. They are both viable options that depend on the needs and infrastructure of the organization.

Tags: Allscripts Consultants, EHR, EHR Implementation, MSO

Galen Healthcare Solutions announced today that Queens Long Island Medical Group has gone live with VitalCenter™, the business continuity solution for health care organizations that rely on the availability of their electronic health records to provide patient care.

Garden City, NY October 30, 2009 – Galen Healthcare Solutions today announced that Queens Long Island Medical Group, (QLIMG) has deployed VitalCenter for its 350 physicians in multi-specialty practices as their business continuity solution for Electronic Health Record (EHR) downtime.

VitalCenter fills a long standing void within the marketplace, addressing the needs of every specialty, by delivering off-line copies of patients’ charts when the EHR is unavailable. A PC configured with VitalCenter, receive updates of patients’ chart information on a regular schedule, without impacting the EHR’s responsiveness. VitalCenter provides the ability to view or print copies of a patient chart on PC’s within a clinic. In addition, the solution allows the provider to electronically document and upload the visit details back into the EHR.

We’ve experienced a number of incidents that have prevented access to the EHR. As a leader in our community we feel it is imperative to provide our patients with unparalleled care. This solution provides the continuity of clinical information that allows that to happen. We researched other downtime solutions, including full disaster recovery solutions, but in addition to being expensive to both deploy and maintain, those solutions did not solve the problem of localized network outages”, said Lenny Brunson, Chief Information Officer of Queens Long Island Medical Group.

Galen’s VitalCenter is integrated with the Allscripts Enterprise Electronic Health Record and will distribute off-line copies of patient charts to each clinic based on the location of the appointment. The solution is flexible enough to accommodate the needs of all of the specialties and allows for each provider to customize the data that is delivered.

Shutting down clinics early for maintenance is an inconvenience for patients and is also a missed opportunity for physicians. An upgrade to the server environment, network or EHR may require that the EHR be unavailable to providers. VitalCenter will continue to deliver crucial patient information to caregivers with no interruption in service.

VitalCenter is the answer to the first question on everyone’s mind when they move to a paperless practice,” said Stephen McQueen, CEO of Galen. “‘How do I safely and effectively see patients if I can’t get to my charts?’ VitalCenter overcomes that obstacle and provides our clients with predictable encounter volumes, regardless of the circumstances.”

The implementation of VitalCenter is a quick and secure process by which it is installed and deployed through a PC installer. The VitalCenter Management Suite allows for client-specific configurability.

VitalCenter allows physicians to document their patient encounters while the EHR is offline. The documents, called VitalNotes are then automatically uploaded to the EHR once a connection can be made.

Another advantage of the VitalCenter Solution was the ease of installation. The system works in such a way that we do not need to impact our production system.   With many concurrent projects, and dependencies, the ease of deployment and support are critical to QLIMG,” said Mr. Brunson.

For additional information or to schedule a demo of VitalCenter please contact Cary Bresloff at 888.GALEN.44 ext 706 or visit vitalcenter.galenhealthcare.com.

About Queens Long Island Medical Group: Queens-Long Island Medical Group, P.C. is a physician-owned medical group that staffs and operates twenty-two medical center offices throughout Queens, Nassau and Suffolk Counties. For more information, please visit www.qlimg.com.

About Galen Healthcare Solutions, Inc.: Galen Healthcare Solutions was founded in 2005 with a specific focus on assisting members of the health care community with the challenging, sometimes daunting task of migrating to a predominantly paperless world. Galen resources possess decades of clinical and electronic health record experience. Galen has been on the forefront of the EHR movement and offers a vast array of skills from database architecture to senior-level project management and implementation services. Galen resources have been involved in hundreds of EHR implementations, from inception to completion, varying in size from 6 physician specialty practices to 1,200 physician multi-specialty organizations. For more information, please visit www.galenhealthcare.com

Galen Healthcare Solutions is the foremost third party expert on Allscripts Enterprise EHR.

Tags: Business Continuity, MSO, VitalCenter

WellSpan Health has just made the move from Allscripts Enterprise EHR’s version 10 to V11. It’s Go-Live Monday and it’s quiet in the command center. How did we get here? 400 Doctors, 1900 total end users, 4 external MSO sites and 60 internal sites up on the EHR, and close to 40 of them completely paperless. 1pm on Go-Live Monday and we have had 125 calls. That is less than 1% of end users calling in with anything. The calls that we are receiving are typical of any go live. Some PCs were had issues with the Allscripts (ActiveX) controls and end users still learning their way around in a new system. We have entered one support ticket into the vendor. What are the elements that led to this success?

The Client Team

The client team at WellSpan Health is deep, and knowledgeable. They take pride in partnering with their physicians, and the physician partners drive the design of the EHR. The physician champions have been intimately involved in the project from classroom training to Go-Live. Their schedules have been adjusted throughout the course of the project to be able to provide clinical oversight to the build process and to act as liaisons with the leadership team internally with the organization. The build and configure team is made up of multiple analysts, three lead analysts and two physician champions. Some of these team members typically work with other products or in specific areas (with Dragon Dictate, with the practice management system, Allscripts Scan, etc.) but have been brought in to meet the staffing needs of the project. All of the people that worked on the build and configuration, as well as the technical staff and the desktop team have been working in conjunction with each other through the entire process.

Testing

The testing of the system was diligent and thorough. There was one person on the team who was a designated testing coordinator. Testers worked through every workflow used in the organization multiple times. The physician champions worked through their workflows and ensured that they had a through understanding of the system and were prepared to discuss the system and provide support to their colleagues. Their testing plan included 16 people working full days in a lab, hammering on the system. They paced their testing with internal issue resolution – they would complete one week of testing and follow it with one week of internal issue resolution, and then test again. They continued this pattern for 6 weeks. This testing plan allowed for their team to become intimately familiar with the new features of the application and clearly validate their build decisions.

End User Training

End user training lasted for a month prior to go-live and provided many options for learning for individuals with different learning styles. There was introductory information available online and a very clear and valuable webcast for end users designed by the client team. Classroom sessions in a lab were offered in 2 hour session and 4 hour sessions by the education team. The client also created a Citrix training environment where end users could log in and practice prior to the V11 deployment. The week before Go-Live, the education team offered V11 Workshops.

Deployment

The Command Center is fully staffed with help desk staff, analysts, the project manager, desktop team along with the Upgrade Consultant and Upgrade PM. Over the course of the weekend there was a dial-in number that administrators could call into to check the process of the upgrade. There is a three tiered issue resolution process in place and as of 2pm on Go-live Monday, only one issue has not been able to be resolved on-site and been logged into the vendor. In addition to the issue resolution process in place, the physician champions are available today to go directly to practices where physicians would be better served by talking to another physician about the workflow and the presentation of the system.

The client knew that even with the thorough education provided, there would be a learning curve for their end users on the initial days logging into the new system. Provider schedules have been reduced for the week of go-live in order to support the end users and to give them time to adjust to their new navigation and adjustments to workflow.

WellSpan Health is live on V11, end users are in and practicing medicine…and it’s quiet here in the command center. While I am normally a person who thrives on a sense of urgency and loves solving problems – I am glad that today is quiet; it means my client has done a really excellent job.

For additional information regarding Galen Healthcare Solutions’ upgrade / professional services please contact max.henson-stroud@galenhealthcare.com or visit www.galenhealthcare.com/touchworks

Tags: Allscripts Enterprise EHR, EHR, MSO, v11

This fall, a team of Galen consultants aided their client, a prominent healthcare system in the Midwest, in actualizing the vision of a ‘practice with no walls.’ This Healthcare system has been bringing their clinics, including hundreds of providers, live on Allscripts Enterprise, enabling the highly coveted shared patient record to be available across a large metropolitan region.  When the independent physicians elected to join this endeavor, the potential benefit was multiplied, but so were the challenges and risks.  While the original implementations were split across two Organizations, each independent practice would constitute its own Organization within the Allscripts EHR and integrate its own Practice Management (PM) systems.

Each member of the Independent Practice Association (IPA) is required to undergo a workflow improvement initiative.  This methodology assists the practice and design teams with building workflows that will maximize their utilization of the EHR.

Interfacing the new practice with the patient records was a significant challenge as sustaining data integrity is of the utmost importance. The risks included overwriting patient data, merging differing patient records, and creating multiple records for the same individual.  Integrating multiple PM systems into an Allscripts Enterprise environment of this magnitude is a challenge with little precedent.  The Registration and Scheduling and Billing interfaces were both new, while the Lab, Document and Hospital ADT were existing interfaces that required modifications to accommodate the new Organizations and physicians.

On October 22, the pilot practice went live on its first of two phases.  Two weeks in, there have been no major issues to note.   This month, the practice will go live with phase 2, which will introduce new functionality. The Galen team will support the client with training and supporting the practice in meeting its goals of a paperless environment.  The providers (and their staff) are greatly anticipating the Charge and Note modules to reduce their manual entry requirements and improve their high standard of patient care.

One last note – on the first day of the Phase 1 rollout, a provider at the pilot practice was with a patient.  The doctor had been working with this patient on a cardiac related diagnosis and referred them to a specialist within the health system.  When the patient returned on that day, the doctor accessed their now shared record and was amazed to find the cardiologists report ready and available to her.  It did not take long for this independent practice to truly appreciate the value of their new Allscripts Enterprise system and their innovative investment in a ‘practice with no walls’.

Tags: Allscripts Enterprise EHR, IPA, MSO, Multi-Org, TouchWorks