Integrated Community EHR

This is a Getting Started resources discussing Community Electronic Health Records.

This discussion between Robert Gleeman and Mark Anderson, CEO of the AC Group, Inc. discussing Integrated Community Exchange or an Integrated Community EHR. This interview is also provided as a written transcription below. Click the arrow to play:

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Robert Gleeman:  This is Robert Gleeman at EMR Update. I'm talking today on Casual Friday with Mark Anderson from the AC Group. Welcome again, Mark.

Mark Anderson:  Thanks again, Rob, for having me on today.

Robert:  Mark, as you recall, last conversation we had you were in a cab going to JFK and we talked about the community EHR, the ECR. And now, you say there is another development that you'd like to talk further on that subject about ICE. What is ICE?

Mark:  Oh, we're coming up with another, of course, three‑letter description of what an Integrated Community Exchange would be or an Integrated Community EHR. And when you're talking about IHEs, the Integrated Health Exchange and we talk about EHR.


But now we're saying, with the change in the Stark Law, a lot of times hospitals, MSOs or IPAs are trying to roll our EHRs to multiple physician practices in a community. And many of the EHR vendors really don't meet those requirements.

Robert:  What is the goal and what is the problem?

Mark:  Well, one of the, the goals is to obviously connect to the community physicians in one community setting so that we can share demographics information about the patient, their insurance information. And then, hopefully share some of the social history, medical history, family history, and then through the CDA requirements be able to share allergies, medications, labs, and other things.


The problem has been that most of the vendors will offer an EMR for the whole community that they can share. but it all has to be set up as one database. And that they can share data because they're in one setting. But most community physicians want their own database. They want to be separate. They don't want everybody getting into all of their records. They'd like to have a separate database but be able to share data through some kind of community hub or community portal.

Robert:  And this community hub or interchange, do you see it as a separate server or a separate entity that the different databases would communicate through?

Mark:  It depends on the community. And we've come up with five different descriptions of the community. An example would be, well, Level One would be if all of the doctors are employed by the hospital. That would be like a Level One product, a Level One community. And therefore you really don't need to have a separate product because they're all employed;that there's a way of setting that up.


But then you start looking at what we call a Level Five community where there are some employed physicians. There's a whole bunch of community physicians that do not want to have one database. They all want to have separate databases. Then you do have to have some type of extra product that can either be offered by the same EMR vendor. Or sometimes. they're offered by a third‑party neutral vendor that can actually provide the links to tile the separate products together.

Robert:  So are you saying that this idea of ICE, an Integrated Community electronic record would actually consist of separate databases that would communicate through a third‑party software product?

Mark:  Correct. It could be the same vendor software product. For instance, Noteworthy Medical has a product that allows the community to connect together with separate databases. Nexion has their CHR product that allows the same thing. E‑Clinic Works has their community product that's out there. There are separate products.


There's also vendors, third‑party vendors, that offer products like Axilato Healthvision, Well Logic, Orion Healthcare, that allow multiple EMRs to actually connect in through a community setting. One of the advantages of the community setting though is that doctors that don't have the EMR or the Emergency Room that may not be using it, can still access and view summary information about the patient which makes a great value to them especially if they're not on an EMR or EHR today.

Robert:  Now you've mentioned some of the heavy‑hitter names in EHR. Is there anybody actually implementing this or is it still in the planning stages?

Mark:  No, if you go back and look at the EHR vendors, I know that, I just got off of the phone with MySys. And they talked about a number of their community settings that they have set up with their MySys Connect product. Nexion has a number of locations with their Community Health Record community product. Two of my clients are actually using the E‑Clinical Works they call their EHRS product which sets up the community. So there are a number of community projects out there that these vendors are using.


Then the third‑party software vendors, there's a few, a number of those that are out there. I happen to be involved in a number of them that Axilato was using. And that Health Vision which was creating these community portals. Probably the most well‑known is the Taconic IPA up in New York that's using Health Vision as their connectivity community portal. And then they're connecting in EMR vendors from Next Gen, All Scripts, E‑Clinical Works and GE Healthcare.

Robert:  You know one of the, one of the most frequent problems that we discuss on EMR Update is the doctor who has joined the so‑called community healthcare project through the hospital and now he wants to back out. He wants his data to be separated and given to him so he can have his own EMR, his own set‑up. How does that fit in to what we're talking about with ICE?

Mark:  Yeah. An ICE‑type of product, and again that's just a new three‑letter name we came up with, is designed around allowing a physician to basically sell his practice to somebody else, back out of the community network, move someplace else, because they have their own separate database.

Robert:  Ah.

Mark:  A lot of times it's on a separate, small server that they can all exchange information on. And sometimes what, depending on the, the companies, like I‑Medical allows that with their product where your data can actually be stored locally on your, in your office, on a small server. But you're still accessing all of the information off of the centralized server that can be housed by the hospital, the IP, the MSO.


Or sometimes the actual software vendor will do the housing of the, kind of an ASP offering of the product. But you still have your data backed up in your office. So once of the requirements is that you have to have separate databases that can easily be taken apart if a physician or a physician practice wants to move out of the community.

Robert:  How much standardization needs to be done before this type of system can be widely implemented and shared?

Mark:  There are a couple parts of the standardization. You have to have a community master patient index for identifying who the patient is. There are some great products out there today that do that. All of the EMR vendors actually have that built in.


So practices can have different numbering systems, but when a patient shows up in my office for the very first time, I can look at my database and say, "This patient has not been here." Then I can look in the community database, find the patient, and have it automatically brought in from an interface so I don't have to ask the patient for all the demographic information and the insurance information.


Then if the patient moves and somebody knows about the move, everybody in the community has that new address automatically updated into their system. Or if the patient's no longer eligible, everybody gets that same update no matter where they are.


But the part I like the best is, having the patient fill out the social history, the medical history, and the family history once and having that go to all the doctors.


That's not quite as standard yet today. But through the CDA standard we are able to exchange clinical data, especially the medications and labs and certain other kinds of things. That's a good standard that's already been established vendors participated with [audio interference].

Robert:  Is there still activity in the CCR?

Mark:  I think that a lot of the vendors are still saying CCR, but the reality is that we've moved now to the CDA standard which is the HL7 version of CCR.


The problem, again, is always that a lot of the vendors say they can do it which is nice, but we need to see it at live sites. We need to see exchanging data between multiple EHR products. Not just exchanging between the same EHR, but at different practices. You've got to start with that, but I want to see more live sites where we're actually exchanging data.


That's where the ICE type of communities make more sense. They have multiple databases and will have multiple EMR products like we did up at the [indecipherable] with four different EMR vendors.

Robert:  How far away are we time‑wise from EHR‑implementations, would you say?

Mark:  I think they are being implemented today. Again, there are probably about 50 of these installed and operational. They're not called ICE. They're basically called Integrated Healthe .NETwork or a C Community Health Record.


The problem is that we really needed to define that. Because if it's only one vendor providing EMRs to an employed physician community, that's different from a truly integrated community separate database type of environment.


So we're trying to better define a community setting with multiple community positions, community databases, and trying to call it something. ICE just seemed to be another three‑letter acronym that we could use to help make a difference between the typical 500 doctor owned and employed physician community and a traditional multi‑specialty, multiple practice community that needs separate databases. We needed a new word for that, so we just came up with ICE.

Robert:  And ICE again stands for what?

Mark:  Integrated Community EHR.

Robert:  OK.

Mark:  Think of it as an iceberg with a little bit on top and a lot underneath that we have to actually have to make this work.

Robert:  What makes it interesting is that we're talking about multiple databases somehow communicating. It seems like we're talking about real concrete standards to get that to work, aren't we?

Mark:  Yeah. Again, through a mass community patient index, which are pretty well standard because most of that's driven off the HL7 standard, and the CDA standard for the sharing of clinical data: Those standards are already set for both of of those.


All we have to get now is software vendors that are providing that in live environments. They can start with exchanging just between one EMR, but then again for these community settings where you've got multiple community practices with separate databases, and they may have different requirements.


We need to be able to share data from multiple EMRs, and that's where we are trying to separate those from the traditional community projects that we hear about that are one large multi‑specialty database. Or, in the case of certain communities, one large [inaudible 11:48] where everybody [inaudible 11:50] everything about every single patient.


And then through some kind of security rules, we may be able to protect certain things. The average pediatric practice does not want a competitive pediatric practice looking at their information. We've got to keep it separate. A type of product like ICE, by definition, will help keep those totally separate because they're separate databases.

Robert:  Very interesting. Any question that the doctors should be asking? If they are approached with this idea of a community integrated EHR with separated databases, what is the main thing the doctor should ask and what does he need to know?

Mark:  I think you start with, "Do I have my own separate database? Because I have a separate tax ID."


Can we share information between the multiple practices that are out there with separate databases?


And then again, if I decide I don't want to be part of the community, can I just leave and take my data with me seamlessly, using the same software product?


And if I decide to leave and I want to use a different software product, can I automatically convert all the data I've entered in about my patient to another product?

Robert:  Looking again into the future with ICE.


We're talking to Mark Anderson from the AEC group.


Thank you once again, Mark. Great to have you on casual Friday.

Mark:  Thanks again.

Thanks again to Mark Anderson, AC Group for supporting our Getting Started resources for Doctors Researching EMR solutions.  

For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here.

Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist 
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX  77316
(c) 281-413-5572
(f)  832-550-2338
email: mra@acgroup.org
web: www.acgroup.org