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Guest Post: Overcoming EMR Integration Challenges

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Dan Neuwirth is the CEO of MedCPU, provider of the innovative MedCPUAdvisor™ platform: with applications for decision support for clinical guidelines, Meaningful Use, and care pathways, that captures the complete clinical picture in real time, including narrative text and structured data to deliver the most accurate clinical and compliance guidance.

There’s no question that healthcare needs to adopt new technology that makes us more effective and efficient and curbs costs, like Electronic Medical Records (EMR) solutions and Clinical Decision Support (CDS) systems. In today’s world, providers of all sizes continue to find it challenging to integrate existing HIT systems with EMRs for a variety of reasons. As our industry evolves, technology solutions need to be smarter and empower seamless integration.

EMR and HIPAA guest author Susan White covers in depth how a lack of connectivity standards affects EMR integration. There are no mandated standards for EMR vendors to follow, making it hard to coordinate data sharing between medical devices and other systems (including from one EMR to another), even at the same facility. As those systems operate in disparate fashions, critical clinical information is often lost or stuck in silos. Most importantly, the information is not where clinicians need it most–at their fingertips, in an exam room, with a patient.

This lack of data sharing is a pervasive concern. One Markle report finds that roughly 80 percent of both consumers and physicians demand that hospitals and doctors be required to share information that improves coordination of care, cuts unnecessary costs, and reduces medical errors.

In 2010, more than $88 Billion were spent on developing and implementing EHRs, health information exchanges (HIEs) and other health IT initiatives. When you consider that the average 10-physician practice spends more than $137,000 per year on prior authorizations and pharmacy callbacks alone, you’ll have to agree that the lack of data integration and sharing get very costly. And although I agree with John Halamka, who recently wrote these challenges exist because healthcare is inherently more complicated than other industries, I am a strong believer that a lot of them can be overcome by the use of smart technology.

We need smart, flexible solutions, which capitalize on existing technologies and require minimal integration. Technologies that employ advanced screen extraction, for example, empower several important improvements in the clinical decision support space such as the capturing and analysis of both free and structured text. A lot of time such solutions are rendered ineffective as they either lack compatibility with leading EMR systems or are too hard to integrate.

As the industry evolves, developing robust protocols for capturing both structured and unstructured data along with standards for data integration and sharing will become increasingly important. With all the data points created on patients every day, we will need a consistent, secure, and reliable way to capture and share patient data among all systems and healthcare providers. What is your experience? What are top data capturing and integration challenges faced by your organization? Looking forward to continuing the dialog and hearing your feedback.

September 15, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Watch for EMR Company Consolidation but Not EMR Software Consolidation

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I’ve regularly talked about my belief that there isn’t just one major EMR market. Instead, I firmly believe that there are a number of EMR markets that are divided by clinic size, medical specialty, and possibly even location. In fact, there’s likely even other factors. There are just far too many EHR companies for this to not be the case.

I think this was also well illustrated in this blog post on Kevin MD about the “Perfect EMR Traits.” Here’s the perfect EMR trait #1:

Perfect EMR Trait #1: The ideal medical record would be tailored to the specific needs of a clinician, only exposing them to portions of the record which are relevant to their work.

Knowledge within healthcare is rapidly changing. Possibly more so than another other industry. Techniques which were considered state-of-the-art, can change in a matter of weeks. The electronic medical record has the potential to be the tool which disseminates those changes down to the clinician, through point-of-care decision support. EMR software should facilitate the clinician decision making, rather than requiring clinicians to keep track of the latest and greatest. This individualistic attitude creates discrepancies in care, which inherently leads to imprecise care.

While it is certainly technically feasible for an EMR vendor to be able to create software that satisfies Perfect EMR Trait #1, it’s just not practically feasible for an EMR vendor to satisfy every clinic size, medical specialty, and in many cases locale. This means that we’re going to see a wide variety of EMR software that satisfies the various EMR market needs.

With this as a preface, consolidation of EMR companies is going to become a very very real thing. However, I’d caution EMR companies that choose to just directly sunset an EMR software acquisition. In some cases, this is a reasonable solution based upon the EMR company’s existing EMR software. Plus, in many cases EMR vendors will be acquiring the EMR market share for their existing EMR software. I’m sure we’ll see more of this.

My recommendation for EMR vendors acquiring EMR software, is to be more selective in the types of EMR software that you acquire. It’s definitely worth considering the idea of sustaining the EMR software development of multiple EMR products. Is it really that hard to see a large EMR company that has an ED EMR software, a General Medicine EMR software, an OB/GYN EMR software, a Pediatric EMR software, etc etc etc.

An EMR vendor making a decision to act in this manner will require them to change how they look at EMR acquisitions. The EMR acquisition targets will dramatically change. Instead of looking for failing EMR companies where they can cheaply buy more EMR market share, EMR companies with this approach should be focusing on a quality EMR software that hasn’t yet achieved the EMR market share that they deserve.

The cool part about the strategy of maintaining multiple EMR software instead of the strategy of sunsetting one or the other is that you purchase a bunch of happy EMR users instead of alienating a whole mass of EMR users that’s software is no longer supported. Of course, this will require proper communication of your goals and objectives so that current EMR users see the benefit of the acquisition and aren’t left wondering what the acquisition means to them. I’m not just talking about standard PR spin. I mean real tangible communication and interaction which demonstrates your plans for the acquired EMR going forward.

An EMR company with this method of EMR software acquisition, also needs a different set of skills. After sunsetting an acquired EMR, you need to have a strong set of integration and transition services to make the change to your EMR as smooth as possible. You also require a unique sales force that can sell the transition to your EMR over a transition to an altogether new EMR software. None of these services are needed if you continue to maintain the acquired EMR. Instead, your company must focus on other redundant services like marketing that could be leveraged across companies.

Of course, this isn’t an easy task to do well. Acquisitions rarely are an easy process. However, I think this is a lesson that was recently learned by Google as well. There’s value after an acquisition to keep autonomous business units. In fact, doing so opens up a whole new set of acquisition targets in a less competitive environment.

If I were a board member at an EMR company, this is the type of stuff I’d be considering. Certainly not every EMR vendor is 1. in a position to do these things and 2. has the culture to make it happen. However, I predict that the EMR company of the future will be a conglomerate of multiple specialty specific EMR software and not just a one size fits all atrocity.

December 21, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Integration with Cisco IP Phones

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One of the lunch demos I saw at the EHR Stimulus tour was a demo of the integration of a Cisco IP phone with an EMR. I’ll admit that they are VERY brave souls to try and do a demo like this since it’s just prone to problems. Demos are always that way. Plus, I think you can get the picture of what’s happening without seeing it. At least I could have and everyone else that couldn’t probably just saw all the configuration and thought it was too complex to even consider.

That part aside, there were a couple of things that were intriguing about the demo. First, as they said, it’s interesting to see how hardware can really affect and interact with your EMR. That’s an interesting concept that I think is worth exploring a lot more. Second, if setup correctly there are a couple features that are interesting and useful. However, I’m not sure it’s really worth the cost or hassle to get these features. They are kind of nice to have, but aren’t deal breakers or makers.

The features that I did find interesting was that it would bring up the patient name/information on the phone when they are calling. I’d be interested to see how much information can really fit on the phone. However, even if it’s just a patient ID which you can use to quickly pull up the patient’s chart, then it’s a nice time saver. Plus, you can quickly verify that it is indeed the patient that’s calling using the information on the phone. Very cool feature and pretty useful. I imagine if you worked in an office with this you’d take it for granted until you moved to an office that didn’t have it and you’d miss it.

The other feature that’s cool is really just IP phone specific and that’s having a soft phone on your computer (basically the phone just runs on your computer and you can use a headset plugged into your computer). Saves on the cost of the often expensive IP phones and I expect we’re going to see some pretty amazing advances in soft phones.

Like I said. These weren’t things that should change your EMR decision, but it is a preview of some of the types of technologies we can see integrated with an EMR.

September 10, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Simple Patient Information and Payment Portal

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Many of you know I’m all about keeping things simple, effective and useful. It’s better to have something simple that does a killer job at what it does than to have something so complex that no one uses it. In fact, that’s really the basis of my simple plan for meaningful use. Of course, this can often be confused as not valuing other items. However, that’s just not the case. You just start with reasonable goals and do amazing things with it. Then, you expand once you’ve conquered something simple, but I digress. The point is that I really enjoy seeing simple systems that just flat out work.

That’s why I was intrigued by an email I received from a reader about their system called ePatientHistory. I think it can best be described as a simple patient portal that tries to do 2 things really well: online patient registration and online patient payments.

I should make a disclaimer that I haven’t used this service other than the demos on their website. However, I really like some of the concepts and I wish more EMR companies would try to create something simple and effective that focus on small goals as opposed to trying to cure the whole world with a patient portal that is so complex no one uses it (man I’m in a ranting mood today). Let’s talk about each function which they call ePatientHistory and ePatientPayments.

ePatientHistory – Online Patient Registration
I tested the demo for this and it was a little buggy and not as intuitive as I would have liked it to be. For example, it didn’t have the standard * next to all the required fields and the pop up that was shown for the required fields didn’t make much since to me. A small thing that makes a big difference. Maybe this just wasn’t shown in the demo, but it would have been nice to had nested questions that were only shown if I’m female for example. That way I can skip the pap smear questions and go straight to the testicular self exam ones.

Also, it was awkward to have to register and then choose the form I want to fill out. Ideally the doctors office could just send me an email that has basically registered me into the system. The email would include a link which I click and get taken to a step by step webpage of what the doctor’s office wants me to do for my appointment. Then, I can’t screw it up as a patient. After I’ve filled out the important paperwork, then let me see the full login and the other features that I may want to use.

Of course, when you’re dealing with a standalone portal like this, the question really is how are you going to get the information out of the system. This system seems to offer a CSV file which can then be imported into an EMR. Ideally, I’d like this company to show me a list of EMR companies that support this type of import. I know that all of them could since CSV is pretty standard, but how many would and if they do would that data be inserted into your EMR in a useful way? Of course, many might just want the health history form to be a nice PDF file that they can upload to their EMR. However, it’s just sad to lose all that data in a PDF file.

The cost structure for this service is interesting. Basically it’s $695 up front and $39.95 per month for hosting. Seems a little pricey to me, but if they can make sales that’s a really good business model to have. You get the up front money and a residual income.

ePatientPayments – Online Patient Payment
This is an interesting module since it’s basic idea is to collect payments. Although, one good part of this system is that it will collect payments over time according to a payment plan. I think this can be really useful in collecting harder to collect accounts. Plus, it can be scheduled to be done automatically thanks to the power of Paypal.

Similar to the other description above, I’m not sure how the patient will know how much to pay. I didn’t see anywhere in the admin that seemed like a place that someone in a clinic could notify someone that they have a bill to pay and come to this portal to pay it. That would be nice functionality. Although, it would be really sweet functionality if it was tied to the EMR where the actual charges arrive. Of course, this is the challenge of using a system that’s not connected to your EMR.

The cost for this is similar to the other one with $395-495 a month up front and then $29.95 per month for hosting. One thing it doesn’t say is how the charges that Paypal charges will be handled. I’m guessing they pass those on to you the end user as well. Paypal is an amazing platform and great for developers since it costs nothing to get started and use it. However, Paypal instead gets paid on the back end with the highest percentage fees of any other credit card processor. I imagine ePatientPayments will want to switch to something other than Paypal as they grow. The savings of using another credit card processor over PayPal will basically pay for the ePatientPayments and then some.

Conclusion
I think we’re going to see a lot more little services like this pop up. I think a number of them could be very beneficial if they’re integrated or used alongside a great EMR. The other good part is that it seems like using stand alone services like this one will still allow you to be considered a “certified EHR” and possibly receive some of the $36 billion of EMR stimulus money.
Read more..

August 22, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.