EMR Solution Set
 AHS Application Services
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Global Works Systems Helps Danbury Physicians in Successful Transition to Allscripts EHR
"Allscripts' and Global Works' combined experience and thorough understanding of the product provide value-added support to the client."
Richard Lyon, DOPS Executive Director
Client Profile
In 2007, Danbury Hospital was completing construction on a three-story, 89,000 square foot addition to the campus that was to house outpatient and diagnostic services. Danbury Office of Physician Services, P.C. (DOPS) was working to finalize the addition of an electronic health records system linking all services electronically. The Cardiovascular, Gastroenterology and General Surgery practices would be moving into the new facility. At the same time, they would all be learning how to use the new EHR. Two of the three practices would function on different floors in the new facility. Two Cardiology satellite offices, located off-campus in two different towns, would also be included in the EHR implementation. Embarking on this transition, DOPS knew that getting support at all of the different locations and meeting the differing demands of each specialty would be a challenge. The physical and technical systems restructuring needed to be finished quickly to meet the opening of the new facility. DOPS also knew additional resources would be required to meet the deadline.
Global Works played a vital role in providing that help and supported the DOPS practices during the deployment and practice relocations. The consulting firm's Allscripts EHR certified services are designed to provide Allscripts clients with the comprehensive assistance that is essential during initial implementation and subsequent roll out to physicians and their various departments.
EHR Vital to Parent Company's Vision of Patient-centric Care
DOPS is the largest, multi-specialty physician group in the greater Danbury area, employing approximately 170 physicians and 400 full and part-time nurses, mid-level providers, managerial, technical and clerical support staff. DOPS' parent company, Danbury Health System (DHS), is committed to anticipating and responding to new developments in the health care system and integrating the services of its system with those of other medical and social service organizations in the region. Long range plans include the creation of a regional health information organization (RHIO) for western Connecticut and portions of Westchester County in New York. The EHR is an essential building block of the planned RHIO. Implementing and expanding its use in physician practices is vital to the success of this endeavor.
In response to increased demand for the Health System's comprehensive medical services, Danbury Hospital planned the addition to its campus. The new patient-centric facility would house state-of-the-art technology allowing the EHR in physician practices to interface with labs and pathology. As momentum built for the new facility and everyone prepared for the groundbreaking, DOPS began the EHR vendor selection process. The task of identifying and implementing the appropriate system would all be done under aggressive timelines. Complicating an already demanding situation, the practices and satellite offices were all situated in different physical locations. Each practice had different requirements.
However, DOPS' biggest challenge was affording the cost of an electronic health record solution. Current practice margins were not sufficient to support initial project costs. Another major hurdle was getting both internal and external resources aligned. When Danbury Health Systems granted DOPS the startup funding and offered the assistance of the Hospital's IT Group it became possible for DOPS to support immediate implementation of an EHR in three of its practices.
Allscripts TouchWorks EHR: Less Time on Paperwork, More Time for Patients
DOPS put together a committee of physicians to review the top options and selected the award-winning TouchWorks Electronic Health Record from Allscripts, using an Application Service Delivery model (ASP) for remote delivery. DOPS was already using GE Healthcare (formerly known as IDX) practice management software and knew that Allscripts worked closely with this system. The physicians were confident that the interface between the practice management system and the EHR would work well. "Our physician committee felt that TouchWorks was the best system for us because Allscripts is one of the nationally recognized leaders in physician practice electronic health records," said DOPS Executive Director and Team Leader, Richard C. Lyon. "TouchWorks functionality supports a medium to large sized multi-specialty group and offers us the flexibility we need to set up systems for very different types of specialists." The committee felt that the web-based architecture, easy customization and automated learning of physician preferences were essential features. Implementing TouchWorks would automate tasks that directly impact the quality of patient care and would allow physicians to spend less time on paperwork and have more time for their patients.
The physical office moves meant that office managers were faced with multiple project challenges aside from the new system implementation. "We also had the usual spectrum of acceptance from physicians that ranged from 'I needed electronic health records yesterday' to 'I'm not interested in an EHR', said Lyon. "We were dealing with aggressive deadlines and multiple and different specialties so we knew we would need additional expertise. We also knew that help would need to be flexible and patient," he stated.
Allscripts recommended Global Works Systems to assist with implementation. Global Works and Allscripts share a strategic partnership that provides clients with expert 3D implementation services, documentation, support, staffing and training. Global Works Allscripts-Certified Consultants deliver comprehensive services ranging from building vital clinical content and preparing the project team and physician early-adopters to working closely with physicians to ensure their understanding of the technology. Additionally, Global Works provides on-site support during each go-live event. "Global Works was responsible for onsite assistance during the go-live and during the move to the new building. They really helped our physicians understand not only how the system worked but what the effect would be on the workflow in each practice," explained Lyon.
Go-Live and Move-All Within Established Deadlines
The implementation of an EHR in multiple locations with multiple specialties is a colossal undertaking and one fraught with the potential for error. Each location needs real-time access to information, without issue or delay. The support team must be able to turn on a dime and trouble shoot - answering questions, making quick changes to settings, explaining processes and catering to the needs of individual physicians and staff members. The installation included TouchWorks version 10.2.3, utilizing the following Modules: Rx+, Note, Document, Dictate, Results (in only), Order (in only), Scan & Transcribe for 33 different physicians.
DOPS assembled an internal team, which varied in size depending on the subject and the interface. Led by Richard Lyon, the team included two practice managers, two lead physicians, a system administrator, four Danbury Hospital IT staff members, and a compliance and coding resource. Six DOPS employees helped create the workflow and build portions of the project. Another six DOPS employees served as super users of the system. During the extended go-live the team had daily and weekly meetings to address issues and identify new resolutions. The meetings were used to coordinate requests for appropriate technical help and maintain focus on patient safety and both patient and physician satisfaction.
Allscripts and Global Works consultants met each morning to assign resources for the day. It was important to have at least one person in each location to provide personalized support to the different practices. "We were on the front lines working side by side with the Allscripts implementation teams during the go-live," said Global Works Senior Consultant- Allscripts Go Live Support, Kevin Dunbar. "We helped physicians who were really excited about the changes and we worked with some who just wanted to quit or pretend that EHR implementation just wasn't happening," he added. "Global Works functioned like the client's right arm," said Lynn Tomlinson, Allscripts Implementation Consultant. "The client had confidence in Global Works. Global Works provided excellent resources who were extremely experienced with Allscripts. They could be trusted to build and change settings during the go-live, which is really important," she added.
The implementation of three offices occurred over a six-week period and the move of these offices to a new building took place over three-weeks. DOPS moved one practice over a weekend and provided two-weeks of in-office support. The remaining two offices moved next. They too received two-weeks of in-office support. Ensuring that the multiple hospital interfaces were transferring information correctly was imperative. "We found that we needed an additional four weeks of on-site support while we were modifying the physician templates to improve workflow," said Richard Lyon. "We were new to the concept of electronic charts and didn't know all of the components and related matters before this."
Improved Patient Satisfaction and Reduced Overhead
Today, almost nine months later, 33 DOPS physicians and mid-level providers and approximately 55 support staff are using the TouchWorks EHR. DOPS physicians enhance and facilitate patient care by accessing the Danbury Health System network to tap into clinical resources and laboratory results and facilitating secure physician-to-physician email. Many DOPS physicians use handheld devices to assist with prescribing, clinical decision-making and patient education. DOPS plans to implement TouchWorks Forms, Results (outbound), Order (outbound) and Charge modules. They also plan to beta the Analytics reporting module to see if this can assist with their pay-for-performance reporting requirements. DOPS expects to have all modules up and functional within the year and are scheduled to upgrade to the highly talked-about TouchWorks version 11 before implementing additional offices. Long-term goals include bringing up three to six new office practices per year. According to Richard Lyon, patient response has been positive-to both the EHR and to the new facility. Although it took three months before patients recognized the practice changes, today they express pleasure with the ease and access of their medical records. Transcription costs plummeted and some DOPS physicians have chosen to develop templates that replace dictated notes. Many use voice recognition software which allows them to generate their own unstructured notes without using a transcriptionist. Costs associated with managing paper documents have drastically decreased.
Mr. Lyon anticipates further savings down the road. At the moment, DOPS is overhauling the process involving reconciliation of patient name and identification formats. Matching up results that are copied to the physicians requires staff oversight. "We expect that as we improve the reconciliation process and have stronger confidence with results placement, we will be able to reduce administrative overhead," he said.
A Value-Added Partnership
Richard Lyon is already thinking about the next rollout. He has a strong vision for how to enhance the implementation and rollout process based on his experience with this one. "We learned a lot this time," he says. "Everybody expected this to be a challenge. Until you experience it you can't imagine all the things you go through - but we did it...we pulled it off." According to Lyon, the doctors who adopted early and were involved in putting together templates did better over all. He feels that physicians need at least two full days of training and plans to include additional time for training and corrections in future rollouts.
Lyon appreciates the benefits of having both Allscripts and Global Works resources available on-site to support the physicians and staff. "Their combined experience and thorough understanding of the product provide value-added support to the client." he stated. When asked what qualities he believes are essential for a good TouchWorks consultant, he lists them: "good communication and teaching skills, good listening skills and, above all, patience." He feels that both Allscripts and Global Works have demonstrated these qualities in the support they provided during DOPS's TouchWorks EHR implementation and deployment.
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