While buying an off-the-shelf EMR solves many problems, it does require hospitals to invest large amounts of capital and spend a long time adjusting the system to clinicians’ needs. For that reason, a number of hospitals are building their own in-house EMR, according to a story in Information Week.
One example of such a buildout comes from Landmark Hospitals, which operates five long-term acute care hospitals. Landmark, which wanted both an EMR and an HIE backbone connecting its properties, wanted to shape the EMR itself. “We found the IT solutions in the open market were not going to meet our needs,” Landmark Hospitals CEO William Kapp told Information Week. “We couldn’t find a solution that made any sense for us and the existing options were prohibitively expensive.”
Kapp and Landmark CTO Joe Morris pulled together an in-house team to build their own EMR. The new product, a cloud-based system with mobile capabilities dubbed Chartpad, provides a real-time stream of vitals, nurse and physician documentation and voice dictation via speech recognition tool Nuance. Landmark used Iguana technology to knit Chartpad and the other EMR systems together, IW reports.
Another hospital which has gone with home-grown technology is Boston’s Brigham and Women’s Hospital, which built an emergency department EMR including CPOE and decision support. The hospital’s Web-based system uses Microsoft .NET on the front end and InterSystems’ Cache database for back end functions.
Yet another example of in-house EMR development comes from the William Lehman Injury Research Center at the University of Miami in Florida, where center director Carl Schulman managed a project which helped the U.S. Army trauma training center meet its needs. The U of Miami works with the Ryder Trauma Center, a part of Miami’s Jackson Memorial Hospital, to train Army physicians prior to deployment, Information Week notes.
Working in partnership with the Department of Defense, a team at the Center developed MobileCare, Web-based software which integrates documentation, education and telemedicine for Army physicians working in the field.
But what about Meaningful Use? Eventually, hospitals that build out their own EMRs have a shot at having EMRs certified. Back in 2011, Beth Israel Deaconess Medical Center became the first hospital to have its home-grown EMR certified as “complete” by the CCHIT. According to CIO John Halamka, the process requires preparation, but it’s doable.
Building one’s own EMR doesn’t make sense if they are just trying to replicate existing EMR solutions and think it’s cheaper. However, the orgs I’ve seen building their own are generally some of the most forward-looking providers who recognize that for entirely logical/rational reasons, the legacy EMRs are built for the legacy reimbursement model. After all, it would be nuts for those systems to have done otherwise.
The forward-looking providers range from a solo MD to much larger, more funded orgs. They have a common thread of building care models that align reimbursement and outcome. This contrasts with the systems optimized for the “do more, bill more” era of healthcare. Eventually there should be off-the-shelf solutions as fee-for-value trumps fee-for-service. Today, most still live in a FFS world so it’s hard for most vendors to justify a fee-for-value centric systems.
Sure, acquiring an EMR “does require hospitals to invest large amounts of capital and spend a long time adjusting the system to clinicians’ needs” if you confine your search to big four vendors who promote their circa-1980 software.
These systems were state-of-the-art back then but today they are “state-of-their-art”.
Who, today, would consider building an equivalent to MS Word in order to be in a position to write letters?
[…] I’ve long had an interest in the topic of when hospitals chose to buy their EHR software versus build their EHR software. In fact, we’ve written multiple times on the subject including Anne Zieger’s piece on “Some Hospitals Still Choosing To Build Own EMR“. […]