How to bring innovation into commercial EMRs

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BOSTON—After years of developing their own EMRs and innovating within those systems, many healthcare institutions are leaving their homegrown systems behind and turning to commercial EMRs. In a session on “Homegrown Innovation in Commercial EMRs” at the AMDIS 2014 Fall Symposium, Jonathan Teich, MD, PhD, CMIO at Elsevier, posed the question: “How do we take some of the actual philosophy and spirit and innovative work in this homegrown environment and bring it into a commercial EMR?”

In 1993, Brigham and Women’s Hospital in Boston implemented the Brigham Integrated Clinical System (BICS), which has since been regarded as one of the most functional information systems in healthcare.

According to Adam Wright, PhD, associate research scientist in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital (BWH) in Boston, and senior medical informatician in the Clinical and Quality Analysis Department at Partners HealthCare, the feeling at BWH over the years was that there was really no need to consider transitioning to a commercial system because “there was nothing that had CPOE quite as good as BICS.”

“You can imagine my nervousness when there started to be rumblings that we were about to do something different,” Wright told his AMDIS audience. It turned out that there were several different options on the table—either continue to develop BWH’s own EHR or go with a commercial system like Epic.

BWH has decided to go with Epic, leading Wright to ask himself, “How am I going to do informatics research and innovation in this system?” Over time, he said, as he learned more about Epic, he has become “increasingly optimistic” that there are “neat” ways to do innovation within the Epic system.

Wright said that BWH and Partners have taken several steps—beyond getting software in place—to encourage innovation within the Epic system.

The first step, he said, was the creation of an innovation council as one of the four councils governing the implementation of Epic. “What was neat to me was that innovation was one of the top level committees or principles, so that at least from the leadership there was a serious desire to continue to innovate within the system,” Wright said.

Among the recommendations that have come out of the committee, Wright said, was one creating a dedicated innovation copy of Epic—a separate copy of Epic that will allow innovators who want to prototype a new idea in the system to build the idea out and test it in a laboratory setting in real time. “This will sort of prove there is value in it before we decide to make an investment to move it into our main environment,” Wright said. “We think that will be a tool that will be helpful for allowing a sandbox for innovation without interfering with the very aggressive timeline we have to do the production and implementation of Epic."

In addition, Wright said, BWH and Partners have devoted a substantial number of technical and analytics personnel who will be working on innovative activities and approaches.

“We’ve also created a set of areas we call fertile fields,” Wright said. “These are areas where we think there are significant opportunities to innovate. We are trying to create a zone where people who are interested in innovating but may not have all the technical skills needed to do an innovation could work.” For example, Wright explained, if a nurse or physician comes forward with a new paradigm for clinical documentation, he or she could approach this fertile field management group and get the technical and analytics resource support necessary to develop this new innovation.

Adam Landman, MD, CMIO of health information innovation and integration at BWH, pointed out that while EHRs are being widely implemented, “there are tons of opportunities to innovate outside of the electronic health record.”

“We are really seeing the emergence of tons of novel health IT tools,” he said. “And the staff I work with, the clinicians, the researchers—our innovators—are very excited about this technology, and come in daily with new ideas.”

The challenge, Landman said, is that many of these innovators and vendors are unfamiliar with implementing health information systems. It can be a particular problem when it comes to issues of privacy and security, he pointed out, since many of the innovations proposed by physicians don’t deal adequately with those issues and won’t meet the privacy and security requirements of an organization like BWH.

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