Friday, March 21, 2008

Allscripts- Misys Merger

Having spent the past 25 years in Healthcare IT. I have seen a lot of companies come and go.
The past 19 years of my career have been spent at +Medic (Misys) and A4 Healthsystems (Allscripts). I have to admit I had an inkling this merger would occur for the past year. I went through the +Medic – Misys merger and the A4 – Allscripts merger and have seen great benefits from both.

Announcement day I did feel a little like Luke Skywalker when he found out Darth Vader was his father! The dark side had now become one with the force.
Reflecting on this merger for the past week has lead me to believe that it is a very important first step towards a more effective approach to solving the Healthcare EHR adoption rate in this country while fast forwarding the “interopability” rates of the current EMR’s/EHR’s.

Yes there are a ton of products and yes there will be some sun setting of current EHR’s take a look around HIMSS and see how many little companies are doing the exact same thing with little or minimal differences in their software. I think we tie ourselves to a product or brand name and derive our sense of personality and who we are from a piece of software. We should step back and analyze more from the stand point are we helping or harming the Physician and how they practice medicine. I also realized how many of my friends are still at Misys and how many family members we will now have at Allscripts, once this merger completes. I think Dr Morrow summed it up well in his article. Free registration gets you the article.

I think we need to re-evaluate our emphasis on what we are really trying to achieve here. We should have less focus on my software can kick your softwares ass... and more focus on what service are we really providing for our providers. Are we first seeking to do no harm?

Much has been said here about workflow and how we can’t change an offices workflow and have the software adapt to the provider and not vice versa.

Let’s take a look at a few examples of where workflow should change. Option A (antiquated) vs option E (EHR) I can list 20 or 30 of these off the top of my head but lets start with this simple one.

A. Patient calls to speak to the Dr to get results on a lab test. If you are lucky enough to talk to the Dr you get your results on that one call. (We all know this rarely if ever happens) What usually happens is the phone operator without an EMR writes a hand written message then passes that to a medical records clerk who pulls the chart and paper clips the message to the chart and places the chart on the provider’s desk. The provider who is busy with patients may see the chart and make a call back at Lunch (if there is no drug rep chatting them up at lunch) or after the day is done, which usually means a message on a cell phone or answering machine. The patient meanwhile sits and waits and worries for hours or days until contacted. Once contacted, and usually by an MA or front desk person, who may not have the results in front of them or know how to interpret the results, they are told they are WNL (Within Normal limits). The patient then asks for a copy of the results (so they can Google them to get some answers for a change) and are told they can not be faxed to your home since it is not a secure fax but you can pick up a copy at the office. You pick up a copy the next day or whenever you can get by the office and notice a few lab values at the upper limits of normal. You call again to ask about these values and you now start this whole process over again. Now if you are happy with that work flow continue to seek out an office with no EMR. If you prefer a more modern approach try this.

E. Your results come back via a lab results interface and the physician signs off on the results within minutes of receiving them and publishes these results to their patient portal. The patient receives an email that they have results posted to their portal and can access their secure login to the portal from home or office and receive the physician’s message as well as the results. The results can then be printed on their home computer or exported to their personal health record. You reply to the physician about the top end normal’s via a secure direct email to your physician. Your physician replies within minutes to your concerns. This is all completed in less than an afternoon. So take your pick which workflow works best for you versus works best for the Doctor? Why preserve the paper version?
I was providing follow up training at an OB/GYN practice this past week in rural Georgia. We are talking a tiny, tiny town here people way up in the mountains. This practice is 100% EMR after being on the EMR for 2 months. I’m talking GYN patient and OB patients. (If you are not familiar with this specialty and the trials of going on an EMR then let me tell you that’s a remarkable feat!) They get how this product can change their ability to provide service to the community. The Hospital meanwhile maintains a paper chart.

While I was training a provider on a template design tool on how we can process their Hospital Short Stay report from our EMR and fax to the hospital while in the Hospital rather than complete it by hand in the hospital…. The Caregiver received a call from Labor and Delivery in regards to an OB patient who was in the ER and the nurse had a few questions. The Caregiver without getting up from her chair… Pulled the patients chart, accessed her pregnancy record, (ACOG form) reviewed a few items, reviewed the online fetal monitor Real time, and was also able to have her discharged in a few mins. She even e-prescribed an antibiotic to the pharmacy which would be ready for the patient once she arrived. This all took about 3-5 minutes, if that. Most was taken up by conversation to the Nurse.

When she hung up I asked how long that transaction would have taken on paper. She replied, “Hours.. and that’s if I could find her chart… I also would have had to drive over to L&D and review her monitor tapes and her chart there.” Again, which workflow do you want to preserve? Keep the mother in the ER for hours needlessly on a fetal monitor and IV etc., or let her go home and pick up her script while on the way home and be done in 15 minutes??? How much was actually saved in ER time and valuable Nursing time not to mention supplies etc with the new workflow? We may never know but you can guess hundreds or thousands of dollars a day.

I routinely contact every client I take Live on our EMR one year and two years after their go-live and ask how things are going and would they go back to paper. Every client has answered no way. Now if you ask this question at 2 weeks or 6 months they may say heck yes take me back! But once they make the move to a total electronic record they rarely if ever want to go back to paper. You have to put in the effort and the results will come … some immediately like e-prescribe, lab interfaces, completing charts notes in the same day, no more lost charts, and faxing consult letters at the end of the visit etc…. Others benefits take a few months or years.

I think this is a bold first step towards a much needed consolidation of the EHR Market place. Many more will soon follow and I can’t wait to see how 10 years from now this will be reflected back on as the starting point of a great expansion in beneficial Healthcare technology. Working toward a common benefit rather than erecting competing fiefdoms that do little to advance EHR adoption.

Allscripts and Misys need to remember that a company is made up of people. Those people provide the companies reputation. People enjoy working for a company where quality of life and a fun factor are present. How the company treats its employees and how much of a fun factor they maintain will go a long way in determining their future and their reputation. Which will also lead to more clients and higher revenue.


Anonymous said...

Thanks for the great post and insight into the EHR process and customer relationship! I too work at Allscripts and have enjoyed the culture (though I've seen less fun than I'd like :-) ... so I'm looking forward to seeing how the folks at Misys respond to the new environment. And hoping we we can learn from/adopt what works for them. Totally agree with your comment about the value of people - and I think Glen feels the same way.

Anonymous said...

The key word you said that hit me was that "people", as in employees, are what have kept these companies alive as long as they have. While the merger is still a mystery as to how it will work out - I think it's critical that the powers that be realize that the best support and the sales people that care, truly care, are the glue in this whole equation. I can go home at sleep at night knowing I've done more than what was expected of my by my customer, who in a great company, becomes a friend albeit long distance many times.

Yes, we're here to help them become efficent in their clincs, etc....but, if they don't get the partnership - and we and every other HIT company throw that word around WAY too much - then even this merger will fail.