Top EHRs 'interfaced,' not integrated

Many leading electronic health record vendors claim their ambulatory-care and hospital systems are integrated, but most are actually interfaced "under the covers," health IT consultant Vince Ciotti (pictured) tells FierceHealthIT in an interview. This applies to almost every vendor that developed either a hospital EHR or an ambulatory-care EHR and then acquired an EHR in the other sphere.

For example, Allscripts' ambulatory-care products are leaders in that field, just as Eclipsys' are in the hospital market, says Ciotti, a principal of H.I.S. Professionals, LLC, based in Santa Fe, N.M. Likening Allscripts' purchase of Eclipsys last year to a "shark swallowing a whale," Ciotti says, "If you're a hospital that uses Eclipsys, you're probably not going to start forcing your physicians to convert to Allscripts, and vice-versa. They're unrelated products, written by different programming teams, for different markets. They have no true integration like Epic and Cerner do, which alone run on the same hardware platforms and data bases."

The same is true, he adds, of physician practice EHR maker NextGen, whose parent company, Quality Systems, acquired inpatient EHR vendor Opus in 2010 and hospital financial management vendor Sphere in 2009. NextGen claims its EHR is integrated with the two hospital information systems, Ciotti says, "but the three run on totally different platforms and databases." They're all good in their niches, but they're independent systems, he adds.

Meditech, one of the largest HIS vendors, is trying to improve its interface with LSS, an ambulatory care product designed by ex-Meditech programmers. Although the two EHRs use the same "Magic" proprietary OS and programming language, Ciotti says, LSS "looks nothing like Meditech's screens."

At the HIMSS conference this past February, Allscripts demonstrated what it called "native integration" between the Eclipsys EHR for acute-care hospitals and the Allscripts Professional and Enterprise EHRs for physician offices. But Ciotti insists that this is primarily " integrated marketing." The two companies' EHRs were designed over many years by programmers totally unaware of each other's work, he says.

Nevertheless, Ciotti doubts that John Gomez's departure last week from Allscripts, where he was chief technology officer, had anything to do with the inability to integrate Allscripts and Eclipsys. Rather, he says, it's probably just a typical example of what happens at the executive level when two companies merge.

Ciotti adds that Allscripts and Eclipsys likely will create the best interface they can, but doubts it will be as effective as an integrated EHR. Doctors who go from their office to the hospital will continue to see a different screen and have to navigate the EHR in different ways to obtain information.


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