Insights & Ideas

Written by Stage7 Systems with panelists:
Mr. Stephen Collins, Vice President of Product Strategy, Allscripts
Dr. Robert Rowley, Chief Medical Officer, Practice Fusion
Dr. Louis Cornacchi, Chief Executive Officer, DocPatientNetwork / Doctations

When Electronic Medical Record (EMR) platforms started breaking onto the scene in the 90’s they were pretty much all built the same way, as vendor-specific software solutions, much like Financial, CRM or HR applications were. As more and more hospitals started their migration away from paper-based environments, they implemented siloed systems to manage their patient EMRs, the pharmacy, the laboratory, and so on.

Now the industry is evolving once again and providers are being asked to share their patient data with other health systems, physician practice groups, and private docs. As that evolution picks up steam, EMR vendors are being asked how their products can be leveraged to more easily create “communities” amongst cooperating providers.

What follows is a series of questions asked of three ranking executives at three separate EMR vendors. Each has a unique value proposition and approach to this challenge. Their responses seem to indicate how EMR vendors that choose to ignore this evolution toward what we call EMR 2.0, may be at risk of losing whatever competitive advantage(s) they started with 10 years ago.

1. Can you explain exactly how your company’s products address the movement towards a more interconnected community of providers where patient data sharing is the centerpiece?

Mr. Stephen Collins, Vice President of Product Strategy, Allscripts:
Allscripts Helios eliminates the need for interfaces in order for Healthcare providers to connect disparate systems to a centralized data repository called the Helios network. What that means is that any vendor out there can use our Software Development Kit (SDK) to enable their product to natively connect up with our open Helios network. Because of this open framework, any provider using a product that connects to the Helios network can access the data stored in the repository by the other network participants and they can use it in their own system even if that system isn’t an Allscripts-based product.

For example, if one of our competitors wants to enable their customers to leverage data stored in the Helios network, all they have to do is use our SDK to natively integrate with it. Then, if John Patient visits Provider A (on the Helios network using Allscripts) but is referred to Provider B (on the Helios network but not using Allscripts), Provider A will be able to share John Patient’s information with Provider B without either having to build an interface between their systems. It really shifts the burden of interfacing systems from the provider to the vendor.

It goes without saying that Allscripts products are already part of the Helios network, which means that out-of-the-gate you’ve got the potential for 180,000 physicians, 1,500 hospitals, and over 10,000 post acute care organizations to be contributing to the central data store – which can then be shared across all of those providers and to providers using non-Allscripts products that leverage the Helios network.

Dr. Robert Rowley, Chief Medical Officer, Practice Fusion:
Practice Fusion is a free, web-based EMR platform for small to mid-sized physician offices looking to go live on a solution with minimal time investment or in-house technical requirements. By design, Practice Fusion is essentially it’s own Health Information Exchange (HIE) for those providers using the solution. Data sharing, which is a function of the system that hasn’t been completely deployed yet, is the culmination of our vision to house one chart per patient regardless of the patient’s geography or where they’re being treated.

For example, if I’m the primary care physician taking care of Mr. Jones and you’re the cardiologist who I referred Mr. Jones to for some concern, I can use the Practice Fusion network to instantly give you permission to see Mr. Jones’ chart, etc. even if you’re not a Practice Fusion user. Taking it a step further though, if you are a Practice Fusion user, you would be able to enter your own notes into the system thereby updated Mr. Jones’ chart for any other provider he visit in his lifetime.

Because we can provide all of that functionality in a purely web-based environment it requires no infrastructure of the customer, no support or maintenance from the customer, and our self-service functionality that we call “Live in Five” means that customers can literally sign up and sign in within the same day. At this point our network is comprised of nearly 60,000 users representing roughly 35,000 distinct practices contributing to over 6 million patient records.

Dr. Louis Cornacchi, Chief Executive Officer, DocPatientNetwork / Doctations
Doctations is built around a concept that we call the “network medical chart” and development on it began in the early 2000’s after we recognized that connecting siloed systems with an HIE might not be the most efficient way to share patient data across multiple providers. We’ve been promoting this cloud-based technology for over 6 years now so I think we were at the forefront of the movement towards an environment in which patient data can be effortlessly shared amongst providers.

Our web-based platform is unique in that we also give patients control over their data so they can share different data sets with different providers, which improves their ability to manage and maintain their own privacy. In some situations, like emergencies or where patients are incapable of sharing their own data, providers retain the ability to share data with other providers as well. It’s really a system that allows for inter-practice communications between distinct practices but also secure doctor-patient communication. Record custodians can simply select the data or documents they need to share and send them to another provider on the network.

With the platform being web-based, the patient’s record is accessible on virtually any device from standard workstations and laptops to iPhones and Tablet devices. It also requires no infrastructure investment on the part of the provider and no data is stored at the provider’s location so security is drastically improved.

2. Understanding the need is obviously there, what do you see as being the most efficient way to share patient data and why?

Mr. Collins, Allscripts:
In our market, which includes everyone from a small physician practice to large academic health systems, we simply cannot afford to develop every single new solution that’s ever going to be needed by our customer base and neither can our competitors. So if a solution is required by a group of cardiologists that want to do predictive analytics on MRI’s, that might serve .002% of the population and maybe 10 of our hospital customers could benefit from it. From a business perspective, it doesn’t make sense for us to develop that specific of a solution. We can still enable that solution to exist though by creating a central data repository, opening up the Helios framework to other software vendors that might be in a better position to develop that solution, and then allowing the provider using that vendor’s product to connect to the network and be able to benefit from the stored data that exists there.

That’s just one example and from our perspective based on the market we serve, it’s the optimal solution to solve the systems interfacing challenges of our customers as well as the requirement to share patient data across multiple providers.

Dr. Rowley, Practice Fusion:
In my previous answer I talked about our Practice Fusion network where we’re natively building the ability to share data amongst other users of our system. That gives users of our platform an obvious advantage to being able to get their patient’s data in the hands of other providers. However, there are also other systems to consider as well. Hospital systems, for example, tend to be separate from physician practices and most of the time they have locally installed applications. And now with the HIE concept coming into view there will be these information hubs that connect those larger entities together, similar to a lab hub that a hospital may use to channel their lab data through.

In those types of scenarios, our platform can plug into those hubs and instantly share data through it and data can be shared with docs on our network as well. It’s a single connection, from us to them, and then overnight all of our 35,000+ practices are connected to that hub without them having to do anything. LabCorp is an example, we have a connection with them, and regional HIE’s will be similar although they’re new enough that the business model behind them has yet to be proven as a sustainable one. We’re not totally sure how that will play out in our strategy.

Dr. Cornacchi, DocPatientNetwork / Doctations:
I think the most efficient way to share data across multiple providers is through a cloud-based system or network. It needs to be a system in which there are no synchronization errors in the patient’s critical data so if another provider, who might not be on our network, updates it the integrity of the data remains intact. In addition, data needs to be immediately available on all types of devices, which is where a web-based platform comes in handy. You can’t have data appearing three hours after a medical decision is made, that will simply bog down the delivery of care.

I think the data sharing process needs to occur at the point-of-care, not above the point-of-care. If you have a real-time exchange of information possible at the point-of-care it will empower the doctor, the patient, and the profession of medical practice overall.

3. In a more connected environment like we’re talking about, how does a provider insure the integrity of the patient’s data and manage their risk once they start sharing it outside of their four walls?

Mr. Collins, Allscripts:
Security with patient data is always a concern. Part of the beauty in using a centralized system like Helios is that we can build the privacy, security auditing, and security-enabled feature sets into the platform’s framework so the provider doesn’t have to worry about it. And, because it’s an open platform with other vendors writing code to natively connect to it, we impose upon them security requirements that they have to adhere to so we’re in essence ensuring that any solution that any provider uses to connect to the Helios network is secure. Not only that but also, those solutions are inherently covered within the spectrum of the auditing built into the Helios framework.

I don’t think this concept opens the providers up to more risk than they have today. Either way, they have to share the data at some point. This is the big new world that we’re in and somehow they’re going to have to push the data out. Pushing the data out over a secure framework into a secure central repository is probably the safest way to do that.

Dr. Rowley, Practice Fusion:
This issue has actually been the focus of a lot of discussion, particularly by legal folks in terms of data ownership. And, when you start transferring data around, how that ownership is impacted. On the one hand the person who creates the document or record, many times the physician, owns the data. But in Healthcare it’s a little different in that the patient really owns the data that makes up that record or documentation where the physicians are the custodians of it. That’s the HIPAA logic and using that as the foundation for sharing data, when you’re given permission to send data to another provider, once it leaves your custody your liability essentially ends. You don’t retain liability downstream. This is also why I mentioned permission because any patient can tell a provider to share specific pieces of data but not others. In that way and by making the system very patient-centric, we can enable patient’s to exercise their ownership of their data and actually limit the provider’s liability.

Stepping beyond data ownership you start getting into personally identifiable data vs. non-identifiable data. If you can’t link the data to a person it’s essentially just raw data that can be used for business intelligence and analytics. Personally identifiable data is more sensitive. And, when you start having patients controlling which pieces of their record can be shared and which cannot, we start to run the risk of creating additional fragmented patient records out there and that goes against our vision of having a single record for each patient so it’s something we have to contend with.

For all of these reasons, there’s a lot of discussion to be had now that we’re embarking on this data sharing journey and I think securing the actual data itself, technically, will prove to be the easy part.

Dr. Cornacchi, DoctPatientNetwork / Doctations:
From our perspective, Healthcare data should be under the control of the patient and it should be distributed to individuals and entities that the patient trusts. Of course, if data on the patient is being collected for the purpose of delivering care or during emergencies, that’s totally appropriate. But, the patient should be able to aggregate that data as they see fit so that the patient then owns, potentially, a “copy” of that data.

The way Doctations approaches this is by having a single data set and enabling the patient to segment off the data they want to share and with whom. By doing this, you empower the patient through that data and you end up creating a system focused on quality of care because the patient decides who can see their data. With the data set stored in a secure central repository and with it being under the control of the patient, who can grant or restrict access to it at any time, we believe that’s a far more secure solution than a siloed system that might be installed in a community physician’s office or in a less-than-adequate data center.

4. How does a provider who just spent millions, potentially, on a legacy siloed system justify migrating to a new platform that has more data sharing capabilities and might be more flexible in the long run?

Mr. Collins, Allscripts:
When most EMR vendors come in the door to sell a provider on their system they’re looking at a rip-and-replace situation. Sure, maybe the new platform will be completely integrated with all of its different modules but that’s a big pill to swallow. The way we’re tackling that issue is by saying, “Don’t throw away your investment. Rather, layer the integration and network capabilities on top of it.” That’s what the Helios product is all about, connecting disparate systems together on a single network of providers so data can be shared amongst them without requiring them to rip-and-replace their existing vendor products. Of course, when the provider is ready to replace their legacy systems, we have solutions to accommodate them there too.

Dr. Rowley, Practice Fusion:
It’s difficult, especially in hospital settings where each department may have purchased their own system for the laboratory, radiology, and so on. In essence, they didn’t just create one big silo — they created many small silos. Given the high cost of replacing EMR systems, or even implementing your first one, our value proposition is pretty compelling for smaller physician practices and rural hospitals simply because the buy-in is so low. You can literally get your practice or facility live on the Practice Fusion network at no cost and with minimal time investment. It’s still a change, certainly, and that requires effort to some degree. Our system was designed in such a way to minimize the cost and effort required on the part of the provider though and I think that’s what has made the solution so attractive in our market.

Dr. Cornacchi, DocPatientNetwork / Doctations:
It will be a gradual migration toward network- or cloud-based technology, it can’t happen overnight. Because many of the hospitals in the U.S. have implemented legacy systems, they’ll eventually have to either retrofit what they have to work in a connected environment or move off of it and justify that expense based on the value they and their patients will receive. Ultimately, the cost of participating in this type of environment and maintaining the systems that make up this environment will be a fraction of the cost as the current systems that are being deployed. The value is there, it’s just a matter of when each individual practice or hospital can internally justify making the move.

5. What are some of the benefits of a more connected environment for patients? For providers?

Mr. Collins, Allscripts:
Well, under our model the provider sees no radical change to their environment but they can instantly see the benefits of using products that are integrated with our platform. Most providers will tell you that they’re frustrated with the current rate of change in the industry. They want their vendors to give them the systems and access to their data but then they also want us to get out of their way and let them practice medicine. We’re offering them that – the support they want and the freedom they need to be effective.

From a patient’s perspective, they’re going to get access to data that they’ve never had before. Personal Health Records (PHRs) have, for the most part, failed miserably to date. It was a great concept but it just hasn’t yet taken off. The reason it hasn’t taken off is the adoption rate is really only good for a certain demographic. For example, a healthy 45-year-old might input their information and keep it up-to-date and take active ownership in it, but their parents in their 80’s probably won’t spend any time on their PHRs so that data will be kind of defunct. In our solution, those patients that want to be actively involved with their data can be and those that don’t want to be, that data is still readily available to them as updated by their provider(s).

Dr. Rowley, Practice Fusion:
For providers, I think having all of the information in one place for a given patient, regardless of where that patient’s care was delivered, is a huge win. Also, being able to scale a practice and analyze different clinical quality metrics so you can measure how you’re doing. As compensation methods move away from fee-for-service and fee-for-volume towards performance-based measures, knowing exactly how you’re doing will become really important. And, with more data available about a patient, we can probably all do a little bit better.

For patients, I think that same access to a consolidated view of what’s going on from all of their different providers is amazingly helpful. Armed with that information, you start seeing very sophisticated patients who know what the different medications are, what treatment options are available to them, etc. And they can be offered prompts for care delivery. For example, notifications when their flu shots are due or a mammogram while participating in interactive health education resources such as forums and patient-doctor Q&A sessions. Once you start looking at a population as a single unit you can really start to see the possibilities take off.

Dr. Cornacchi, DocPatientNetwork / Doctations:
The ability to share data with other docs in your practice, to share results with your patients, for your patients to communicate with you, and for your patients to provide their own data to other providers they may see are all huge benefits to the providers. It increases the patient’s involvement in their care and their awareness of what’s going on behind-the-scenes because they are ultimately the stewards of their data, which brings up the next point.

With patients being the aggregator’s of their data, they can share it with whomever they want. The data itself will be entered and updated by their various providers. In that scenario, a patient can simply login and see a holistic view of their medical record and if they’re going in for a visit to a new provider, they can grant access to the pieces of data relevant to that visit. It gives them more control over their own data without making them solely responsible for keeping it up-to-date.

6. How does this type of solution aid providers in delivering better, faster, and cheaper care?

Mr. Collins, Allscripts:
By tying into multiple solutions, not just our own, we can manage the finances. A big part of what clinicians worry about right now are re-admission rates because for the Accountable Care Organizations (ACOs) it’s not just taking care of the patient, it’s making sure you’re not re-admitting the patient or you start getting penalized. Managing the finances related to that gets you to the true benefit of all of these outlier solutions that can now communicate back into the Helios network. This gives providers additional components that can help them manage the patient, see the patient, talk to the patient when they’re at home, to manage the pharmacy components, etc. This alleviates any downside for a clinician in terms of how they’re going to treat the patient. It’s also a lot faster because all of the patient’s information is right there so collecting redundant patient data doesn’t have to be done anymore.

Dr. Rowley, Practice Fusion:
At Practice Fusion, we’re pretty optimistic by nature. The way we see it, in a connected world with all of the tools needed by a physician easily accessible, the recommendations that come out of that type of solution will be more information-driven and will lead to better care for the patient. For example, if a patient comes in you’ll be able to see where they’re at in their care continuum and make recommendations for the next step. And, with all of their information being right there and immediately available to you as a provider, it’ll be much faster at the point-of-care. Also, amassing data centrally and analyzing that data in a non-identifiable way can give providers powerful insights into correlations of diseases, medication conflicts, and things of that nature further driving up the quality of care for the patient.

Dr. Cornacchi, DocPatientNetwork / Doctations:
A great deal of time has been spent honing our solution so at this point, when I see a patient, I can document the interaction within a couple of minutes. In addition to that though, the patient can also participate in the documentation process and most of my patients do. Outside of those active patients though, I probably have another 25% that don’t have the medical information that I need when I see them. In those instances providers are able to simply pull back data shared from other institutions on the network or request it from those that aren’t. For example, if I need the patient’s latest MRI results, the MRI center can forward me that even if I’m a provider who isn’t on the Doctations network. This model is much faster and more reliable than where most practices are today because it’s all about having the right data available to the doc at the right time. This enables the provider to make the right decision, which results in the safer delivery of care.

7. Have you seen the idea of data sharing coming up on more customer “must have” lists recently or is it still a difficult concept for some/most to understand?

Mr. Collins, Allscripts:
It’s a little bit of both. I think it’s in the Top 3 of priorities of everyone I’ve spoken to in the past 6-12 months but it’s also true that it’s very difficult to understand. Part of that is that it’s difficult to determine how much the government is going to require vs. how much a provider actually needs to be able to share vs. how much data is actually available. We hear a lot of, “Hey, I’ve got to communicate and I’ve got to have the data. I’m not really sure what to do with it, yet.” What data and how much is required varies based on who’s asking for it because the CEO’s worried about cost-effective population management, the CMO’s concerned about improving care quality, and the CFO is figuring out how to save the practice or health system money. So, yes, the need is there on all sides but each constituent is looking at the data for different reasons so it can make it difficult to determine the best solution.

Dr. Rowley, Practice Fusion:
It’s absolutely coming up more often, particularly amongst primary care physician practices that we work with. In primary care, one of the buzzwords is determining a patient’s “medical home.” And, there’s actually a recognition program for day-to-day practices that are officially recognized as that medical home, which translates into getting more money from payers. Clinical quality measures and performance management are also key drivers of this because providers want to be able to look at how their practice is doing and how they’re going to continue boosting quality while keeping costs under control.

Dr. Cornacchi, DocPatientNetwork / Doctations:
Yes, it comes up frequently. I’ve been in a few meetings recently at large hospitals discussing the rollout of new EMR systems and in both cases the topic of the patient being able to move from provider-to-provider and institution-to-institution was brought to the forefront. In one meeting, one of the first comments made was, “If we have this system and the system’s being housed by our hospital, does that mean we all get to communicate with each other and exchange information?” The answer was, “Well, no, not right away. Maybe in the future.” That kind of answer put the whole audience in shock because you go through all of this expense of connecting your facility and then you can’t even talk to referring physicians. So yes, absolutely. I think people realize that if they’re going to spend all this money and time, they want to be interconnected. They want to be on a network.

ABOUT ALLSCRIPTS
Allscripts provides innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. The company’s clinical, financial, connectivity and information solutions for hospitals, physicians and post-acute organizations are the essential technologies that enable a connected community of health. For more information, visit www.allscripts.com

ABOUT PRACTICE FUSION
Practice Fusion provides a free, web-based Electronic Medical Record (EMR) system to physicians. With charting, scheduling, e-prescribing, billing, lab integrations, referral letters, unlimited support and a Personal Health Record for patients, Practice Fusion’s EMR addresses the complex needs of today’s healthcare providers and disrupts the health IT status quo. Practice Fusion is the fastest growing EMR community in the country with more than 60,000 users and 6 million patients. For more information, visit www.practicefusion.com

ABOUT DOCPATIENTNETWORK / DOCTATIONS
DocPatient Network Inc. is a company dedicated to creating innovative new, Internet-based means of transacting healthcare. The goal is to make healthcare more accessible to patients. Our sole purpose is to substantially improve the process of generating medical documentation in all venues of healthcare: the physician´s private office, the physician group’s office, the ambulatory surgery center, and hospitals of varying sizes. We bring you the benefit of electronic patient medical records without the burden or expense of difficult-to-use software. For more information, visit www.docpatient.com