Home Forums Discussions General Discussion EMR collaboration

http://www.fierceemr.com/story/cern...-interoperability-partnership/2013-03-05

I saw this article about the big boys working together for better interoperability. Thought it was interesting. Has Ac been invited to the table?

It would be interesting to hear directly from AC about this. Personally, I would be shocked if they were invited to participate; equally surprised (but happy) if they approach the group about joining. These are the biggest EMR companies in the inpatient and hospital-owned world. The 400-pound gorilla that is not participating is Epic, and it may be that the whole exercise is an effort to push back on Epic's growing dominance in the market.
Either way, it would be great (but unlikely) for one of the little guys- AC- to be included.

I am going to agree with JBS, this is more about the herd gathering together for mutual protection from an aggressor or to act proactively to head-off action from the government "we're here from the government to help you and we have devised the really spiffy clearinghouse you WILL use."

The one thing that you *can't* convince me of is that the primary motivation is patient care or better informing the clinician actually rendering treatment.

As I have been saying for four+ years now, AC does the most to improve it's long-term viability in the marketplace by making inter-operability with third-party solutions *The Priority* second only to charting encounters.

The user-base could have been saved a multi-year mis-adventure in the already crowded PM marketplace if AC had not been determined to re-invent the PM wheel.

I will acknowledge that developing for inter-operability can be significantly more challenging than stand-alone development, but the resultant work is more tested, more reliable, and more useful than stand-alone software.

This is far from a new or novel thought, it is rather a practical application of Metcalfe's Law.

IMHO, now is the time for AC to focus on two things:
<1>Refine their core product - things like "The 81" and Orders in particular
<2>Become open to (and then proficient at) inter-operability so that other hardware and software can rapidly inter-operate with AC. This adds value to everyone; end-users, AC, and the third-parties.

Indy,

I agree that the AC management has had us go through a multi-year misadventure. The goal, though, was good.

I disagree that they should work on interoperability. Why? Because it's very hard to do. We know where that leads; another misadventure.

What AC did wrong was to try to re-invent PM. All they had to do was add a normal billing program, and we would have been good a year ago. A good program to emulate as far as billing goes is AltaPoint. Each bill is a separate bill, unlike Medisoft. If a patient's insurance changes, the old is still in the bill you generated so that you can see if that was the problem. You enter all necessary info for that bill right on that bill (referring physician, other place of service such as nursing home, hospital, etc...). If you are doing CLIA labs, you specify the referring physician (yourself), and then the POS (your office). The CLIA info is entered into the claim.

You open up a patient's file, and you can go into a ledger only on that patient. You can see which claims have a balance. Click and the claim opens up to show charges and payments.

If full PM means being able to track each box of needles we buy, then I really don't need that much detail (Altapoint allows that tracking too).

What we really need is claims management. We need better integration between rolodex and claims. We need the program to bill properly.

What we don't need is the headache that comes with each "bug fix" version of one program not working properly with another, and each vendor blaming the other. We also don't need AC to try to do everything at once in the billing section. They wanted to automate everything with Gateway, but couldn't. Now they have backed off, but we don't know how far.

The bane of insurers would be single payer healthcare. The bane of EHRs and us would be a government developed and mandated single EHR. But, the government wants Big Data, so interoperability is coming with MU-2 and beyond. We have to have interoperability, or we will get the government developed and mandated EHR.

Who wants to have to buy an expensive qualified EHR after you've spent all your incentive money. I remember following the eClinicalWorks forum years ago when it was still small enough to solve problems and call India to get an update every month. It worked for them because the programmers were so cheap. But, now you have to have a PhD in eClinicalWorks to know how to use it.

Presently, an image of a progress note is adequate, so the easiest to use note maker will sell well, as AC has.

But Big Data wants granular data on every part of the visit rather than an image, note or even video. That data will be used generally to manage all of healthcare, and specifically to be digested and presented back as needed to everyone on a patient's team.

IMO, AC needs to become a framework for holding many modules that will allow us to deal with whatever kinds of patients we see. AC needs to become a hub to manage the data streams coming and going in every direction. AC needs to be a kernal with standardized connections to apps from multiple vendors for every possible use, as we use our working life to feed Big Data.

PM/Claims management will be a module/API/app, just like e-prescribing, accounting, scheduling, etc..

How much effort would it take for us to be able to have different vendors into SureScripts than NewCrop? That would be popular. Some would want the free service, some the premium service that other vendors could provide. My former e-prescribing in the cloud is not so slow.

If you're not going to do meaningful use or want an integrated PM, why have the bloat in your version? Why have to pay for it? There could be some popular options that help increase the number of AC users, instead of frustrating some to please others.

So my suggestion is for AC to think of itself as iOS and do what it takes to get the most apps in it's store while it is the most popular EHR for small practices.

Originally Posted By: DanWatrous
How can there eventually be more than several EHRs? Since the consolidation is just starting, how do you think AC will end up?


The EMR world seems to me highly analogous to the word processing world at the onset of the PC. Remember Word Star, Word Perfect, Apple Writer, and the rest? None of them could read a document created in another program. Word Star required that you tape a cheat sheet of arcane commands to the monitor to be able to edit the document ("Let's see; ALT-SFT-CMD 3 will let me select the paragraph...")

What we have is just the same. I can't just import a record from a practice using E-clinicalworks (or, even AC for that matter). There is no standardization at all. The commands are bizarre and unintuitive. The advertised elimination of redundancy by cleanly sharing records is a pipe dream.

I really feel that what should have happened at the beginning is that, rather than giving doctors $$$ to use an EHR, the feds could have given that money to Microsoft, said "build the EHR equivalent of Microsoft Word" and then given it away for free, with a deadline that a practice seeing Medicare start using it by some date or else. But instead, as Dan said, economics will now dictate the small players here will eventually go the way of Apple Writer. By then I hope to be retired.

@Dan,

When we bought our big screen TV a while back the sales rep at Sears asked what kind of system we had, and when my wife said rabbit ears, I thought he was going to laugh, but then realized it was no joke.
So I don't get out much and have gravitated to watching PBS on occasion, but there was this documentary on an artist named Ai Wei Wei from China, and during the interview in his cat infested studio he said something that has been niggling at me. It was rather what he did not say that bothered me more. But he talked about his 40 cats but there is only one cat that can open the door of the studio, but when the cat leaves the studio he (the cat) never closes the door behind him.
But I think what you said about AC thinking of itself as an iOS has the same fundamental thought this oppressed artist in China is trying to convey in his art, and comparing himself to the cat opening door.
I think AC has the key to open the door, and keep it opened, with an approach as you suggest.

To be clear, I agree with folks who are saying don't re-invent a Patient Portal when Updox is already working and Phressia has one in the works. Establish a common interface and concentrate on the core product and value.

With sufficient logging and documentation, delivering interfaces (the first part of interoperability) is precise, but straightforward work. Properly done, it is can be implemented in phases, so that the interface becomes more robust over time (can do more things and pass more data).

We have a client that has some data that is incorrect in the database, and we are doing the forensic work to determine how the data got gobbered up - the logs will tell us, and the end-goal is to get things sorted and turned back on unless the vendor (or the interface) is at fault. Again, not hard for someone with DBA skills, just precise work.

AC, like many smaller Tech companies, has a tendency towards Not Invented Here (NIH), and so capabilities sourced outside have been generally un-welcome. That may be changing, and it is in everyone's interest that AC continue to change to a more receptive and insightful mindset.

I have to agree with Indy et al who are advising AC to stay in the EMR business and create an interface to other vendors for the PM components:
-- Amazing Charts is bogged down with annoying bugs. They have needed fixing for several versions. Usability is suffering and I am tired of making excuses to my staff and other physicians
-- Third party vendors such as Updox are going to keep up with future AC versions. They operate on a subscription model and AC integration is essential
-- CME in an EMR (ie PriMed) as a future "enhancement" of AC? You've got to be kidding...