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

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