Master Questions & Answers
A. AEHR Overall
B. Connectivity and Integration
C. Costs and Financial Impact
D. Clinic Operations
E. Using the AEHR
F. AEHR Design and Standardization
G. Devices and Infrastructure
H. Training and Support
A. AEHR Overall
1. What is an AEHR?
An AEHR (ambulatory electronic health record) is the patient’s medical record in digital
format, capable of being shared electronically within our practice and across different health
care settings. The AEHR includes patient demographics, medical history, medication and
allergies, immunizations, test results, electronic prescribing, radiology images, visit
documentation and billing information. It is used by clinicians and care teams at the point of
care and throughout the patient management process.
2. How is an electronic health record (EHR) important for my practice?
An EHR makes it easier to provide care that is safe, results in the best possible outcomes,
and meets patient expectations. It allows us to integrate with other applications to better
manage patient care across the full continuum of service and track, report and benchmark
outcome data. It also supports improved documentation for coding and reimbursement and
provides more timely access to patient information.
The CHI AEHR will:
• Improve the safety and quality of our care for patients
• Enhance patients’ experiences
• Provide physicians, clinicians and staff with necessary tools and information
• Eliminate duplication and waste
• Better position us for the future
In addition, by achieving “meaningful use” of an EHR, we may be eligible for incentive
payments and may avoid financial penalties under the American Recovery and
Reinvestment Act of 2009 related to care of patients covered by Medicare.
3. What results can we expect?
The AEHR is expected to provide significant tangible benefits in care improvement,
Improving the care of chronically ill patients
Preventing adverse medication reactions
Improving patient education so patients may be more involved in their care
Though care improvement and benefits can be difficult to track, the Ambulatory Oversight
Council has approved the following metrics for measuring AEHR benefits for efficiency and
timeliness of information, coding and claim processing, quality of care and patient
Reduction in transcription costs through the increased use of online charting tools and
voice recognition software
Improved level of service coding resulting from AEHR documentation and coding tools
Decreased paper chart costs with elimination of paper chart supplies
Decreased costs for preparing charts for new patients
Reduced claim denials due to more complete and better documentation
Improved health maintenance compliance with AEHR education and tracking of tests
PQRI measures will be defined by the Ambulatory Quality Council.
4. What is the value of having one AEHR program for all practices?
Having one overall AEHR program creates value in several ways. One AEHR program is
intended to promote safe, effective and efficient workflows and patient care outcomes for all
physician practices, ultimately making it easier to do the right thing for patients every time.
One program also reduces the IT burden for individual practices and networks and
generates efficiency and cost savings for ongoing program maintenance. Additionally, using
a single AEHR provides both inpatient and outpatient providers quick access to key patient
information, while allowing practices to adopt leading practice workflows. In the future, one
EHR will position our practices, local organizations and regions for the changes expected as
the result of health reform legislation.
5. Why was Allscripts selected as the vendor for our AEHR program?
Allscripts is one of the nation’s leaders in providing AEHR solutions for physicians with more
than 170,000 users across the U.S. The organization’s sole focus is electronic solutions for
physicians, and it is one of the few companies with the organizational structure and
resources to support a systemwide implementation the size of Catholic Health Initiatives and
deliver a flexible product to meet our needs.
B. Connectivity and Integration
1. What hospital and other programs will our AEHR “talk” to?
At go-live, the clinic AEHR will be connected to the clinic’s scheduling, registration and
billing system, so that patient demographics can interface or “flow” into the AEHR.
Once the enterprise master person index (EMPI) is in place, the clinic AEHR will also
include interfaces so that orders may be sent electronically to hospital-based ancillary
departments, such as laboratory and radiology, and resulting data tied to the order may flow
back into the patient’s record. A charges interface will transmit billing information captured
within the AEHR to the billing system.
Through the OneCare program, CHI is working toward one universal patient record
accessible to providers across all care settings within the organization. CHI currently has
several parallel OneCare projects under way to implement EHRs in its hospitals and to
connect various clinical systems to one another. However, it will take several years to
achieve full connectivity.
2. Will data from our in-clinic chemistry, lab and imaging equipment flow into the AEHR
or will we have to enter it manually?
It depends. These workflows will be evaluated during advance planning and new interfaces
may be implemented in the future. Interfaces will be included for outside lab and imaging
3. Why won’t our ambulatory EHR “talk” to the EHR in the hospital emergency
department or hospital?
Through the OneCare program, CHI is working toward one universal patient record
accessible to providers across all care settings within the organization. This will take several
years to accomplish systemwide. CHI has several parallel OneCare projects under way to
implement EHRs in its hospitals and to connect various clinical systems to one another.
C. Costs and Financial Impact
1. What costs will my practice incur with implementation of the AEHR versus what
costs are covered by the national office?
The national budget covers the cost of devices (tablet and desktop computers, printers,
scanners), infrastructure (including installation of wireless networks), training development
and ITS implementation. The national budget also covers the time and expenses associated
with the involvement of practice representatives on the Clinical Project Team that is
designing the AEHR. Individual practices will cover the time associated with training practice
D. Clinic Operations
1. What impact will the AEHR have on our practice operations?
Ultimately, the AEHR will provide us with the best tools to care for our patients, better
access to information for making good decisions and workflow efficiencies to improve our
bottom line. However, during implementation and until we reach a level of proficiency in
using the program, the daily workflow may change and some users may feel challenged by
the learning curve. In addition to the changes in workflow, there will be new ways of
communicating and new ways to document our notes and other work electronically. It is
strongly recommended that practices schedule reduced patient volumes for the first weeks
of go-live. We anticipate full use of the AEHR and a return to the pre-go-live visit baseline for
productivity by 12 weeks after go-live.
2. How does patient information get into the billing system with the AEHR?
As a patient’s care is documented within the AEHR during a visit, billable charges are
captured within the system. These charges then “flow” electronically into the clinic’s billing
3. What lessons have we learned from the Des Moines implementation?
The AEHR project team has learned valuable lessons from Des Moines. A few takeaways:
Users should brush up on their basic computer skills.
Check your local training departments for classes to improve your skills
using Outlook, Microsoft Office and keyboarding. Users with basic
computer skills adapt to using AEHR more quickly.
View the Introduction to AEHR webinar available on LEARN, which covers
both an introduction to AEHR navigation as well as basic AEHR-related
Windows terminology necessary for a positive training experience.
AEHR users should regularly check email.
The communication team emails relevant information through newsletters.
After your clinic is live, important AEHR tips and system updates will be
After training and before go-live, use your training exercise workbook and practice
your skills by assisting with abstraction and logging into the AEHR Sandbox.
4. What is being done to prevent downtime and to recover if there is a disaster?
To recover from unplanned downtime in a disaster, CHI opened a “backup” or secondary
data center in Texas. Our primary data center is in Denver.
Certain planned downtime is required, such as for system maintenance including upgrades.
We will usually schedule planned downtime when our clinics are closed, such as overnight.
Unfortunately, there may be occasions when unplanned or emergency downtime must occur
during normal operating hours.
Computer users must always be prepared to continue business in the event of downtime,
whether planned or unplanned. Downtime procedures for clinics using the AEHR include
using paper forms to document patient care and following instructions for updating the
system when it is once again available for use.
5. Will the electronic health records of employees be kept confidential?
Yes. We appreciate the importance of assuring employees that their personal health
information will be confidential. Prior to a region's initial set of AEHR go-lives, every current
employee’s ambulatory electronic health record contained at any clinic using the AEHR
system will be marked as “secure.” If a user attempts to access a secured record, the user is
first warned that the chart is "secure" and is then prompted to enter a reason for accessing
the record before the user can proceed. The user’s actions will be tracked and audited on a
specific report. Note that when new employees are hired after go-lives have begun, clinic
managers will have the ability to also secure the charts of these new employees who did not
exist during the initial chart secure process performed by the AEHR project team.
E. Using the AEHR
1. How will workflows change with the AEHR?
Most current processes where paper is involved will be changing with the new electronic
system. This means much of what you do in a clinic with the implementation of the AEHR
will change in at least some subtle way.
The CHI AEHR is designed to closely follow a set of 50 certified workflows. The AEHR
project team will work with users to document current workflows and match them against the
certified workflows. We’ll work together to identify the gaps between the two and develop the
process changes necessary to bridge those gaps.
2. In what ways will we be able to personalize the AEHR to meet our practice needs?
Because different practices have staff functioning in different roles, practices will work to
identify staff in the various roles available within the application. Additionally, individual
practices can create “favorites” for medications and defaulted (pre-selected) items in orders
or review of system elements. Examples of decisions made at the national level include:
Note Content by Specialty, Chart Viewer, Orders, Favorites and Work Lists. Examples of
decisions about the build that will be made locally are: Patient Locations, Encounter Status
and Task List.
3. How will prescriptions for controlled substances be handled with the AEHR?
To assure that pharmacies will accept prescriptions from clinic providers that are presented
by patients, all scripts for controlled medications (Schedule II-IV) should be recorded in the
AEHR then written manually on security paper (prescription pads) and signed. This standard
process may be modified in some states to assure compliance with differing local
4. How will providers monitor and note drug seeking behavior?
The provider may choose a diagnosis corresponding to drug seeking behavior and/or
document his or her findings in the provider notes contained within the patient's electronic
chart. The patient banner within the CHI AEHR will not contain any wording or abbreviations
related to drug seeking behavior. In addition, a chart alert will not be created to indicate drug
The documentation of this behavior will be excluded from the FYI section of the electronic
chart given the lack of security/privacy within the FYI section as well as the ability for anyone
to add, change or delete comments within the FYI.
5. When using the AEHR, how long can I pause before I need to log in again?
How long you can pause before needing to log in again depends on the device and software
you are using. The AEHR is set to automatically log out a user who has been inactive for 15
minutes. Users’ individual logins serve as their electronic signatures, so “timing out” protects
users as well as patients. It also helps us comply with HIPAA regulations and allows us to
track who accesses and updates patients’ records.
Individual devices also timeout after a period of inactivity and may go into “sleep” mode or
power down. To resume using the AEHR after a device timeout, you must log in again.
Other software you are using may have a yet another timeout period.
6. How will stat orders be handled with the AEHR?
When there is an urgent need for immediate action to ensure the health or safety of a
patient requiring a stat order, providers and staff will communicate verbally just as they do
now. The providers will document the order in the AEHR after the immediate patient need
has been addressed.
F. AEHR Design and Standardization
1. Is our AEHR being designed from scratch?
No. We purchased Allscripts AEHR that has a foundational build updated over time with
experience from more than 40,000 provider users. Allscripts' Care Guides and Certified
Workflows serve as the starting point for all work to decrease variations in care and support
leading practices across the organization.
Certified Workflows are the detailed steps and content to enter in the patient record to
complete a particular part of the patient visit. Workflows include nonclinical and clinical
workflows such as scheduling a patient, using care guides, managing medications,
administering immunizations, verifying results, documenting notes for various visit types and
making a referral.
2. How were decisions made for the AEHR’s design, clinical content and workflows?
There are two groups that have had very specific roles in determining the structure, flow and
content of our AEHR. First was the Ambulatory Oversight Council (AOC), which was made
up of practice executives and national staff. The AOC’s role was to define the overall
guidelines for how our AEHR will be designed and built, ensure that the project timelines
and budgets are met, and resolve issues as needed. The governance structure has
changed. Now, AOC’s responsibilities have been rolled into the Employed Physician
Integration Council (EPIC). A list of EPIC members is now available on Inside CHI.
The Clinical Project Team (CPT), made up of practice physicians, mid-levels, practice
leaders, practice managers and nurses, has responsibility for taking the model AEHR and
customizing its contents and workflows. They work closely with the Ambulatory Quality
Workgroup to ensure that clinical content aligns with evidence-based practice.
3. I understand that we will be moving toward being paperless with direct entry of data
where possible. What is the value of promoting “discrete data entry?”
Our goal is to reach a point where the majority of information is entered into the patient's
electronic record via check boxes or from drop-down menus, and is therefore “discrete
data,” data which is both searchable and reportable. Free text notes and scanned
documents are not discrete data.
4. What decisions have already been made about the overall AEHR program structure
and key workflows?
The Ambulatory Oversight Council and Ambulatory Quality Workgroup made a number of
decisions in April 2010 that became the foundation for the Clinical Project Team’s work
designing our AEHR.
These foundation decisions define our AEHR program structure:
Pursue a paperless EHR.
Expect provider order entry. The role of support staff in entering orders will comply with
state scope of practice acts, federal regulations and CHI policy.
Standardize content, process and workflows across the organization to the extent
Create national scanning and abstraction standards. Data will be extracted and imported
from other ambulatory EHRs. Data will not be extracted and imported from inpatient
Drug utilization review alert levels (drug/drug, drug/allergy, etc.) will be standardized at
the national level.
Encourage minimal use of dictation/voice recognition for documentation and record
Provide additional security and privacy for certain documents, schedules, employees
Diagnoses will be associated with all medication and diagnostics orders, without use of
Clinical staff will be able to prepare medication renewal requests for providers and
complete orders as indicated by protocol.
Clinical staff would give immunizations per protocol with a retrospective “sign off” by the
Providers would not be required to supply a reason for requesting a non-formulary
Scanned documents would be electronically signed to enhance “time to information
Photo identification of patients will not be required in the AEHR. Decision to use will be
Residents would be the primary party receiving results, with attendings receiving a
5. What testing is done before go-live?
Testing helps the AEHR team uncover any problems and work out issues prior to go-live.
Several layers of testing are conducted prior to go-live:
Load testing involves multiple users logging in and using the AEHR system from
multiple computers at the same time. This stresses the software, hardware and the
network to help identify any bottlenecks and the maximum operating capacity of the
Unit testing is conducted by the AEHR implementation team as each individual
component of the system is built for every clinic. This helps to ensure that newly added
items are correct before entering the next phase of more detailed testing.
Simulation testing consists of executing multiple exercises to simulate actual workflows
so the AEHR team can assess how the AEHR software and devices function. It is also a
chance to evaluate workflows. This testing could take one day for a clinic and involve the
clinic’s manager, at least one provider, and super users in various roles. The AEHR
implementation team is conducting simulation testing internally, as needed, and will
notify specific clinics about any necessary simulation testing that could require the
involvement of a clinic’s staff members.
Think of integration testing as checking to see if information is flowing properly
between computer systems. Integration testing focuses on “interfaces,” in other words,
how individual components of the AEHR work together. For example, a lab order is
placed, creating an interface transaction with the hospital lab system; the lab results are
tied to the order then flow back into the AEHR via another interface. This testing is
conducted offsite by the AEHR project team.
6. Will the AEHR have voice recognition capabilities? Will I be able to use dictation?
Yes. Dragon Medical, the leading voice-recognition software from Nuance used by medical
professionals, is directly integrated with the AEHR. With this option, a provider can use voice
recognition to dictate directly into the electronic health record, as well as give voice
commands to navigate within the application.
The use of Dragon, however, should be thought of as a process to augment the standard
templates and note forms already designed and available within the system. Dragon will
NOT be the primary source of documentation.
The use of charting tools is encouraged for visit documentation with transcription being
reserved to add depth and richness as necessary. Fully developed drop-down menus,
checklists, and templates for free text and notes capture entry of discrete data elements,
enhancing the outcome of quality and consultation reporting and resulting in significant cost
savings for practices.
For additional information, read CHI’s position statement on the use of Dragon voice
recognition software, which is posted on Inside CHI and www.chionecare.net.
G. Devices and Infrastructure
1. What are the options for AEHR equipment and computers?
Practices will use HP tablet PCs and desktop PCs to view patient records on the AEHR,
document patient visits and enter orders. Hardware decisions are made during advance
planning in each region. The hardware team will evaluate user feedback in each market and
will be open to new options as technology changes.
Des Moines clinics received the following hardware:
HP Tablets with docking station, keyboard and mouse
The HP Tablets will replace existing desktop computers for providers. HP Tablets may be
used as mobile devices, and, when docked, function as desktop computers.
2. When will we know what equipment and devices our practice will have?
The timing of device decisions for individual practices will be made several months before
individual go-live dates based on the implementation schedule. The new devices will be
delivered and installed in clinics.
H. Training and Support
1. What training will be provided prior to go-live?
Prerequisite classes will be available online via CHI’s LEARN system beginning six weeks
before go-live. Super Users will receive training six weeks before go-live. The remaining end
users will receive instructor-led training on workflows specific to their roles two to four weeks
before go-live. Simulation exercises will be distributed after instructor-led courses to allow
students to practice within the AEHR Sandbox. Go-live support, job aids and reference
materials will also be available.
2. What are Super Users? Can they keep fulfilling their current roles?
Super Users are clinic staff members who receive additional training and practice with the
AEHR (Ambulatory Electronic Health Record). Super Users are utilized as local experts and
mentors to other AEHR users, and are the initial point of contact for questions and
assistance during various phases of the AEHR deployment (pre-go-live, training, go-live and
post go-live). It is recommended that Super Users scale back from usual clinic
responsibilities the first few weeks after go-live so they are available to help peers.
3. About how much time will training take?
Training will vary depending on the role of the user. Super Users will participate in 16 hours
(four four-hour sessions) of training in classes that have no more than 10 students. Super
users must also attend role-based training classes.
All users must complete the AEHR prerequisite course, Introduction to AEHR, on CHI’s
LEARN system prior to attending classroom training.
Providers will receive eight hours of instructor-led classroom training, clinicians receive 10.5
hours, and staff will receive two to four hours.
AEHR Classroom Training by Role
Role Required Training
Super Users Four 4-hour sessions
Clinic Managers One 4-hour session
Providers, Fellows, Residents, Medical Students, NP, Two 4-hour sessions
PA, Health Coaches, PT
RN, MA, LPN, Nutritionist, Ancillary Staff Three 3.5-hour sessions
Front Desk, Medical Records, Administrative Asst. One 4-hour session
Rad/Lab Techs One 4-hour session
Abstractors One 4-hour session
Billing Staff One 2-hour session
Scanning Staff One 2-hour session
View Only Staff One 2-hour session
Once training is successfully completed, providers and staff members will be provided with a
user ID and password. Additionally, users will receive an exercise workbook to use to
practice, as well as job aids and reference materials on completing key activities.
4. What’s the difference between Super User and Role-Based Training (RBT)?
Super User Training is a high-level overview of all roles in the day in the life of a provider
and clinic staff using AEHR. Super user training takes participants through the entire patient
process from checking in at the front desk, to taking the patient to the room and taking the
patient’s vitals, to conducting the patient exam, to ordering labs and radiology, to processing
lab and radiology orders, to checking out the patient, to completing billing.
Role-Based Training is much more detailed training that includes every aspect of a
person’s specific job function. There is role-based training for every role: front desk, nurse,
provider, radiology/lab, billing and medical records.
5. Do Super Users have to attend Role-Based Training?
Yes. Role-Based Training builds on concepts introduced in Super User Training. You will
attend the appropriate role-based class for your specific position (provider, clinical, rad/lab,
6. Will we need to schedule coverage for clinic staff when they are in training?
Each clinic manager will have to make the determination of whether it is necessary to
backfill for staff while they are in training.
7. Are providers compensated for training?
Yes. You should expect more information from your local finance leadership on the process
and dollar amounts.
8. When we go live with the AEHR, about how long will it take before I am comfortable in
using the program?
That depends upon you. Individuals who complete prerequisites, attend classroom training,
review video vignettes and spend time practicing in the Sandbox environment will become
comfortable more quickly with the new application than those who have done minimal
preparation prior to go-live. Support will be available for individuals who might require
additional computer skills training.
9. Will we have onsite support for go-live?
Practices will have an implementation team on site two weeks after go-live. The number of
go live staff members will be based on the size of the clinic. The teams will work closely with
providers and staff to ensure a successful go-live at each site. Additional support team
members and project managers will be available through a virtual command center.
10. What support will be available after go-live?
The Clinical Help Desk is specially trained to support needs that will occur from the
implementation of the AEHR and other OneCare applications. CHI also has dedicated
Physician Liaisons to support providers and their use of ITS applications. Super Users in
each clinic are also key to the success of the AEHR implementation before, during and after
11. How will users be able to practice using the AEHR?
The AEHR Sandbox is an online site where users can practice using the CHI AEHR
software for patient encounters. The number of employees who can access the site at any
time is limited.
To request access to the AEHR Sandbox practice environment, send an email to
AEHRSandbox@collab.catholichealth.net, noting your name and specific reason for
requesting access. If you are requesting access for more than one person or a group, it is
okay to send one email listing all names.
1. What is abstraction?
Abstraction is the process for consistently and safely transferring core information from a
patient’s paper chart into the AEHR. Anyone planning to assist with abstracting data into
AEHR must attend AEHR training.
2. During the abstraction process, where do I keep the form?
It is recommended to keep the abstraction form with the paper chart at all times for two
If the patient visits the clinic more than once before go-live and during the abstraction
period, it will be easy to find the form to make necessary updates.
It will be easy to identify if abstraction is in progress for a given patient chart.
You may want to create a log to keep track of the patients’ charts that have been abstracted.
You will want to quickly pull all abstraction forms as soon as you are able to enter
information into the AEHR prior to your go-live.
You will want the abstraction form to be handy so you can continue abstracting patient data
until all the abstracted data is entered into AEHR.
3. May I modify the standard abstraction form?
How you document information to be abstracted is flexible. Three abstraction forms were
designed by a team of clinicians nationally – forms for adult, pediatric and specialty
practices. The forms are samples and can be edited to fit a clinic’s patient population and
The forms include all of the pertinent discrete data that caregivers need transferred into the
electronic health record before go-live. Some practices may already have key information
organized in the chart for entering efficiently. In this case, the abstraction form may not be
4. I work in a surgical specialty practice. We do not see many chronic or long-term
patients, but more on a short-term, episodic basis. Is the abstraction form of any
benefit to us?
Typically, the abstraction form is of little benefit to a specialty practice that sees patients
periodically. Abstraction for these clinics will most likely begin following staff training. Upon
completion of training, staff should do the following:
Continually monitor the schedule for go-live week to identify scheduled patients and
For patients referred within the clinic network, look up the patient in the AEHR to
determine if their clinical information has already been entered.
Where information has already been entered for a patient, review it to be sure it is
If no information has been entered, review the information sent with the referral and
enter available key clinical data into the AEHR.
At the time of the appointment, review all of the information with the patient, to
ensure it is complete and accurate.
5. Who should enter the abstracted information into the AEHR?
Anyone who is planning to assist with abstracting data into AEHR must attend training.
Providers and clinical staff have found entering abstracted data to be good practice using
the AEHR, so all should be encouraged to participate. Registered nurses, licensed practical
nurses, medical assistants or other clinicians who enter data clinical data should perform the
work under the guidance of a physician.
6. How do I know if a paper chart has been abstracted and all pertinent data entered in
to the AEHR?
Clinic managers may choose a system for identifying when a paper chart has been
abstracted and all data has been entered into the AEHR. For example, you may mark the
front of the chart with the date and a large written “A,” a sticker or stamp that reads