Eliminating the Interoperability Question

I just finished reading Victoria Brock’s excellent post Stop! Just stop with the “Interoperability”. In it she expresses the frustrations with healthcare systems vendors that represent their products as “interoperable” to non-IT buyers, knowing that those people will assume the best of what interoperability could mean. This is a phenomenon of human nature that I blogged about 12 years ago!

I agree with Brock. We need to educate our colleagues involved in reviewing clinical IT systems to stop asking the Interoperability Question. It is too vague and gives the vendors a chance to say yes to a different question than what is truly being asked. We need to train our non-IT colleagues to think about what they mean when they say interoperability. We need to give them examples of alternative questions, such as:

  • How will the medication list in your system automatically reconcile with the medication list in our core EHR? Where have you done this?
  • How will the allergy list in your system automatically reconcile with the medication list in our core EHR?

Brock reminds us that these interoperability questions involve three parties, the two application vendors and the client. Because something is possible doesn’t mean it will happen of all three parties are not committed to the work. We need to educate our colleagues that these interoperability questions cannot be answered by one party alone.

Those of us that are very clear about the the problem we are trying to solve and the new problems we are trying to avoid will have the most success.

My ePrescribing experience

One of the best moves I have ever made was selecting and installing the Purkinje ePrescribing product. Purkinje sells an EHR product too, but I really cannot speak to that.

Purkinje uses the Software as Service model, so there is no server hardware to manage. You just need to set-up a secure connection to their data center over the Internet. The software is web-based, so we did not have a special client to install.

We have been using their ePrescribing tool for nearly 5 years and our physicians really have embraced it. It is very simple and our incidence of downtime and unavailability have been well within our expectation. Purkinje had some great functionality that the bigger players did not have when we made the purchase. Most importantly, the system has a lot of clinical content that reminds our doctors about clinical research and costs specific to the illness they are treating. So, for example, if a doctor is treating a hypertensive patient for the first time the system will provide the doctor a quick, unobtrusive alert that reminds them diuretics are the preferred first line of therapy in most patients and a fraction of the cost of most alternatives.

Purkinje Screen Shot (fit)

We were able to get rid of the prescription pads quickly.  I have heard many anecdotes about the system catching medication and allergy conflicts that might have otherwise been missed.

Through interfaces to our MEDITECH Magic HIS the doctor’s are able to select patients from their schedule that appears in the ePrescribing system. Each time the medication list is updated we send a report in MEDITECH so our patient’s medication list is available in MEDITECH’s PCI.

This is why I support Medicare’s push for electronic prescribing. Unlike the Leapfrog group’s poorly considered call for CPOE, ePrescribing is easily accomplished, commercially available and proven to truly be be beneficial to the health, safety and pocketbook of patients.

Modern Healthcare Online – EHR and Physician Anger

David Burda’s piece on physician anger with Electronic Health Records is interesting (Alexis Polles is the original presenter).  Modern Healthcare’s Daily Dose suggests these frustrations are related to poor design and poor training.  Of course excellent design would minimize the need for training.  I agree with that take.

However, the original speaker seems to indicate that some physicians are unable to adapt to this way of practicing medicine.  Our experience is that 1 to 2 percent of doctors may have trouble embracing clinical IT (regardless of design and training).  As you prepare to roll out your clinical IT systems I think it is critical to know how you will handle that 1 to 2 percent.  I hear a lot of people talk about a “lack of senior management support” with clinical IT efforts.  I think we put senior leaders in a tough position when the checks are signed and the physician problems beginning to pop up.  If you have that conversation in advance and agree on the course of action, we will find senior leaders more support.

It will be useful to discuss some real uncomfortable scenarios.  What if the one physician hold-out is your top admitter?  What if you are experiencing 10% physician resistance?  Too often we sugar coat these challenging projects.  That will really cause a lack of senior leader support when your EHR or CPOE effort turns out to be something other than the bed of roses it was portrayed.

EHR Resource Estimates

I don’t think most healthcare leaders understand the effort these Electronic Health Records systems require.  While the hardware and software expenses are significant, they are dwarfed by the level of implementation effort required.  I am working on a number of resource estimate models to implement a “fairly comprehensive” EHR for a 400 physician medical group.  While the hour estimates can vary be EHR product all of the estimates are breathtaking.  Currently, the high end of the range looks like 300,000 hours.  But, we still aren’t done scrubbing the numbers.


I am always frustrated how some often used terms in Healthcare IT are used in very different ways by different people. A simple example is Electronic Health Record (EHR) and Electronic Medical Record (EMR).

For a period of time the term Computer-based Patient Record was hot, but that seems to have been a short-lived fad.

So, what is the difference between and EHR and an EMR? As we are in the midst of developing a new EHR strategy for our 400-physician group this is a debate that is near and dear to my heart.

I think CCHIT and HL7 EHR-S do a nice job of describing core EHR capabilities. Those would include medication management, allergy list, problem lists, immunization, etc.

However, we are looking for a phrase that captures what we are trying to do. For our purposes we are saying that the EHR promotes the practice of medicine. Whereas an EMR is simply an electronic version of the traditional medical record. That is, the information is in there and it is retrievable, but it is generally organized around the hospital departments.

We have great doctors at Affinity and Ministry. Our goal is to continue to provide better tools that allow physicians to focus on the practice medicine, not search for data. By giving them IT systems that present the most clinically relevant information to care for each patient we can make these doctors even more efficient and effective.

What is your definition of an EHR?

My TEPR Presentation

Here is the presentation that Dr. Paul Veregge and I gave at TEPR 2006. Paul did all the work (thanks Paul):

Data Mining for Disease Management and Patient Communication

I call it the Poor Man’s EHR. It demonstrates how you can achieve many of the benefits of an EHR by data mining your existing systems. It is a great approach if you don’t have $60M in your pocket.