Clinical Solutions

The Coalese solution is a data aggregation and medical record access tool which makes EMR/EHR data more accessible to the health care team including homecare, paramedic/EMT, pharmacist, physicians, hospital staff and other authorized healthcare workers, using any browser-enabled access point, including mobile devices.

Coalese leverages existing investments in EMR/EHR systems and the large body of patient medical records information that is stored in such systems. The use of the Coalese product facilitates team collaboration/communication and enables improved patient outcomes.

Coalese is NOT a shrink-wrapped solution. It is a configurable integration appliance that can adapt to any situation, any hardware specifications and any IP-enabled mobile device.

health analytics


  • No training/education required
  • No impact on EMR performance
  • Improved Patient Outcomes
  • Better Disease State Management
  • Additional Revenue Generation, where applicable
  • Minimal or no IT support requirements
  • Low cost solution alternative to development
  • Rapid implementation timeframes
  • Short term return on investment, typically measured in weeks or months, rather than years.

Coalese Open Standards

The Coalese products and solutions make extensive use of open healthcare, IT and internet standards, tools and best-practices to ensure that the solution is extensible, maintainable, and evolvable in the long term such that it will preserve solution investments in the future.





Mobile Access

Coalese can be used to provide access to patient records on any browser-enabled device connected to the internet. A wide range of devices is supported, including:
  • Smartphones (eg. Blackberries and iPhones)
  • Tablets (eg. iPad)
  • UMPC (Ultra-Mobile PCs)
  • Laptops
  • Desktop computers
  • Compatible with wired, wireless and cellular internet access
  • All patient data is protected using strong encryption techniques and requires two-factor authentication. Data is secure; guaranteed!
  • The user interface dynamically adjusts to the screen size, dimensions and features of the device
  • Touch sensitive devices, such as iPhone smartphones, UMPCs and tablets allow the user to just tap buttons with their finger
  • Users are free to select the best device that suits their role and mode of work
  • Homecare nurses might prefer to use smaller, more portable UMPC-like devices with both WiFi and Cellular connectivity capabilities, but that still provide a larger viewing screen.
  • Physicians, for mobile access to their patient records, may prefer smaller, pocket-able smartphones
  • EMT/Paramedics might use laptops built into their ambulances

Customers can leverage existing hardware and mobile device investments, or to choose new and innovative devices that suite their particular needs, preferences and budget.
Raven on the iPad

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Metrics and Analytics

Coalese provides advanced reporting of physician metrics and analytics indicators:
  • Dramatically reduces effort required for validation of patient lists
  • Reduces staff time for chart reviews
  • Improves accuracy for inclusion criteria
  • Improved chronic disease patient welfare
  • Enhanced ability to focus on preventative measures
  • Reduced systemic healthcare costs
  • Fast and stable implementation
  • Allows for one-click patient medical record access to verify validation criteria
  • Disease state identification is real-time and searchable
  • Zero performance impact on EMR/EHR system or physician workflow
  • Flexible & responsive search, aggregation and reporting
  • Flexible metric/report definition
  • Multiple report output formats (HTML XML, Microsoft Excel Spreadsheet, PDF, etc)
  • Facilitated validation of patient assignment to physicians
  • Comprehensive patient chronic disease categorization
  • Intuitive ease of use = No training/education required!
  • Facilitated accuracy and validation of metrics, through display of rationale for categorizations

Running Metrics and Performance Indicator reports using Coalese employs a simple and intuitive user interface that requires no training. Because there is no learning curve, physicians, clinic administrators and even PCN/LHINS/Regional staff can quickly produce full-features metrics reports.


Metrics Request


Coalese Raven also includes role-based access controls, so that only personnel authorized by the clinic/physicians are allowed to run Metrics and Performance Indicator reports. The Coalese Advanced Metrics Management system can be accessed securely from any web browser.

VPL Metrics Report

Advanced Metrics provides a wealth of real-time panel reports and metrics, including, Hypertension, Diabetes, Cervical Cancer Risk Screening, COPD, Cardiac Disease and Smokers At Risk, to name a few. These reports quickly and easily identify patients that have or are at risk of contracting specific conditions, thus allowing the collaborative care team to institute preventative measures, which greatly improves patient welfare and reduces systemic healthcare costs dramatically. Integrated graphing and charting provides "at a glance" summary information to the practitioner.

Coalese uses sophisticated algorithms to determine if a patient "has" or "is at risk of" specific chronic condition. These algorithms evaluate observations, lab results, prescribed medications and perform advanced pattern matching on free form text encounter notes. Many physicians using EMR systems enter the bulk of their key diagnostic and assessment information in free form text, so Coalese has implemented multi-faceted pattern matching to extract diagnostic information from different sources.

HTN Metrics Report

Coalese takes a step beyond just identifying positive and negative indicators and diagnoses: it also identifies patients that are at risk of developing a chronic condition. This capability allows physicians to pro-actively assist in the preventative management of their patient's health, thus improving patient welfare and reducing systemic healthcare costs. Taking steps to prevent "at risk" patients from developing debilitating chronic conditions such as diabetes, hypertension, cervical cancer and COPD holds out the promise of huge benefits to the patients, the healthcare system and society as a whole.

The user can also show the detailed reasons why a patient was flagged with specific indicators by simply clicking on the "Show Rationale" button beside the patient entry they wish to validate.

Metrics Rationale

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Support for Paper Based Physicians

Many physicians are still using paper-based patient medical records and are resisting automation. Convincing these physicians to implement technology raises many challenges for both vendors and healthcare oversight bodies. Physicians cite many objections based on the experiences:
  • Steep learning curves and extensive education
  • Workflow changes can be very disruptive
  • Reduced productivity
  • Implementation complexity is very high
  • Clinical benefits can be dubious for a long period
  • Frustration from staff
Raven on Multi-touch All-in-one computer


Coalese has been optimized for touch-sensitive screens and provides an exceptionally intuitive and friendly way for paper-based physicians to access their electronic patient medical records.

Coalese, in conjunction with an EMR/EHR, can make it easier and more attractive for paper-based physicians to move to an electronic medical records management system, while maximizing the benefits of automation, by following a hybrid implementation process:

  • The clinic implements their selected EMR system
  • A Medical Records Assistant is trained in the use of the EMR system
  • Physicians either dictate, hand-write or use Raven's simple Data Entry ability to create their encounter notes which are then entered into the EMR by the Medical Records Assistant /li>
  • Paper-based physicians are provided with the intuitive Coalese Viewer and an all-in-one touch sensitive computer to give them easy access to their patient medical records and thus sidestep the effort, time, trouble and expense of learning a complex EMR system
  • Raven's Physician Appointment View provides the doctors with an easy to use and compact look at their appointment schedule
  • Raven's PDF-based medical record output capability can be used to print patient medical records prior to an appointment, if a physician wants to avoid computer use altogether
  • Physicians can also gain secure access to their patient's medical records on mobile devices such as iPhones and on their home computers.
  • Raven's primary care collaboration tools can enable improved communication between the greater primary care team by providing access to designated portions of medical records to allied healthcare workers such as homecare nurses, ER staff, pharmacists and EMTs

This hybrid approach of combining Coalese an EMR/EHR system addresses the typical challenges and objections by paper-based physicians, and makes it easier to provide an electronic alternative.

Advanced features such as multi-factor graphing & chronological timeline view, patient access to medical records using Patient Portal and Secure Messaging provide the physician and clinic staff with easy to use yet powerful capabilities to further improve the healthcare services that they can provide to their patients.

The combination of Coalese capabilities with an EMR / EHR system can be the impetus for sceptical paper-based physicians to make the transition and automate their clinical medical records.

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Patient Portal

Many patients are becoming more involved with their own healthcare, actively participating in and directing their own healthcare needs and decision making. Wide acceptance of internet security capabilities and use by increasingly technology savvy patients coupled with an ageing population is driving demand for electronic access to information by patients. Simplicity and intuitiveness make it easy to offer patients access to a subset of their own health records using an online Patient Portal feature.

Patient Portal


With privacy and legal matters top of mind, Coalese allows for custom disclaimers and one-time click-through agreements for patient access, with an example shown below. Appropriate legal verbiage and disclaimers would typically be provided by the provider and customized during the installation and configuration to address privacy and liability limitation needs.


Patient Portal Disclaimer

Coalese provides strong authentication and authorization features to ensure that a patient can only access their own patient record, or those records for patients for whom they are authorized caregivers. Role-based, physician level filtering can be used to limit what information a patient is allowed to view and to also suppress access to categories of information, for example: STDs/HIV, mental illness, drug abuse and other areas designated as "sensitive" and "suppressed" by the physician owning the medical record.

Role-based access controls also allow a clinic to set up tiered subscription levels for Patient Portal subscribers and control what optional features will be made available to various subscription tiers. For example, a &basic& subscription might only allow the subscriber to view limited portions of their patient record and only use the icon-based, intuitive Raven interface. A "premium" subscription would allow the patient to see more of their medical record and add the ability to display Timelines, Graph observations and generate PDF output. Finally, with a "concierge& quot subscription, the subscriber would receive all "basic" and "premium" features along with secure two-way messaging to their physician for consultations and the like.

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Cancer Screening Analytics

Cancer Screening analytics offer many unique features and benefits, including:
  • Comprehensive screening reports for the top three cancer concerns, including breast, cervical and colorectal
  • Automatic reporting of Cancer Screening program progress
  • Validation of diagnostic indicators; why the patient was included for audit purposes
  • Program was designed by a practicing physician
  • Zero performance impact on EMR system or physician workflow
  • Flexible & responsive search, aggregation and reporting
  • Multiple report output formats (HTML XML, Microsoft Excel Spreadsheet, PDF, etc)
  • Automatic reporting of Cancer Screening program progress
  • Intuitive ease of use = No training/education required< /li>
  • Facilitated accuracy and validation, through display of rationale for categorizations
  • Easy/Quick "Fix This" capability to manage patient diagnostic indicators
  • Full process and implementation assistance provided
  • Improved screening and preventative focus for key cancer types
  • Enhanced ability to focus on preventative measures
  • Reduced healthcare systemic costs
  • Program was designed by a practicing physician
  • Fast and stable implementation
  • Proven solution delivery

Cancer Screening Report Request

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Comprehensive Care Plans

There is an increasing recognition of the importance of primary care in providing comprehensive and coordinated health care delivery. Many jurisdictions have developed programs to encourage preventative health for complex patients. Both the patient and collaborative health care team, led by the physician, can use such plans to identify and manage chronic diseases.

Coalese has developed and deployed a solution that ensures specific program criteria is met and generates reports for the physician and patient based on program guidelines. This subsequently enables the health care team to follow a guideline based plan with specific goals for each aspect of patient care. The priority of providing a comprehensive and yet easy to deploy solution means that minimal staff and no technical resources are required from the clinic perspective. Coalese applies sophisticated search criteria to formulate an assessment of a physician patient panel utilizing established clinical practice guidelines. An important aspect of this solution is that Coalese searches include advanced free text and natural language searching capabilities to ensure that physicians not consistently utilizing the EMR field structure, such as those who dictate clinical encounters, will obtain accurate results.

Once a physician or clinic agrees to participate in the program with Coalese, a full practice and clinic review is completed and patient candidates are presented in a report for the clinic staff to begin scheduling appointments. Automation of the call schedules, patient reports and identification of eligible patients are included. Once the patient and physician sign off on the plan, the collaborative team transitions in to manage the patient going forward with the physician providing oversight.

Benefits

  • Improved chronic disease patient welfare
  • Enhanced ability to focus on preventative measures
  • Reduced healthcare systemic costs
  • Fast and stable implementation
  • Proven solution delivery

Features

  • Identification of patients eligible for CCP on an ongoing basis
  • Scheduling of periodic CCP appointments
  • Automated generation of pre-filled CCP forms for physicians
  • Automatic reporting of CCP program progress, including completed plans, potential and outstanding
  • Validation of inclusion criteria so that physician can quickly see why patient was included for audit purposes
  • Zero performance impact on EMR system or physician workflow
  • Flexible & responsive search, aggregation and reporting
  • Multiple report output formats (HTML XML, Microsoft Excel Spreadsheet, PDF, etc)
  • Comprehensive patient chronic disease categorization
  • Facilitated accuracy and validation, through display of rationale for categorizations
  • Full process and implementation assistance provided

For further information, click her to see the full Complex Care Program case study.

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Multi Clinic Data Access

Using the Coalese Patient-Oriented Delivery Foundation, cross-clinic queries and consolidated views of patient records can be utilized across multiple clinics in different geographic areas. Coalese enables mobile team members to access patient records regardless of the worker's location or which clinic(s) a patient record(s) is located.

Cross-Clinic Query

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Historical Data Archive

One very unique and beneficial Coalese solution is to provide a consolidated view of historical, orphaned medical record data for physicians and clinics that convert to a new EMR/EHR. The Coalese Integration appliance transforms historical data into HL7 3.0 CDA format.

Historical Archive


This solution is unique in that it avoids conversion of historical patient record information into a new EMR/EHR system by giving physicians the ability to view archived historical records and perform trend analysis, graphing and other advanced analytical techniques using the Coalese visualization tools. Physicians also gain the ability to share designated portions of their historical patient records with the wider clinical care team, including homecare nurses, EMT/Paramedics, pharmacists, specialists and other authorized healthcare workers.

This solution reduces conversion risk and costs, eliminating the need to translate/transform historical patient record data into a new EMR/EHR where coding and nomenclature issues can be problematic. Physicians can perform longer-term trend analysis and retain access to historical information, as required by law.

Another key benefit is that access to historical records is available early on in the migration process so total migration timelines/costs can be dramatically reduced and the need for physician retraining is reduced.

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Security and Privacy

The delivery and preservation of privacy and security are intrinsic to Coalese. Security and privacy measures are strictly enforced at all steps in the collaboration and access process:
  • Two factor user authentication is used to ensure only authorized users obtain access to sensitive patient medical record information. Optional hardware key based 2-factor authentication is also available
  • Strong public-key encryption is used, without exception, for all data transmission across the network, between Coalese and the user's browser. This makes it feasible to use the public internet as a secure transport network, eliminating the cost associated with proprietary networks
  • Role-based access controls in Raven only expose the portions of a patient record that a particular healthcare worker is authorized to view. Role-level permissions can be specified at both the clinic (EMR/EHR system) default level and also at the individual level /li>
  • Audit trails for all access to patient medical records to facilitate monitoring of all access points
  • Secured and locked-down Linux operating system environment, with extensive security components (firewalls, disable root login, etc.) included to provide a highly secure deployment platform for healthcare integration
  • Remote management is also authenticated using bi-directional digital certificates and uses strong encryption for all remote management across a network. Remote Management can also be disabled if required
  • Custom disclaimers and one-time click-through agreements for user access. Appropriate legal verbiage and disclaimers must be provided by the clients legal counsel and will be configured during the installation to address privacy and liability requirements

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Role Based Permissions

Coalese is a role-based permission hierarchy - only authorized information from a patient record is presented to the screen, with both read-only and read-write capabilities.

As an example, a homecare nurse might be allowed to view physician encounter notes, whereas a Paramedic/EMT might be prevented from seeing such notes. There are no limitations on the number of permission groups and roles within each group or configurations.

Edit Role


User driven interface tools allow for specification of both keyword based and period based designated access permissions. For example, encounter notes that have sensitive terms such as "HIV" or "Cognitive Impairment" can be easily suppressed from being viewed by any or all roles. Similarly, permissions can be set so that, for example, only the most recent 10 lab results or lab results for the past 6 months would be displayed for specific roles.

A high-level, easy to use, browser-based User and Permissions Administration interface provides a "self-service" capability to clinic staff to manage authorized Raven users and to set both clinic and physician level role-based designated access permissions for those users.

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Hardware Based Authentication

Coalese supports the use of hardware key 2-factor authentication for those clients who desire or require hardware-based user identification and authentication above and beyond the built-in two-factor authentication capabilities.

The Coalese authentication key is a hardware USB device that works on multiple platforms which does not need any client software. With a simple touch on the key, it sends the user's identity and a unique, encrypted pass code every time it is used.

Hardware Authentication

Secure

The hardware key combats common ID theft issues including phishing, key loggers and other means of eavesdropping. Users that have been issued keys employ a two-factor authentication/login process were they enter their User_ID / password and touch the hardware key to generate additional one-time credentials

Easy

Identification and authentication is performed in seconds without the hassle and risk of error when typing. Log-on is simple - the user plugs their key into a USB slot and touches the illuminated circle on the key

Portable

Works on all computers and devices with USB ports, platforms and browsers with no client software needed. Works with legacy login and requires no re-design of current website layout.

Green

The robust, ultra-thin and battery-free design increases lifetime and reduces environmental impact

Flexible

Coalese authentication keys can be selectively issued to appropriate users. For example, a clinic may elect to use built in 2 factor authentication for normal users, but require hardware authentication keys to be used by administrators.

Ease of Administration

It is easy for clinic administrators to issue, revoke or replace Coalese Raven authentication keys using an intuitive web-based user interface

Low Cost

Authentication keys are inexpensive and thus affordable to issue to a large number of users, including patients accessing the Patient Portal

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Intuitive User Interface

Accessing patient medical records with Coalese employs a simple and intuitive user interface that requires no training on the part of healthcare workers. There is no learning curve so teams member.

Raven UI


Specific sections of the patient record are accessed using visually distinct icons/buttons that provide "at a glance" recognition and selection of sought-after information without the need to search the entire medical record. All the user needs to do is to click or tap the desired button. The intuitive user interface requires no training. Users become proficient within a few minutes of starting to use the tool.

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Advanced Charting

Coalese provides advanced charting capabilities to display complete patient medical records on a chronological timeline and to be able to graph observations. The timeline feature provides a comprehensive, chronological and scrollable view of a patient's medical history. Events and items on the timeline can be drilled into to see more detailed information, all without leaving the timeline view

Timeline View


The timeline and graph views are integrated with the Coalese user interface, making it easy and quick to change between the toolbar, timeline and graph views of a patient record. The user can also select which items they wish to see on the timeline, which can be very useful for patients with chronic illnesses and charts with a large quantity of events on a regular basis.

The timeline and graphing advanced visualization features build on the robust role-based, designated access capabilities. The timeline and graph views can be made available to patients who have been authorized to view a subset of their patient record with patient Portal.

Graph View

Since these optional timeline and graphing features are integrated with the role-based access control mechanisms, it's a simple matter to allow only certain roles access to these advanced visualization tools.

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Print Ready PDF Output

Coalese provides the ability for users to generate print-ready, formatted PDF versions of a patient medical record. Users can generate a condensed Patient Medical Summary (typically one page long) or select what portions of the medical record they would like included in a more comprehensive PDF report. Users can also select whether and which attachments they might like included in the report, such as medical images (ex: X-Rays, CAT/MRI scans, digital photos of skin conditions, etc.), and even attached documents such as diagnostic reports from specialists, DNR requests and more. Reports are user configured in a real-time environment.

PDF Report Request

The PDF feature builds on the robust role-based, designated access capabilities, and thus the user will only be able to select and/or see items in the PDF output report or summary that they are authorized to access.

With the inclusion of branding in the PDF report, such as clinic logos and contact information, printed output can be perceived as a more "credible" rendering of a patient's medical record by other medical professionals.

Using the Coalese Patient Portal feature, clinics could allow a patient to generate their own PDF report for their own records or to take with them for other appointments.

Raven allows for customization and branding of the PDF output. Clinic logos, contact information, disclaimers and other text or images can be included in the output. Appropriate legal verbiage and disclaimers would typically be provided by the clinic's legal counsel and customized during the installation and configuration of Raven to address privacy and liability limitation needs.

Here is a sample of a condensed Patient Medical History Summary report, created with a single click:


PDF Summary Report

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