The dream of one enterprise system for different applications has not exactly turned out the way many in the industry had hoped. Though some core vendors offer limited accessibility to their own clinical offerings in one screen, hospitals have too many standalone clinical applications and not enough integration functionality.
While physician portals can tie many of these applications together, a more complete solution that some are embracing is aggregation, which brings information together and places it at a user's fingertips without multiple sign-ons or screens. And because aggregation solutions are vendor agnostic, they can combine and deliver patient information from multiple sources in a standard format, relatively easy to compare and analyze.
“Having all the information in one spot just makes sense,” says Marcus Bost, CIO of Adena Health System, a two-hospital system in Chillicothe, Ohio, who is using a portal aggregation solution from Medseek (Birmingham, Ala.). “You couldn't imagine having to look at the stock exchange and going to 16 different screens,” he says. “For us to be catching up to other industries is the long-delayed transformation in healthcare.”
And as hospitals go to pay-for-performance and get fed new information and protocols, most feel that information is going to be the lifeblood of healthcare, just as it is for other industries.
Larry Stofko, senior vice president and CIO of 14-hospital St. Joseph Health System in Orange, Calif., is an early adopter of Amalga, Microsoft's (Redmond, Wash.) aggregation solution. He says that information from these IT solutions fills the needs of a changing healthcare system. “The paradigm used to be data into information, and then into knowledge,” he says. “What we're doing now is taking it a step further - data into information, to knowledge, and now, to action.”
Recently, Orem, Utah-based KLAS examined available aggregation solutions that provide a single view of clinical data from disconnected systems and interviewed hospitals to see how aggregation vendors are delivering on the promised benefits. According to KLAS, from a functional standpoint, dbMotion (Pittsburgh) and Microsoft are in one peer group, while Carefx (Scottsdale, Ariz.), Medicity (Salt Lake City), Medseek (Birmingham, Ala.) and PatientKeeper (Newton, Mass.) comprise a second group.
“This is a new area that's gaining a lot of traction really quickly,” says Chris O'Neal, director of corporate reporting at KLAS, and a principal author of the report. “Though only 85 hospitals in the U.S. are currently using aggregation solutions, there is a lot of interest.”
The Microsoft and dbMotion peer group markets platforms that, in essence, can replicate the databases from 100 or more systems by aggregating on the back end - and Microsoft also offers the capability to integrate with its HealthVault personal health record (PHR). According to the KLAS report, while vendors in the other peer group have shown the ability to connect with a handful of primary and secondary systems, they still have challenges in branching out much further. Though they do a satisfactory job of aggregating information, they act more like physician portals. So with such a range of function, is there any one clear winner?
While each solution has its pros and cons, in the end it comes down to the healthcare system.
“It really depends on the customer, and what are their goals,” says O'Neal. Large hospital systems with huge quality initiatives want to do business intelligence reporting in addition to aggregating data across the IDN for physicians, and for these, O'Neal says an Amalga or dbMotion makes sense. “The value of solutions like Amalga only increase over time,” he says. “But if you look at a small hospital that's been on its core clinical for years, it may be important to them to save their money and go with one of the other aggregation solutions.”
What kind of money? The purchase can run to $1 million for Amalga, while one of the portal-like solutions can run about $200,000. And, adds O'Neal, no one knows yet what add-ons might cost for a solution like Amalga.
Though cost is one factor, it's not the only one, says Jeremy Bikman, vice president, research and strategy at KLAS. “When you factor in the level of IT strength in an organization, budget, where they are with IT adoption, executive support and advanced clinicians, it really changes the dynamics,” he says. “So where Amalga or dbMotion might be perfect for one client, it might not work for another.”
Bikman says he believes hospitals will have to get an aggregation solution, but what they choose depends on the IT lifecycle at the hospital. “The Partners and the Mayos already have their strategic plan and are moving on to the next thing,” he says.
While his organization is not quite as wired as Partners HealthCare or the Mayo Clinic, Adena's Bost says he is finding that his Medseek solution works perfectly for his needs, and has been driven mainly by physicians. “We're always looking for ways to make our doctors more productive and this was one,” he says. At Adena, 2008 was dubbed, ‘The Year of the Physician,’ and the Medseek aggregation solution was one of the tools Bost introduced.