Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Client – UMass Memorial Health Care

Project:  UMassMemorial V11.2 Upgrade

Project Timeframe:  February 7, 2011 – June 13, 2011

Client Contact: Emily Lazaros, Allscripts Application Manager

“I would like to take this opportunity to tell you of our experience with our Galen upgrade team.   Troy Forcier and Kristie Gilbert are, in a word, fantastic.  They are professional and knowledgeable, and have been with us on this upgrade every step of the way.  Kristie’s project management skills and proficiency with the application are exceptional and Troy is about as calm a person as I have ever come across.  This gives us, the client, a real sense of comfort.  And as the IT Ambulatory EHR lead for this upgrade, in an organization of this size, that is invaluable.

….

Last, but not least, we have had lots of laughs and fun together through this process.  Thanks to them and Galen for helping to make our 11.2 upgrade a success.”   –Emily Lazaros, Allscripts Application Manger at UMass Memorial Health Care

 UMass Memorial Health Care is the largest health care system in Central and Western Massachusetts, and the clinical partner of the University of Massachusetts Medical School. The Medical Center has a total of 12,350 employees with approximately 1,700 physicians and 3000 registered nurses representing clinical expertise in Cardiology, Orthopedics, Oncology, Emergency Medicine, Surgery, Women’s Health and Children’s Medical Services.   UMass, on the cutting edge of technology, utilizes Allscripts Enterprise Electronic Health Record^TM (AE-EHR) as a means to help with continued excellence in clinical care and patient service.  Over the last several months UMass has worked, very successfully, with Allscripts and Galen Healthcare Solutions to upgrade their AE-EHR product to version 11.2.

The underlying motivation for this version upgrade was of course, Meaningful Use.  While there are incentives for moving to the new version, the idea of having to implement new functionality with potential workflow impact is regarded with dread.  There are dozens of models for how to complete an upgrade, most of which are painful.  The vendor and we, as your consultants, must take ownership over finding the best model for your practice to reduce the pain of upgrading.  Since Meaningful Use is the ‘next big change’ in healthcare, this change needs to happen for all medical practices across the US.  So the question remains, how do you increase your chances of success? Your Galen consultants will help lead the way.

The duration of this particular upgrade project was a brief 19 weeks, leaving us little time to configure the new AE-EHR version 11.2 functionality and guide UMass towards decisions that would qualify them for all Meaningful Use criteria.  In addition to a rapid project timeline we encountered other challenges: the release of process documentation simultaneously to the stages defined in our plan and shifting resource allocation as priorities changed.  Throughout the entire process, though, we were able filter the information, analyze the functionality, provide appropriate guidance, and enjoy the camaraderie of a great group of UMass team members!  We can now take great pride in knowing we were helping thousands of people use their version 11.2 AE-EHR product in a Meaningful Way.

A week after UMass has transitioned to end users, the real challenge of analyzing their data and incorporating their new configuration into their daily lives will prove to be a reality once the Galen team returns to assist with the Stimulus Set.  I know we are all up for the challenge!  Our willingness to help our clients, to test our knowledge of the latest cloud technologies and data reporting and to pass it along will be a very rewarding journey.  If the final product can be as great as the first steps in helping UMass upgrade their base AE-EHR version 11.2, then sign us up…Galen is ready to go! 

UMass was a fantastic group to work with and we look forward to helping them implement the Stimulus Set.  Congratulations to the staff at UMass for a successful upgrade!  We also appreciate the positive feedback from UMass and plan to make the same impact with other clients.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Meaningful Use, Successful EHR Implementation

With a majority of healthcare organizations being multi-site as well as an increasing trend in MSO oriented healthcare systems, the ability to effectively manage and deploy EHR to entire physician networks is critical to achieving an integrated patient record and reducing disparate records across physician networks.  The release of Allscripts Enterprise EHR version 11.2.x brings the movement towards meaningful use and reimbursement incentives; as well as penalties.  This requires that organizations develop the capacity and knowledge required to take on, prioritize, and execute multiple EHR initiatives simultaneously.  In many cases this involves what seems like the never ending rollout of sites, practices, and acquisitions that comprise these complex physician and community based networks.

So what is really involved in order to make this happen?  Is it really just about system configuration, setting system preferences, writing interfaces, analyzing workflows, and installing hardware?  Cumulatively it is, but who makes this happen and why don’t they grow on trees?  This article aims to take a step back and take a hard look at the soft skills needed to ensure not only a successful initial installation of EHR, but the underlying principals needed in order to ensure a fully functional, well seasoned, and confident EHR deployment team.

Perhaps a quite common question or source of anxiety presented to on site vendor support is “Well what happens once you’re gone?  Who is going to take care of us?”  The following are pre-emptive measures that organizations can take in order to ensure that once the “experts” leave, the pace of the EHR implementation can maintain its course.

Initiate the Transfer of Knowledge

The fast and furious pace of installing EHR at a particular practice can sometimes leave the remaining implementation and support staff straddling between new support duties and ramping up additional practices.  Don’t wait for the knowledge to come to you….go to where the knowledge is.

• Identify the key drivers and what the critical build aspects are for the organization or practice installation.  Don’t just now what they are, but take the next steps and get a head start in building towards expert level knowledge in those areas.
  • Attend product focused webinars
  • Invest in either remote or on site focused system maintenance or functionality driven education courses
• Granted these elements can require time and some capital to achieve, but the long term return on investment will come in the form of self sufficiency

First Impressions Are Everything

Remember that through the eyes of a practice going live on a brand new electronic health record the initial round of go-live support and change management will set the tone for the long term relationship between the practice(s) and the core EHR implementation team.

• Get the core team’s faces out there and work to establish a positive rapport with new and upcoming practice(s), but keep in mind not to overwhelm them.
• Make sure the practice(s) know that as a team they will be working together directly with the EHR implementation team and that they will not be experiencing this change alone.
• Let the practice(s) know that it’s okay to ask questions prior to go-live and work to eliminate that potential perception go-live day is a just a silent time bomb waiting to explode.

Cross Training & Skill Set Ramp Up

Get as many of the core EHR and support team involved in all phases of the project life cycle for a given practice.  This will help build the perspective and broaden knowledge needed not only to maintain autonomy and depend less on other team members, but also increase the support capacity of each team member.  This can translate into increased support bandwidth and end user satisfaction.

• Encourage every core team member to participate in clinic walkthroughs, workflow assessments, go-live support, and the post-live optimization process.
• Provide internal or “brown bag” presentations (post-live) so that other team members can become familiar with each other’s focus or area of product specialty.

Remember that once the “experts” leave, the core EHR implementation and support team is the lifeblood of the implementation and a key driver to any organization’s long terms success with EHR.

Good Luck!

Tags: Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Successful EHR Implementation

As physicians migrate to the Electronic Health Record, there are many new systems and processes they have to learn and adapt to.  One of these systems is voice recognition software, such as Dragon Medical 10.  I have worked with some physicians recently who were implementing a new EHR in their office, as well as transitioning from a transcription service to Dragon voice recognition.  This introduced some new challenges which I hope to shed some light on in this article.

Dragon Medical has the ability to ‘Type as you Talk’, which allows the user to dictate blocks of text and see this appear in their note in the EHR.  This has a huge benefit to the provider by allowing them to review and finalize their documentation for the visit immediately, rather than waiting a few days to receive the note back from a transcription service.  We discovered that there are some steps that you can take to improve the performance and/or accuracy of Dragon.  Here are a few to note:

1. Spend the time training Dragon to recognize your voice.  During this process, the application will learn how you speak, and adapt to your voice patterns.  This will prove to be very beneficial in the long run.
2. Follow the recommendations for the settings for your EHR vendor.  The Dragon representative will have recommendations on how settings should be configured based on the EHR you are using.
3. When words are not typed correctly, correct them using the built in features of Dragon to Train it on how you speak those words.  This will save you time and energy as you become a more advanced user of the speech recognition software.
4. Have reasonable expectations.  Dragon is a tool that improves over time.  When you first begin using speech recognition software, it only has a basic understanding of your vocabulary and how you speak.  It will take time for the application to improve, which will occur naturally as you train it when words are not recognized correctly.

These are a few items that will hopefully help you be more successful when using speech recognition software, such as Dragon Medical.  I have also found that it is beneficial to have a follow-up training session with Dragon after the user has been using it for a few weeks/months.  At this point, the user understands some basic functionality, and is usually interested in how to do more complex functions such as Macros.

Tags: Allscripts, Allscripts Enterprise EHR, Dragon, EHR Implementation, Enterprise EHR, Integration, Successful EHR Implementation

When an organization starts out on the long road of implementing an electronic health record the project manager will typically research what steps the organization needs to take to make their EHR project a success.  Learning from others is the most efficient use of resources. So what are the factors that those who have gone before you feel make an EHR project successful?  I will post a series of articles covering these many factors.

Part I- Organization Planning & Internal Governance

Developing a project charter is the first step. The project charter has several components that include the project description and business objectives and success criteria. This is an important part of the charter, if you do not know what you are hoping to accomplish or know what success of the project means to the organization the chances of reaching success will be difficult at best.  Other components of a project charter include listing the stakeholders, vision, project scope (another important piece, as scope creep will happen without it), assumptions and dependencies, constraints, milestones, business risks, resources and finally an approval section where the executive team’s signatures will be placed to demonstrate their approval and acceptance of the project charter.

The development of a formal project plan with identified milestones will assist not only the project manager but the executive steering committee to determine the health of the project. The creation of a great project plan includes receiving input from the project team.  This allows each member to buy into the journey that are about to embark upon.

The next component of planning for your organization’s EHR project is developing a communication strategy.  A well thought-out strategy that includes formal communication channels is crucial.  Once the project picks up speed the lack of communication can cause unnecessary hurdles.

Some additional components of organization planning and internal governance are determining a decision matrix that outlines how specific types of decisions will be made and ultimately approved.  Forming your committees that include providers, executives, and clinic leadership will facilitate the support required for your EHR project to be a success.  Having a commitment from the members of these committees is crucial as you may need their backing upon occasions throughout the project.

The final component is establishing a solid infrastructure and reliable network.  Addressing any infrastructure concerns before you begin your project is essential because once you pick up speed on the project, this area risks being left unattended which can cause hardship on reaching your goal of achieving SUCCESS!

Watch for Part II – Exceptional Project Management and Control

Tags: Allscripts, EHR Implementation, ehr project, Enterprise EHR, project success, Successful EHR Implementation

 When an organization is in the initial planning and budgeting phase of their EHR project, one of the most common questions to come up with is how much should I budget for this project? 

Several sources researched had varying numbers for the cost per provider. The cost for implementation, range from $25,000 to $60,000 with a mean of $42,500. Maintenance costs range from $5,000 to $18,000 per provider per year. The details from several sources are listed below: 

Harvard – “Based on the informatics literature, the initial implementation cost of an EHR for private practices averages between $40,000-$60,000 per provider and the cost of maintenance averages $5,000-10,000 per provider per year.” http://mycourses.med.harvard.edu/ec_res/nt/191A1C43-AEF8-4244-8215-F39C690A4E6B/EHRseries.pdf

 Ahrq.gov – “The research indicates that the average purchase and implementation cost of an EHR was $32,606 per FTE physician. Maintenance costs were an additional $1,500 per physician per month. Not surprising was the finding that smaller practices had the highest per-physician implementation cost at $37,204. The study also found that the average cost for EHR implementation was about 25 percent more than initial vendor estimates.” http://www.ahrq.gov/news/press/pr2005/lowehrpr.htm

Perot Systems – “For physician groups, the CBO reported that total implementation costs for office-based EHRs ranged from $25,000 to $45,000 per physician, with annual operating, licensing, and maintenance costs ranging between $3,000 and $9,000 per physician” http://www.perotsystems.com/MediaRoom/Library/ServiceOverviews/ServiceOverview_CostsAndBenefits.pdf

EMR and HIPAA – “It is estimated that the cost of purchasing an EHR system is $33,000 for each physician, with an additional cost of $1,500 per doctor per month for maintenance. This expense has cost challenges for many providers, especially those in small practices. Some estimate that the long-term cost-savings produced by a national health information network could reach $77.8 billion a year from a reduction in medical errors, diagnostic test duplication, and administrative expenses.” http://www.emrandhipaa.com/emr-and-hipaa/2009/06/01/scholarly-study-on-cost-of-ehr/

Since the federal incentive payments are being offered, the next question is whether or not those funds will cover the cost of implementing an EHR will be covered. 

Avalere Health - “These new incentives are intended to motivate doctors to adopt EHRs, yet for many physicians, the level of the incentive may not reflect current financial realities,” said Jon Glaudemans, a senior vice president at Avalere Health.  “Given this gap, EHR adoption will still require a significant investment by small physician practices.  In today’s economic climate, many physicians will struggle with this calculus.” http://www.avalerehealth.net/wm/show.php?c=1&id=808

MGMA - “…physician-owned practices with paper medical records generally spend $20,000 per full-time equivalent (FTE) physician on IT (chiefly for hte billing system) and have less profit (medican total medical revenue after operating cost per FTE physician) compared with groups with EHRs that spend more than $20,000 per FTE physician on IT have a substantially greater profit than those that spend $20,000 or less on IT.”   Gans, MSH, FACMPE, D. N. (2010, July). Investing in Technology: How Information technology expenditures affect the bottom line. MGMA Connexion,  19-20.

Jerri Cowper

Tags: Allscripts Enterprise EHR, EHR Implementation, Successful EHR Implementation

We here at Galen have seen a greater influx of requests to be able to integrate client’s EHR environments with 3rd party applications and/or internet websites.

I’ve created a few examples that I’ve added to our Wiki page.

1. http://wiki.galenhealthcare.com/Patient_Portal_Integration

With this case study Galen had a client who has implemented a patient portal application whereby patients are able to send messages to their doctors regarding tests, results and general questions. The client was looking for a way to have the provider be able to integrate this application directly into the EHR. With RelayHealth’s help we have succesfully built a prototype whereby a provider can seamlessly communicate with a patient in the most efficient manner possible!

2. http://wiki.galenhealthcare.com/images/5/57/Add_new_Web_framework_documents_to_the_EHR.pdf

In this example a client was looking for a new link on their vertical toolbar which would allow them to display any website in their current workspace (the main viewing pane of the EHR). This one example integrates the website directly into the EHR window without having to navigate through a new tab or window, showing a FRAX calculator. The other tab actually has the ability to take in patient context (height, weight, blood pressure, etc.) and pass it into a form automatically populating fields to save physicians valuable time. This article goes through the steps involved in setting up new vertical toolbars, horizontal toolbars, and workspaces to set up these outside websites in the EHR. The actual code to populate patient context is fairly complex but definitely something Galen would love to help out with!

Tags: Allscripts, EHR, EHR Implementation, HL7, Integration, Successful EHR Implementation, Technical

How many times have you asked yourself during the process of creating workflows if the exercise was worth it? I posed this question to Joseph Solin, project manager at ABQ Health Partners. He explained that he spends two hours reviewing the workflows with each clinic one week prior to their go live week. During this review he goes step by step through each workflow with the clinic that is affected by the phase. He explains that the workflows are like “learning to dance with the EHR so you are not tripping over each other.” For example if users don’t understand that certain electronic prescriptions will not transmit to the pharmacy until the provider authorizes the task, the clinical staff may end up duplicating efforts trying to get the prescription to the pharmacy.

Many important questions are sparked by the users during these meetings as Joe reviews the differences in their workflow today and what their workflow will look like with the EHR. These are questions that are typically answered during the meeting and often times reassure any anxieties the group may be experiencing prior to their go live. A thorough review and understanding of the clinical workflows will give users an appreciation for the need to adjust their workflow to the EHR and provide more efficient use of the EHR from day one

Tags: Allscripts Enterprise EHR, EHR Implementation, Successful EHR Implementation

As reported on EMR and HIPAA, CMS has made comments on the Meaningful Use Interim Final Rule public, providing an additive level of transparency and CMIO promptly provided a summary of the EHR comments. In light of the transparency CMS/HHC/ONC yields in regards to the Meaningful Use Interim Final Rule, we encourage members of the healthcare IT community to take full advantage of the comment period, which ends in less than a month from now. To encourage ongoing dialogue, we have published a Meaningful Use FAQ in which we anticipate aggregating questions that persist in the community and also encourage active participation. For instance, in a previous post, I pondered how meaningful use would be communicated.

Other items to note in regards to lingering questions surrounding Meaningful Use and ARRA as a whole:

• Dr. John Halamka also addressed the public comments on the Interim final rule on his blog post.
• Many questions persist surrounding interoperability standards, and as John over at EMR and EHR addressed on his blog post, the Healthcare Information Technology Standards Panel (HITSP) was recently extended to be operational until April 30th only. How will this impact communication of meaningful use from organization to the government?
• We recently updated our meaningful use matrix to include which functionality supporting MU measures are delivered in the Allscripts Enterprise EHR (AE-EHR). John at EMR and HIPAA is also collecting a number of the various matrixes that people have put together around the EMR meaningful use criteria

If your organization is looking for assistance in exhibiting meaningful use, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts, Allscripts Consultants, Allscripts Enterprise EHR, EHR Implementation, Meaningful Use, Meaningful Use FAQ, Meaningful Use Matrix, Successful EHR Implementation

There is quite a bit of buzz in the healthcare IT community surrounding the ONCHIT/CMS release of the Meaningful Use Interim Final Rule and the  and the EHR certification requirements. The author of HISTalk kindly spent his New Year’s Eve poring over the documents to provide an excel worksheet summary of the actual criteria and thresholds and the author of the Medical Software Advice blog did a great job of outlining definition, features and measurement with his blog entry.  I thought I would take it a step further and provide some meaningful information to CFOs and PMs by taking a stab at quantifying the effort involved with each measure. First some background information and disclaimers:

• This estimated effort is based on 50 physician multi-specialty organization.
• It is intended to give a ballpark of effort involved and the numbers serve as estimates only.
• It does not necessarily scale linearly with number of providers or specialties.
• The effort only addresses four categories of effort – implementation, technical, interface and training.
• Categories of effort not addressed include project management, systems configuration and deployment, networking configuration and deployment, hardware (including desktop) deployment, and helpdesk and on-going support.

The meaningful use matrix with effort broken-out can be found on the Galen Healthcare Solutions Wiki.

Now that we have presented the effort involved, let’s delve into how EHR deployments – specifically  AE-EHR deployements – are typically phased:

Phase I: Base, Document, Scan and Dictate

Description: Provide a baseline level of EHR functionality to all users. Real-time access to physician schedules, transcribed and scanned documents, facilitation of dictation.  Data conversions, Scanned charts and documents, Base Deployment. This approach typically appeals to all providers regardless of technical aptitude and would not require significant workflow changes

Advantages: Clinical information access internal and external to the clinic, reduced level of change for physicians through the use of dictate, realized benefits of decreased errors and re-work.

Interfaces:

• Registration & Scheduling
  • Real-time inbound registration and scheduling feed from practice management system.
  • Initial bulk-load of existing active patients and appointments
• Transcription
  • Real-time inbound transcription interface from transcription system.

*Phase II: Rx+, Note, Forms, Results

Description: Add medication management, structured note and results

Advantages: Ability to collect structured information facilitating use of panel queries. Additionally, formulary compliance, and prescription faxing/e-prescribing to pharmacies and ability to capture results as discrete data elements

Interfaces:

• Results
  • Real-time inbound results interface from lab system.

*Phase III: Order, Charge

Description: Facilitates charge capture and order transmission.

Advantages: Completes the access to centralized patient data and further enhances the quality of care and service to patients.

Interfaces:

• Orders
  • Real-time outbound order interface to lab system
• Charge
  • Real-time outbound charge interface to the practice management system.

*Phase II and III can be combined based upon the organization requirements

In conclusion, one of the biggest questions that lingers for me is how the data is to be relayed to the government such that organizations can be evaluated as to whether or not they meet the thresholds to receive the incentives. Custom reporting comes to mind as precedent has been set here, specifically with PQRI and Medicare HCC. Galen Healthcare Solutions certainly can provide custom reporting specific to organizations needs in order to communicate meaningful use. Another solution is Allscripts Clinical Quality Solution powered by TeamPraxis. In the meantime, we wait for the rule to be finalized and anticipate announcement of how the meaningful use data is to be relayed.

If your organization is looking for assistance in exhibiting meaningful use, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Custom Reports, EHR, EHR Certification, EHR Implementation, Integration, Interfaces, Meaningful Use, Meaningful Use Matrix, Reporting, Successful EHR Implementation

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Carbon Copy, Successful EHR Implementation