The Issue:

v11 Notes in Allscripts TouchWorks™ EHR contain valuable discrete patient data.  The problem, however, is the data is locked away in an inaccessible format that can’t be reported on even by experienced reporting analysts.  Accountable Care Organizations (ACOs) and others using the Patient Centered Medical Home (PCMH) models need this data for various reporting functions.

The Solution:

Galen Note Form Reporting tool for reporting analysts makes Allscripts TouchWorks™ EHR v11 Note data easily accessible and puts the data in a format that makes reporting familiar and easy.  Without Note Form Reporting, extracting v11 Note data from TouchWorks™ EHR in a meaningful way is nearly impossible.  While users may be able to write a query that yields a desired set of data, it is extremely slow and nearly impossible to maintain.  Galen’s Note Form Reporting resolves this issue by doing the hard work for the user, so retrieving custom data is quicker, easier, and more maintainable.

What are our clients saying about Note Form Reporting?

Galen Healthcare’s Note Form Reporting product has enabled Genesys PHO unlock the true reporting potential of Allscripts’ unstructured note. At the PHO, we use a combination of highly customized and original note forms. By utilizing this software, we are able to mine and analyze data that was once locked in an unstructured v11 Note document. This ability has allowed us to report opportunities in patient care and streamline many once burdensome workflows within provider offices. Additionally, Galen’s support has been tremendous, helping us maintain reporting availability through upgrades and technical issues. Galen has been very supportive of our needs and continues to be a valued partner of Genesys PHO.

Matthew Hoover, Manager of Systems and Application Development  from Genesys PHO in Flint, MI

Use Case:

Beth is a reporting analyst at a large practice that is a Pioneer ACO.  The group analyzes the reporting requirements for Accountable Care Organizations.  After their analysis, they find many data points are currently stored in v11 Notes, and new data points are most easily documented in v11 Notes.  One morning, Beth’s manager asks her to develop a report as proof to show the group how they will meet the ACO requirements.  Beth finds that unlike all other data in the EHR, the v11 Note data is not found in discrete fields in the Works database.  It’s found in complex V11 Noteform documents of which she cannot makes heads or tails.  With Galen’s Note Form Reporting, Beth is easily able to build a query that returns the discrete patient data she requires.

For example, let’s say PHQ-9 screenings are needed on CCDs for this healthcare organization to successfully attest for meaningful use.  Unfortunately, these PHQ-9 scores are recorded in the v11 note.  There is no way to easily pull out the PHQ-9 score without having it be in a discrete field.  The v11 notes are stored as Noteform data which makes reporting on them very difficult because they aren’t in discrete fields.  By extracting the depression screen out of the note, we can gather useful data that we wouldn’t have been able to previously such as:

1. Evidence that the physician actually administered the screening (important for physician quality measures)
2. The patient’s answers for the screening
3. PHQ-9 scores

Here are some other examples of questions our clients have answered using Note Form Reporting that they otherwise would not have been able to answer:

Which of our providers are not performing smoking counseling on smoker patients?

What is the percentage of diabetic patients who have received eye and foot exams in the past year?

Can’t we just search the note data directly from our database?

Unfortunately, no you cannot.  The v11 Note data is stored in a complex, nested XML format, with frequent references out to other areas of the XML and to discrete look-up tables in the EHR.  Each time a Note Form or Input Template is changed in the EHR, the resulting v11 Notes will have a different XML structure.

Galen Note Form Reporting processes the data into a more accessible, relational format so you can query it in minutes rather than months.

Who uses Note Form Reporting?

Note Form Reporting transforms the v11 Note data into a format that is queryable.  Users of Note Form Reporting are SQL report writers.  Galen will work with your reporting team to ensure you have proper training on the Note Form Reporting data structures, and Galen is also available to create reports on your behalf.

Can Note Form Reporting work without impacting our production EHR?

Yes.  Note Form Reporting performs a brief nightly data extract that pulls the note data into a new database.  This new database is completely separate from the production EHR database.  It is designed to not interfere with the operation of your system.

Is there anything I can do with the data from Note Form Reporting other than reporting?

With NoteForm Reporting, not only can you turn non-discrete data into discrete data, but you can also use that data to incorporate into processes to improve workflow.  As one recent example, Clark & Daughtrey, together with Galen, implemented a charge automation process utilizing Note Form Reporting.  C&D uses the v11 Note to capture Healthcare Effectiveness Data and Information Set (HEDIS) measures assessed during a visit, which is important not only in assessing the quality of care for the patient, but also to the providers’ HEDIS Star rating score that is linked to their year-end compensation.  More importantly, low scores for HEDIS measures can result in their insurance carrier moving their patients to another provider group.  Needless to say, capturing the correct information from the notes is crucial for staff and providers at C&D.

Prior to implementing Note Form Reporting, staff at C&D manually reviewed the notes looking for the HEDIS CPT codes and would code the visit accordingly.  With Note Form reporting, a SQL job process pulls the HEDIS CPT codes, assigns the correct ICD-9 code to the charge codes, sets and submits the charge in TouchWorks™ and from there, pushes the charge to Practice Management for billing.  This is both a time and money saver, as it frees up the staff at C&D to work on other important projects.

More Information

Justin Campbell’s original debut of Note Form Reporting: https://blog.galenhealthcare.com/2011/07/11/ehr-unstructured-data-mining/

Here is a link to a webcast from Galen’s own Fallon Hartford regarding querying documents from the document table: http://wiki.galenhealthcare.com/Advanced_Queries:_Querying_the_Document_Table

 Coauthored by Fallon Hartford and Evan Lea