Home Forums Discussions General Discussion Hospital Interface with AC

Does anyone have one? We work at a hospital which has been using Allscripts but is now going to Epic. We would love to be able to communicate with other providers, the hospital labs and radiology, etc. via an interface, rather than paper/fax. I know that Epic is spreading like wildfire, so I am hoping someone already has experience with an AC-Epic interface.

Jon,

I do not have any experience with an interface, but have you been using the feature in Updox to invite other non-Updox physicians to transmit patient information?
I have not been using this send invitation feature (under the tool tab), but was wondering if this may be a workaround if an interface is not available.
Sorry, not much help there.

We've tried it. We only had one positive response. Eventually I gave up. Updox needs to put some effort in it's own marketing.

I have one referring physician using UpDox, but it took some doing, and he pretty much does it only as a favor to me. It is cumbersome. As to the hospital (Banner operated) forget it. That also brings up a point that the hospital is a community hospital, getting contributions from the community, and the governing board has a contract with Banner to manage it. But in reality it is a " Banner health facility". There is no interest in interfacing with independent physicians, despite the fact that many of us have contributed to it heavily over the years. At least two in state hospitals run by Providence gave discounts and tech support to their local physicians to use e-Clinicalworks, and made an effort to interface with them. Our state electronic healthcare network has just invited area wide participation, and we will see how that works. The hospital is ostensibly a player.

After years of dealing with the hospital, I recently started doing my procedures at a local independent surgery center. I cannot describe how much better it functions for both me and my patients. I now only use the hospital facilities under duress.

I don't know of an interface but if AC was going to try one, Epic would be a good starting point. It just seems to be the best of the hospital EHRs in my opinion. That's why it's spreading like wildfire.

eClinicalWorks puts alot of effort into getting hospitals to use their system, and quite a few doctors then use it due to an initial subsidy from the hospital.

Thanks for the responses. While Updox has its value, it does not address what I have in mind. Only a tiny percentage of the docs we deal with have (or will ever have) Updox. The same is true for AC.

This is an issue for us right now: we work in an environment where most doctors are now employed by the hospital and use the hospital EMR. By default, this makes communication and transfer of reports and records easier with the hospital-employed GI group. Some sort of interface between my EMR and that of the primary care providers (which is Epic) would address that.

I also see this as a much broader issue for the future of AC; which means it will impact all AC users. How is AC going to prosper or even exist 3 or 5 years in the future? I don't see AC gaining tens of thousands of users like Practice Fusion, Epic, or even eClinical. If the company survives it will be with a relatively small user base, and that group will need to be able to communicate more efficiently with the mass of physicians using the "big" EMR's that surround us. Perhaps this is more of an issue for us as specialists, but ultimately will apply to the primary care providers as well.

How will this communication occur? An interface with AC seems like the logical way. As Travis points out, Epic is spreading like wildfire. It surprises me a bit that no one at AC and none of the 5,000 or so AC users has tried to set one up.

Any thoughts?

Because of how hospitals operate, their entrenched vendors actively resist any new technology [that they don't bring].


We have multiple clients who would desire an interface with hospitals running Epic, The hospitals in turn have been unresponsive to unsympathetic for the most part. Two of the clients are having more success; one operates out of a hospital facility, and the other is an independent group that are also hospitalists.


What AC currently has on offer in support of Epic is an import-only function that will bring in plain text via a radiology interface.

Our clients want/need more, and so we are investigating alternatives that hospitals will support

Jon and/or Indy,

Our local hospital utilizes NextGen, so is there a way to make an interface with AC to interact with the 5-10 most commonly used hospital EHRs?

One of the attractive features of Updox is that the dendritic tentacles of secure messaging, not e-faxing, is a possibility. I wonder if Tobin or someone from Updox could elaborate more on this feature as we move forward into phasing from e-faxing to secure messaging. And give us a comparison of positives and negatives comparing the two options, an interface between AC and hospital EHRs vs. secure messaging with AC/Updox with EHRs.

I guess I am not sure what an AC interface with NextGen or Epic will add to my practice and also if Updox even has the capability of carrying out a similar task.

Jimmie,

Several different subjects in there.

Hospitals are already looking to the communications part of MU2 which they will get from their incumbent vendors. I've had more than one turn up their nose @ Updox because they have their own vendor who is promising their own proprietary solution.

Here are some summary pieces about MU2 & Comms
http://www.ehrdoctors.com/mu2-and-hie/
http://emrlogic.blogspot.com/2012/10/mu2-and-direct-messaging-part-1.html
http://emrlogic.blogspot.com/2012/10/mu2-and-direct-messaging-part-2.html

The take-away is that the Gov is driving this, and so large institutions will comply.

Updox is already done/doing the work for MU2 (note the direct messaging fields), so AC would be foolish at this point to not leverage Updox's focus on communication for that portion of MU2.

All that said, compliance is a long ways from useful collaboration between Doctors/Providers.

I suspect that the large players will render the minimally compliant product, and it will be up to independent Physicians/Providers to drive real collaboration.

If our local hospital chains follow their usual behavior, each will provide a buggy interface to be installed without IT help on our office computers. It will be less useful than calling for a report, and less prompt. But it will "comply" with gubbermint mandates.

Indy,

Thank you for the response and links.

I am just trying to better understand the concept of "interface" in juxtaposition of my self-interest of running my practice.

From your perspective I'd suggest that you stick with Updox for now, knowing that the hospital is not going to be helpful, unless foremost, you have privileges, or second that you order many labs from them.

As a group you may be valuable enough to the hospital that getting additional quantitative data might be worthwhile.

One way to look at it is what do they have [lab data, notes] that would be worth some effort?

We did receive word that our three largest hospitals are coordinating with the state Electronic healthcare exchange, and we should be able to go live soon. It remains to be seen how much and what kind of data is made available.

Indy,

Sure appreciate the input! Since going live with AC 11/11 in our area I count 15 new AC users and I am including 2 that will be starting soon in our group.
The hospital may be starting to notice.

Keep us updated on the interface issue.

Thanks to all for the input; I was hoping we could get a useful conversation like this started on this topic. The overall issue is inter-connectivity which we want for various reasons and in different ways. One of the drivers is certainly MU; as we have already seen, those MU dollars are a powerful force in the world of EMR development.

For now, though, I am thinking of something more basic to our practice, namely communication with other providers. State health information exchanges have a role here, as David points out. It will be great if we can easily access discharge summaries, medication lists, and maybe even consults, labs, and radiology reports from all of the surrounding hospitals on our patients. HIE's may enable us to do that.

On a day to day basis, what we all deal with to varying degrees is doctor-to-doctor communication, and I am speculating about how that can be facilitated. So if Jimmie wants to send me a patient, it would be helpful to both of us (and ultimately the patient) if he can efficiently send me everything from a consult request ("I am concerned about this guy's dropping hematocrit; can you see him quickly"); to demographics to pertinent notes, labs, and work-up. It would be equally helpful for me to be able to easily transmit my findings back to Jimmie.

Updox is great, if we both happen to have it. Unfortunately, just as with AC, Updox users are a tiny minority of the universe of providers, and will likely remain so.

A much more common scenario, and one that will probably only increase in frequency, is communication between an AC user (us) and a specialist or primary care provider who is employed by a hospital. In that case, the other party will be using one of the "big" EMR's. In addition, if you send your patient to the hospital for labs or imaging, or if the patient is hospitalized, then all of your information will be coming from that EMR. How does that information all go back and forth? In the past it was mailed; now some of it is faxed. To my mind, ideally, it would travel via an interface.
So facing a reality where 1% of the providers use AC and perhaps 75% use one of a handful of EMR's, wouldn't it make sense for us to take the initiative and try to get interfaces established between AC and Epic, AC and Allscripts, etc?

This is a little off topic but still in the same vein. As I am in the process of closing my office I am getting records copied for patients. My initial plan was to fax them to the patient's new doctors but, some were 400 pages and, even those much smaller took up way too much time to fax...tied up our machine and the machines on the other end. Actually had an office call us and chew us out for faxing it.

Then thought about UPDOX but, without the docs on the other end having it, and the learning time required by my staff, I did not think it would work smoothly.

Thought about printing to paper and mailing....time-consuming and my printers are on their last legs.

So, decided to burn to CDs. We print to Paperport desktop, bundle the documents there and then burn to CD. Luckily I have 4 computers with CD burners. This is much faster than printing to paper. This seems to be working well....not real cheap but manageable.

We then have the patient come in and pick up their disk and take it wherever they want. Now, here is a funny....had a patient bring their disk back and told us their new doctor could not accept this format because they did not have the means to read it!!!!! HUH??? In 2013, in the land of Obamacare, an office whose docs are younger than I does not have a computer which will read a CD full of PDFs? I told the patient they should go back to that office and tell them that was the only format they were getting and, as they apparently were taking on a boat load of my patients, and because this format is the ultimate in Obama's patient portability in health care scheme, they should find a way to read the CD or I would steer my patients away from their antiquated office. No other patients have returned with their CDs.

"So facing a reality where 1% of the providers use AC and perhaps 75% use one of a handful of EMR's, wouldn't it make sense for us to take the initiative and try to get interfaces established between AC and Epic, AC and Allscripts, etc?"

Isn't this what the AAFP looked at about 10 yrs ago and gave up???

Me thinks the only option will be that somewhere in the future Unc Sam says "...here is the source code/data base/exchange format that will need to be used for all electronic medical records here in the U.S.of A, you can make your EMR look as pretty as you want as long as it fits the database/exchange format.

Leaving it up to private enterprise doesn't seem like it will happen without a large price tag applied to the end user to pay for multiple interfaces.

Most of the big EMRs do not want to have interoperability as this would not make them the only game in town at a particular hospital. While the standards state that CCD's and the like have to be able to flow back and forth, very little real information is contained. Poorly executed standards.

Wendell is spot on - I have seen it for 30+ years - knowledge is [sea]Power, and fiefdoms are made around controlling data and limiting & controlling it's flow.

I am confident that the vendors will be aiming for minimally meeting gov requirements while blocking the intent of the enhanced flow of data to improve patient care and outcomes.

Koby, I agree 100%. I am chronically furious that the ONE thing the government could have done when deciding to meddle in the EHR world was insist on a common data standard. Now we have this tower of Babel, just like the early days of word processors where Word Perfect could not read a Word document could not read an Apple Writer, etc. If you see a patient of mine, your notes should appear seamlessly in my record, in order, with appropriate labs in HL-7 format; not just dumped into imported items in a lump of PDF files.

Since the competing EMR companies aren't going to do it, the hospitals aren't going to do it, and yet many of the Doctors in private practice desire/need/would use it, that appears to be an opportunity to innovate. I wonder ...

Interesting story, Leslie. I suspect that this "receiving" doctor will find a way to "not read" records in any format you send. Perhaps you should call and offer to read the chart to him/her over the phone....

My guess would be that CD's will be the most economical way for you to do this, taking staff time and supplies into account. Kind of poetic justice that Paperport is the program that makes it work for you...

David, I know from past discussions here that you and I are on the same page on the failure of government here in mandating a standard. Given that they failed to do so and at this point show no intention of changing (sorry Koby), then I think we need to look elsewhere.

When we got our first interface 3 years ago, Quest said "$500". Labcorp gave us one for free. Big surprise: our Quest business went way down and now they are offering to do it for free.
The moral is: the default position is that interfaces cost providers a fortune. The reality is that they need not.

I don't see a need for us (or others) to have a multitude of EMR interfaces; I know that for me, one would enable me to communicate with the great majority of the docs with whom I share patients.

If the AC's of the world become convinced that their future is enhanced or secured by interfaces like this, I bet they will build them.
If not, then it may be up to the Indy's of the world to help us out (and maybe make a few dollars in the process).

I read somewhere in one of the throw away magazines that even though primary care is the highest% of physician types to adopt an EHR, still about 50% have not and most are in small offices and self employed. So I think there is still a market for AC.

I also think we in primary care have to remind ourselves not to think in a western fashion about this issue, there is no reason to slay the dragon when you can become the dragon.

What I mean, is that if it makes sense to run a business and stay in business by creating an interface and have someone like Indy do it, why not?

JBS,

Yes, I thought you would appreciate the Paperport reference.
I will be using Epic in my next enterprise. I will let you all know how it compares.

EPIC is a rolling catastrophe.
Like driving to the supermarket in an M-1 tank.

It is a nightmare to try to read a record from an EPIC - equipped hospital when the patient is returned to the practice.
Doctors fume and fuss when they try to use it, but doesn't matter -- they aren't important, and apparently, neither is patient care.

Younger and more clever old doctors do seem to master it, in the sense they get home before midnight -- but their notes contain nothing of value.

And the cut and past feature means that every doctor who sees the patient just appends another paragraph, and the "HPI" consumes three pages of endless repetition.

BAH!

Oh dear, Leslie, sorry your are leaving our AC family.

I learned so many things from you, including also being a Paperport devotee.
Best wishes, and hopefully less stress in your next enterprise.

Leslie,

I, too, want to wish you the best in your next evolution. I hope you will still be part of our lives as you proceed

Thanks to all, but I still plan to lurk on the boards....you are my buddies. And, since I will now be an employee, I will need some place to vent! Just hope I can keep my mouth shut and suck it up. For those that know me, this will be my biggest challenge, way beyond Epic!!

Leslie,

If you need a place to vent and blow off steam, you are always welcome out here, heck, we could go south into Jellystone and you could be one of the main attractions!!! Seriously, good luck in your new position.

The Fall Meetup will be in Laramie this year, so I think I can get unanimous consent to put you in-charge of the hospitality suite. It's only proper that the Queen of Quick-Keys should hold court.

And what I really want to hear is: what lies on the other side of that curtain?. Many will have to face the same choice in their careers, and reside in that place "That makes us rather bear those ills we have, than to fly to others that we know not of".

I may take you up on that, Indy. I love Wyoming and may actually get a vacation next year.
Jimmie, I am not selling my office equipment yet because I just do not trust myself that I can do this. So, be careful what you offer because I also love Montana and you may find me knocking on your door with 3 U-Hauls full of crap and three horse trailers full of horses, donkeys, mules and chickens!

Leslie,

The chickens may have a tough time with the hawks. We will have to figure how to keep the donkeys away from the horses so we do not end up with more mules, for awhile any way. The mules should be okay. The winters have kept most of the Californians away for about 9 months of the year, so you won't have that issue to deal with for 3/4 of the year, and they prefer the West side of the divide mostly anyway. If you have any extra room in either the horse trailers or U-hauls, before leaving southern Indiana, I might have you bring my old man along too, his wife needs a break, but my wife may hurt me if you do that. I will have to think on that one a bit.

Leslie-
Have you read the recent articles in Family Practice Management regarding becoming an employed physician and the trade-offs? If not, I recommend that you do so. Being your own boss is still the best thing.

Being your own boss is generally the best thing iff you can make enough money at it to live a lifestyle you wish. It is becoming increasingly difficult to do this in any profession, unfortunately.

Bringing this up again in view of the recent announcement that Epic and eClinical have now developed a bidirectional interface.
This is clearly a priority for the "big" EMR's... once again, I think it is even more important for AC to get into this business.
http://www.marketwatch.com/story/ec...ly-to-make-ehrs-interoperable-2013-09-24