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Interview with Allscripts President and Xerox Executive VP About $500 Million Hosting Services Contract

Posted on April 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many of you probably already saw the announcement of the $500 million contract that was signed between Allscripts Healthcare Solutions and ACS, A Xerox Company, to provide hosted IT service for the Allscripts’ Sunrise Enterprise Suite. Considering the size of the contract, I thought it would be interesting to do an interview to learn more about the Allscripts and ACS (Xerox) relationship.

The following is an email interview with Lee Shapiro, President, Allscripts and Chad Harris, Executive Vice President and Group President, ACS Healthcare Provider and IT Applications Solutions. They duck a few of the questions, but provide some information about their relationship that I think’s useful and interesting.

Lee Shapiro, president, Allscripts

What percentage of Allscripts Sunrise Enterprise Suite customers use the hosted model vs. in-house servers?
There are approximately 50 remote hosted clients.

Why did Allscripts choose to outsource the hosting after having the infastructure in place?
As the payment paradigm in healthcare shifts and our clients’ growing and complex needs around new regulatory requirements continue to evolve, ACS, A Xerox Company will support Allscripts as it scales to deliver service levels required for diverse healthcare settings.

Immediately ACS will begin to focus on standardizing and optimizing our operational processes, help to manage our Service Level Agreements on system availability and enhance our recovery and security capability.

This alliance also helps us deliver faster client case resolution. Longer term, it will enable us to deliver a richer toolset, broader set of monitoring capabilities, access to geographic data centers and new services. Allscripts will still have a remote hosting business and will continue to manage all aspects of the alliance and client relationships. Data is always available whether it is remotely hosted or not.

Do you expect to outsource the hosting of MyWay and other Allscripts hosted EMR products to ACS down the road as well?
Allscripts is always evaluating options to provide the best service support for its growing and diverse customer base.  Right now, our ACS alliance is the best solution to meet current and projected needs.  We will continue to evaluate.

Are you concerned that customers will have issues with having to work with two large companies?  Instead of “one neck to ring” they will have multiple companies that can point the “proverbial finger” at the other.
Allscripts is excited about this partnership and the response has been overwhelmingly positive. We will continue to manage the client relationship at every level, including sales and support and will also provide our healthcare industry domain expertise in partnership with ACS’s world class remote hosting infrastructure.  This is a single solution for our clients.  It is an exciting combination.

What share of the 96 providers using these remote hosting services are hospital versus ambulatory?
Allscripts has not entered to an agreement with ACS on ambulatory.


Chad Harris, executive vice president and group president, ACS Healthcare Provider and IT Applications Solutions

Describe how the transition of hosting will occur for existing customers.
The transition of hosting services will be seamless for Allscripts customers. From a governance perspective, Allscripts will continue to have a direct relationship with hosted clients, handling overall client relationship management activities including fielding service requests and projects, reporting, invoicing, and sales support.

ACS, A Xerox Company, will run and maintain the current systems by assuming responsibility for day-to-day technical delivery and data center operations, and supporting Allscripts in its continued service of new and existing hosted customers.

As part of the arrangement, ACS maintains the existing Allscripts data centers under what is commonly referred to as a facilities management agreement.  ACS will optimize the data center footprint and technical environment overtime under a structured long term plan involving no impact to the clients.  Additional capacity will be provided to support growth and expansion via ACS’ global data center and operations network.

ACS will introduce industry standard best practices, new tools and other forms of automation, as well as additional services including advanced recovery to improve service excellence, performance and reliability of the hosting operation.

Will Xerox be bringing their expertise in printing and scanning to this relationship as well or only their hosting operations?
While Xerox technology is not specifically part of the current hosting engagement, ACS is investing in a Healthcare Innovation Lab for Allscripts to evaluate integration of new technologies, cloud computing solutions and  client-specific deployment and testing initiatives. In addition, ACS and Allscripts will form an Innovation Council to evaluate future technologies and work processes that will help Allscripts support the changing needs of providers.

After the recent Amazon cloud hosting outages, what’s ACS and Allscripts doing to make sure similar outages don’t occur?
The Allscripts application environments are critical patient care systems and as such require an architecture that supports a very high level availability and performance. Under the new hosting partnership, ACS will work with Allscripts to maintain and improve application uptime and operational resiliency through a high availability architecture and advanced recovery capability. High availability is achieved through the deployment of failover technology, or methods, that ensure system availability and transaction protection. The most common configuration utilizes the active/passive clustering approach.

The Sunrise Clinical Manager (SCM) application is cluster aware and is configured in a clustered environment. ACS utilizes the high availability clustering supported by SCM application servers to ensure that all single points of failure are resolved and the application can quickly return to service after a loss of the primary server

SaaS EMR versus Client Server EMR

Posted on January 2, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I think the debate over a SaaS based EMR versus a Client Server EMR is never going to end. Maybe we should just have a peace treaty and decide that whoever has a SaaS EMR is going to love the SaaS model and the benefits and features of a hosted EMR solution. The client server EMR people are going to love their in house “doctor controlled” EMR software with its inherent features and benefits.

What inspired this post? A few old threads popped up on my stats page. First, is a SaaS EMR versus Client Server EMR poll I did back in June of 2009 about which type of EMR setup people prefer. Here’s the results (as of this posting):
Client Server EMR (Client Install) – 35 Votes
Client Server EMR (Web based) – 28 Votes
Hosted Web based EMR (SaaS/ASP) – 84 Votes
Huh? – 3 Votes
Doesn’t Really Matter – 7 votes

That’s good enough as a tie for me. Probably reflects the chasm we have in EHR and EMR companies. There’s plenty of each to go around.

The above poll also led me to this post about the myth that a SaaS EHR is required to show meaningful use. I forgot that some EMR companies (or likely their sales people) were spreading these crazy myths about meaningful use.

SaaS EMR vs. Client Server EMR and AAFP in Denver

Posted on September 22, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I knew that my previous post about the cost to update an EMR would bring out the people who like to back the SaaS EMR model versus those who like to back the Client Server EMR. As I’ve said before, it’s one of the most heated debates you can have in the EMR space.

I realized in the comments of that post why it’s such a heated topic. It’s because once an EMR software chooses to go down one path or the other, it’s nearly impossible to be able to switch paths. Why? Cause if you do choose to switch you basically have to just code a new application all over. Basically, the switching costs are enormous. So, only a few software companies (let alone EMR software companies) ever change from one to the other.

Considering the high switching costs, that basically means that an EMR vendor that is SaaS based has a strong vested interest in the benefits and upside of the SaaS model of software development. The same is true for Client Server EMR software and client server EMR companies looking at the benefits and upside of the client server model of software development.

This entrenching around a software development methodology (for which they can’t change) is what makes discussing each model so interesting. Each party dutifully makes the most of whichever software development methodology they’ve been given.

Of course, from the clinical perspective it’s sometimes hard to cut through all this discussion and get good information on the real pros and cons of each model.

In that vein, I’m looking for a couple EMR and HIPAA readers that would be interested in making the case for one or the other. All you’d need to do is create a guest blog post on the pros and cons of your preferred method. If needed, you’d also be welcome to do a response post to the other method’s post as well.

If this interests you, leave a comment or let me know on my Contact Us page. I think this could be really interesting.

On a different note, it looks like I’m going to be attending the AAFP conference in Denver next week. Is anyone else planning to be there? Anything I should know about the conference to get the most out of it?

EMR Vendor Practice Fusion’s CEO Interview

Posted on October 5, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many of you probably realize how much fun I have ragging on the SaaS (hosted) EMR model. I admit that I love playing devil’s advocate. I think that’s what makes me great when working with an EMR, but I digress. What people don’t realize is that I really love the SaaS EMR model and I think it’s just as viable an option as a client server EMR. I just haven’t drank the Kool-aid for either side yet.

With that background, I was excited for the chance to do an interview with one of the biggest fans of the SaaS EMR model, Practice Fusion. In fact, they’ve even taken it one step further in providing a free, ad-based EMR. The following is an email interview I did with Practice Fusion CEO, Ryan Howard.

Give us a summary of Practice Fusion for those who aren’t familiar with the company.

Practice Fusion provides a free, web-based EHR for physicians. We’re the fastest growing electronic health record community in the country, just passing the 20,000 user mark in September.  Our system includes charting, scheduling, integrations with lab networks and billing providers, eRx (in October) and unlimited support – all at no cost.

What guarantee do you provide to users that are concerned about their data being stored offsite?

Our guarantee to our physicians is that Practice Fusion provides a level of service that is dramatically higher than they could ever do on their own. From a practice’s perspective, they have access to world-class infrastructure that only a Fortune 500 company could afford. This includes data redundancy, automated back-ups, biometric security, Cisco firewalls and bank-level encryption. For a physician to build this independently would cost millions of dollars.

What about those who might be concerned that Practice Fusion might not be around forever (always a possibility) or will be acquired by another EMR vendor and they’ll be unable to get access to their EMR data to move if they wish?

A practitioner always retains ownership of their data. They can choose to export their data from our system at any time – just as we offer free uploads of data into the EMR, our team will also assist with free exports as requested. This would be true in the highly-unanticipated event of a merger or closure of our system as well.

Do you provide any mechanisms for doctors to take their data from your system and move to another EMR?

Practices using our EHR always retain ownership of their data and can export any time if needed. Just as we offer free imports of data into our system, our support team can also assist with extracting records to be transferred to a different EMR.

What do you tell doctors who are concerned about how they’ll continue seeing patients if their internet goes down?

There’s risk with both paper and electronic methods. Think about what a doctor does in his office with paper records: what happens if the offices burns down or records are stolen?

Internet connectivity is generally a concern for all internet-based models. Practice Fusion has a number of ways to circumvent this issue. While a doctor is using our EHR, data entered about the patient is constantly being saved. If the computer crashes or the internet fails, the visit is automatically saved. The physician can log back in, pick up where the session was lost and continue directly with patient.

Specific to the operations of a practice facing long-term downtime issues with their broadband company:  Practice Fusion has partnerships with various hardware providers who offer network redundancy utilities for physicians. For example, these systems can seamlessly transition to a cellular network if there is a broadband issue in the office.

How will Practice Fusion be approaching EHR certification and the billions of dollars in EHR stimulus money?

Practice Fusion is pushing toward HHS certification aggressively. Our physician team – Dr. Laffel and Dr. Rowley – has been working closely with the HIT committee and other thought-leaders throughout the past year to ensure that the final criterion for “meaningful use” reflects what is best for physicians and patients. The criteria for EHR certification are still in development but we’re certain that Practice Fusion’s system will meet the requirements. And, if something emerges that we weren’t expecting in that process, Practice Fusion’s SaaS-based platform allows us a degree of flexibility that other systems can’t match. We’re very comfortable with the certification road ahead.

What effect do you think the EHR stimulus money will have on adoption of EHR software?

It’s the silver bullet. The EHR stimulus incentives are helping to push widespread EHR adoption in a sector that has traditional been hesitant to make the switch away from paper. And, honestly, physicians were hesitant for good reason considering the expensive, bulky, IT-intensive solutions that dominated the market in the past.

Now, things are changing quickly and the market is in a frenzy. Vendor bottlenecks are already becoming an issue with the surge in demand. Traditional EHR systems with 12+ week integration schedules can’t keep up with requests. I see Practice Fusion’s five minute online set-up process, Live in Five, as a big advantage in the market as this tidal wave approaches.

Which standards are Practice Fusion adopting to provide for portability of data between Practice Fusion and other EHR vendors?

Practice Fusion’s open platform accommodates HL7, CCR and XML portability. And as one of the only true SaaS based EHR’s, we can quickly adapt our system as new portability standards emerge.

Practice Fusion will also be launching an innovative new feature called Chart Share at Health 2.0 this fall. This system allows physicians to securely share crucial patient data with other providers at no cost with no integration. It’s a major step toward collaborative care and will allow doctors who don’t have interconnected EHR technology or haven’t made the switch to an EHR to still receive and use digital records in their practice.

Describe 3 specific features which make Practice Fusion special (not including your pricing plan).

  • Practice Fusion is the only EHR with a true SaaS-based model. Other vendors – such as eClinicalWorks and Allscripts – claim to be SaaS but in fact use old-school ASP technology.
  • Our ‘Live in Five’ set-up process is unique in the market.  Physicians who are interested in Practice Fusion’s EHR can sign up online and start charting in five minutes. An entire practice can be set up in a single afternoon.  No risks, no consultants, no downtime – fast and simple integration is key.
  • I am also proud of Practice Fusion’s advances in connectivity. Physician using our free EHR can access integrated Surescripts along with real-time Quest Diagnostics and BioReference labs within the system. And we’re constantly working on adding new integrations to this list based on our community requests. With Practice Fusion, doctors are set-up with these sophisticated integrations with no cost and no development time.

What technologies and devices do you think will be the future of EMR software?

I fundamentally believe that the only way to solve the problem of national adoption of EMRs is to accommodate physicians through a web or cloud-based platform. Once this is implemented, the benefit will be unprecedented. Central reporting and trending of patients’ chronic conditions will enable providers and caretakers to identify emerging trends and truly perform evidence-based medicine.

What is needed is a unified platform to be a conduit between patients and their doctors. There are a lot of devices – such as Continua and smart phone applications – that monitor patients’ chronic conditions. The challenge is to integrate this data in EMR’s in a meaningful way to improve the quality of care.

EMR Updates in SaaS EMR World

Posted on September 18, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I was writing my last post about updating your EMR software, I knew that I had to also write a post talking about the update process for an SaaS (often called hosted) EMR solution.

Basically, updating your SaaS EMR is a two edge sword. Hosted EMR vendors will often talk about how great a hosted solution is because you never have to go in and update your server’s software. The updates just happen and are all managed by the EMR vendor itself. Kind of like if you use any of the free email services like Gmail. It’s updated all the time and you don’t have to worry about it. Essentially updates to an SaaS EMR work similar. The updates are applied on the server that’s managed by the EMR vendor and you automatically get the latest updates.

It’s worth noting at this point that this really is a huge time saver. I hate dealing with updates of client server based EMR software. I even push out the updates to my over 100 computers using an automated solution, but I still hate doing it. There’s always some sort of issue with some computer not updating properly. In an SaaS EMR solution you just have to make sure that your web browser’s updating doesn’t screw things up. Otherwise, no need to worry about updating every computer in your clinic when your EMR decides to update.

However, the second edge of the sword is that you EMR software will just automatically update. When all goes well this is great. When there is a problem with the update then you didn’t have a chance to test it first. You don’t get to choose when the updates happen (usually) and that includes delaying an update while you wait for another enhancement to fix what the update breaks. I will say that most SaaS EMR software are much quicker to fix if something really bad does happen with an update. The point is that you’re much more at the mercy of your hosted EMR vendor when an update is done. It’s nice to have it hassle free, but sometimes the hassle is worth it.

Let’s hear your stories. I know you all have them. That includes challenges with updating both in the hosted (SaaS) or client server world. Share it with us in the comments.