Allscripts Enterprise EHR Orders Synchronization

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Allscripts Enterprise EHR Orders Synchronization

• The Iowa Health System Experience
• Michelle Kenworthy, Senior Application Analyst
• Jessica Duer, Application Analyst

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Agenda

• Background and Introduction
• Order Synch Process
• Lessons Learned

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Background and Introduction

• Utilizing v10.2.3 AEE
• Originally planned to go live with v11 in
  February of 2008
• In preparation for that go live, we went through
  the orders synchronization process
• This presentation outlines the synchronization
  process in v10

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Iowa Health System

• Hospitals
• Iowa Health Des Moines
• St. Lukes Hospital, Cedar Rapids
• Finley Hospital, Dubuque
• Trinity Regional Medical Center, Fort Dodge
• Trinity Regional Health System, Quad Cities
• Allen Memorial Hospital, Waterloo
• St. Lukes Regional Medical Center, Sioux City

• Clinics
• Iowa Health Physicians
• Partners in Health
• Childrens Hospital Physicians
• St. Lukes Clinic Network
• Trimark Physicians Group
• Trinity Physicians Group

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IHS Facts and Figures

• 135 clinics in 71 communities in Iowa and
  Illinois
• 550 providers (500 currently utilizing AEE)
• Labs performed at 30 different interfaced
  laboratories and radiology exams performed at 20
  different interfaced locations across the state
• Approximately 9,000 laboratory and radiology
  orders in the Item Dictionary at the time of
  synching
• Utilizing Allscripts Enterprise EHR v10.2.3 (all
  modules except Charge)

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Orders Synch Process

• Evaluate current entries in Item Dictionary
• Create a Parent or Master order for each unique
  order in the Item Dictionary
• Attach each child orderable result(s) to the
  appropriate Parent or Master order
• Evaluate current entries in Requested Performing
  Location Dictionary
• Synch each child orderable to the appropriate
  Parent or Master order
• Inactivate child orders or make Unavailable to
  Order in Item Dictionary
• Test order and result interfaces

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Evaluate Current Item Dictionary

• Perform an Order Result SSMT extract
• Group all like orderables together
• If using the Charge module, orderables should be
  grouped by CPT code and order because the charge
  will be dropped based on the Parent order
• 2500 orderable groups were identified
• Orders Synchronization SSMT.xls

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Create Parent/Master Order

• For each group of orderables create a Parent
  order
• Use the most common name and a new unique code
• Add a special identifier to the name and the code
  to help distinguish these in the Item dictionary.
  
• Orders Synchronization SSMT.xls

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Attach Child Orderable Result(s) to New Parent
Order

• Replace child order description, code and
  mnemonic in the Order Result SSMT spreadsheet
  with the new Parent order description, code and
  mnemonic and load
• Create an Order Detail SSMT spreadsheet for the
  new Parent Orderable to include any additional
  order instructions, modifier picklists, patient
  instructions and the communication method
• If utilizing the Charge module you will also need
  to load an Order Charge SSMT spreadsheet to
  attach the appropriate CPT code to the new Parent
  order code
• Orders Synchronization SSMT.xls

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Evaluate Requested Performing Location Dictionary

• Selecting the performing location on the order is
  what drives the correct order being placed
• There must be an entry for each performing
  location that utilizes a unique set of order
  codes

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Synch Child Orderable to New Parent Order

• TWAdmin/OrderAdmin
• Search for the new Parent order
• Choose the Performing Location
• Enter the appropriate orderable description, code
  and mnemonic
• SSMT
• Order Performing Facility Identifiers
• Orders Synchronization SSMT.xls

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Inactivate Child Orders

• Child orders need to be marked as inactive or
  unavailable to order in the Item Dictionary
• Cannot be done with SSMT
• Must be done manually or through a database script

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Test Order/Result Interfaces

• In a synched environment the order field in the
  result message files against the Order Performing
  Facility Identifiers table instead of the Item
  Dictionary
• No longer have to add the child order to the Item
  dictionary
• If the order code in result message is not
  synched to a Parent orderable for the performing
  location, the result message will error in
  ConnectR.

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Lessons Learned

• Perform in depth scenario testing for order and
  result interfaces
• We had labs that were partially resulted at two
  or more different performing labs. In this case
  all performing labs must be synched to the order
  code that was utilized even if it is not that
  labs order code.
• Make sure all performing locations are being sent
  in the interface record. If a performing location
  is missing, the result will error in ConnectR.

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Lessons Learned

• The level of synching the can be achieved is
  dependent on the lab and radiology facilities
  order compendium
• You cannot synch more than one child order to a
  Parent order for a performing location.
• Example MRI Lower Extremity
• SSMT will load the Order Performing Facility
  Identifiers spreadsheet but it will not work in
  the application.

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Lessons Learned

• Users had a hard time choosing a performing
  location for those Lab and Radiology facilities
  that had multiple performing locations and code
  sets.
• Order groups were still needed
• You can implement the Default Performing Location
  functionality to assist users, which we did after
  the fact.

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• Questions?