The Allscripts Problem Mapping Tool (PMT) is an application that facilitates the mapping of Medcin defined terms and concepts to clinical terminology defined by Intelligent Medical Objects (IMO). As part of Enterprise EHR v 11.4, Allscripts has chosen to integrate the IMO Clinical Interface Terminology into areas of the Enterprise application. The IMO vocabulary contains over 260,000 terms and concepts which are mapped to standardized vocabularies such as ICD-9-CM, ICD-10-CM, SNOMED CT, HCPCS, CPT, LOINC, MeSH and UMLS. It is important for clients to realize that Medcin terminology will still be utilized within certain aspects of Enterprise:
While many Allscripts clients may be under the impression that the mapping of Medcin terms to IMO vocabulary is strictly an exercise in moving toward the use of ICD-10-CM, the reality is that the mapping must be done as part of the preparation for a v 11.4 upgrade. In fact, certain thresholds of mapping must be accomplished by the client before Allscripts will confirm an upgrade date.
Before getting started with problem mapping, and in order to ensure best outcomes with the Problem Mapping Tool, Galen recommends that clients take the latest update of Medcin (supported by the client’s version of Enterprise), and install the latest Allscripts Note Form and CareGuide releases. Galen also recommends that organizations keep the Xferonly (transfer) database installed on their production server since it does appear to impact the results associated with HPI: Problem Note Forms within the Problem Mapping Tool.
As part of their support package for problem mapping, Allscripts provides clients with two files. These files contain mappings that have already been completed by the Allscripts Clinical Content Team:
- Approximately 5000 Medcin to IMO problem mappings (where exact matches, 1:1 were identified)
- A default set of ICD 9 diagnosis to IMO problem mappings
Via the Problem Mapping Tool, the client can determine whether they will utilize the Allscripts mapping, and to what extent.
The Problem Mapping Tool provides a dashboard clients can use to gauge where they are in terms of mapping completeness. It is important for clients to know that the percent of mapping completeness is not contained within a single value: There are actually multiple measurements within three different levels of mapping that must be completed before a tentative upgrade date will be provided by Allscripts:
- Patient Problem List (instance) data
- Build Problem (Note Forms, CareGuides, Flowsheets, Favorites)
- Build Diagnosis – CHARGE – $$
Mapping specialty and user favorites takes special consideration for the client, because a lot of time can be wasted mapping favorites that are not frequently utilized. Below is a Galen Mapping report card. In this example, you can see that even though Problem List Instance Data (active problems on patient charts) is mapped at 96%, the Specialty and User Favorites percentages are seemingly low. However, through a more in-depth analysis, the client may discover that the percentage of favorites mapped is actually acceptable.
What happens if things are left unmapped? The Medcin problems that are Patient Instance Data will still display on the patient’s Active Problem list, and the end user will be prompted to manually convert the problem to a new IMO term if that problem is assessed during a patient visit. While a goal for clients should be to minimize this ad hoc prompting during the workday, for some problems, it might make sense for the provider to convert the problem during the patient visit to ensure a more accurate description of the problem.
In contrast to Patient Instance Data, it is important to note that any specialty or user favorites that are left unmapped will no longer appear on the end users favorites list.
Prior to the client’s upgrade, there are some additional considerations to take note of, a few of which include:
- Key words/Quicksets – these are NOT part of the PMT conversion, but are important to plan for if an organization uses keywords and quicksets frequently.
- Customized HPI: Problem Note Forms – these will add time to the mapping process.
- The client should understand usage of charge items such as exploding sets, and where diagnosis codes are being assessed from. Not only will this help to ensure that charge items are mapped thoroughly, it will also minimize time wasted mapping charge items that are not used.
- IMPORTANT: Currently, Charge Encounter Forms in a Hold for Review status at the time of upgrade are NOT converted through the upgrade process. So as part of their preparation strategy, clients may want to consider getting all of these forms submitted prior to their 11.4 upgrade.
Often, clients ask us here at Galen what kind of time and resource allocation they should set aside for the completion of their problem mapping exercise and 11.4 upgrade planning. Unfortunately, there is no magic number we can provide for this because of the extent of variability we see among clients and the many factors that contribute to the overall complexity of problem mapping. Considerations such as the size of the client, the number of specialties the client encompasses, the extent to which the client uses CareGuides, whether auto-configuration was utilized for HPI Note-forms, how the client has configured charge and charge groups, and whether or not the client uses specialty and user favorites are some of the items that must be factored into planning for successful problem mapping.
As always, we encourage you to contact Galen if you have any questions about the Problem Mapping Tool, and/or if you would like one of Galen’s experienced staff to assist you in your problem mapping project.