Kaiser's Epic Project, VeHU, and Customer-Extensible EMRs/EHRs

I received an email narrative from Dr. Bob Miller who is the Director of Pathology Informatics at Johns Hopkins. It was full of very useful information so I am posting it below as received. I am sitting on some other emails from him in a similar vein that I will also post in upcoming days. (BAF)

I recently got a copy of the book that Kaiser just published about their multi-billion dollar Epic deployment: [Connected for Health: Using Electronic Health Records to Transform Care Delivery]. Unlike many similar tomes, which typically contain theories and grandiose plans, Kaiser's book contains hard facts and descriptions of what they have actually accomplished.  I would encourage you to look at a copy.

I had a fascinating time a couple of weeks ago attending the VA's "VeHU conference" in Las Vegas. The VeHU is their VistA EHR yearly technical and team-building conference, which they allowed outsiders to attend this year for a small fee for which 2010 content is just now being readied. There  was no conference last year.

The Conference lasted four days at Caesar's Palace: 2,000 attendees, 180 technical presentations; 150 vendors, and 140 posters from VA sites. The plenary sessions that were at times reminiscent of revival meetings and/or a rock concert. Excellent and informative technical sessions; and I found I was there from 8 o'clock in the morning until 7 o'clock at night.

I attended not so much to learn about the VA's technology, which I already know a lot about, but rather to hear about the VA's organizational processes and values -- some of which we may have to adopt if we are to succeed with a monolithic "One Patient, One Record" system (i.e., Epic).

Each VeHU attendee carried a Nintendo console-like SpotMe device that was used with RFIDs for recording attendance at sessions, and for finding other attendees by RFID "ranging".  Cool technology which the Caesar's Palace technical folks said maxed out their conference area wireless infrastructure.

I am beginning to refine my thoughts on "customer-extensible (programmable) EHRs", of which the VA and Epic are quintessential examples.  Also, I am learning more about Cerner system extensibility using Command Language (CernerCCL) -- which you know much about; and Eclipsys'...ObjectsPlus and other extensibility mechanisms.

Kaiser and the VA are a way ahead of everybody else -- including joint NHIN projects with the Navy at San Diego and Norfolk and their EHR accomplishments are convincing me that "EHR-extensibility" is a critical success factor. And I am believing more and more that the generalization also applies to health care, "Organizations that make strategic use of IT are all writing software -- at least at some level."

Comments

[Art_Vandelay]

I agree with your thought that extensible EHRs are a critical success factor for larger organizations. Most vendors have some form of extensibility, some better than others. Epic has SmartForms, SmartText, Note Writers and extensibility points. Eclipsys has ObjectsPlus and a pretty rich API. Cerner has CCL along with Millennium Objects (their API). McKesson has a Portlet Model and iForms. Kaiser is creative with their data and data marts - in essence, registries. Much of Kaiser's work is actually custom outside of Epic. Epic does have a strong partner with Cache at their core and especially if paired with the Ensemble Integration Engine. I believe the future will be with flexible enterprise clinical data repositories linked with a forms/workflow engine to fill-in the gaps of the EHRs. Loose coupling is the real key and linking with a well-established and stable API. One has to be careful not to CCL, ObjectsPLus, SmartForm, extensibility point, etc. their way out of upgrades and they also need to be sure the vendor isn't already writing something into their upgrade path. It is a real challenge to pull something out once it has some momentum and then work back towards the vendor's "vanilla flavored" option. Great Post!

[Mark Metzler]

Here is a useful new website you might want to consider:

Biomedical Device Integration Tech Corner
http://bmdi-tech-corner.com

"An archive of technical documents, protocols, standards and procedures useful for clinical engineers and IT professionals involved in biomedical device integration and connectivity to electronic medical records (EMR)"

[Software Web App Development]

2,000 attendees, 180 technical presentations; 150 vendors, and 140 posters from VA sites....it is quite big to manage application flow.