As one of the main vendors in the ambulatory EHR space, Allscripts has been getting a lot of calls since HITECH moved the market. But in a change from the past, those calls are not only coming from interested physicians, but from hospital CIOs who want to underwrite licenses for both owned and independent practices. As the vendor’s deal with New York's North Shore Long Island Jewish attests, the sale of ambulatory EHRs is, more and more, moving through the hospital CIO's office. To learn more about how HITECH is effecting the sale of outpatient EHRs, HCI Editor-in-Chief Anthony Guerra recently talked with Allscripts CEO Glen Tullman about where he sees the market going.
GUERRA: What would your advice be to hospitals CIOs that want to engage IPAs?
TULLMAN: Well, I think everybody is talking today. I think you have to be going out there engaging in the market, you have to be talking with a variety of players. This is changing, and it is happening in real time. The time is now, and this is happening now. So from that perspective, I would just encourage people not to sit back.
GUERRA: Epic wins a lot of deals because they can offer both acute and ambulatory products. How do you feel going forward with just having the ambulatory piece?
TULLMAN: Epic touts one system and, in fact, they’re very much fighting integration. But we all know that the ability for a hospital to own every practice and every system, that’s just not the American way. I mean, go out in the market, is everybody going to be forced onto the Epic system? I don’t think so. So we think a better strategy is to integrate with what people have. They aren’t going to go and rip out all the Cerner systems to put Epic in. That’s not realistic. So we work with, and we are willing to work with, anyone and everyone to integrate our systems. Why? Because it’s better for the patient and that’s what healthcare ought to be about. So the Epic philosophy of, “We are going to force people to use Epic and just use one system,” that’s their philosophy, but I don’t think it fits with where the country is. So I see us as a country saying, “We have a variety of systems out there, and we’re going to have those systems in place for years and years, and we have to fix healthcare now.”
GUERRA: What do you mean when you say Epic is very much fighting integration?
TULLMAN: Their philosophy is not to open up their system because they want to force people to buy only Epic, and they make it very hard to change information, to share information and the like. Whereas all of the other major systems are working cooperatively, they’re the exception.
GUERRA: Have you ever dealt with a hospital that had Epic as an inpatient system and wanted Allscripts as their ambulatory solution?
TULLMAN: I don’t really think that’s happened, but I couldn’t tell you for sure. I would just say, generally, they are known in the market for being very, very difficult to work with.
GUERRA: What are your thoughts on where certification is going?
TULLMAN (who is a member of the CCHIT Board of Trustees): Well, first of all I think that right now the general thought is that CCHIT is just in the process of publishing some guidelines now, and that they will be the certifying body. The government has left open the ability to have others. I don’t think that’s a good thing. I think having multiple standards is kind of like VCRs and Betamax. That caused a lot of havoc as opposed to having one standard. Let’s have people compete on the quality of the systems, as opposed to which standard they’re using. So we’re big supporters of CCHIT, we’re big supporters of one standard for the market, and we’re supporters of increasing those standards to make it tougher on the vendors.
We ought to force interoperability, within 18 months all systems should be able to exchange information in a CCR or CCD format, we ought to have minimum requirements that are very tough in order to get the taxpayers’ money. What the taxpayers are investing in is helping us to get better information, and we have to get that information, we have to be able to communicate that information, and share that information. So that’s our position – use CCHIT, make it tougher on the vendors by increasing the standards, force interoperability within 18 months or 24 months at the latest, and help us build a connected system of health using information technology.
GUERRA: My interpretation is not that they’re proposing different standards for different certifying entities, but one set of criteria from HHS or CMS.
TULLMAN: I think there’s a lot of discussion around it. At least the initial conception was there could be two or three bodies that did certification. What that would set up is vendors might choose to go to one certification body or another, which again, we think doesn’t make a whole lot of sense. So we’re pleased that, at least initially, CCHIT looks to be the sole body to do the certifications. We’re hopeful that happens.
GUERRA: What products do you plan on getting certified by whatever entity winds up doing it? Do you plan on supporting all of your software, including the Misys products?
TULLMAN: Right now, we’re trying to see what the final standards say. We have a number of different products that are certified today, that meet CCHIT standards. We’re going to see what the new standards are, what they require. We have three different products, an enterprise product for the largest users and integrated delivery networks and academic medical centers, a mid-range product for multi-specialty groups called Professional, then a product for the independent physician practices; one or two or five docs, and that’s called MyWay. Each of those three products we expect would meet certification, and those are the go-forward products in our strategy.
GUERRA: Are the Misys products included in that?
TULLMAN: Yes, depending on which Misys product. Remember, Misys’ biggest footprint is 110,000 practice management users. That’s the biggest part of the Misys base. All of those practice management systems are being supported. The question is on electronic health records, which electronic health records those Misys users will choose, and we are going to work with them to choose the ones that are best. For those folks who have a Misys electronic health record, we’re working with them closely to upgrade them to whichever of the solutions we have that fits best.
GUERRA: How do you retain as many customers as possible while switching them from one product, or version of a product, to another?
TULLMAN: Well, first of all we are investing a lot to make sure that the upgrade is seamless. I’ve used the example of switching cell phones, it can be painful or it can be easy, and that has less to do with the technology. It’s more to do with what’s the process surrounding it. If you heard on our call, we’ve invested millions of dollars in a program called Ready. Ready speeds not only implementation, but it helps to create, essentially, a factory approach for upgrades that says, “Look, we’ll get all your data upgraded, we’ll switch all your data instantly.”
So from that perspective, one, you never want to lose any customers – you make it easy. Second, keep in mind that in this economy, the idea that a physician practice is going to rip out a practice management system – that there is no stimulus dollars to replace – to put in a new one is really, really small. They just aren’t going to do it. What they want is to upgrade on top of that with an electronic health record, and if you go to the small practices, and that’s the predominant number of the Misys base. I always joke that they want one throat to choke, they want one number to call. They don’t want a practice management system from us and an electronic health record from someone else, because then when something breaks, everybody points fingers at the other guy. They want one system. Well, we can provide that and we do. So we’re working hard, we’re highly confident that we won’t lose customers and, in fact, we’ll gain a lot of customers.
GUERRA: I heard that the Version 11 initiative didn’t go quite as well as you might have hoped. What can you tell me about that?
TULLMAN: Well, we had the leading industry product in Version 10 and when we contemplated Version 11, we wanted to be able to take healthcare to the next level. Let me give you an example. In Version 11, when a physician enters a diagnosis, the system checks to see if there’s a clinical trial, and then pops up a message to the physician to say, “Did you know there’s a clinical trial for this patient?”
Now, that’s pretty fascinating because I’ve been in a situation where a family member missed a clinical trial because, even though the physician was very good, she told me that she couldn’t possibly track all of the clinical trials that were out there due to all the inclusion and exclusion criteria. But now, this new software really does information-enable physicians. It gives them the information they want. I mean, think of a system that would basically Google and answer all your questions if you’re a physician in real time. So that’s the good news.
The challenge is that when you have all those engines triggering searches and the like, that takes a lot of power. So if you put Version 11 in and you hadn’t upgraded all your servers and the like; it’s going to run slower. That would be a typical problem that we had. Similarly, Version 11 was very configurable, and so what people loved about it was you could do almost anything with it. One of the challenges when you put a product out there that allows users to do anything is that they actually do anything, and that makes it tougher to train on and tougher to service and the like.
So we had some challenges because of the power of the technology. It’s kind of like if you give a young person a racecar, and then you’re surprised when they get a ticket. They say, “All I was doing was doing exactly what you told me I could do with it.” So we had a little bit of that challenge. We’re over it now. Version 11 has made great progress, and I think people are doing some very compelling things with it.
GUERRA: I’m just wondering what the take away from there is. Is it, don’t give the kid a sports car, or when you give him the sports car, spend more time telling him how it needs to be used?
TULLMAN: I think it’s the latter. I think the lessons learned are, one, we want to give our users as much information and power as possible. There’s no question about that. But we could have been more prepared in educating the base about how to use it. Two, was to do a better job of educating our own people of how to train for it. So there were a lot of lessons learned and, as I said, people say, “Well, would you do it again?” Absolutely, because Allscripts is a leader in innovation, and if we don’t innovate who’s going to do it? I don’t see our competitors doing it.
We were the first to bring out our system on the iPhone, and then on the BlackBerry, and then on the Windows mobile device. We were the first with the sophisticated kiosk and on and on. We were the first with some of the sophisticated decision support. So each one of these breakthroughs didn’t work perfectly the first time around, but that’s part of the innovation process. Healthcare needs more innovation, not less.
It’s like if you have an iPhone, some people complain about aspects of the iPhone, and then you say, “Why don’t you use something else?”
“No, I wouldn’t give that up,” you say.
So it’s the thing we all deal with technology.