Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

I recently read an article that raised the question of who owns your health data. By ownership, I am referring to who has the power to either access or give someone access to your medical information. There are many interested parties in knowing all about you for valid reasons:

• Your PCP wants to know what care you have received so s/he can effectively manage your health
• Your specialists want to know your medical history so they can rule out contra-indications and assess for conditions that could affect the effectiveness of your treatment plan
• Your insurance providers want to know the health status of their covered patients so they can effectively calculate the risk of their covered members
• Your state and federal governments want to know population level data so they can effectively manage public health and policy initiatives

Those are a lot of players interested in what is recorded about you in EHRs around the country. Do each of those players need to know everything about you? When we visit a physician to deal with a problem, we are putting our trust in them to make medical decisions for us. Certainly they may need to know your medical history. Therefore, we could say that every physician we interact with should have the right to access your medical record. I don’t know about you, but as a patient that sounds scary. A dermatologist doesn’t need to know about a patient’s erectile dysfunction to remove a wart!

I am currently working on HIE and ACO integrations and have been grappling with the technical challenges of seamlessly integrating information from Medicare’s Opt-Out program and from the ACO’s opt out program with the care management programs that the PCPs have signed up for. This got me thinking, if I have the right to withhold medical information from my physicians, can I hold them responsible for missing a diagnosis when they did not have a complete medical history or medication list? Providers certainly don’t think so! While we haven’t found it yet, there is a balance between sharing enough information for everyone to do their jobs, and the patient taking responsibility for managing their medical record. At the core of the ACO model is the concept of a PCMH which focuses on the physician-patient relationship as a way for both of them to manage the patient’s health together. If we as patients want to have ownership of our medical identity yet still provide the necessary information for everyone to do their jobs, then it is time for us patients to become more involved with all the members of our health management team and to understand the implications of both sharing and withholding information.  As a data analyst, I know most organizations share healthcare data securely with only those who need it and data is not being abused. As a consumer, I also know that nobody predicted that FICO scores would be used by insurers and employers. We need to know who is using our data for what purposes and voice our concerns to our healthcare providers and lawmakers.There are many benefits to sharing data openly with ER docs, ACOs, state HIEs, etc. that I am sure you can imagine. So if you are choosing to withhold your information, I urge you to review the implications of withholding information and the responsibility it places on you with your PCP.

As a childhood hero of mine was once told: “with great power, comes great responsibility!”

Tags: EHR, Healthcare IT, HIE, HIPAA, Patient Safety

I recently had a nice chat with a colleague analyzing HIT industry trends for Kalorama Information. Kalorama does industry research for the medical and life sciences for many of the major news and consulting organizations. I got in touch with her specifically because of Kalorama’s analysis on EHRs in 2012 which was used by Bloomberg Government for their (very expensive) EHR industry analysis for provider and vendors. She found that in 2012 one of the most immediate challenges for providers was implementing EHR systems that meet meaningful use standards. She also found that vendors were having trouble with interoperability and usability.

Fast forward to 2013; a lot has changed. Epic has grown to dominate many markets. Allscripts has a new CEO and a few new toys to play with. eClinicalWorks has become a force to be reckoned with in the small practice space. However, the challenges the providers are facing have changed. My colleague and I talked for a while about various organizations we each have worked with and came to the same conclusion: providers are now having trouble with interoperability and conversions of data.

The majority of physician offices have implemented EHRs, but they must now communicate with other entities such as HIEs and ACOs. With the increase in mergers and acquisitions, we are also seeing an increased demand for conversions from one system to another. These problems involve a thorough understanding of the underlying data structure as well as a solid foundation in interoperability standards such as LOINC, HL7, SNOMED, and CDA. The vendors have the expertise to work on the problems for their products, but they are not enthusiastic about helping clients switch off their platform. Selling the EHR has been the primary goal for vendors in the past, not technical support that moves a client away from their product. Vendors are under the assumption that if they make switching off their product difficult, then clients will be less likely to undertake the conversion or integration with a product that is not part of the vendor’s family of products. While this is definitely true for disgruntled clients, it only makes it frustrating for clients who do not have a choice in the products they work with. This reality has led to some very important questions.

Where is an organization to go when their own vendor is not supporting their efforts? How do organizations extract meaningful data from such complicated or cloud based databases? How can we become self-sufficient in managing our data? How does an organization meet new institutional and government requirements? Galen can help clients with these challenges, but vendors need to help by making products that play nice with others.

At the end of our conversation my colleague and I simultaneously came to the same conclusion: “Organizations feel like their data is being held hostage!”

Tags: Clinical Conversion, Data Conversion, EHR, Healthcare IT, HIE, HL7, ICD-10, Integration, Interoperability, Meaningful Use

In the mid to late 90’s, at the beginning of the Dot-com bubble, the World Wide Web was available to anyone as long as you had a computer and a dial-up connection.  If you had these, you had the necessary resources to get connected and were likely eagerly seeking new websites to explore.

Now, imagine you are providing healthcare services, and you have the following resources available to you to enhance your practice that you did not have 15 years ago:

• EHR
• Analytics platform
• Accountable Care Organizations

With plenty of IT staff and government money, the next best step is to invest in a major analytical/data mining department. To be able to effectively use an ACO, there is a critical need for analytics or the use of “Big Data.” According to a report by IDC Health, advanced analytics is a top priority for participants in ACOs. The question I keep asking myself is; “Who is the first to the pie?” Insurers? Hospitals? Medicare?

When 40 hospitals and 30 health insurance companies, as well as interviews with industry experts and vendors were asked the different ways they were interested in using analytics:

• 66% of survey respondents cited identifying at-risk patients;
• 64% cited tracking clinical outcomes; and
• 57% cited clinical decision-making at the point of care (Government Health IT, 3/15).

The difficult question that hospitals are faced with is how they can implement a sound, efficient analytics department. The first company to emerge that satisfies this need will benefit greatly from this opportunity. At this point, you may still be wondering what the Dot-com bubble has to do with analytical ACOs. The picture I’m trying to paint is the hospitals are the stockholders; the government is the venture capitalists, and the companies providing analytical tools are the web site companies. I think the ACO analytics market is very fragile right now because of immature or inexperienced buyers investing in a very green market. The lingering question out there is; where will you be when the bubble pops?

Tags: Accountable Care Organizations, Analytics, Business Intelligence, Data Mining, EHR, EHR Unstructured Data Mining, Reporting

A couple of weeks ago I wrote a blog post on the current trends in the EHR industry. I mentioned that users of Allscripts products have increasingly been switching away from Allscripts to other vendors. Either Paul Black at Allscripts is following this blog, or he looked at the Allscripts client list because he is looking to reverse that trend. On March 6^th, Allscripts announced its acquisition of two companies dbMotion and Jardogs in an attempt to improve both their Allscripts product lines and to continue to enhance to the Allscripts community’s ability to share information openly. For those of you who may be worrying about Allscripts’s commitment to its own products, don’t fret! Concurrent with this acquisition, Allscripts has pledged over $500 million to improve its own product offerings. However, some of you may have never heard of either of these newly acquired companies, so I thought I would provide a brief overview of each acquisition.

Sold for $235 Million 

dbMotion was founded as an independent company in 2004 in Israel with a significant investment from the University of Pittsburgh which hoped that dbMotion could help solve some of its data interoperability needs. dbMotion lets healthcare companies take data from many different electronic records systems and normalize it to a common data structure That data normalization helps hospitals with business and clinical intelligence, and it lets patients access all their health data in one central location. Allscripts likely bought dbMotion because data analytics and open sharing of information is where the value and growth will be in healthcare now that most hospitals and physician groups have a core electronic record system in place.

Sold for undisclosed amount

Jardogsis a Springfield, IL based company that has seen use of its FollowMyHealth online health record grow to about 13,000 hospitals and other health-care providers nationwide. The cloud based FollowMyHealth solution, which Jardogs launched in January 2011, gives patients access to a single online portal in order to send and receive information to and from their doctors, hospitals and other health-care organizations. This means that patients can have immediate access to their medical records, including test results and doctors’ notes.  As a founding member of the CommonWell Health Alliance, Allscripts sees the Jardogs product line, specifically FollowMyHealth , as a promising opportunity for increased patient engagement which aligns with the Allscripts Open platform strategy.

Tags: Allscripts, EHR, Enterprise EHR, Healthcare IT, HIE, Integration, Interoperability, Meaningful Use, Reporting

Recently, another consultant mentioned her frustration with “an old bug” in the Enterprise EHR. She went on to tell me the numerous times she had seen clients throw up their hands in frustration when they attempted to enter smoking information under a patients Social History. She went on to state that there is a “Known Issue” and she wondered if and when it would ever be resolved. She was talking about the Social History statement of “Smoking Cigarettes For ____ Pack-years 305.1”. She went on to explain how the system wouldn’t accept the “words” they were trying to enter. Immediately, I knew the issue…and it wasn’t the system. The intended data for this field is numeric, not text. I went on to explain to her that this is a field where we can document a measurement of lifetime tobacco use. For example: If a patient smoked 1 pack a day for 4 years, they would have a 4 pack-year history. If they smoked 2 packs a day for 4 years, they would have an 8 pack-year history. I had her try plugging “8” in and, as I expected, it worked! Yes, we did the math, but putting the right information in the EEHR made it work correctly. So, it wasn’t broken after all!!

 
Documenting pack years alerts the provider that they need to be watching for certain cancers and a myriad of other diseases. In women, as some studies have suggested, they need to start looking at lower smoking levels than men. Of course, no matter the gender, the higher the pack-years, the higher the risk. I could go on about the risks of smoking, but I’ll leave that for another time and place.

 
One might wonder why we document it that way instead of just saying they smoked 2 packs a day for 4 years. It’s more concise (we know how important being concise is to a busy provider!) and standardized so that all cigarette smoking is viewed in the same terms of “a pack a day” for “x” number of years. Think about how some people change their smoking habits from time to time. They might smoke 1 pack for 3 years, half a pack for 2 year, and 2 packs for 1.5 years. That’s cumbersome. “7 pack-years” is so much easier to read and gives a clearer picture of the cancer risk—which is the reason we’re documenting it in the first place.

 
The consultant was so relieved to know what to do. I hope this was helpful to you as well!

 
There is a wiki on Pack-Years.

Tags: EHR, EHR Implementation, Enterprise EHR