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An interesting discussion surfaced during an executive session client panel at Allscripts Client Experience (ACE), our annual user group meeting: Should we measure outcomes or compliance?
Of course, the ultimate goal is to improve clinical and financial outcomes. Healthcare organizations want to know that they’re delivering the best quality care for the lowest possible cost. But is measuring the outcomes themselves the fastest way to improvement?
How MediSync achieved nationally recognized chronic disease outcomes
One of the panelists was Charlie Hardtke, chief operating officer at management services organization MediSync (Cincinnati, Ohio, U.S.A.). MediSync uses Allscripts TouchWorks® EHR and Allscripts Practice Management™ to help its medical practices earn national recognition for chronic disease management. The story is the subject of a new case study.
Hardtke stressed the importance of engaging clinicians to define outcomes and processes, based on patient data and analytics. Some physicians were concerned about setting targets for clinical outcomes, because of the many variables that are outside a caregiver’s control.
“The key to engaging our physicians was to focus on measuring compliance with evidence-based processes instead of outcomes,” he said. “If we didn’t produce the outcome we wanted, we could change the process…It removed the concerns and compliance skyrocketed.”
If the process is well-designed, improved outcomes will follow. For example, by following data-driven processes MediSync helped one practice achieve evidence-based standards for 92% of its hypertension patients, compared with just 40% before the initiative. It has achieved similar results for other chronic diseases, such as pediatric asthma and diabetes. Commitment to quality processes has also enabled a payment collection rate of 99.2%.
“It’s a journey that takes many years,” Hardtke said. “You need to involve all your physicians to drive success and keep the momentum going.”
To learn more about MediSync’s journey with chronic disease management, download this free case study.
Search for examples on data analytics in health care, and you’re likely to find lots of stories featuring large integrated health systems in urban areas. But don’t overlook what’s happening in rural communities such as Hutchinson, Kansas. It’s the focus of a recent Healthcare Informatics article, Innovation on the Plains: Hutchinson Clinic’s Bold Data Moves.
Hutchinson Clinic CIO, Bob Davidson, points out that though the clinic is based in a small town (population: 45,000), more than 262,000 patients from across the state actively rely on the organization for care. With Allscripts TouchWorks® EHR as its core solution, Davidson shares advice on the value of data, including these insightful quotes from the article:
Value of coordinated care
“Our doctors have to do their own rounds with the hospital across the street, and take turns covering their call, and so on. And since we implemented the EHR system, and it’s available for them everywhere, and it helps the doctor to do more than just stabilize a patient over the weekend; they have enough information that they can start treatment. And consequently, the hospital stay moves them closer to recovery…We work closely with the hospital across the street, and they do have an EHR, but they mostly use ours, because it’s so complete.”
Value to physicians
“… in terms of the value that the doctors are deriving from all this, now, they get reminders, warning signs, that a particular patient is due for their hemoglobin a1c, for example; and more broadly, the doctors can look across their patient population for whatever chronic disease program they have, and they can see how they’re doing. And they’re very competitive, and the data helps them do a better job.”
Value for managing diabetes
“The really great thing about the EHR and the way we’ve utilized it—we’ve been collecting discrete data on our patients for years now and that has enabled us to really look at our population. For instance, when we were certified for the diabetes recognition program for NCQA, every one of our primary care doctors qualified for DRP certification on the first run, just because of the data available and the fact that they had been using the data to manage the diabetes population very well.”
Value of patient involvement
“We’re also working with Allscripts on their Achieve product, a goal-oriented, task-oriented engagement tool. If a doctor wants a patient to check their blood glucose three times a day, there are tasks for the patient to complete through FollowMyHealth. So if you have a patient from Dodge City who might be diabetic, and if there’s a significant change, the doctor can contact the patient, to bring them in to be seen, and that will encourage that communication process. The toughest part is just getting them to sign up. Once they’ve signed up, it’s not that hard to get them to use it. I myself am a big fan of it as a patient.”
North Shore – Long Island Jewish (NSLIJ) is one of the largest integrated health systems in the United States. Our team recently interviewed NSLIJ Chief Medical Information Officer Mitchell A. Adler, MD.
Q. How did NSLIJ respond to Ebola?
A. NSLIJ is one of only 35 centers in the U.S. approved to treat Ebola, which is a tremendous accomplishment. Like most health systems, we also needed to quickly develop an Ebola screening workflow to identify patients at risk for the disease.
Using evidence-based guidance from the Center for Disease Control and New York Department of Health, we presented all patients with two screening questions, one about recent travel to affected areas and the other about the presence of symptoms.
We screen ambulatory patients on the phone when they make appointments, before they physically enter any of our facilities and potentially expose our patients or employees. We also screen patients when they arrive at our facilities, as early in the encounter as possible, in case that information has changed.
Q. What were the key pieces to developing the NSLIJ Ebola screening workflow?
A. We needed our workflow to enable us to do three things: 1) Enter the responses to the two screening questions as discrete data, 2) Display the responses in a flowsheet, and 3) See the responses in our Allscripts TouchWorks® EHR, even though all responses from scheduling or arrival are recorded in another vendor’s system.
We got the help we needed from Allscripts to get this project completed within a matter of days. It was a very gratifying experience.
Q. What was the result of implementing the new Ebola screening workflow?
A. The results have been better than I expected. We have a reporting mechanism that pulls information from our separate scheduling, registration, and EMR* systems and shows the effectiveness of this new workflow. It gave us some insights about how we introduce new workflows, educate staff, receive feedback and continuously improve our processes.
If we have to institute another workflow to address a different illness, we can. It’s not technically difficult, it’s more of an administrative effort to efficiently roll it out to the 400 or so ambulatory practices we have in our system.
Q. Describe your experience with Meaningful Use in 2014.
A. 2014 was a very stressful and demanding year for every health system – and EMR vendor – across the country because of Meaningful Use requirements. They were challenging for both Stages 1 and 2 throughout the year. It didn’t matter which EMR they had, healthcare organizations faced difficulty ensuring proper workflow and reporting to obtain incentives and avoid penalties.
NSLIJ successfully attested to Stage 1 in 2014, for many of our first-time attesters. I’m very proud of this accomplishment. We received a lot of support from Allscripts along the way. I’m confident that most of our remaining first-time attesters will successfully complete this process during the Q4 2014 reporting period. We’re also well positioned to achieve Stage 2 attestation in 2015.
Q. What advice do you have for other organizations attesting for Meaningful Use?
A. I think that many of the Meaningful Use criteria are actually meaningful. We should focus on using the EMR in meaningful ways. More importantly, the EMR technical people should remember how important their work is to benefit patients.
You can learn more about NSLIJ’s response to Ebola in a free new eBook, Fighting infectious disease: A look at Ebola.
Editor’s Note: Electronic Medical Record (EMR) is another term for Electronic Health Record (EHR) or Electronic Patient Record (EPR).
The popularity of a recent blog post, 6 tips for achieving Meaningful Use Stage 2, shows there’s a lot of interest in real-world experience and advice on this topic.
Physicians’ Alliance, Ltd. (Lancaster, Pennsylvania, U.S.A) just completed a whopping 61 Meaningful Use Stage 2 attestations in the third quarter of 2014. We learned more about their experience from IT Director Barbara Eberly, Physician Practice Liaison Nancy Snavely and Quality Initiatives Coordinator Vicky Martell.
1. Physicians need to champion the portal
Barbara Eberly: When we launched FollowMyHealth, we started with the usual tactics: bulk invitations, posters, temporary employees who enroll patients. But it still didn’t get us where we wanted to be. Reports showed that providers were the key to selling it. That’s when we turned the corner on patient engagement, when providers realized it had to come from them.
2. New employees adjust quickly
Nancy Snavely: Because the workflows were already established, it was easiest to adjust for providers who were new to the organization. They didn’t have old workflows to adjust and could just run with it.
3. Friendly competition fuels progress
Vicky Martell: We run individual reports for every measure for every provider, basically a dashboard with green highlights for measures they are passing, red for danger or failing…They like to see how they’re performing and it starts a little friendly competition with their peers.
Barbara Eberly: We had a few providers that were not on board in the beginning, but then they saw 50 others successfully attesting…Running and distributing frequent reports really helped everyone meet that threshold.
4. Stay informed the whole time
Barbara Eberly: TouchWorks EHR is designed to help us meet the measures and gives us the reporting we need…that’s been key to us. Knowing where our providers are throughout the attestation period gives us the opportunity to work with those who aren’t making it.
5. MU Focus in 2015: Patient engagement & referrals
Barbara Eberly: We need to keep on target for a whole 12 months, instead of just three months. We’re going to need to keep that patient portal and engagement going strong…On the referral side, we don’t have a lot of other providers in the area who use an electronic health record, so meeting this measure for a full year of referrals could be tough.
Thanks to the team at Physicians’ Alliance, Ltd. for this advice. Are there other tips you would add? Please share in the comments below.
Editor’s Note: If you’d like to learn more about the benefits of using TouchWorks EHR and what you can expect from the solution in 2015, Greg shares more of his thoughts in a recent video.
According to recent quality reports of 220 Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP), Coastal Carolina Quality Care ranked third overall and second in care coordination. This ACO and its associated physician practice, Coastal Carolina Health Care (CCHC), use Allscripts TouchWorks® EHR and FollowMyHealth®.
We recently interviewed CCHC Chief Executive Officer Stephen Nuckolls and Associate Administrator Carrie Hagan about their success with MSSP and the Meaningful Use incentive program. For 2014 four providers attested for Stage 1, and 38 providers attested for Stage 2.
What’s the secret to their success? Nuckolls and Hagan share these six tips for achieving Meaningful Use Stage 2:
1. Allow plenty of time
Carrie Hagan: “We started the implementation process back in November of 2013, working towards attesting in the second quarter of 2014…We wanted that intense focus for a longer period of time, because we wanted to give the providers and staff the opportunity to implement new workflows and target interventions appropriately. That would give providers more time to complete it.”
2. Remember that several measures build on Stage 1
Carrie Hagan: “Some of the measures are carryovers from Stage 1, and they are easier because it did not involve new workflows and the staff were very comfortable with the measures. Things like reporting patient demographics, vital signs, order and results.”
3. Anticipate spending more time on Stage 2 measures that require patient response
Carrie Hagan: “The three toughest measures for us were the ones that required patient response: two patient engagement measures – the portal and secure messaging – I really encourage people to take advantage of the auto-invite feature that’s now available on the portal.”
Stephen Nuckolls: “To get patient engagement, personalize messages as much as possible…the more personal you can make those requests, the better.”
4. Focus on a few measures at a time
Stephen Nuckolls: “It’s hard to get the team’s attention on all quality measures at the same time. So we promote a few at a time, meet with nursing staff, and really focus on the things we can do to move the needle.”
5. When the going gets tough, don’t give up
Stephen Nuckolls: “About seven or eight weeks into it, several physicians didn’t think they would meet the measures. But we found the right strategies, and they succeeded. So, even if you’re two months into a three-month cycle, don’t give up.”
6. Work closely with your electronic health record (EHR) vendor
Stephen Nuckolls: “EHRs are very complex. This attestation process is very complex. It takes a team working closely together to make sure everything is working the way it should…Allscripts helped us work through all of that.”
To learn more about Coastal Carolina Health Care’s success, you can download a free case study.
Editor’s Note: On December 16, 2014, Greg White published a follow-up blog post, 5 more tips for achieving Meaningful Use Stage 2, featuring advice from Physicians’ Alliance, Ltd.
When I meet with Allscripts TouchWorks® EHR* clients, I’m impressed with how they use it to create value for their organizations. We found great examples in a recent interview with Dr. David Graham, chief information officer and chief medical information officer at Memorial Health System (Springfield, Illinois, U.S.A.).
Memorial Health System is one of the clients leading the way in its use of TouchWorks EHR data. Here are some of the highlights, in Dr. Graham’s own words:
1. Improve clinical results
“I can use examples in all the specialties we have in our primary care, from mammogram screening rates in our obstetrics group to hypertension care in our internal medicine practice…Incredible improvements we’ve done through partnering with our physicians and putting that data that comes out of TouchWorks EHR in front of them.”
2. Spend more time with patients
“[TouchWorks EHR] improves the abilities of our physicians and nurses to spend more time with our patients that they weren’t able to in the paper word.”
3. Change incentive programs for physicians
“One of the key advantages is…a risk incentive program for our providers, where we withhold ten percent of their income every year and we put very specific measures for them on clinical performance to earn that money back…having the data, the rich experience from the Touch Works database on quality measures and other performance measures we can give them regular feedback on a monthly basis.”
4. Improve access for patients
“We went from a fee-for-service model to an RVU [Relative-Value-Units] model that allowed our physicians to become agnostic to the payer. They don’t have to worry about whether the patient is with Medicaid, Medicare or private insurance. Access is central to Memorial’s mission. Now, they can bring more patients to the practice that didn’t have the opportunity before.”
5. Negotiate more favorable risk-based contracts
“Now that we have the data coming out of the TouchWorks EHR we can go to insurers and tell them how we’d like to change some of the metrics…They’ve been responding very well to that just at a slower pace than we would like.”
6. Earn more from payers for care coordination
“One managed care company came to us and said they wanted to give us three or four people to run their care coordination. We said, ‘No, we’ve got the tools within TouchWorks EHR. You pay a little extra and we’ll manage it.’ That turned out to be great for both parties.”
7. Prepare for regulatory changes
“We have a distinct advantage at Memorial Health System in being able to give our providers regular feedback on how they’re performing… Partnering together with Allscripts and the Touch Works product has allowed us to understand their performance, their needs, and implement changes that allow us to be ready for not only Meaningful Use but also for ICD10.
8. Enable collaboration with other providers
“I get a lot of pressure regularly from our acute care vendor to why don’t we switch now to their ambulatory solution since we’ve been on an EHR for almost five years now. It’s easy for me to look at them and say we get so much benefit out of the Touch Works system. It’s easier to use. It’s more effective and the data that we can pull from it to help improve our own care and also partner with the Springfield Clinic and the Southern Illinois University School of Medicine.”
To learn more about Memorial Health System’s success with TouchWorks EHR, you can download a free case study.
* Editor’s Note: Electronic Health Record (EHR) is another term for Electronic Medical Record (EMR) or Electronic Patient Record (EPR).
Editor’s Note: On June 3, 2015 we removed outdated supplemental material from this blog post.
A great deal has been happening within the TouchWorks EHR Business Unit since we formed in 2013 and renamed the solution earlier this year. Our clients are demonstrating that a healthy EHR core is the best way to thrive in a changing healthcare environment.
To keep you up to date on the latest from TouchWorks EHR, here are our top five recent updates:
1. Recognized as one of the best ambulatory EHRs. Based on client survey data, Black Book Rankings recently named Allscripts the 2014 “Best of the Best” Ambulatory EHR for Interoperability, Communications and Connectivity. TouchWorks EHR also earned the 2014 #1 Top EHR Vendor Ambulatory ranking for Independent Practice Associations and multi-specialty practices. In the independent Black Book study, TouchWorks scored better than 90% of EHRs in 17 out of 18 key performance indicators.
(See more about the 2014 Black BookTM for Client Experience and Satisfaction Rankings for Healthcare Technology and Managed Services on its website.)
2. HealthCare Partners saves millions. HealthCare Partners (Torrance, California, U.S.A.) reported some stunningly positive results from one of its commercial-payer ACO partnerships: $4.7 million in savings during the first six months of 2013. Analysts call it the first tangible proof of the potential of such relationships as the HCP-Anthem Blue Cross partnership is a blueprint of an ACO.
Credit for a portion of this savings goes to HCP’s investment in technology. HCP expanded its nationwide partnership with Allscripts last year by further deploying TouchWorks EHR across its California medical group sites and selecting Allscripts population health management solutions, including the FollowMyHealth® patient portal and dbMotionTM Solution connectivity platform.
(See more in this news release: Anthem Blue Cross and HealthCare Partners Saves $4.7 Million in Six Months)
3. Coastal Carolina Health Care featured as CMS model program. Coastal Carolina Health Care (New Bern, North Carolina, U.S.A.) uses TouchWorks EHR reporting capabilities to provide more preventative care for its patients and reduce the number of emergency room visits and hospital readmissions. The practice and its Accountable Care Organization (ACO) have been so successful, it was featured as a model program in the Centers for Medicare and Medicaid (CMS) Learning Systems for Accountable Care Organizations.
(See more in this case study: Using a healthy EHR core to form a successful ACO)
4. Hutchinson Clinic extends value of EHR. Hutchinson Clinic (Hutchinson, Kansas, U.S.A.) uses TouchWorks EHR, Allscripts Practice Management™ and FollowMyHealth® to manage its multispecialty services. With Allscripts Open platform, Hutchinson Clinic has extended the value of its EHR by successfully integrating several third-party applications, such as IntelliDose® for oncologists, M*Modal® and Dragon Medical® speech recognition, and Winscribe. These powerful combinations have helped Hutchinson Clinic improve clinical, financial and operational results.
(See more in this case study: Ready for the future with a healthy, Open EHR core)
5. Investing in TouchWorks EHR. First, we established the Allscripts TouchWorks Innovation Lab, expanding our Center of Excellence in Burlington, Vermont, U.S.A. This “sandbox” environment uses de-identified client databases with integrated surround solutions to reflect real-life production environments. The development team and clients will use this environment to design, develop and test new releases of TouchWorks EHR software to improve installations, upgrades and code quality. We’ve also added 25 new developers to this team, underscoring our desire to continually improve our solution and strengthen client satisfaction.
(See more in this data sheet: TouchWorks Innovation Lab – Quality Through Collaboration)
Working closely with our clients, we’ll continue to invest in and improve TouchWorks EHR. It is the healthy core solution 46,000 physicians and numerous successful ACOs depend on to deliver quality care in a changing regulatory environment.
Editor’s Note: Greg White will be presenting alongside Judy Hanover, Research Director of IDC Health Insights and Dr. Larry Holder, CMIO of Southern Illinois University HealthCare, regarding: What’s Next for Ambulatory EHR? Getting Real about Usability, Productivity and Meaningful Use.
Craig Dreher, chief information officer at Mercy Health System (Portland, ME, U.S.A.), recently observed, “In the Accountable Care Organization (ACO) environment, you have to do everything exactly right. You get paid only if you meet certain measurements. Can you imagine applying those standards in other places, like the airline industry?”
That’s an interesting thought. Instead of a set price in advance for each flight, what if airlines could only receive payment upon meeting certain measurements? The flight must take off and land on time. Gauges must prove that the plane used correct amounts of fuel and oil. The pilot reports in a timely and precise manner to air traffic control. This is what is being asked of medicine.
What if consumer behavior also contributed to whether or not airlines receive payment? All passengers must stow their carry-on baggage safely and use their seat belts while seated. If they don’t follow instructions and are injured, it could affect the airline’s income.
While the airline and healthcare industries have distinct differences, the analogy helps illustrate the complexity of accountable payment systems. There are a lot of variables in the complicated shift to value-based care.
Healthy core EHR helps Mercy Health System manage complexity and growth
Dreher believes that well-designed solutions can manage the complexity of the accountable care environment in healthcare. “The key to success is simplified operations. Period,” he said.
Mercy Health System recognizes that having a well-built electronic health record (EHR) at its core is essential to the organization’s success, even as it experiences a period of rapid growth. “If you build the foundation well, you can grow,” Dreher said. “We can’t go back and redesign the EHR every time the organization wants to grow.”
Beginning in 2012, Mercy Health System rolled out Allscripts TouchWorks® EHR, Allscripts Practice ManagementTM and FollowMyHealthTMpatient portal. These tools and an accelerated implementation strategy enabled Mercy to successfully build 24 ACO reports in 90 days. They have also helped secure $1.35 million in Meaningful Use, PQRS and e-prescribing incentive payments.
Like many health systems, Mercy Health System understands the importance of rising to the challenge of accountable care. By continuously striving for better quality care, they’ll help improve health for all of their patients.
You can read more about Mercy Health System’s experience in a new case study.
Editor’s Note: We edited this post on June 16 to identify the correct amount of incentive payments.
We’re renaming our ambulatory electronic health record (EHR) solution for larger practices: Allscripts Enterprise EHRTM is now Allscripts TouchWorks® EHR.
Enterprise replaced the TouchWorks brand in 2008, but we found that it caused confusion in the marketplace. “Enterprise” can describe an industry-wide EHR licensing model, or it can suggest that it is a solution for both acute and ambulatory segments.
So, we’re returning to TouchWorks, which better represents this intuitive, provider-friendly solution. As one client told me, “Our providers still call it TouchWorks anyway.” I believe clients will take the transition in stride.
There is no change to the solution right now. But several improvements are underway, including changes to the User Interface (UI) over time.
We plan to build on the momentum this solution has achieved, including an 11% year-over-year improvement in overall KLAS score. Our large practice EHR meets the needs of healthcare organizations today and tomorrow, with benefits such as:
1. Designed by physicians, for physicians. TouchWorks enables an efficient workflow in the exam room, which gives physicians more time to spend with patients.
2. Enables customization. Physicians can change the system’s documentation and reporting functions to meet their needs, making it easier to effectively and efficiently care for patients.
3. Works well with other solutions. Open architecture facilitates interoperability with other Allscripts and third-party solutions.
4. A healthy core EHR. It’s the starting point of effective population health management, a strategic imperative for many healthcare organizations.
For more information about TouchWorks, you can watch this video about the name change.
What does the name TouchWorks mean to you?