Tuesday, January 29, 2013

Integration...... The Final Frontier!

I am often approached with the question what best practices work well in the FQHC market? I always tell folks that if you have seen one community health center….. you’ve seen one community health center. Each organization is as unique as the next. However, some standard best practices and key concepts can be followed to ensure you get the most out of Dentrix Enterprise.
1.    Integration is key:
a.    Communicating a shared vision – Integration is paramount and organizations leadership need to empower this vision. Working in silos is no longer an option.
b.    Understanding both languages – Primary Care and Dental providers speak different languages. Team members will need to develop a new language, and it will be important to learn and begin to incorporate the ideals of working together to improve patient care. And most importantly, Medical Directors and Dental Directors need to listen to one another and work towards a single, unified front.
c.    Providing integrated solutions – Organizations must work to develop innovative solutions that work in both primary and dental care settings to maximize returns and minimize duplicative functions. Be sure to budget for and invest in integration tools.
d.    Mitigating conflict – Conflicts between dental providers, CEO’s, and Organizational Leadership must be avoided and dental leadership should be able to moderate open discussions between stakeholders.
e.    Building Trust – Understanding the “Big Picture” while the Meaningful Use incentives are certainly important, let’s not forget the other core reasons for implementing an EDR which include patient safety and improving the oral health care of the underserved communities we serve.

2.    Types of common Integration interface options:
One of the most common interface languages used today is Health Level 7 or HL-7.  Implementing an HL-7 interface between your Medical EHR and Dentrix Enterprise is a key feature that should be budgeted for and implemented prior to going live on Dentrix Enterprise. One of the true benefits of implementing Enterprise Dentrix vs. Core Dentrix is the ability for the software to have HL-7 messages flow between disparate systems. i.e. Medical EHR and Electronic Dental Record (EDR).  The following segments of HL-7 are intricate to minimize duplicative data entry and to stream line processes. Some of the more common segments of HL-7 are:
a.    ADT- (Admit Discharge Transfer) - Typically refers to patient demographics such as Name, Date of Birth, Social Security Number, Address, and Phone Number.
b.    DFT- (Detailed Financial Transaction) - Typically refers to a financial transaction that is sent to a billing system and is used for patient accounting purposes. This message might include things like ancillary charges or patient deposits.
c.    SIU- (Scheduling Information Unsolicited) - Typically refers to messages used to communicate information about a patient’s appointment from two disparate scheduling systems or clinic’s practice management system.
d.    ORU- (Observation Result) - Typically refers to messages such as clinical lab results, imaging study reports, EKG pulmonary function study results and patient condition i.e. diagnosis history, problem list, vital signs, allergies, clinical notes, etc.
These interface engines are typical between the various medical EHR systems and Dentrix Enterprise. Additional costs will be incurred to implement these segments of integration and most often are uni-directional. So budget for these features and consider them a “Must Have”.
Another, type of interface that many software vendors are exploring is called Application Programming Interface or (API) for short. This allows the communication between various software components within an application. For example, wouldn’t it be efficient if the Dentist or Dental Assistant can update the patient’s allegies and current medications from within Dentrix Enterprise.  With a simple click on the Dentrix Enterprise data entry screen the user is taken into the corresponding component of your medical EHR maintaining one point of prescription entry, one allergy list and one complete medication list.
Stay tuned for next month’s post where we will dive into best practices and standards utilizing Dentrix Enterprise.


Friday, January 11, 2013

New Year…. New Workflows

There is something about a new year that brings new beginnings and new hopes. A new year helps us reflect on our previous successes and failures and allows us to formulate a roadmap for future success. This is also an opportune time to evaluate your business and I.T. processes and determine what works and what does not. Conducting the following work flows will identify gaps in your workflows.
  • Patient workflow- "Patient workflow" means many different things to different people. Certainly, patients are the main focal point. Understanding and truly assessing your current workflow on an annual basis from a subjective viewpoint is a critical piece of the pie that will help redesign and improve your electronic processes with minimal impact on "People Flow". Having someone objectively document the entire workflow from the time the patient walks in the front door all the way through the waiting room, triage, treatment and discharge is a required step in improving patient flow and overall patient satisfaction.

    • Create visual landmarks within your office and within your health center so patients can reorient themselves.

    • Don’t move the patients unnecessarily. It confuses the patient and wastes staff time.

    • Avoid having a circular flow which can create bottlenecks. While the intent may be good idea, People typically try to exit the same way they came in.
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  • Provider workflow- Dentists and Hygienists contribute the most critical flow in the office. Why? Because all revenue is generated by providers. If their flow is inefficient the practice and health center can be impacted.
    • Breaks down the silos.

    • Understanding how your providers operate in the operatories is crucial in managing a successful EDR implementation and most importantly ensure utilization.

    • A key element of a successful implementation is the pre and post workflow assessments.

    • How do the provider’s communicate with their support team?

    • How do the provider’s communicate with each other?
  • Perceived/Expected workflow- Take the time to talk to the key individual stakeholders and listen. Listen to what they expect the EDR to do and not to do. Make a list of "Must Have" vs. "Nice to Have" items.

    • Become one with the providers

    • Listen! Listen! Listen! (Take notes)

    • Implementing an EDR is not an IT project. Implementing an Electronic Dental Record (EDR) should be considered an organization wide project where IT will play a major role.
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Having the key stakeholders take ownership of their own Enterprise Database with the support of I.T. will not only ensure success it will aid in adoption. Remember, the days of simply implementing an EHR are gone. FQHC’s and their affiliated providers now must adopt and utilize certified EHR technologies in a "Meaningful" way. They address specific key items to address health disparities and specific quality measures.

If you want more information on Meaningful Use in the Oral Health arena the Dentrix Enterprise website is a great place to look. There is great information at
 
Also, take a look at "Facts & Myths on Meaningful Use" http://www.dentrixenterprise.com/pdf/C-ENTMUFAQ-Q312.pdf