Epic Systems Customizations or “Personalization?”

Healthcare Informatics published an article in its June 2008 issue, entitled “Behind the Curtain,” in which Carl Dvorak, executive vice president is asked about the reports that hospitals who adopt Epic are find themselves doing many customizations after the go-live. How true is this? In the article, Dvorak states that it’s not really customization, but personalization of templates’ look which the author of the article, Mark Hagland, has in mind. Dvorak reasons that nobody really customizes software these days. I don’t think that’s the case, however.

Software customization firms, including CodePartners, BeaconPartners, or larger consulting firms, such as IBM, for example, are in great range of both number and IT solutions, and they must be serving someone. There is certainly quite a bit of report customization (or “personalization”) for the hospitals, but the IT firms also help in go-live and workflow maximization after the go-live, which is also a sort of customization. I would also suggest other optimizations that people are looking for include enabling Epic modules to collect data from databases (such as a variety of children’s statistics) which are not default information in Epic. Others include viewing or suppressing certain information, or rearranging it according to what each practice is doing with the module.

Healthcare IT Adoption and Tech Standardization

In an opinion piece featured in the American Medical Association publication American Medical News published July 2008, the AMA expresses concern that pending legislation in Congress about healthcare IT standardization would leave physicians out of the decision-making process. In particular, the AMA names technical standards, privacy and financing as being the most frequent obstacles to IT adoption in the healthcare setting.

The lack of standards stands is noteworthy. If the US government is encouraging shared files similar to programs underway in Canada and in the UK, then this will be a larger problem as electronic health records and other forms of IT in healthcare expand in the US. Within the large-scale health systems area, there are several large enterprise groups, including McKesson, Epic Systems, Cerner, and Siemens. Each has its own unique data reporting and EHR system. But these larger groups make up less than half of the medical facilities in the US; about half of clinical care is conducted in practices with three physicians or less. The larger enterprise IT options are not scaled to suit the smaller practices, and between each practice, because of the lack of standards, there is the potential for automation without coordination.

The opinion piece states: “To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records.” Is this the answer, however? Would standardization ensue to facilitate technical standards simply because of legislation? It seems at that point, there is less of the input for which the AMA advcates and a release of control of tech standards to the strongest IT solutions company in the marketplace.

Training to use EHR technology

I'm reading the July 2008 issue of "Health Data Mangement" and there's an article entitled "Training the Next Generation," written by Beckie Schuerenberg, where the merits of teaching medical students how to use EHR programs are described and a programs at schools such as Vanderbilt University's School of medicine are outlined. In my last post, I suggested this might be a good way to encourage EHR adoption, and I'm glad to see that it is happening, though, as Schuerenberg describes, it is by no means wide scale across medical schools.

I think a next step would be to show them how to be empowered through specific types of customization, to get physicians and physicians-in-training to think about how and what types of patient data would they require in their respective fields, or how it would change according to where they are rotating.

In addition, how do we promote EHR through other types of training? Not only future physicians, but others, such as medical office staff, or other health care professionals such as PAs should be exposed early in their education as well.

Promoting Electronic Health Record Use

In an article published in the New York Times on June 19, 2008 “Most Doctors Aren’t Using Electronic Health Records,” author Steve Lohr observes that using electronic systems in health services delivery can improve accuracy, reduce costs, and facilitate information sharing. Yet the cost of implementation in small practices (1-3 physicians), which account for half of the medical care practices in the US, has been prohibitive such that only 9% of them are using electronic records. The article goes on to describe government intervention, including $150 million project, which offers small practices to make the transition.

How can we increase the number of physicians who use healthcare IT, so that the benefits of more accurate care, lower costs, and information sharing become widespread? It seems we need more than just a government intervention. One place is in medical school: though many physicians in training have an already packed curriculum, the students are so driven for good patient care and efficient results, that it’s a good place for them to get exposure to the merits of healthcare IT before the opportunity costs of changing while already in practice kicks in. Since many students are in medical school associated with large university medical centers, it might mean they have exposure to the enterprise packages, such as Epic Systems or Cerner, and it is probably hard to see the whole picture when working with just one module on rotation. So bearing all the benefits in mind would help. I think making EHR use a reality depends somewhat on initiatives such as these. I strongly suspect that IT soloutions companies would also be willing to chip in towards creating a curriculum unit on IT in healthcare.

Healthcare Informatics, Healthcare IT

Healthcare Informatics has really grown as a field and I want to use this space to air out some of my thoughts as I learn about it. I'm currently an MBA student, and I want to see all the different angles of delivering healthcare technology and management in that process.

It seems to break down in to a couple of different areas, and that categorization probably changes depending where you're located in the chain of people affected: patient, medical practitioner, IT specialist, software or hardware company. I'm interested in everything, including policy and the proliferation of associated technologies (think electronic health records or RFID in the hospital, for example), but I'm most interested in providing the IT solutions to the end users (medical staff, and sometimes, the patient).

I invite people to comment or add their thoughts.