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Patient portals create interoperability puzzles

How mobile operating systems, EHR vendor interaction and health system implementations complicate patient portal interoperability.

KSF Orthopedic Center was an early adopter of patient portal technology, the patient-to-doctor communication programs that are at the heart of the nationwide push toward electronic healthcare systems and bedrock for ONC's patient engagement initiatives driven by meaningful use.

When KSF installed its first patient portal three years ago, the program was called "Medfusion," the brainchild of North Carolina entrepreneur Steve Malik. But soon Malik sold the company to digital consumer finance software giant Intuit Inc., which renamed the portal "Intuit Health" as it grew and developed its features and interface.

Malik bought his company back from Intuit in 2013.

Customer happy it's back to Medfusion

Kevin Harris, IT director of the 10-doctor Houston orthopedic clinic, is happy to have it back and pleased that the words "powered by Medfusion" are on the KSF-designed user interface that patients use to view their medical records, request appointments and send secure messages to their doctors.

Medfusion puts everything on their end. It provides a lot of ease.
Kevin HarrisIT director, KSF Orthopedic Center

"Now it has that Intuit 'click, click, click,' but it's got my website layout and color scheme," Harris said. "Intuit picked it up and made it pretty, and it's still pretty. It was a really good ride to be on.

"But we're really lucky to be back [with Medfusion]," Harris added, saying the connection with a smaller company seems to offer more responsiveness. "Now I can get Steve Malik on the line when I need him."

Medfusion hews to same strategy

Malik not only rebranded his original portal with the original name, but he's also sticking to his strategy of being a third-party add-on -- an alternative to the big EHR systems that come bundled with proprietary portals, such as Epic Systems Corp.'s MyHealth.

For Harris' part, he said grafting Medfusion to his GE EHR was easy, taking all of 90 minutes.

Another route is that taken by other big EHR vendors is to acquire a competing EHR that built its own portal, such as Malik's former business partner, Allscripts Healthcare Solutions, Inc. Malik hit Allscripts with a lawsuit after it bought Medfusion competitor Jardogs, LLC. Malik alleges Jardogs owes him several million dollars for breach of contract.

Allscripts uses Jardogs' FollowMyHealth to power its portal, just as it used to use Medfusion.

Harris' clinic uses GE's Centricity EHR system but has declined to use GE's built-in portal because he says he likes how Medfusion works more, particularly how Medfusion hosts the portal on its servers, relieving stress on his own servers. Harris noted that GE has worked amicably with Medfusion.

"Medfusion puts everything on their end," he said. "It provides a lot of ease."

When portal developers, vendors tango

Malik, in an interview with SearchHealthIT, applauded Intuit's stewardship and focus on consumer ease of use, for which Intuit products such as TurboTax and Quicken are famous.

"Intuit is a great brand," he said.

Malik said Medfusion's core market is now physician practices but the company "will continue to move upmarket" to larger healthcare systems such as accountable care organizations.

Malik continues to tout his device- and operating system-agnostic approach. His company, he said, focuses on simple implementation of Medfusion with any EHR.

He's also not reluctant to take shots at Allscripts, even with a lawsuit pending.

"We had a contract they didn't abide by," he alleged. "Frankly, they weren't paying us."

Meanwhile, Malik is aggressively pursuing many of the physician practices that are Allscripts customers that once used his portal, in an attempt to get them off FollowMyHealth and back on Medfusion.

"In regards to Medfusion, Allscripts does not respond to outstanding litigation," Allscripts spokeswoman Concetta DiFranco said in an email. "Our focus is, as always, on our clients and providing them with the best possible population health and healthcare information technology solutions."

Patient portal implementation can be complicated

Phil Kahn, interim CIO at UMass Memorial Health Care in Worcester, Mass., an Allscripts-Jardogs customer, said integrating any patient portal into a big organization like UMass Memorial sometimes is a challenge when it comes to making it work easily on iPhones and Android devices and across different operating systems. He also said that interoperability complications crop up in other health data systems besides EHRs; they're not confined to mobile devices and patient portals.

That being said, Kahn said FollowMyHealth works well with the Allscripts EHR and its secure messaging function has made it easier for the hospital system to attest to meaningful use stage 2 patient portal measures.

Let us know what you think about the story; email Shaun Sutner, News and Features Writer, or contact @ssutner on Twitter.

Next Steps

Patient portals could help engagement, reduce liability

Patient portals help providers meet stage 2 criteria

CMS releases meaningful use stage 2 attestation stats

This was first published in August 2014

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