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The EHR Manifesto
By Recently RIFed
A spectre is haunting America — the spectre of Meaningful Use. All the powers of traditional vendors have entered into a holy alliance to exorcise this spectre: Executive Office and ONC, Allscripts and Eclipsys, Epic, Cerner, McKesson, and Meditech.
Where is the software vendor that has not been decried as unusable by its opponents in power? Where is the software vendor that has not hurled back the branding reproach of unusable software, against the more integrated vendors, as well as against its reactionary adversaries? (My apologies to Karl and Friedrich).
10 Point Program to Improve EHR software
- Less configurable. The Demotivators® said it best “When people are free to do as they please, they usually imitate each other”. Every hospital or physician practice is unique — they uniquely solve the exact same problems everyone else is facing.
- Better designed. End-user input and UI design should be part of the specs, not the pilot.
- Customer-prioritized enhancements. Fifty percent vendor-driven (sales and demo feedback, regulatory requirements, infrastructure, etc.), 50% prioritized by customers. Yearly process, projects grouped to be equal number of hours, one vote per licensed bed, top x projects will be roadmapped to fill 50% time.
- Consensus-driven standard content and configuration. Vendor designed, large group customer editing — majority rules, everyone uses.
- Remote hosted. 99.999% uptime, capacity and response time are key requirements.
- Rapid install. If you’ve followed 1-5, training the end-users should be the most time-intensive phase of the implementation.
- Qualified buyers. We’ll sell to you if you agree to: follow our standard workflows, use our standard build and participate (end-user input, content design, and prioritization). Must agree to mandate adoption! Better to support 50 involved, committed customers than 100 unhappy, non-standard, partially-implemented, low-adoption targets.
- Equitable pricing. Low upfront, subscription-based. Every customer pays the same, scaled by size or volume.
- Play nice with other vendors. Integration > Interfacing > Interoperating.
- Record portability. Remove vendor lock-in. The intersection of the NHIN and CCDs with the market transitioning to replacement will make this a necessity. You know it will be mandated eventually.
I can’t think of a single vendor that would get a passing grade on my 10-point scale (even the industry darling would only receive a 40%). But please, prove me wrong and post comments. As I review my RIF package and dust off my resume, I’d love to be proven wrong (and find out they’re hiring) …
Personally, I’d love to see a new breed of vendors emerge. Maybe someone will submit a FOIA request and hire a team of developers and clinicians to polish and fill in missing functionality. Maybe even someone willing to follow my manifesto and explore a co-op or non-profit corporate structure. Forget the socialization of medicine, let’s socialize the vendors. Until that happens, I’ll continue to remain anonymous and try to work from within.
Jump-Start HIEs with Integrated Health Records
By Ravi Sharma
One of the challenges that most EHR systems will have in satisfying the government’s Meaningful Use requirements will be to establish connectivity and interoperability with other providers’ systems and ancillary services. Disparate data from multiple providers must come together as a more complete patient-centric record to achieve this goal, and not all providers are ready for it. These and other business and logistical issues are some of the challenges that health information exchanges (HIEs) have encountered.
One solution is to use technology to leverage data generated through existing business relationships. This can be done through a Web-based, patient-centric “Integrated Health Record” (IHR) that integrates data from multiple sources and institutions. An IHR provides up-to-date, community-wide, patient-centric data such as lab and imaging orders and results, incorporating both hospital and reference labs.
It also can be used for ordering prescription drugs and leverage the patient’s allergies, drug history, and even lab data to prevent adverse events. Physicians can even follow the inpatient encounters for patients admitted in connected hospitals, along with outpatient data, from anywhere over the Web.
IHRs also improve the ability for patient care teams — physicians who must collaborate to provide comprehensive care — to coordinate care and share patient records. Today, such clinical information between referring physicians is shared via fax, mail, or phone. Even when practices have EHRs, they’re often unable to send key patient data electronically to other physicians who may be using different EHR systems.
The Meaningful Use criteria require such exchanges to occur using standards such as Continuity of Care Document (CCD) and the Continuity of Care Record (CCR), but few systems are capable of using such standards. That’s partly because EHRs aren’t designed for information exchange and also because, in the absence of HIEs, the transmittal of CCDs requires point-to-point interfaces. An IHR that already can create connections to multiple EHRs can act as a link to exchange CCDs or CCRs.
The IHR is not designed to replace EHRs or CPOE systems, but rather to collaborate with them to connect them with other information sources. In that sense, the IHR unifies and facilitates the patient-centric data exchange between various entities to realize the formation of HIEs. The IHR further facilitates the integration of data from multiple sources by normalizing data from disparate sources using standards specified in Meaningful Use, criteria such as LOINC for discrete lab data.
Rather than upfront investments in MPI and other expensive technologies, HIE pilots can greatly benefit from the use of technologies like the IHR. The IHR can not only serve as basic HIE, but facilitate HIE participation by providing key information where and when it’s needed on the front lines of patient care.
Ravi Sharma is president and CEO of 4medica.
Thoughts on Eclipsys-Allscripts
By Tim Elliott
The coming together of two heavyweights in the healthcare IT industry, Allscripts and Eclipsys, has the potential to open doors for their existing and future customers, third-party developers, and patients. There will be some challenges, too — including helping current customers integrate legacy Allscripts and Eclipsys systems alongside new modules — but this can be considered another opportunity for outside vendors whose technologies bridge the gaps between Eclipsys and Allscripts applications.
Detractors may be lampooning the Allscripts / Eclipsys “One network, one platform, one patient” slogan, but in truth, the merger does create a cohesive, cradle-to-grave care solution by uniting pre-acute, acute, and post-acute care information, as well as simplifying financial and performance management with non-clinical data.
The use of a common .NET technology stack offers the possibility of seamless integration and increased usability for clinicians and administrative staff. It also makes it easier for third-party software providers to deliver bolt-on solutions that further enhance Allscripts / Eclipsys offerings in physician practices, hospitals, home health, and other care environments. These external vendors will be crucial if Allscripts / Eclipsys is to succeed in bringing together previously disparate patient populations, which will require capturing and managing data from multiple sources in a centralized manner.
Tim Elliott is CEO of Access.