Webinar: Allscripts Performance Improvement Opportunities- Friday April 29th 12:30 EST

Please join us for a FREE WEBINAR- An insightful look into understanding specific Performance Improvement opportunities in an Allscripts TouchWorks and PM environment.

Please register here



Lessons Learned – Allscripts PM V14 Upgrade

Culbert recently engaged with a client who requested assistance to successfully accomplish their Allscripts PM V 14 upgrade. It was a great opportunity for them to assess current practices and incorporate optimization of workflows, policies and procedures to ensure consistency across their large, multidisciplinary organization.

As with any project, there were lessons learned along the way revolving around preparation, planning and execution. Some of those learnings included:

  • Preparation – establish your PM support team

Who will assist in understanding the new functionality and its impact on your system set up and current workflows? This team needs to be comprised of members across all departments in your organization.  IT may lead, but you will benefit most by including Finance and Operations.  Reach out to Finance to establish those that are responsible for standard reporting.  Work with operations managers, supervisors and front end users to identify the potential impacts on day-to-day activities.  Also, make sure your Allscripts application support is in place when discussions regarding upgrade begin.  In our most recent experience, the Practice Management application support was not identified early enough and was inconsistent throughout the implementation process.  Having a single source to work with would have significantly streamlined things.

  • Planning – establish your upgrade database

Establish your own plan regarding implementation and testing. Don’t rely solely on the vendor.  In addition, know the database where you want your testing to take place.  During our implementation, the decision between TEST and TRAIN databases was a back and forth issue for some time.  Ultimately, the decision to load the upgraded version into TEST was made by IT and Allscripts agreed to update the database with a current copy of PROD.  This was helpful in training users, and duplicating some automated processes.  Unfortunately, there were few options available to allow complete testing of interfaces.  Based on your organization’s number and complexity of interfaces, be prepared to address issues at go-live that could not be properly tested.

  • Testing – create your testing plan

Have a testing plan and issues-tracking process ready for your team to implement as soon as your testing environment is established. Since Allscripts does not provide, nor recommend any formalized testing plan, be as thorough and specific as possible when identifying items to be tested and re-tested and how issues will be documented and quantified.   Ask your PM resource for a list of previously-identified issues and bugs from the version being implemented and ensure those that impact your organization are included in the testing plan.

  • Execution – go-live date

Choose a go-live date that works for your organization. Give yourself enough time, based on your available resources, to completely test all functionality and document current issues.   Ensure your issues list establishes a “no go” threshold that would push your go-live date until resolved or that the work-arounds provided are acceptable to your organization.  Remember to assess the workflow, manpower and financial implications of any work-around, and establish a reasonable time frame for resolution.

Lastly, if you are performing both EHR and PM upgrades concurrently, as this organization did, ensure that your voice on the upgrade team is heard. Underscore your importance in the process and insist on specific follow up dates and people responsible for resolution and assistance.





Allscripts PM v14: Workflow Enhancements

The release of Allscripts PM v14 includes several advantageous workflow enhancements, enabling more robust Registration, Scheduling and Billing capabilities. This upgrade presents an ideal opportunity to evaluate current practice management operations, and truly leveraging the new functionality to drive workflow efficiencies, improve data capture and quality, and improve overall staff productivity. Patient responsibility as a percentage of overall reimbursement continues to increase. The new v14 Automated Self-Pay Collections functionality provides various workflow automation capabilities based on client specific policies and procedures. The Culbert v14 upgrade approach tightly integrates overall business process transformation into the upgrade project. This requires tight coordination between practice operations, revenue cycle operations, IT and Allscripts resources.
Culbert’s area of expertise

  • Re-design of scheduling templates, consolidation & standardization of Appointment Types which resulted in a 25% increase in available appointment slots.
  • Re-design of Self Pay Management operations including new staffing plan and new training program inclusive of role, workflows, policies and procedures, and application functionality.
  • Development of Key Performance metrics and baseline measurement to monitor ongoing patient access and revenue cycle performance.
  • Evaluation and re-design of Front Desk (Check In/Out) workflows, policies and procedures.
  • Improved TouchWorks integration including CIE conversion.
  • Project management of the implementation of the RCxRules workflow automating engine to improve claims processing, reduce denials, and maximize reimbursement.

MIR_3989-Brad Boyd

Allscripts Upgrade Services

Effective TouchWorks Upgrade Project Management


Allscripts TouchWorks upgrades or hotfix changes often require a combination of Allscripts and client resources.  Ultimately, project oversight responsibilities fall upon the client to ensure that the workflow and application changes support every organization’s unique requirements.   Delineating the upgrades responsibilities between Allscripts and client staff is a key factor to completing this work in a cohesive and timely fashion.

While Allscripts brings essential technical knowledge and experience to the table, the client still needs to be in control to ensure alignment with their unique requirements. An internal client project manager can safeguard that the client’s questions and concerns are addressed in a timely manner and that their timeline and needs are first priority. Allscripts provides proven project plans which can be easily personalized for each client. This aligns Allscripts’ best practices with client constraints and requirements.

Pre-requisites are provided by Allscripts, but must be verified for each client environment before the upgrade can occur. This often requires bridging a gap between EHR support and IT, again reinforcing the need for an internal project manager with insight into an organizations current state workflows.   Additionally, knowledge of current configurations and customizations ensures that the upgrade leverages new features and functionality, while maintaining any client-specific personalization.



Allscripts PM -Truly Effective Practice Management with Custom Reporting

Practice management (PM) software operates the full revenue cycle of a medical practice, from patient registration and scheduling to claim submission, claim follow up and payment posting; it operates the all-important business side of healthcare.  And, while all of these activities are vital components for the successful operation of a medical office, without reporting, practices cannot assess the true health of the business and have a lesser ability to be proactive with corrective measures.

We all know that the running of daily, monthly, annual reports is so critical to assessing the health of a medical practice and Allscripts-delivered reports represent a great start to understanding how healthy a practice is at any given time.  Like all well-developed practice management systems, Allscripts PM offers a wide range of performance reports to help assess practice health in terms of operations, statistics and productivity.  However, what if there is information a practice desires that cannot be delivered using a canned report?  What if you need a full patient list based on visits grouped by rendering provider and grouped by particular age groups?  What if you want to explore the top 20 diagnoses or procedure codes submitted by your providers, grouped by provider with textual and graphical representations?  What if you want a complex payormix report with textual and graphical representation as well with user-defined parameters (by particular date range per query run, for particular payors or insurance categories)?  This is where a custom reporting strategy can help.

So, what does the strategy look like?  Well, it doesn’t have to be complex.  It can be made up of one individual in your organization who is familiar with Crystal Reports and a basic understanding of relational databases.  One user can create queries in Crystal and distribute the reports to end users as requested or you can implement a Crystal reader solution on one of your PM servers so end users can run the reports themselves, with security to run the queries dictated by Active Directory or the like.

You don’t have to have an expert in Crystal Reports to extract data, however.  In fact, you can extract data from the back end SQL database utilizing any data mining tool such as Microsoft Access or Microsoft Excel as well.

Whatever tool you choose to use, do think about the following when considering your solution:

  • What IT expertise do you have in house that we can use to develop a custom reporting solution? Do you have anyone who is well-versed in Crystal, Excel or Access? If not, look into getting help outside the organization to assist with developing and implementing a solution as well as training current staff on report writing so you can be self-sufficient in the end.
  • Do your custom reporting needs or organizational size dictate consideration of an enterprise Crystal Reader solution or does it make more sense to designate one person to write queries and distribute reports to end users? Enterprise Crystal Readers can be purchased and most are reasonably priced and you will get much bang for the buck in terms of the valuable data you will now be able to access.
  • Assess whether the data you are looking to study is actually being entered into the system and if it is, determine if it is it being entered into an available, reportable field. If data you need is not currently being captured, refine workflows or add an element to the current workflow (Additional Info custom question, for example) so that the data is captured and thus, extractable and useable.

Developing a custom reporting strategy can allow you to take the management of your practice to a whole new level.  Additional reporting opportunities will allow for more opportunity to monitor your practice’s health and well-being because a well thought out solution will help you better understand the full spectrum of your business operations.  With the development of a cost-effective, custom reporting solution, the management of your practice will be at your fingertips and will be well worth the effort to implement.



eReferrals- Allscripts

The process involved for paper referrals has long been a source of frustration for patients and providers. After a decision has been that a referral is needed, the patient is generally left waiting until they are contacted by the specialist’s office for appointment scheduling. The timing involved in this step alone can increase patient anxiety, which in turn leads to unnecessary phone calls and administrative time spent tracking down referral statuses.


Another flaw in current processes leaves primary care physicians less informed than the patients themselves immediately following the referral visit. Until correspondence is received by the primary location, all parties are again left waiting.


The addition of an Allscripts eReferral functionality provides a number of benefits from a coordination of care and quality standpoint for both patients and providers. The administrative advantages involved can also provide long term efficiency increases. The following goals should be considered as you contemplate an eReferral implementation.


  1. Speed of Communication – The reduced amount of time for transmission and receipt of the actual referral is most apparent here. The cumulative effects of time saved by the electronic transmission, reduced administrative effort, triage time reduction, and decrease in unnecessary follow up appointments are all impactful.
  2. Enhanced Decision Making – An increase in efficient provider interaction via eReferral messaging provides a much better platform for decision making than current processes demonstrate. This interaction can also bolster the referring physician’s repertoire and understanding of how to work up certain conditions.
  3. Reduced Appointment Scheduling Times – Intertwined with increased communication speed, cumulative effects of time saved by the electronic transmission, reduced administrative effort, triage time reduction, and decrease in unnecessary follow up appointments are all contributing factors to patients being seen in a more timely manner.
  4. Elimination of Duplicate Testing – The ability to easily send a comprehensive description of the current progression of a patient’s work-up greatly reduces the potential for tests to be repeated unnecessarily.


These factors are among the most prominent in the advantageous nature of an eReferral implementation. The significant increase in administrative efficiency, improvements in outcomes of care, and seamless interaction between involved caregivers an eReferral system can provide are all organizational upsides that warrant consideration.


Webinar: How to Best Navigate the Transition from ConnectR to CIE-Friday Aug 22 12:30-1:30 EST

Date: Friday, August 22, 2014
Time: 12:30 – 1:30 EST

Designing, implementing and maintaining streamlined, efficient, and accurate interfaces between your patient access, clinical, and revenue cycle applications, as well as with medical devices and ancillary systems is an integral aspect of sharing patient information throughout the continuum of patient care. Beginning with TouchWorks EEHR V11.4.1, Allscripts will be transitioning their interface engine solution from ConnectR to their Common Interface Engine (CIE) solution.
To explain the fundamentals of this new solution, how it’s features can help optimize your interfaces and how to best navigate the transition from ConnectR to CIE, Culbert Healthcare Solutions invites you to join Dave Oxtoby, Interface Consultant, for a FREE webinar on Friday, August 22nd at 12:30 Eastern.

This one hour online webinar will discuss and demonstrate the following:

• CIE fundamentals and key features.
• Important changes to the interface solution’s integration with Allscripts TouchWorks EEHR.
• Strategies for making the transition from ConnectR to CIE.

Date: Friday, August 22, 2014
Time: 12:30 – 1:30 EST

From ConnectR to Rhapsody-Allscripts Scores with Interface Shift

With ConnectR support being dropped by Allscripts after 11.4.1, a move to its Common Interface Engine (CIE) is now imminent for Allscripts EEHR customers. Although this may be seen as a daunting task by many, the outcome will far outweigh the work needed to get there. CIE is based upon Orion’s Rhapsody suite and is primarily composed of four major parts: the Rhapsody engine, the IDE, web-based monitoring and the EDI toolset.  The engine is the backbone of the system, working in conjunction with the other components to deliver a robust solution that allows for a far more granular approach to interface design than its predecessor, ConnectR.

The Integrated Development Environment (IDE) is a visual development tool that provides drag and drop components for every point of your interface.  It includes support for multiple types of source and target connections and data formats.  Multiple engines can be connected to from a single IDE session and an extremely useful help and reference set is included.

The EDI tools consist of EDI explorer, EDI Message Designer and EDI Map Designer.  All tools are accessible from the IDE or as standalone programs from the start menu.  These tools provide a means for developing and testing your interfaces that was not found with ConnectR. EDI Explorer lets the user connect, send test data and view responses using imported message definitions or new message definitions created in the EDI Message Designer.  Data can be transformed and mapped in EDI Map Designer and scripting can be performed using Rhapsody’s Symphonia language (Java based).

Web-based monitoring is available from anywhere on the domain and allows interface administrators to delegate day to day monitoring and error-handling without giving access to the IDE.  A solid message search feature, notification configuration and user-management are also included.

The reconciler feature, available to be added for error-handling in any route from the IDE, is another feature that gives administrators the ability to separate high level support functions away from the design of the interfaces.  Pushing unfiled messages (unmatched results, items not found in the OID, etc) to the error queue within Allscripts EEHR allows reconciliation and re-filing to be handled without having to give access to any CIE components.

Although tools for ConnectR to CIE migration are still being developed, with the right planning, support, training and time, a successful shift to CIE can be achieved without too many headaches and/or disruptions.  The end result is an interface design tool that will radically improve dataflow between systems in terms of accuracy and manageability and allow support to be handled at all levels of your EHR team.


Medical Practice Management: Automation

Tips to Enhance Productivity for Non-Clinical Staff

Do your front and back office staff a favor:  Set defaults in TouchWorks PM

In preparation for an EHR implementation, organizations typically customize notes and templates for the clinical staff as this is the normal course of EHR build and development prior to implementation.  The purpose of these customizations is to minimize the number of keystrokes and clicks necessary to complete any given task during the patient visit.  Invariably when we roll out an EHR, we also implement a new practice management (PM) system as well and go through a similar build and development phase prior to actual go live.

During this PM development phase, we build and customize back end master tables so they represent the organization in terms of departmental units, locations, providers, resources, procedures, schedules, diagnoses and claims data.  While these master tables are the backbone of the PM system and we can automate much in this area, there are additional opportunities for automation to eliminate keystrokes for the front and back office staff alike, just as we do for our clinicians in the EHR.

Save keystrokes during the build process

During the initial build of the PM, the Master tables are developed based on the specific organization’s needs.  Much thought must go into building these tables so that any negative downstream effects are understood and hopefully, avoided.  However, when building the Master tables, serious consideration should be given to each opportunity to set as many organizational defaults as possible.  A prime example is the Master table, Practice Options.  Within this one Master table are over 30 global defaults that can be set in the areas of:

  • General Options
  • Registration
  • Scheduling
  • Charge Entry
  • Payment Entry

While Master tables can be used to set many global defaults, there is even more opportunity to automate functions for front and back office staff within each module.  Unlike the global defaults that are set in Master tables, these defaults are user specific.

While automation and customization is critical to increasing usability for providers in the EHR, we cannot stop there.  We must remember to give that same thought and attention to our PM system so that we can increase usability for our non-clinical staff as well.  Talk to and question staff.

Inquire whether they know about these time-saving defaults.  If they do not know about them, show them, and explore additional time savers as a team.  We all understand that as end users and supporter of the PM system, there is much we cannot control.  However, automating and simplifying everyday processes setting a few, simple defaults can produce positive effects in terms of both productivity and staff satisfaction.

Protect Custom Work Before PM/EHR Upgrades

It is important to apply upgrades to Practice Management (PM) and Electronic Health Record (EHR) systems as they are released by your vendor.  Taking upgrades as they are released ensures that you have the latest content available.  As we all know, upgrades take much preparation and planning and one item I always address is the backup and safekeeping of custom .rpt reports when preparing for an Allscripts PM or EHR upgrade.  Items such as PM encounter forms, EHR prescriptions and EHR order/lab order requisitions can be customized for your practice and I have customized many over the years.  I learned the hard way, long ago, the importance of keeping regular backups of my customized reports.  During upgrades to Allscripts PM and EHR the .rpt reports are overwritten by standard versions, thus, wiping out all custom changes.  To prevent the loss of custom reports I began creating backups every two weeks and started placing a copy in a safe location off of the Allscripts servers.  Then, post-upgrade, I simply replace the standard copies with my custom versions and I am back in business.  Of course, if the new version of the .rpt has additional functionality that I want to use, most of the time I can simply paste my .rpt format into the new shell and I have both my custom changes and any new functionality (simplified procedure description, but you get the point).  I have saved myself a lot of re-work in implementing this routine.  Again, vendor updates are important and should be applied regularly, absolutely.  However, I suggest that the best way to approach upgrades as they relate to custom reports is to be pro-active, back them up, and save yourself a lot of re-work!