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

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

The era of electronic health records has arrived and opportunities for innovative uses of data are plentiful for providers and vendors alike. Fueled by financial incentives from the government as well as meaningful use requirements, organizations that best position their data to help providers deliver patient centered care will flourish. Physician organizations are also becoming larger through growth, acquisitions, and mergers. These growth milestones provide organizations opportunities to reflect on the capabilities of their current medical record system in order to decide if their current system will keep them competitive in the future. These are the three types of organizations that will be purchasing a new Electronic Health Record (EHR) system in 2013.

The New EHR Adopter

  Buying a new EHR is not cheap which may explain why many smaller physician practices have held out on the investment as long as they could. Only around 20% of providers are attesting to Meaningful Use in the US. However, government mandates and incentives are forcing providers to overcome their resistance to EHRs. While larger practices initially lead the charge into the digital record world, SK&A has shown that small physician practices are growing their EHR adoption rates faster than larger physician organizations over the past few years. According to KLAS, many of the smaller provider organizations are using cheaper vendors such as athenahealth, eClinicalWorks, and Practice Fusion which have been enjoying their recent growth.

While there are still some larger organizations that need to adopt an electronic medical record system, the majority of the New EHR Adopters over the next year will continue to be small provider organizations.

The Acquired Converter

While the smaller practices are still adopting EHRs for the first time, larger practices, which boast an adoption rate over 78%, are experiencing a different phenomenon. Rather than leading the pack in adoption rate growth, they have been increasingly switching vendors! One reason for this is due to consolidation that is occurring throughout the healthcare system. Federal incentives for the development of Accountable Care Organizations are driving larger physician groups and hospital systems to acquire the small practices in their local area. According to the American Family Practice Journal, the only non-government EHRs that are predominantly used by these large physician practices (>50 providers) are Allscripts Enterprise, EpicCare Ambulatory, Cerner Millenium Powerchart, and InteGreat EHR.

As acquisitions and mergers continue, organizations will have an increasing need to be able to both communicate clinical information between existing applications as well as convert data from one vendor’s EHR to another. While the messaging standards such as HL7 and CDA are easing the integration pain, conversions are becoming increasingly difficult for organizations. Many smaller vendors have data structures that are easy to understand, however they often do not store data discretely making conversions a nightmare. Larger vendors have the benefit of storing data in a more logical way, however the sheer volume of data combined with the lack of support during the conversion process makes transitioning between EHRs extremely difficult. While it is understandable for a vendor to dissuade groups from moving off their software, some providers are beginning to feel like their data is being held hostage!

The Disgruntled Replacer

The last purchaser archetype for 2013 is for the small, but growing minority of providers that are dissatisfied with their EHR system. The CDC reported that a vocal 15% of all providers reporting to them are dissatisfied with their EHR choice. Some of these providers chose a vendor based on price and have outgrown their current EHR’s capabilities, while others chose an EHR that was not a good fit for their organization. These providers often have specific needs in their organization and need extra support from the vendors in order to meet the incentive goals that drove them to purchase their EHR. They need to integrate with local Healthcare Information Exchanges, report on quality metrics, report on financial incentives, and make adjustments to the EHR to fit the way they practice medicine. Providers don’t need to know how the software works; they just need to know how to use it effectively. However, IT specialists know that the quality of the data in the EHR is only as good as the quality of the data put into it by providers. Without the proper workflow training and support from the vendors on how to make the EHR work for a provider, organizations will have a difficult time just using the EHR and never realize the benefits of electronic data management. However, according to the American Association of Family Practice Management, 56% of primary care providers are not satisfied with EHR vendor support and training. This may be why the percentage of EHR sales to physician organizations that already had some form of EHR rose from 30% in 2011 to 50% in 2012 and is showing no sign of slowing down.

A Look Ahead

KLAS recently reported that vendors such as athenahealth, eClinicalWorks, Epic, and Greenway Medical Technologies are gaining market share while the traditional ambulatory EHR vendors such as Allscripts, Cerner, GE, NextGen, and McKesson are struggling to continue the explosive growth they saw over the previous 10 years. While no one vendor is the best for every organization, it is clear that the struggling vendors need to focus on creating better products and supporting them for their customers. With Cerner and McKesson in the lead in revenue and Epic and Allscripts in lead with the most implementations in the ambulatory space, the big players have an opportunity to learn from their mistakes. However, the ambulatory market is still open for any vendor to improve the EHR data structures, design more user friendly interfaces, design products specifically for specialty practices, and utilize technologies from other tech sectors such as phone apps. EHR implementations will continue to be a significant investment for organizations and it will be exciting to see the improvements to EHRs in 2013.

Tags: Adoption, Allscripts, Business Intelligence, Data Conversion, EHR Implementation, Epic, Healthcare IT, HIE, Implamentation, Meaningful Use

Did you know there are at least 300 active HIEs being tracked and the number of public/large private HIEs is growing by ~30% each year (according to KLAS)? Have you heard the acronyms CCD, CCR IHE, HIE, IHE, or XDS and wondered what they stood for and meant? Are you aware that Allscripts offers a set of web services to facilitate clinical exchange between Professional/Enterprise EHR to HIEs or other EHRs in the community (both Allscripts and non-Allscripts)?

Who: Allscripts Interface & Technical Analysts

What: Allscripts Clinical Exchange Interoperability Workshop

Where: 70 Federal Street, 7th Floor, Boston, MA 02110.

When: Wednesday, December 12th, 2012 from 9AM-5PM with lunch provided. There will also be a cocktails and networking hour from 4PM-5PM with beer, wine, and light snacks.

Why: Learn about the details clinical exchange interoperability within Allscripts

Cost: FREE

Agenda:

• Health Information Exchange (HIE) and IHE (Integrating the Healthcare Enterprise) background and overview
  • PIX – Patient Identity Cross Reference Manager
  • XDS.b – Cross-Enterprise Document Sharing
• Standards and specification overview:
  • Allscripts CED (Clinical Exchange Document) format
• Allscripts IHE Web Services Overview
• Demonstration: Clinical exchange interoperability between two Allscripts Enterprise EHR environments
• Custom clinical exchange solutions
• Much more!

Please contact us if there is a topic you would like to learn more about that isn’t in the list above.

Travel: If you are driving into the city, there are parking garages nearby. The cheapest and most convenient is the Winthrop Square Parking Garage at $20/day. If you are coming in from out of town, there are many hotels in the area. Also note that we will have wireless internet and workstations with a hardwired internet connection available for those who need it.

Space is limited – register today!  If you can’t make the training, it’s OK! Galen offers free webcasts about every two weeks.

Tags: Allscripts CED, Allscripts Community, Allscripts Cross Document Sharing, Allscripts Health Information Exchange, Allscripts HIE, Allscripts IHE, Allscripts Integrating the Healthcare Enterprise, Allscripts MPI, Allscripts PIX, Allscripts XDS, CCD, Galen Hosted Workshop, HIE, IHE, Interoperability, MPI, PIX, XDS