Archive for the tag 'Technical'

The Integration of Mobile & Smart Technology within the Healthcare Industry



As a fellow millennial, I have grown up alongside the progression of technology. Despite being young, I have witnessed pivotal moments of what I like to call “The Innovation Timeline”. I witnessed my dad’s transition from a work “beeper” to a thick Nokia cell phone and of course the advancement toward “smart” and mobile technology.

It seems technology has integrated itself into almost every facet of contemporary life, such as getting a cab or going to the doctor. Whether you’re walking through a small town or metropolitan area, you’ll most likely see people with smart phones. Mobile technology has evolved immensely, and its ability to meet varying levels of complexity is why it has a new and unique role within the healthcare industry. A potential outcome of this integration could be the increased availability of data as well as the availability of data without overhead costs.

The fusion of mobile technology and healthcare enables both users/patients and medical professionals to engage in a new, modern, and possibly more accessible take on patient care.  Last summer at Boston University’s Medical Campus, I worked in the Health, Technology and Change Lab on a project focused on the implementation of a mobile app for hypertension patients. The app utilized The Dietary Approaches to Stop Hypertension (DASH) Diet and tracked daily consumption as well as blood pressure and weight data.

The goal of the study was to determine whether the diet in app form could further assist in reducing high blood pressure and decrease the probability of complications associated with hypertension. Since I worked during the trial period and primarily assisted with development tasks, I unfortunately wasn’t able to see any conclusive data. Still, it was remarkable to both witness and contribute to a project dedicated to the integration of mobile technology and healthcare.

During Apple’s recent Keynote, the company introduced The Apple Research Kit carrying the message, “Now everybody can do their part to advance medical research.” Apple’s Research Kit is an open source framework allowing researchers and developers to create apps that could potentially discover the next medical breakthrough.  Despite being new, leading institutions have already employed this powerful resource and developed apps focusing on asthma, Parkinson’s disease, diabetes, breast cancer, and cardiovascular disease research.  The institutions behind such apps include The Dana Farber Cancer Institution, Mass General Hospital, and the University of Oxford…just to name a few. The existence of Research Kit, brings to mind how it will affect the very definition of who a researcher is and what makes a researcher…well a researcher. As previously stated, “Now everybody can do their part to advance medical research.” Not only does this infer that anyone from a young developer to a retiree could make substantial strides in medical research, but it causes one to consider how the healthcare industry could develop when both medical professionals and non-medical professionals are working together for a specific cause. It will be interesting to see how far individuals will use this resource as well as the potential impact it may have on the healthcare industry.

The healthcare industry isn’t only growing in terms of mobile applications, innovative surgical planning technologies have been developed as well. Form Labs, a Boston based tech-company specializing in the design and manufacturing of 3D printers have assisted medical professionals by 3D printing surgical reference models. Ordinarily, surgeons have used 2D methods (such as CT scans) for studying a patient’s anatomy before going into surgery. In my opinion these methods are inefficient due to the fact surgeons and other medical professionals lack the ability to see the ENTIRE picture, which creates inaccurate planning.  The use of Form 1+ (their 3D printer model) and CT scan data (used as a blueprint) allows surgeons to have a physical representation of the specific patient anatomy they’ll be operating on resulting in the safest and possibly most efficient method to planning a surgery.

As technology continues to evolve and inspire future innovators, “The Innovation Timeline” will further expand. These innovators will develop the next generation of technology, which will replace the innovations mentioned above. In my opinion, this is only the beginning of the integration of mobile/smart technology within the healthcare industry.

Load Testing Allscripts Enterprise EHR™


  1. A feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.
  2. Desire to do something, typically accompanied by unease.

If you have ever worked on a project that has required a significant change to your Allscripts Enterprise EHR™ infrastructure then you certainly know the feeling. You’ve carefully planned your infrastructure, done extensive functional / unit testing and now comes the day of go-live. How will your new infrastructure handle a production load?

This question is far too common, but I have recently worked with a major health system that made significant infrastructure changes and used HP LoadRunner to simulate load given common resource intensive workflows like Note & Results Verification. Here are few lessons learned to share about this experience:

  • Value – Licensing around load testing software is expensive and is normally based on the number of users in which you want to simulate load – the more load you want to put on your system the more it costs.
  • Risk – Using HP LoadRunner requires a few minor configuration changes to every web servers where load will be tested. This will require a server admin to make changes to the web servers which will then need to be reverted after load testing is completed. Please use caution when scheduling your load testing to ensure that these changes can be reverted and a subsequent smoke test can be executed in a timely manner.
  • Define your workflows: Simulation testing is 100% based on capturing and scripting workflows which can be very timely – in some cases it can take days to script out just one workflow in your load simulation software. In this client’s case, we used 4 common workflows including a Nurse Note for Urgent Care Visit, Chart download, Results Verification (POC orders) via worklist, and Charge.
  • Technical challenge: Using HP LoadRunner we had to programmatically create/copy both test patients and test users. So if your maximum threshold for testing is 1000 users then you will need to create 1000 test users with unique logins and 1000 test patients.
  • What is your organizations baseline? Load testing is based on concurrent users, but Allscripts has a variety of different user roles all which have varying demands on the system. In the aforementioned client’s case, it was decided that a clinician role would be used where common workflows could be utilized. Once you have your role selected you will need to create a tiered approach where you are starting with an average number of system users and slowly ratchet up the simulation testing against your capacity (and even beyond).
  • Add a little chaos… Once you have captured your baseline numbers rerun the simulation just short of your capacity using real testers. Click around and measure the impact to your load testing given workflows that aren’t being accounted for in your load simulation. Compare these results with your baseline numbers.

Automatically Capture Charges from the Note


I am currently working with Clark & Daughtrey Medical Group to solve a unique problem. The group, which boasts national accreditation in many of its specialties, is looking to report on PCMH measures in innovative ways. So we started a conversation on how we could help them reach their PCMH goals. We discovered that their payers are reimbursing them for performing various clinical assessments. To do this, they have custom charge codes that are manually entered into the practice management system based on a medical coder’s review of each note. The medical billing staff spends hours every day sifting through these notes and entering the charges based on pre-configured flags in the note. With over 800 patient visits every day, this task is tedious and costs the practice a lot of money.

They asked us if there was a way that we could help them report on certain items in their notes. Unfortunately the note data is not discrete like medications and problems. It is actually a complex document stored in a format known as XML.While XML is a structured language, the document is first compressed then stored as one long string of text in the database. This means that if you wanted to search through the note in the database you would first have to decompress the note and then scan through the entire document for an identifier that is specific to that note. That is a nightmare for any type of reporting!

After talking with the staff at Clark & Daughtrey Medical Group we realized that this entire process could be automated! Using Note Form Reporting, I have developed a way to identify the appropriate check-boxes in the note and automatically submit the charges to the EHR. If the level of service charge has already been processed, then the charge is automatically submitted to the practice management system; if the encounter level charge has not been submitted then the provider will see it in the Allscripts Enterprise application just like any other charge waiting to be submitted. Clark & Daughtrey Medical Group will no longer have to waste time and money searching these notes for charges, the possibility of human error will be reduced, and the charges will now appear in both in the practice management system and the EHR.



Announcing Allscripts Analytics and Reporting Training

Do you create reports from Allscripts data? Are you tasked with making changes to existing reports? Do you track Meaningful Use data? Do you create worksheets to track Bridges to Excellence, GPRO, or IPRO data? Have you ever wondered how to utilize the Allscripts Analytics reporting tool? Do you want to learn how to create your own custom reports? If you answered yes to any of these questions, Galen’s Technical Services team would like to invite you to a full day of reporting training in Boston.

Who: Allscripts Reporting Analysts

WhatAllscripts Analytics and Reporting Training

Where70 Federal Street, 7th Floor, Boston, MA 02110.

When: Wednesday, June 13th, 2012 from 9AM-5PM with lunch provided. There will also be a cocktails and networking hour from 4PM-5PM with beer, wine, and light snacks.

Why: Learn about the details of reporting with Analytics and working with custom reports.

Cost: $250/seat


  • Analytics overview
  • Analytics reporting review
  • Developing a report with Analytics
  • Review of reporting within Allscripts
  • Demonstration and customization of a report
  • Deployment, testing, and best practices
  • Much more!

Please contact us if there is a topic you would like to learn more about that isn’t in the list above.

Travel: If you are driving into the city, there are parking garages nearby. The cheapest and most convenient is the Winthrop Square Parking Garage at $20/day. If you are coming in from out of town, there are many hotels in the area. Also note that we will have wireless internet and workstations with a hardwired internet connection available for those who need it.

Space is limited – register today!  If you can’t make the training, it’s OK! Galen offers free webcasts about every two weeks.

Technical Assessments: Improving Performance and Reducing Risk

One of my first client-related activities after joining Galen Healthcare Solutions was doing data collection for a Technical Assessment. One of our senior resources was on-site, and he thought this would be a good opportunity to get my feet wet.

A full Technical Assessment of a client’s EEHR environment involves reviewing server hardware, software, settings, network configuration, etc. The benefit to the client of these assessments is two-fold. First, we can identify and attempt to resolve performance bottlenecks, typically stemming from misconfiguration. Second, we can identify general areas of concern, such as staffing, hardware, software, or future growth concerns.

To begin, I went through and confirmed a server listing with the client for both their production and test environments. I then proceeded to collect pertinent information for each server, including a number of role-specific items, for example, the version and service pack level of SQL used in the Clinical Database Server. This process is akin to the System Certification process done during EHR upgrades.

I collected a considerable amount of the necessary data with a VBScript-based application, which leveraged Windows Management Instrumentation (WMI) and dumped most of what I needed into text files for each server. I then proceeded to populate that information into my reports, and I shared those with my team. The details of those findings were compiled into a written report by the senior resource and presented to the client.

Shortly after the report was delivered, I was notified that one of my findings had been found to be the cause of one of their most significant issues. A misconfigured “Lock pages in memory” Local Security Policy setting was hindering their ability to properly fail over the clinical database cluster to another node. It is required that the user running the SQL Server service is configured to have this ability.

I have done a number of similar assessments for other clients over the years, and it is always interesting to find out what new information we can provide our clients to help them better utilize their systems. It is also great to be able to put a face with a name. As part of the Upgrade Team here at Galen Healthcare Solutions, we look forward to helping clients through the changes necessary to implement new and upcoming versions of EEHR and the updated technology that goes along with it.

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