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Creating opportunities in clinical informatics education

  • Jennifer MacGregor
  • 04/28/2016

Sir William Osler, the Canadian physician frequently described as the Father of Modern Medicine, was an innovator in medical training. He created the first residency program for specialties and introduced bedside clinical training as part of physician education. He once said: Observe, record, tabulate, communicate. Use your five senses…Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert. Though Osler said this more than 100 years ago, the principles are still relevant today. Observe, record, tabulate, communicate – modern clinical informatics strives to help clinicians with all of these foundational aspects of medicine. Allscripts is working with world-class Canadian education organizations to create additional opportunities in this field. Partnering with Dalhousie University to improve healthcare IT education opportunities Dalhousie University is known for providing its researchers and students […]

Some time ago (i.e., 2008), the Centers for Medicare & Medicaid Services (CMS) implemented policies aimed at eliminating reimbursements for several “never events.” CMS estimated that avoidable adverse events and errors cost $300 million annually – not to mention unnecessary patient suffering – and so needed to end. High among the focal never events were falls, including falls with injuries, and decubitus or pressure ulcers (PUs), especially those of higher severity, risk and cost, Stage III or Stage IV. Yet no computer can turn a patient to avoid a pressure ulcer, nor catch a patient to avoid a fall. So how can a programmable electronic health record (EHR) make a difference? Conquest of pressure ulcers and falls is not simple, but can an EHR help? PUs are the second most common of the never events, estimated to occur for as […]

Today there are many steps to processing claims, and each one is an opportunity to gain or lose money. Practices are weighing the pros and cons of different approaches to managing their revenue cycle, including relying on experts from outside their organizations. Arbor Family Medicine (Westminster, Colorado, U.S.A.) Office Manager Mikie Gonzales talked about her experience with Allscripts Revenue Cycle Management Services™ (RCMS) in a recent interview: Gonzales discussed some of the myths that surround decisions to bring in a revenue cycle management services partner. Her experiences are similar to other clients and “bust” some of the most common myths: Myth #1 – We’ll lose control of our billing activities. As responsibility for claims – from submission to sorting out denials and beyond – shifts to a services partner, some practices fear that they are also giving up control. However, […]

In a recent Client Outcomes Collaboration Program webinar, Allscripts clients shared how they have used the LACE index to identify patients who are at risk for readmission. Based on what they’ve found, they’ve taken different approaches to intervening with their patient populations. What is LACE and how does it help prevent readmissions? The LACE index, designed to identify patients who are at risk for readmission or death within thirty days of discharge, is based on four factors: L – Length of stay A – Acuity of admission C – Co-morbidities E – Emergency room visits The higher a patient scores on this index, the higher the risk of returning to the hospital. Hospitals are beginning to use LACE as a tool to stratify patients based on their risk level and work to reduce unnecessary readmissions. Many healthcare systems are working […]

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EHR design requires user input, early and often

  • Ross Teague, Ph.D.
  • 04/07/2016

Adherence to user-centered design (UCD) best practices is key to improving electronic health record (EHR) usability. A recent white paper reviews UCD best practices, and how they help improve usability and patient safety. Unfortunately, many EHR vendors skip a crucial step in UCD: formative testing. In this phase, software designers test early versions of the technology with actual users. They’re not testing completed code or solutions ready for market, but rather prototypes, wireframes or even early sketches. Good formative testing is iterative, meaning designers must gather and address feedback from users several times before finalizing the software. To illustrate how the formative testing process works at Allscripts, here’s a recent example from our Allscripts Sunrise™ Ambulatory Care solution. Example: Formative testing for a new task module The Sunrise team conducted formative usability tests on a newly designed task module with […]

Every year, clinicians manually enter billions of point-of-care test results (such as urinalysis and cholesterol tests), from paper printouts into electronic health records (EHR). This is a time-consuming process, as a single test result can contain a dozen different numerical values and units. Each data point is an opportunity for error. To solve this problem one of Allscripts Developer Program partners, Relaymed, researched the current methods used by clinicians and incorporated this information as part of its user-centered design process to create its own automated workflow. Unfortunately, when Relaymed researchers evaluated the manual methods for entering test results into the EHR at multiple organizations, they found it doesn’t always happen successfully. Relaymed Chief Executive Officer Neil Farish reports that his team of researchers found numerous issues, including a continuous printout of lab results left hanging from a device for more […]

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Guiding principles for EHR design: A 10-point checklist

  • Jeanne Armstrong, M.D.
  • 03/22/2016

As one of the clinical architects of Allscripts TouchWorks® EHR, I work hand in hand with our functional architect, product owners and user-centered design (UCD) experts. We work as a team on new designs to make sure we’re using best practices to improve usability. We developed the following guiding principles as a checklist to help us better focus our product development on what users need: 1. Let users do their work when and where they discover it needs to be done. Reduce the amount of unnecessary clicks to complete a workflow. Design navigation and workspaces to enable users to perform a wide variety of tasks, while tailoring them for the most frequently performed actions. Where possible, free cognitive resources with automation. 2. Acknowledge chaos. Consider users who perform tasks in chaotic work environments, where interruptions are expected. Make it easy […]

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United in safety: Making patient safety a top priority

  • Geoff Caplea, M.D., MBA
  • 03/15/2016

This week marks National Patient Safety Awareness Week, but in practice, Allscripts makes patient safety a priority all year. Everyone across the healthcare industry has a part to play in keeping patients safe from harm. Here are some recent examples of how Allscripts and clients are using technology effectively to keep patients safe: Improve electronic health record (EHR) usability with user-centered design (UCD) – A well-designed software solution can improve patient safety and clinician efficiency. This white paper reviews best practices and illustrate UCD concepts with examples from Allscripts electronic health records. Monitor patients in the hospital for faster, more effective treatment – Evidence-based clinical decision support, combined with 24/7 monitoring can help clinicians intervene quickly with appropriate treatment. For example, Allscripts SunriseTM clients have used technology to help defend against sepsis, eliminate common hospital-acquired infections and reduce C. diff […]

Drug-drug interaction (DDI) alerts are supposed to help clinicians reduce risk of prescribing medications that may result in adverse drug events. The adverse events reflect medications that, when prescribed together, can cause bad events and outcomes for patients. But it is well proven that “alert fatigue” does harm, and in this case, negatively impacts any favorable intents or efficacy of avoiding DDIs. Alert fatigue, including for DDIs, happens because of the onerous number of alerts considered low-value by clinicians and information overload, causing prescribers to override or ignore alerts as often as 98% of the time. Another reason for limited impact of DDI-related alerts is that, for some specialties, the prescribing of the drug combinations tagged as DDI risks are commonplace and already proven to be good, efficacious medication approaches – cardiology among the most frequent. The medical staff at […]

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Making a difference in The Diabetes Belt

  • Jeanne Armstrong, M.D.
  • 03/08/2016

The Mississippi Delta, a region in the American South along the Mississippi River, faces higher rates of diabetes than the rest of the United States. In fact, the Center for Disease Control has identified the area as part of “The Diabetes Belt,” where 11.7% of people have been diagnosed with diabetes, compared to outside the belt with only 8.5% of the population. The Delta Health Alliance (Stoneville, Mississippi, U.S.A.) shared how it is using Allscripts solutions to manage diabetes care for better clinical and financial outcomes in a recent case study and video: A lack of physicians in the Mississippi River Delta region can limit patients’ access to health care. Providers need solutions that can help identify and improve communication with at-risk patients. To help meet demand for proven technology, the Delta Health Alliance is a collaboration of 60 Federally […]