Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Does your practice utilize the Finish Note task in Allscripts Enterprise EHR^TM? 

If you answered yes, then this blog is for you.

In this article, I wanted to show you two possible outcomes when working in your  v11 Note. You will notice that there are two similar workflows to add and commit clinical data in the note that will impact how a Finish Note task appears in a user’s task list.

While you will find that these two workflows are scaled down to be very basic and generic, I wanted to limit them to clearly demonstrate the difference between the two.

Workflow #1: Committing data while saving and closing the v11 note

In this workflow, we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Select “Save and Close” in the Note window
4. Select “Save and Continue” on the Encounter Summary
5. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- One Active Finish Note task

So in this case, using the Current Patient – All or Current Patient – Active task views, you will see that just one Finish Note task has been created in an active status.  The task indicates that the note has been created and saved.  Keep in mind, at this point, that the commit action occurred while the user selected Save and Close in the Note. In this workflow, the system only reviewed the data once.

Workflow #2: Committing data prior to saving and closing the v11 note

As we did in the first workflow, here we assume that the user already has the patient in context at the clinical desktop.

The basic steps of this workflow are as follows:

1. Create a new v11 note
2. Add a new clinical item
• For example: add vitals to the patient chart
3. Click the Commit button
4. Select “Save and Continue” on the Encounter Summary
5. Select “Save and Close” in the Note window
6. Navigate to the Task List and select the Current Patient – All task view

Here you can see that the outcome is:

- A Complete Finish Note task and an Active Sign-Note task

If you use a task view that simply shows Current Patient – Active, you would not typically see the Finish Note task in this instance, but instead the Sign-Note task.  This means the note has not been signed and might not be the task you expect to receive if you seek the Finish Note task.

While a Finish Note task has been generated and marked as Complete, there may yet be information to add to the note.  The logic behind this workflow is that the second action of “Save and Close” is the second review after having hit “Commit”, and therefore results in the outcome we see here.  In this case, the system has reviewed the data twice, and the Finish Note task in regards to this note is completed and the active Sign Note task is automatically generated.

My advice in this situation is to follow Workflow #1 when working in a v11 Note. If users are creating a note and adding clinical data, but need a provider or second user to receive a Finish Note task and add additional items to the note; use the first workflow.   This way, the Finish Note task will be assigned and visible to the correct person, and users will be trained in such a way that ensures the success of this workflow.

Please don’t hesitate to leave your feedback below or Contact Galen Healthcare Solutions should you have further questions!

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, Galen Webcast Series, Tasks, TouchWorks, v11, v11 Note

With the release of version 11.2, Allscripts Enterprise EHR^TM has the ability to define acceptable ranges for vital sign readings based on age and gender. Once this range is defined, when a vital sign is input and falls outside the defined range, users are alerted that this value is an abnormal result.  The alert is shown as a red beaker, displayed next to the value in either the Health Maintenance Plan (HMP) or as bolded, red text in the Note Authoring Workspace (NAW).

While four vital signs (Systolic Pressure, Diastolic Pressure, Heart Rate, and Respiration Rate) are pre-delivered with ranges, clients can create their own ranges for any other vital sign, such as Weight.  These ranges are defined solely using the SSMT tool using the RID – Reference Range content category.  This means that clients do not define these ranges anywhere inside the Enterprise^TM application, instead, are only able to be defined using SSMT.

Tip:  The four pre-delivered vital signs will need additional values populated as the user configures the reference ranges.

First and foremost, the organization needs to ascertain what the actual ranges will be.  The NIH Clinical Center provides their guidelines of vital sign ranges. One example of guidelines they provide is Pediatric resting values.  The organization should be aware of the resources should determine which guidelines to follow, whether it is the American Heart Association or NIH Clinical Center.

Once the decision has been made for which data will drive the decision to move forward and be used by the organization’s EHR, the System Administrator can begin to use those decisions to load the data to the system.

Now let us explore the basic fundamental steps to set up the Vital Sign Reference Ranges.

1. First be sure to backup any data prior to making changes in SSMT.
2. Access SSMT and extract the data from the RID – Reference Range content category
3. Copy the data to a spreadsheet that has the cells formatted to “text”
4. Edit the spreadsheet; the following are the applicable column headers:

• [A] HDRResultable Entry Code: value from the Code field in the Resultable Item dictionary
• [B] Resultable Entry Name: value from the Name field in the Resultable Item dictionary
• [C] Where Performed: can be a null value – if populated the range will apply to the resultable item specific to that preforming location
• [D] Reference Range Type: must be set to Numeric
• [E] SEX: leave blank if using for both genders, otherwise M for male and F for female
• [F] Lowest value: lowest allowable value for the vital sign to be considered normal
• [G] PanicLowValue: needs to be a unique value and at least one more than [F] and less than [H]
• [H] LowNormal: needs to be a unique value and at least one more than [G] and less than [I]
• [I] HighNormal: needs to be a unique value and at least one more than [H] and less than [J]
• [J] Panic High Value: needs to be a unique value and at least one more than [I] and less than [K]
• [K] Highest Measureable: highest allowable value for the vital sign to be considered normal
• [L] Reference Text: This can be set to indicate the text to be displayed in the Results Entry dialog screen indicating the range. So if the range from [F] to [K] is 40-90, indicate such in this field.
• [M] Answer: This field is left null.
• [N] Abnormal Flag: Does not need to be set to any value
• [O] Is Inactive (Y/N): Set to Y if setting an item to be inactivated, otherwise set to N
• [P] Create (Y/N):  Must be set to Y if creating a new entry, otherwise set to N
• [Q] Age Min: beginning point for the age range; the lower number
• [R] Age Max: ending point for the age range; the higher number
• [S] Age Units: units of the age range; ex: Days, Months, Years

1. Save the spreadsheet
2. Be sure to clear the text box field in SSMT
3. Copy all applicable rows of data from the spreadsheet and paste into the SSMT box (do not copy the header row)
4. Load the data
1. Return to the Enterprise EHR^TM application and validate using a test patient the applicable vital(s)

While these are basic instructions to successfully set the reference ranges, the steps should provide success in loading the reference ranges.  There are a few main points to reiterate in this process:

• Please back up any data prior to using SSMT.
• Pay close attention to the bullet steps for the column headers indicated above. Certain columns require certain information.
• Ensure the Resultable Item information is reflected in the spreadsheet as it is in the RID
• Keep in mind that columns [F] through [K] must be populated with unique values, that are not 0. [F] must be the lowest acceptable normal value, while [K] must be the highest. The numbers in between CANNOT be the same value!
• Set [P] to a value of Y when creating new values
• Try loading one line to begin – to ensure set up is correct.

 It is important to note that this enhancement has no direct effect on Meaningful Use Core Measure 8 – Record Vital Signs. The Record Vital Signs Objective states: “Record and chart changes in the following vital signs: (A) Height (B) Weight (C) Blood pressure (D) Calculate and display body mass index (BMI) (E) Plot and display growth charts for children 2-20 years, including BMI”. The measure being “for more than 50 percent of all unique patients age 2 and over seen by the Eligible Professional, height, weight, and blood pressure are recorded as structured data”. In reviewing the measure documentation, there was no mention of measuring whether or not the vitals being recorded are being flagged as abnormal.

Allscripts Enterprise EHR^TM version 11.2 offers a plethora of excellent features and this functionality certainly allows users to optimize the system and how charts are viewed. The return from defining these ranges is to provide the visual indicator that certain recorded vitals are abnormal for the patient in context.  So, while there may no added benefit from a Meaningful Use standpoint, there is certainly clinical benefit to utilizing this functionality.

Tags: Allscripts, Allscripts Enterprise EHR, EHR Implementation, Enterprise EHR, v11

This week, the world lost one of the most innovative people of our time. Steve Jobs, co-founder of Apple Computer, passed away leaving behind quite the legacy. I feel obligated to honor Steve Jobs this week and reflect on how he affected technology in health care.

It is amazing to reflect upon the history of Apple computers. It seems not too long ago, I was learning how to use a Macintosh computer playing Number Crunchers and Oregon Trail in Elementary school. Back then, the idea of a computer with a mouse was relatively new technology! Twenty years later, Jobs’ vision has evolved technology well beyond that grey box, keyboard, and mouse.

Take this timeline for example:

• May 1984 – Macintosh was released using a graphical user interface controlled by a mouse (courtesy of Xerox technology)
• April 2010 – Apple releases the first iPhone, optimizing a user interface that would pave the way to the iPad and an extensive library of applications that remains the most popular OS to developers today.

What an advancement in technology in twenty six years! So while the only Apple product I own is an iPod, I remain deeply amazed at the technology Apple offers and how much its technology touches our lives. Apple products remains as probably the most popular choice for mobile computing in the United States.

Business Insider published an article in July 2010 titled “10 Ways The iPad is Changing Healthcare”.  While it’s a quick click through the list, you certainly get a feel for the opportunities the iPad has presented to healthcare. Examples included “Going Green”, cost savings, and information consolidation. All this was made possible with the vision of Steve Jobs.

Did you know?:

According to Wikipedia on Steve Jobs:  “Jobs is listed as either primary inventor or co-inventor in 338 US patents or patent applications related to a range of technologies from actual computer and portable devices to user interfaces (including touch-based), speakers, keyboards, power adapters, staircases, clasps, sleeves, lanyards and packages.”

Being in the Electronic Healthcare Record industry, I want to share a couple examples that resulted from Jobs’ technology.

Thank you to the iOS software and the work by developers at Allscripts^TM, there are two applications that Allscripts^TM offers that can be utilized using an iPad or iPhone.

ePrescribe:

This application allows providers to use their iPhone/iTouch to view patients from their Practice Management System.

Features:

• Summary page that identifies and presented problems, allergies, unprocessed medications, and any active medications
• Allows providers to write prescriptions using an excellent, user-friendly design
• Displays formulary indicators and DUR
• Can submit Rx’s direct to Pharmacy, Send to Mail order, and send to a printer

For more information on Allscripts^TM ePrescribe, visit their webpage to learn more.

Remote EHR:

This is another excellent application that is utilized by healthcare facilities using the iOS software that allows providers to remotely control their AllscriptsTM Electronic Health record from any location.

Features:

• Provides real-time access to patient summary information
• Includes ePrescribing to the patient’s pharmacy
• Integration with Charge capturing and attaching diagnosis codes to scripts
• Compatible with Allscripts^TM Enterprise EHR v11 (among other Allscripts products!)

For more information on Allscripts^TM, visit their webpage to learn more. Additionally, Galen Healthcare Solutions offers a Wiki page with more information regarding Remote EHR.

So, thank you Steve Jobs for making such applications possible. Remote EHR and ePrescribe are two examples of the results of Jobs’ achievements and have allowed for better patient care.

Share your thoughts! Give us your feedback on how you’ve used this technology in healthcare and how you see its benefits or contributions.

As always, do not hesitate to contact Galen Healthcare Solutions for more information.  Galen is a Preferred Platinum Partner of Allscripts^TM .

Tags: Allscripts, Allscripts Enterprise EHR, EHR, Enterprise EHR, ePrescribe, Healthcare IT, iOS, Remote EHR, Steve Jobs, v11

The system is upgraded to Allscripts Enterprise EHR^TM (AE-EHR) version 11.2.x- now what to do? Evaluation of current workflows and deciding on the Meaningful Use measures the organization will be using are the next steps. This article will cover some basic key concepts of Meaningful Use as it related to the application and processes as well as examples to provide the foundation to move forward and build. Ideally, obtaining a baseline of the workflows currently used today in each site/clinic prior to the upgrade itself is the recommended approach. This article will highlight at the end the recommended timeline and priority items to provide the best success of not only the upgrade but more importantly capturing meaningful use.

Step 1- Evaluate current state workflows of each site and the role of the end user population

Even if the site recently went Live or had training- end users continuously find new ways to use the application. AE-EHR version 11 in general provides multiple ways to enter information and despite the best training and/or trainer, an end user may change their behavior over time.  Not only will a potential different workflow result in inaccurate testing of what is believed in the workflow; it may potentially allow for an area of missed training when moving to version 11.2. Here’s a great example, suppose clinical staff were not trained to enter problems, however over time the providers and office managers of a site have asked clinical staff to enter the problems for physicians. This would have an impact on training for meaningful use. Or, perhaps the staff is trained to enter smoking status on the social history but behavior has recently changed by the end users and they started capturing it in the comments field in vitals because the end user thought it would be quicker.

The best approach is to go to each site and evaluate each role on what they currently do in the application, as well as how they document in the application. This will allow the testing team to accurately test the role based workflows as well as train as appropriate on workflows. Once the current workflow is established then the foundation for configuration and re-training can begin.

Step 2- Decide which of the Meaningful Use Measures will be used by the organization.

The 15 Core measures will be required by all eligible providers, however only 5 of the 10 menu sets are required.   Additionally, of the 44 Clinical Quality Measures, three of the Core or Alternate Core will need to be used and three of the remaining Clinical Measures will need to be decided upon in order to have a total of six Clinical Quality Measures.

This step can be quite a task depending on your organization. Here are some sample questions to ask:

• Who will be the lead decision maker?
• What teams need to be informed of the Meaningful Use objectives- Business Admin, Executive, Physician Core team?
• Are there multiple teams that will make decisions on different aspects (clinical versus business versus administrative)?
• Do those key decision makers know about Meaningful Use and if so at what level – high-level or detailed?
• Will basic ARRA- Meaningful Use training be required?
• How will government incentives be paid out (to the organization, to the physician, to the site)? This will be asked at meetings and better to be prepared when instituting workflow change.
• What providers are eligible in the organization?
• Will the eligible providers report for Medicare or Medicaid?
• Who is responsible to enroll each provider with CMS?
• Does an analysis of potential eligible providers need to be assessed to make the decision of MU reporting?
• Does an analysis need to be done, and what patient population and/or diagnoses are seen by eligible providers to select the appropriate Clinical Quality Measures?
• Will eligible providers have a choice on whether to participate in MU reporting or will it be decided by the organization?
• Will each site, specialty, or provider select the measures (MENU and Clinical Quality Measures selections) or will it be directed from the organization?
• Will there be a team dedicated for Meaningful Use?
• Who will track the user’s behavior to ensure the necessary information is obtained?

These basic questions will allow the core Upgrade/Meaningful Use team to be prepared for configuration, workflow re-design, testing, and end user training. Each item can have a direct affect on one of the aspects of the upgrade/MU project. For example, if all eligible providers will be allowed to decide which measures they will select for reporting then the configuration team will need to configure to all CORE, MENU, and all 44 Clinical Quality Measures. In addition, if each provider selects their own measures ideally the training would be tailored around the measures for that eligible provider. Training all providers on all 44 Clinical Quality Measures or all 10 MENU items that may not pertain to that provider will not increase retention of the information and workflow change and likely decrease the MU reporting success.  Another example, from the above proposed questions is Medicaid provides a greater financial return if the measures are met however what if no one meets the necessary 30% of patients? Does it make sense as an organization to increase an eligible provider’s percentage of Medicaid patients to capture the higher value and if so who makes this decision and how does the front office staff know to direct more new patients of a certain insurance to a certain provider?

Step 3- Workflow Redesign for Meaningful Use

Once the system is configured and reviewed by the implementation consultant during the upgrade process, the workflows will need to be re-designed to meet the Meaningful Use Measures to guarantee success! A workflow is not just the use of the application but also the process in place for monitoring the Meaningful Use within the organization. At this point, the system has been configured by the organization configuration team (system analyst) based on Steps 1 and 2.  However, unless the users actually change behavior Meaningful Use will not count. Here are some examples below that will need to be considered based primarily on the CORE, MENU and Clinical Quality Measures.

• CORE EXAMPLE:  Suppose that currently the organization doesn’t allow clinical staff to enter and/or update problems or medications on patients, however the providers have not been keeping these lists up to date. Will the organization allow the clinical staff to begin to perform these tasks? Does configuration need to change to allow for retrospective/prospective authorization? Does enable verification of problems need to be added? Do clinical staff need to be trained how to do this item?

Remember there are many new alerts for Meaningful Use however everything doesn’t have an alert and likewise an end user can ignore an alert.

• MENU EXAMPLE:  Providing a Summary of Care Record to the patient and Patient Education. First, who will be responsible for providing the Summary of Care Record- clinical staff or providers? Will the Clinical Summary provided by Allscripts be used or will it print out from the v10 or v11 note? If the patient is a portal patient and you don’t want to provide a Clinical Summary or a non-portal patient how will the provider state if no Clinical Summary is to be provided? What/Who/How is the workflow to be defined, tested, and trained? Regarding Patient Education, will there be a standard developed if not already implemented such as every new medication prescribed by the provider the patient will receive the Drug Ed for that medication? How will the patient instructions be populated and printed?
• Clinical Quality Measure EXAMPLE:  Adult Weight Screening and Follow Up- many sites may already obtain the patient weight today and this may appear as an easy Clinical Quality Measure to capture. However, there are a couple of items to consider, by adding a free text box for comments to document if a patient denied obtaining their weight and if used would count for Meaningful Use. Is this configured already and/or do end users know to enter this information to count for Meaningful Use? In addition, to meet this measure the BMI of the patient needs to be evaluated and based on the patient’s age and BMI an additional workflow must be completed. Part of that measure states if the BMI is greater than 25kg/m2 a follow up plan must be in place. What will that plan be if not already used by an organization/site/provider? Will there be a dietary consultation or a BMI Management Follow Up Order? Will the end user be able to select from any of the potential recordable actions: Dietary consult with the appropriate SNOMED or the BMI Management Follow Up order with the appropriate CPT code? Will the clinical staff perform this action at the time the vital is taken or will the provider be responsible for adding this item on the patient.

These are some examples of Meaningful Use and all the decisions, configurations, and workflow changes that could be affected. This article is not all inclusive, rather, it is intended to begin the process for the team to meet the Meaningful Use objectives.  Please feel free to contact Cary Bresloff, Cary.Bresloff@GalenHealthcare.com, for further questions, guidance, or consultation on Meaningful Use and the impact to an organization.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Meaningful Use, v11

In an effort to improve the way patient data is accurately maintained, the Health Care Industry is undergoing a historical transformation.  The initiative is fueled by the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Reinvestment and Recovery Act (ARRA) of 2009.  There are certainly a lot of preparations in the works to make this movement the next big shift in how medical care is provided.  With that comes advances in health technologies and the computer systems we incorporate to make it all happen.

The standard now has become an advanced network of cloud technologies, interfaced labs, pharmacies and networked providers all at your fingertips.  One would need a full team of dedicated professionals to navigate through the bests tools available to be ahead of the game, or a specialized group now called, the Upgrade Team.  A team of technically advanced, inquisitive and dedicated people to spend tireless hours scouring through new developments and documentation, who choose the proper tools and encourage you to set up your organization to succeed. 

The next best thing for an organization has now become Allscripts Enterprise EHR^TM version 11.2 (AE-EHR).  Because many clients have not yet participated in an upgrade process, but have instead experienced a net new implementation, service pack update or simple hot fix, we want you to be as prepared as possible. 

To begin, you will be assigned an Upgrade Team from the vendor which will include a Project Manager, an Upgrade Technician, an Upgrade Consultant and an Interface Analyst.  Your internal team should have representation for those same roles,  and in total your team should have at least 8 to 10 resources.  In addition to this core team, a group of Physician champions, super users, testers, trainers and help desk personnel is recommended to help run the command center and support each other during the actual Go Live week.

When the process begins, we hope that you take time to review all documentation available to you. Please refer to the Galen wiki and various Webcasts, Sales Force, and Client Connect.  You will be instructed to partake in the Allscripts eLearning courses, as well as an 8 hour instructional guide to the process by your Upgrade Consultant.  The Upgrade Team will introduce you to all the new functionalities in AE-EHR version 11.2, the Meaningful Use attestations, and will assist you in building your system to work seamlessly with your organization.  Part of the process will also incorporate the newly released Stimulus Set to the base AE-EHR version 11.2 application.  You will be responsible for attesting that your system is set up correctly to handle all the new requirements.  For this, you will need to allow various members of the Technical Team access to analyze and report how you have organized, mapped and set up your data.

To make sure the project stays on track, two weekly meetings will be held over the course of your 19 week upgrade.  The Project Manager will coordinate all resources for their action items and responsibilities, while the Upgrade Consultant meets to discuss the application, testing and build stages of the upgrade.  The Upgrade Tech and Interface Resource are invaluable pieces to the puzzle that will help you throughout the process, and will be available to you in addition to these meetings.  To start, a copy of environment is created to mirror your live system and is then upgraded to the new 11.2 version.  To personalize this base and to utilize the application, we need to configure the new parts to their full potential.  Many of the new functionalities in AE-EHR version 11.2 are in the areas of Security, Preferences, and new Tasks that all have been designed to help you meet the Meaningful Use criteria. 

As the go-live date approaches, testing has been as thorough as possible and all training has been passed along to your end users, we encourage you to prepare everyone for the new version.  It is recommended to provide reference materials for all users to avoid high traffic through your call center on go live Monday.  We also recommend an organized ticketing system to track the concerns that may arise, and a resource that may be available to uninstall and reinstall controls for various computers, tablets and devices that may not have been updated.  Your Upgrade Consultant will be with you throughout the entire go live process remotely, and host an open bridge screen share to walk you through the build process, testing concerns and later onto issue resolution.  You may request that the consultant be on site for this and an additional contract will have to be submitted.  Either way, the entire team will have constant contact with you throughout the first week of your live system.  Post upgrade, the one week transition period will help all team members decompress from the previous 19 weeks.  We will hold meetings to review our outstanding issues that came from the go live weekend as well as any outstanding Sales Force tickets that could be considered critical to your success.  Once we have transitioned past this first week, all outstanding minor concerns will be processed by the Allscripts post live queue and closed appropriately. 

For those of you who may be taking the Stimulus Set component after your go live with AE-EHR base version 11.2, you will once again be in contact with your Project Manager and Upgrade Consultant to repeat the process in building the set and moving forward successfully in attempts to use your Electronic Health records in a Meaningful Way.

Tags: Allscripts Enterprise EHR, Enterprise EHR, Enterprise EHR version 11 Upgrade, Upgrades, v11

As Allscripts Enterprise EHR v11 implementations continue across the country, many have found added value in the new functionality and enhancements. New features such as the clinical desktop, simplified navigation and right-click menus make Enterprise v11 easier for users at all points of patient care and conducive to greater utility. With clients ranging from small independent practices to massive health systems, the deployments are as diverse as the users logging in each day.

Over the past few months, I have had the privilege to be on a team of professionals that is genuinely navigating and building out v11’s newest functionality. St.Vincent Health (an Ascension Health ministry) , headquartered in Indianapolis, has been in the process of deploying v10 at the St.Vincent Physician Network since 2005 and in 2007, was awarded one of the first Allscripts Client Success Connect awards for their innovative interface development. Key accomplishments that have established their role as a leader in the area of integration are their interfaces with:

1. St. Vincent Health’s inpatient facilities,
2. Children and Hoosier’s Immunization Registry Program (CHIRP) which enables access to centralized pediatric immunization records,
3. Surescripts,
4. Transmitting Lab Orders, and
5. Accepting Laboratory and Radiology results from multiple vendors.

I will feature more about these in a future entry. For almost a year, St. Vincent has been looking to initiate their v11 upgrade, then following their final v10 rollout in February, redirected all efforts to v11 design, build and change management.

Directed by Margie Cornwell (RT, RDMS, PMP), a veteran of the Enterprise EHR project, most of the team was sent to Enterprise EHR training in March and since then, dove headlong into its full-fledged deployment. About 6 weeks from go-live, the build activity workbook is complete, the broad training strategy is in motion, and testing is underway. Then when 11.1.6 was released, St. Vincent Health displayed their versatility and decided to proceed with the upgrade in stride, while sustaining the original go-live date. From the beginning, the schedule has been remarkably rapid, but by maintaining positive attitudes, team-focus, and a willingness to go the extra mile, the team remains on task.

As a member of this team, my efforts have been focused on bridging the v10 order and results data into v11’s structure as well as preparing the items for mapping to the Order Concept Dictionary. Gaining this insight has given me a great chance to explore the benefits and value of Careguides and the improved Health Management Plans from both an application and administrative perspective. The St.Vincent Health resources have essentially been responsible for their own destiny; supplemented by a diligent Allscripts upgrade team and a couple of other external experts.

Contributing to St. Vincent’s ongoing success is their support methodology. During a go-live, the Enterprise EHR team members are physically on-site. Having these diverse skills and backgrounds is very beneficial to the various users and troubleshooting required. As is common, the team members range from clinicians to IT, but St. Vincent makes a special point to assure all are available for rapid response.

The perpetual willingness to embrace the cutting edge demonstrated by St. Vincent Health  has resulted in their being one of the first to stretch Enterprise EHR v11.1.6 to these limits and the chance to be a part of this talented team is enviable.

Tags: Allscripts Enterprise EHR, v11

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