I’ve said it before and I’ll say it again… it is impressively difficult to integrate data from one or more EMR systems into a cohesive analytical warehouse database. Especially if you’re doing it from scratch.

In my last two blogs (Data Integration: Taming the Beast of Healthcare & Data Integration: Taming the Beast of Healthcare – Part 2) I demonstrated how to reduce time and cost extracting data from your EMR systems and getting it into your warehouse ready for complex analytics and reporting through the use of pre-built “accelerators.”

Before any organization takes on the job to build a data warehouse there needs to be a reason to do it. In IT we sometimes call these “Business Requirements”.

Here’s How it Works.

Someone in a healthcare organization comes to IT and says “we need a bunch of reports to report to the Government and manage our procedures better. Plus, we’d like to analyze our patient and financial data to see if we can provide better service to our patients at a lower cost. We need it right away and we don’t want it to cost tons of money”.

You work with them to come up with the list of reports they want and the analysis type results their looking for.

Working from these, your technical staff looks at existing EMR systems to identify the data fields that meet the requirements and determine the scope of the project. You need Patient, Encounter, Account, Procedure, Diagnosis, Organization, Location, Claims, Medication and Medication Orders, Lab Orders, Clinical Findings and some other stuff, just to get started.

That’s somewhere in the neighborhood of 15+ systems, 353+ source tables, and 2,933+ columns. You’ll need to design a database, build hundreds of programs, test and verify the data and so on (a totally fictitious and ridiculously meaningless set of numbers but I’m trying to illustrate that it’s a bunch of work). You suddenly realize you’re going to need help or this will take forever to complete and cost millions of dollars.

To make things more complicated operational systems store and process data in a co-mingled subject state. This means an encounter focused system stores encounters with associated patient, diagnosis, procedure and supporting clinical orders and clinical finding data all designed mixed together. This makes it easier to store and update transaction data.

But a warehouse cannot be transaction focused. The data design needs to be highly normalized to reduce redundant data. Since it also requires data spread over long periods to spot trends and look for treatment and outcome patterns, the warehouse needs to store billions of records to get meaningful analytics results. This requires a different storage scheme. This is best served with a dimensional star schema design (as described in Part 2). But you will need to re-organize the data before you can load it into a dimensional structure.

So in order to load the warehouse we need to tear apart the source transactions and load the data into subject oriented (Patient, Organization, Encounter, etc.) Atomic database.

The Atomic database is a highly normalized 3rd normal form (sorry, that’s relational model terminology) making sure it is re-linked together to make sure you got it correctly stored.

Note: This is a key factor in the design of the intake gateway, the final piece of the Perficient Analytics Gateway for Healthcare.

Luck you!  You read my blog (all three parts) and you know just who to call!  But you’re skeptical.  Can this be true?  So you reach out to several healthcare organizations and they all tell you the same thing… call Perficient!  These guys are amazing and you’ll love them!

When we get the call we’ll tell you what we have.

In this illustration you can see,

1. The Perficient Analytics Gateway – for Healthcare, a set of pre-built processes that gets your warehouse built and loaded in significantly less time.
2. A stable Industry standard Unified Data Model (the one we partnered with and built our product for).
3. Nearly turn-key processes to move the data from Source to Stage to Atomic to Dimensional databases made ready for analysis and reporting.

What makes this a standardized process, is it’s alignment with the Atomic database of the Unified Data Model. The stability of the Data Vault Hub & Satellite structure (as described in Part 2) allowed us to design Pre-Stage database tables using a Standard Input Format (for those of you who can’t live without acronyms, we’ll call this the SIF) that has the same columns as the Atomic. A type for a Hub & Satellite combination and another for relationships etc. We have a few others, but you get the picture.

We use the SIF to store source data in subject oriented boundaries, maintaining relationships to all of the related Hubs aligning all with the Atomic model. This makes ingestion programming easy and reusable. It also provides a mechanism for filtering and transforming source columns as preparation for warehouse processing.

The “Intake Gateway” portion of the Perficient Analytics Gateway – for Healthcare is;

1. Used to extract data from your sources into the intake “SIF”. This is designed to accept data from any system.
2. Processes and stores SIF records in the Pre-Stage database
3. It helps filter out duplicates, clean, validate, re-format, etc. incoming data for final loading to the warehouse.
4. ETL process to move the data from Pre-Stage to the Atomic.
5. Standardize date formats, eliminate garbage data, validate codes and consolidate similar input from multiple systems.

Shown here is the basic data flow from Source to SIF.

To make this all work we create mapping documents with adequate information to drive a mechanical code generating process that creates the ETL and ELT programming necessary to load the SIF tables correctly. The remaining pre-built ETL programs do the rest.

Data format in all of the columns in the SIF tables is a variable character (with some minor exceptions) at max length so no matter what length or value is coming in from a system for any given field it will be accepted. The warehouse field data types are then used to guide the programs for outgoing data types to match.

Since the warehouse model rarely changes, the programming to move the data from SIF (Pre-Stage) to Atomic works most of the time with little or no modification.

This is a tremendous time saver as shown below.

Of course, I’ve simplified this to keep it short.

Needless to say, Perficient’s BI team, source system knowledge and experience, the components of the Gateway and the Data model aren’t cheap. However, in comparison to doing it all yourself from scratch, it’s considerably faster, cleaner and less expensive than you might think.

Give us a call!

Healthcare providers need to create useful, not to mention required, reports and they need to perform complicated analysis. To do that effectively requires bringing disparate information from multiple operating systems together. The goal… find opportunities to improve patient care and lower operating costs. To accomplish this, operational data has to be extracted and integrated.

Integrating clinical data at this level of detail requires a (wait for it) monstrous effort. To satisfy these complex reporting and analysis requirements requires finding the needed data in many operating systems then merge it all together in a usable way. Let’s see what it takes.

To load and maintain the efficacy of clinical information in a warehouse requires expert knowledge of source systems and a deep understanding of warehouse structure and design. Lack of expertise in these areas can adversely affect the quality, accuracy and usability of a data warehouse.

Many companies have faced this challenge. Some succeed while others fail but failure means money down the drain. Bad, missing or inaccurate data may impact important decisions and even threaten proper patient care. This is not the place to skimp on expert resources.

To start, buy or build a database(s) that will satisfy the necessary reporting and analytical requirements. It should be a clean, accurate well thought out standardized design with complete, normalized and dimensional Provider and Payer data patterns. It must be subject oriented, multi-tenant and a highly extensible data structure.

Now, design an intake process that can receive data from any Electronic Medical Record (EMR) or Electronic Health Record (HER) system or other ancillary systems. The intake design would have to be generic so it could absorb data from any system.

Then, design programs to transform and load the raw data into a staging area for validation and cleansing. Following the data model pattern, design programs to move the now clean data into a normalized integrated database.

Finally, design programs to move data through the normalized model structure to a highly functional, turn-key but customizable, dimensional (star schema) data base.

By aligning the design of intake, data load, transformation and data movement processes to the model pattern, you can use this tool set over and over again. Now that I think of it, this looks like something to build and sell!

No, this would take years to build, refine and package for sale.

But what if someone has packaged these components into a healthcare reporting and analytical data warehouse integration tool set. If they built it, it would decrease build time, complexity and provide the acceleration needed to get your warehouse on-line in less time (and less cost) than it would take to do it from scratch.

What if they had a group of experts in healthcare data integration? That would be cool. Made it a team that has experience and knowledge of the top tier operational healthcare systems. People with intimate knowledge of how the packaged integration tool set operates. They would have years of experience implementing this system in multiple locations around the country.

Now that I think of it, I might just know about something just like that and I think I know just where to look!

Tune in next time and I’ll tell you all about it!

Till then…

In healthcare, most data is exchanged electronically between partners via EDI (Electronic Data Interchange), and “Big Data” is helping the industry become more efficient and productive. EDI originated because it provided a structured mechanism for sharing data between disparate organizations and systems.

The more common means of transferring data from source to a data warehouse is ETL, but there are times when you might want to consider using ELT (see James Serra’s “Difference between ETL and ELT” or Daniel Harris’ “ETL vs. ELT: How to Choose the Best Approach for Your Data Warehouse”).

EDI allows the healthcare industry to bring in information needed to help perform analytics. However, in the past, the issue was being able to house all the information and easily retrieve it. There are still some issues with EDI regarding data quality, but that is getting better as each business is learning the need for reliable data to perform their analytics.

EHRs (Electronic Health Records) also play a big role in the ability to perform analytics, and there is an immense amount of raw data available in EHRs, EMRs (Electronic Medical Records) and EDI. “Big Data” now provides a greater opportunity to use this information to perform critical analytics by applying business intelligence techniques.

In the past, the EDI data went to a data warehouse. Now with “Big Data,” the industry is able to house and analyze the information for visibility and quality. When linked with the adjudication system, organizations can get a more complete view of what is happening in their business and deliver real-time analytics of clinical, financial, as well as fraud and HR.

Analytics allow for the examination of patterns to determine how care can be improved while reducing the need for repetitive hospital stays and limiting excessive spending for testings etc. This allows the healthcare industry to reduce fraud, waste, and abuse. “Big Data” allows them to store and go back in their data history to analyze large unstructured datasets to detect anomalies and patterns.

Stay tuned for “How EDI Relates to Cloud Computing.”

It seems appropriate on Valentine’s Day to write love letters. This is my letter of adoration to Meaningful Use. In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills. My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons. I could wax poetic about the ease of checking on appointments and reviewing lab results. The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy. It was love at first click.

Instead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic. I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications! I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila! Several hours later, I received an email confirmation from the pharmacy that they were processing my order. Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software. I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view. I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life. This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past.

Like a lot of relationships, alas, things are not perfect. The EMR and patient portal have a mobile application that is still very basic. It gets high marks for security, but lacks the medication refill capability of the patient portal. I would venture a guess that it will be there eventually, but it brings to mind the challenges of screen real estate on a typical web browser on a laptop versus a mobile phone. Nevertheless, love can overlook some imperfections.

In a period when our government is making these big investments in electronic medical records and expecting Meaningful Use to be demonstrated in return, it’s time to send out some positive news: keep the faith and push forward because the healthcare consumer will benefit. I know that simplifying the ordering of refills seems like a small thing in the course of things, but if it saves time, productivity and especially errors, then it is a big deal. Thanks to my physician, who re-invested and made the commitment to real Meaningful Use. Here’s your love letter!

P.S. — No personal healthcare information (PHI) was harmed in the making of this blog. If you are curious about which EMR software is so terrific, stop by our booth #2035 at HIMSS, and I will whisper it in your ear. HIMSS 2014 is going to be a great event!

What’s transforming the ways in which healthcare is provided?

• legislation
• new competition
• innovative incentives
• a call to refocus on priorities
• a more empowered and digitally engaged consumer, who has more and greater expectations for quality of care and convenience of care.
• a renewed attention on healthcare by the consumer market thanks to ongoing press about healthcare.gov and the Affordable Care Act
• new services and business models in healthcare that we’d never seen before recent reform

…and much more.

Susan DeVore, CEO of our partner and client Premier healthcare alliance, wrote a post yesterday fro HealthAffairs.gov titled, “The Changing Health Care World: Trends To Watch In 2014.” In the article, she introduces the new trends she expects to see in healthcare this year. We are also seeing each of these trends impact conversations about investments our clients need to make this year and next year.

I have summarized the trends below.

1. Investments in Chronic Care –

• Chronic conditions increase costs by 3X, so, “The biggest health care consumers are those with multiple chronic conditions.”
• We should see more investments in Ambulatory ICUs and patient-centered medical homes as providers work to improve their shared savings payments and better manage chronic conditions within primary care facilities.

2. New Job Roles in Healthcare

• DeVore has seen an increase in the popularity of hiring “health coaches” who are there to listen, inspire and motivate and spend time getting to know the patient’s family and life situation as it affects their ability to both access care and to care for themselves.

3. Home Health Care

• Back to the days of the house call.
• “Marketing firm BCC Research predicts that the market for remote monitoring and telemedicine applications will double from $11.6 billion in 2011 to about $27.3 billion in 2016.”
• Technology is increasing access and convenience of healthcare from outside the traditional care setting, especially for rural, hard-to-access locations.

4. Employer Attention on Health

• The Accountable Care Act lets employers increase wellness incentive dollar value from 20 to 30 percent of total coverage.
• Many employers offer incentives for pedometer use or for quitting tobacco or lowering obesity and diabetes rates.

5. Private exchanges become more popular

• This puts the power of choice into the hands of the employee / consumer
• Employees can also customize their coverage to their own needs and better manage their healthcare budget.

6. Further movement toward Value-Based Purchasing

• The Hospital Value Based Purchasing (SVSP) program penalizes provider organizations who fall behind their peers on key metrics such as clinical quality and patient satisfaction, with the penalties set to go up in the next few years. The program also rewards organizations that improve their score over time and outperform industry benchmarks.
• Sustainable growth rate (SGR) is a method for calculating physician payments. Congress will vote this year to “fix” problems with SGR, moving physicians to VBP. This will tie incomes to quality of care and cost improvements.

7. Data will begin to talk as walls fall down

• DeVore says, “Providers are inundated with new technologies that enable them to automate processes and capture new types of clinical data.” That’s quite an understatement from what I have seen.
• More systems will become open to innovation and sharing of data this year, in a provider-led push to do so.

8. New and more creative partnerships in healthcare

• Last year, “drug chains partnering with physician groups to create ACOs based around retail clinics,” says DeVore. But this year, “look for the trend to include community-based groups, including social service agencies, area gyms, and other non-health care service providers.”
• Providers are beginning to look at the “whole person,” and this means unconventional, innovative ways of providing care.

Exciting stuff!

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Consolidation and Mergers

Healthcare entities, both payers and providers, have been making an increased effort to capture market share and dominate their geography. Smaller players are being picked up by larger players, consolidating physician practices and health plans. These mergers have driven digital strategy projects and paperless environments, with an increased interest in advertising and public facing websites to try to attract market share.

• Changes in Hospital Finance Drives Flurry of Mergers
• Partners-South Shore merger review grows
• Cadence Health plans to merge with Rockford Health System
• Blue Cross of NEPA, Highmark exploring ‘stronger’ partnership
• Area hospitals promise transparent merger

Extending Your EMR

Healthcare professionals have been very vocal about the challenges that come along with electronic medical record systems. The workflow in many EMR systems was created by a programmer and works the way it was programmed, not the way healthcare professionals work. Several technology tools were made to extend or approve upon EMRs without ripping the code apart, often by putting it into a browser or allowing it to be mobile.

• EHRs can’t do everything
• 9 Reasons Doctors Hate Their EMR
• Docs blame EHRs for lost productivity
• So much data-gathering, so little doctoring
• How connected is EHR user satisfaction to vendor choice?

Security and Privacy of PHI

The further we develop our technology, the more security risks we’re introducing at the same time. BYOD and wireless networks increase the mobility and sharing of data, which is helpful for diagnosis and storage but risky for protecting PHI. There is a delicate balance between how much security is enough and when security will make it impossible for us to manage the system.

• Addressing BYOD security at a large medical research center
• Factoring healthcare BYOD policies into network security
• 3 tips for proactively protecting PHI
• Sloppy Handling Of Patient Data Always A Danger
• Data Security Added to Worries About Website

Fragmentation of Health Records

While interoperability is a key trend in healthcare, the cost of care is driving us away from this goal. In order to save money, patients are now going to several different pharmacies and stores to get discounted prescriptions where they can, fragmenting their health records. If the only time these medications are reconciled is when patients visit their primary physician, that’s not often enough to prevent adverse drug reactions.

• Why Healthcare Tech will save your life …and your wallet
• Interoperability: A critical mess
• Connecting a new world of care: why interoperability is vital for the NHS
• Health IT can improve care coordination for complex conditions
• Docs can prevent adverse drug reactions by looking up info on mobile phones

FDA Oversight

In September, the FDA revised its guidelines on what mobile medical applications need to be regulated and what are harmless to consumers. Now the FDA is wading into the issue of what else they need to regulate and what they don’t. This week they decided t to block 23andMe for providing medical advice without a physician involved. The FDA will battle where the concept of ensuring accurate medical information will start and stop.

• Congress delves deeper into FDA mHealth oversight
• U.S. approves drug tracking, compound pharmacy oversight law
• The HIT Group wants input into FDA regulation of health IT
• Here’s why the FDA is targeting 23andMe
• FDA to 23andME: Stop genetic tests

Chronic diseases are among the most common, costly, and preventable of all health problems in the U.S². The use of disease registries can play a large role in effectively managing these diseases. Despite some of its limitations, disease registries can provide useful knowledge on specific patient populations, allowing for more proactive, coordinated and focused care and education, ultimately resulting in improved outcomes and decreased cost.

What do you think? Do you believe disease registries can improve the management of chronic disease?

Resources for this blog post:

1. http://www.medterms.com/script/main/art.asp?articlekey=33490
2. http://www.cdc.gov/chronicdisease/overview/index.htm
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490197/
4. http://www.idph.state.ia.us/hcr_committees/common/pdf/clinicians/1005_draft_disease_registry.pdf
5. http://www.chcf.org/publications/2004/05/chronic-disease-registries-a-product-review
6. http://azdhs.gov/biomedical/aztransnet/documents/The_Value_of_Patient_Registries_in_Clinical_Research.pdf
7. http://www.healthandwelfare.idaho.gov/Portals/0/Health/Rural%20Health/Watts%20-%20Chronic%20Disease%20Management%20Patient%20Registry%20Final.pdf
8. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20ComputerizedRegistriesInChronicDisease.pdf
9. http://azdhs.gov/biomedical/aztransnet/documents/The_Value_of_Patient_Registries_in_Clinical_Research.pdf

As I have written before, I currently see several physicians who do NOT use an EMR in the office. They are awesome diagnosticians, people and mentors but they have not taken the leap to the electronic health world. Now, add in two hospital networks that do NOT have patient portals for accessing my records and you get one big, fat medical record quagmire! I would love to have my entire medical record in one place AND have portable access to it. Will I ever reach that goal? Do I need to establish a relationship with a new physician just to obtain my goal? I certainly hope not! So what can be done to make my dream a reality?

This quest has certainly led me to devour insights from industry experts, read countless blogs and articles and consider the drastic move to a new physician. So I was intrigued when I read the Wall Street Journal article, “Image Sharing Seeks to Reduce Repeat Scans“, this week. Allowing patients to have access and the ability to TRANSFER images to multiple providers reduces cost, redundancy and ultimately, radiation exposure for the patient. In addition, it allows the patient to “own” their health. Although this is certainly a step in the right direction, this is an isolated sharing of information, not connected to the rest of the patient’s history, just another piece of the puzzle. How can we solve the entire puzzle?

Health Information Exchanges (HIE), Personal Health Records (PHR), and Patient Portal development could certainly help create a more complete record. Development of a unique patient identifier, recently advocated by Health IT evangelist, Brian Ahier, could hasten collection of records across the country. All of these would help collect medical records that are now being electronically generated.

However, many of us have records that were created long before EMRs even existed. These would need to be attached as PDFs or scanned and attached as documents to the record. Perhaps a very progressive site would be able to use Natural Language Processing (NLP) to mine those records and pull out discreet data to populate the record. Finally, the record would invariably need some good old- fashioned manual entry to finish the job.

So will my dream of a complete, portable Health Record ever be realized? I think so…with a little help from my “friends” (EMR, HIE, PHR, portal, scanners, NLP and others) and a lot of manual work on my end. Even as a physician patient, there’s work to be done. What about tackling yours?

As a big fan of kevinmd.com, I enjoyed reading David Nash, MD’s take on how doctors need an “EMR 3.0” analytic engine for accountability and that creating an analytics tool that monitors gaps in care for a provider’s population is very important for accountable care. We also agree that as successful as the big EMR vendors have been that they don’t have an analytics engine that promotes accountability and measurements of quality and safety. My argument is that as a result of the large number of data sources in the typical healthcare organization due to the myriad of healthcare applications, the analytics engine needs to combine data from all of those sources, normalize the data and deliver the quality and gaps in care dashboards independent of the EMR system.

David’s practical idea that clinicians need an analytics engine that sits on top of the EMR, one that is capable of sweeping up clinical data and converting it to information that will improve clinical decision making, is accurate and exists today. Moving all of those data sources into a centralized enterprise data warehouse with a comprehensive and standard healthcare data model is the key to success. Reconciling the medical vocabularies to a set of consistent data elements empowers real analytics. Those capabilities exist in a well-established product called BI-Clinical from CitiusTech and that product has the key capabilities outlined on David’s wish list as an “accountable” primary care clinician in the modern healthcare environment, including:

• A data warehouse that combines clinical, administrative and financial data
• Calculates and reports on all 33 of the Accountable Care key measurements
• Disease registries to monitor and evaluate patients – not just individually but as a population
• Tracking of chronic disease management for patients with specific diagnosis like asthma
• Information on medical management including appointments, receivables and operations
• Ability to set and compare a practice with national benchmarks
• Ease of accomplishing these analytics on-line and via mobile devices, like a tablet

The best aspect of this comprehensive analytics engine is that it is built on the Microsoft business intelligence products to keep the total cost of ownership down and it can be deployed as a cloud-based solution, if needed. If my response seems too enthusiastic, there are many incomplete or partial solutions for healthcare analytics in the marketplace that solve only one or two key aspects because they lack a measurement engine that comes with 600 pre-built key performance indicators including certified Meaningful Use metrics or Physician Quality Reporting metrics. It is a common complaint fielded by those of us in healthcare consulting: “We know that we collected the data in the EMR and it needs to be combined with cost data to evaluate treatment alternatives or the cost of outcomes.”

I hope Dr. Nash is attending HIMSS 2013 in New Orleans and he can see this EMR 3.0 analytic engine solution in the CitiusTech booth (#4169), the Microsoft booth (#1127), shown as HealthBI, or the Perficient booth (#1555). I believe he will be impressed with how the BI solution addresses his wish list and is available today. Be sure and ask to see the Gaps in Care demonstration as well; it is really state of the art.

Based on the most recent meaningful use statistics published by CMS, the majority of Eligible Physicians submitting MU claims for Medicare have not been paid. Medicaid is only marginally better.

Providers who are shopping for EMR systems must pay attention to the track record of the vendor and investigate claims these systems are MU compliant. Vendors have to conduct an in-depth certification process. Shoppers should expect to see the resulting confirmation from ONC proving EMR systems they are considering have passed this certification. They also should be clear all along what is expected from them to qualify for MU stage 2 reimbursements.Collecting Meaningful Use dollars is difficult but not impossible. It will require the Provider to study and understand the nuances of these requirements and start developing habits that ensure payment well in advance. Providers must shop wisely. The statistics above indicate many systems claim to support Meaningful Use during stage 1 apparently fall short in some way or another. Meaningful Use stage 2 will be much more onerous for both the EMR vendor and the Provider to qualify. This implies the majority of EPs are not demonstrating MU as per the CMS guidelines. In my last blog, I talked about software forcing providers to change the way they practice medicine to qualify for Meaningful Use. Today, I’m sharing some numbers that illustrate the difficulty of getting paid even after all this change.In order to be included in this report, Providers must successfully demonstrate Meaningful Use, and meet the allowable-charges threshold as well as all program requirements to be included in this report.

Meaningful Use Stage 2 requirements will push a lot of EMR vendors out of the market. This is good for Providers since they have fewer choices and far less marketplace noise. On the other hand, many vendors will claim to be stage 2 compliant who are not.

Buyer beware! The Savvy Shoppers will prevail.

Meriter Health Services has long been committed to using information technology to deliver efficiencies and improve patient care. To simplify the important patient-facing elements of care delivery, Meriter uses Epic’s electronic medical records (EMR) software, EpicCare.
The organization recently teamed up with Perficient on the implementation of Microsoft SQL Server 2008 data management software and other technologies in the Microsoft BI stack to work in conjunction with Epic.
Here is an excerpt from the case study describing the solution:

As longtime users of Microsoft Office, Meriter wanted to ensure users’ interactions with the BI tool were a natural part of everyday work. Choosing a Microsoft-based BI solution would also allow the BI experience to be delivered through the existing and familiar collaboration portal, based on SharePoint 2010 – giving users a seamless, “self-serve” environment.
Meriter engaged Perficient to assist with the deployment. Perficient business intelligence specialists worked with the organization to gather objectives, define the scope, and deploy the BI solution to Meriter Hospital’s orthopedics practice and to the Meriter Medical Group, which manages the administration of clinics. An enterprise-wide deployment of the BI solution is slated for early 2014.

The result of this pairing has been a decrease in costs, increased efficiency across the organization, and the ability develop more standardized practices and protocols – a key component of quality. To learn more about Meriter’s use of the Microsoft BI stack alongside Epic, read the case study or watch the video below. You can also read Microsoft’s version of the Meriter case study for additional information.

Who would have imagined ten years ago that many of us would spend hours using a slingshot to fling hacked off birds on a single mission to destroy arrogant pigs? We do this using computers smaller than our dinner plates while sitting on airplanes, park benches, the family room sofa, and sometimes at work. For those of you who have not heard of the game “Angry Birds,” you should make this a goal over the holidays.

The premise of the game is simple. The pigs have stolen the bird’s eggs and they want revenge. Each bird has their own specialty and the gamer has to use these specialties to destroy all the pigs in each scene. If they fail, the pigs laugh at you. If they win, the birds celebrate. Each scene gets a little harder to complete creating the addiction.

Last week, I was part of a conversation describing physicians in much the same way. They are angry because they spent a lot of money to purchase an EMR solution that qualifies for Meaningful Use only to find the system forces them to change the way they practice, doesn’t meet all their needs, or isn’t going to be upgraded to meet Meaningful Use stage 2 requirements. We concluded many independent physicians are ready to find something better but they are afraid of losing their current investment of having to spend a lot of time and money migrating to a new system.

This is comparable to Angry Birds. It starts off easy then gets more frustrating. First, the physician uses paper to run their practice. This seems easy enough and has worked well for a long time. Soon the payers impose reporting and other rules that limit their freedom. Then the government steps in with new requirements. Unlike the payers, the government dangles a carrot in the beginning to feed the addiction. Pretty soon, the physician spends hours every day in unproductive time trying to eliminate their version of the pigs -the requirements.

Most software companies create something that is easy to develop, but does not readily embrace the actual business procedures. Their solutions work in theory but are often clumsy, sometimes impossible to fit into a physician’s business practice. They are closed systems that make it difficult to get data into and out of them, and many do not share information with related systems such as practice management or electronic prescription (ePrescribe) systems.

There are solutions on the market that address this. These are designed by architects who first understand the physician’s business and then create software to address these needs. These companies are intuitive enough to reverse the industry trend and design solutions that start with the business processes. There are not a lot so far, but they can be found with a little effort. Instead of angrily fighting the pigs, physicians can find these businesses and remove a lot of their angst. They should look for the following:

• A track record and testimonials of successful solutions
• Architects with actual healthcare industry experience
• Developers who understand the nuances of healthcare
• Companies who have practicing physicians who are directly involved in the design

Angry Birds is a game. Angry Doc’s is a tragedy. It doesn’t have to end this way.