The Death of an Electronic Note

The Death of an Electronic Note

Dearly beloved, we are gathered here today to remember our good friend the V10 Note.  For years he stood the test of time, unwavering in his ability to assist providers in documenting their patient visits.  He was multifaceted in that end users were able to document using point-and-click options, free text, Dragon, and the infamous text templates.  Built upon the “group” premise, the V10 Note was everything to everybody and then some.  He stood by our side through good and bad and through thick and thin.  He stayed faithful during the very short-lived life of the ACN.  He leaves behind several siblings…the V11 note and the “New Note” coming with 15.1.  Although he will be sorely missed by many, rest assured that he has moved on to a much better place.  Understand that he would want the same for all of the current V10 note users. 

As many of you might be aware, Allscripts recently made the announcement that they would be sunsetting the Version 10 (V10) Note and the Allscripts Clinical Note (ACN) with the release of TouchWorks™ EHR Version 17.1.  While I am sure this was not a surprise to many people, it has led to some scrambling and concern within the V10 community.  Transitioning to a new electronic note is just one more thing that has been added to a very long organizational “to do” list.  In addition to preparing for an upgrade to 15.1, an entirely new version of EHR, the thought of having to stack one more block on top of a leaning tower is certainly worrisome.

Let me be completely honest, as someone who has done numerous Phase II Note Upgrades (V10-V11) over the past few years, transitioning off of the V10 Note isn’t going to be a walk in the park.  Most organizations will attempt to build every V10 text template as a noteform, only to realize that this approach won’t work. This is because every provider in their organization has his or her own set of text templates.  It can be very overwhelming and figuring out how to successfully standardize without rocking the boat too much can seem like an enormous task.

The only way to tackle a Phase II note upgrade is with time, skilled resources, and an effective transition plan.  In one instance, a large teaching hospital came to Galen asking for assistance moving from V10 to V11 Note.  We evaluated the organization’s current state. This included looking at the number of specialties, resources to assist with the transition, competing projects, timeframes, and the budget. Galen then came up with a formal transition plan and total cost. The client’s goal was to have 45 specialties live on V11 Note within nine months.

In order to meet that goal, Galen put four highly-skilled remote note builders on the project.  Each consultant built one complete set of notes per specialty, completing a total of four specialties each month.  As the notes were completed, the onsite training commenced. With the assistance of client-side resources and onsite consultants, rolling go-lives were initiated.  Every month, four new specialties would go live and at least one support person was physically placed at each site to ensure adequate support.  Along the way additional specialties were added to the scope.  However, the team was successfully able to account for the new specialties and still finish in 10 months.

Overall, there are many things that will need to be considered prior to transitioning off of V10 Note.  Some of the most important considerations are listed below:

  • Should your organization go up on V11 Note prior to upgrading to 15.1?
  • How much time will it take to transition off of V10 Note?
    • What notes/noteforms need to be built?
    • How much time will it take to build each note/noteform?
    • What naming convention will be utilized?
    • Will the chart structure need to be reworked?
    • Who will champion the build for each specialty?
  • Does your organization have the resources to be able to effectively, learn, build, train and support the transition to a new note?
  • How much training will be required to get providers proficient on a new note? Who will train them?
  • How much training will be required to get analysts up to speed on building notes? Once they learn, how efficient will they be?

These are only a few of the high-level considerations.  Depending on what path your organization chooses, there may be other considerations that are specific to data gathering and building with 15.1 in mind.  In general, a Phase II note upgrade can take anywhere from eight weeks to eight months depending on the scope and project plan.  Often times, overzealous organizations get V11 Note training with the intent to build all of their own V11 Notes. But, then get bogged down with day-to-day operations and other responsibilities. They’ll never get back around to actually building the V11 Notes.  To avoid this, and again, depending on the project plan, my recommendation is to train resources who can devote the majority of their time to building notes and/or hire resources who already have substantial note development and note building skills.

To learn more about V11 Notes, visit our wiki and check out a recent webcast on note enhancements in 15.1!  Also, please feel free to leave your condolences for the V10 Note in the comments section below.  Thank you!

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