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Allscripts, Northwell Health to build next-generation EHR

Northwell Health CIO John Bosco's vision for the EHR includess artificial intelligence, voice recognition and the cloud.

An EHR vendor and a healthcare system have teamed up to build a next-generation EHR, one that uses advanced technology and is based on feedback from physicians and nurses.

The goal of the new EHR will be to address issues physicians experience with EHRs today. John Bosco, CIO at Northwell Health in New York, said that includes time spent on data entry, clunky navigation and the overwhelming amount of medical information presented.

"We are still on generation one of EHR systems, and physicians across the country are still struggling mightily to use them," Bosco said. "Health systems are struggling with how complex these systems are to deploy and how expensive they are to maintain. So we think it's time that someone begin working on a next-generation EHR that addresses all of the issues and challenges that physicians have with today's systems."

John BoscoJohn Bosco

Northwell Health, New York's largest healthcare provider, will be working with EHR vendor Allscripts Healthcare Solutions Inc., to build a next-generation EHR that incorporates input from physicians, nurses and other medical experts at Northwell and relies on an infrastructure that includes voice, clinical decision support, artificial intelligence and machine learning.

The Northwell, Allscripts alliance

The Northwell-Allscripts partnership to build a new EHR started unofficially last year.

Bosco saw the beginning of the new EHR Allscripts was working to build and was drawn to the EHR's "strong technology underpinnings," including the technology it would feature such as AI and cloud. The product was immature, but Bosco said he saw its potential and wanted in.

We think it's time that someone begin working on a next generation EHR that addresses all of the issues and challenges that physicians have with today's systems.
John BoscoCIO, Northwell Health

He approached Allscripts executives with an idea: "You can bring the software development and project management expertise to the table, and we will bring the intelligence and expertise of our clinicians, physicians, nurses and other folks that are involved in running ambulatory practices," he said. "We'll bring them all to the table and together we'll firm up a vision for what a next-generation EHR should look like."  

Kim Franks, vice president and general manager of consumer health at Allscripts, said partnering with Northwell to build out the next-generation EHR was a "no-brainer." Allscripts, one of the top EHR vendors in the market alongside companies like Cerner and Epic, wanted to develop a product from the perspective of a clinician, and Northwell, with a medical group of 4,000 employed physicians, was a natural fit to provide that input. Northwell Health is also Allscripts' largest customer.

"They have thousands of providers, and they have a very strong system with a usability lab that already exists today that we could leverage to get feedback," Franks said.

The next-generation EHR from Allscripts is focused on infrastructure. Franks said the vendor researched the problem of physician burnout often linked to issues with EHRs. One of the problems Allscripts homed in on is that EHRs are often built on 20- to 30-year-old technology, she said.

Legacy technology makes it hard to take advantage of new technologies, according to Franks. Allscripts believed a new EHR platform built in the cloud would not only be more nimble but could "adapt easier to changing healthcare needs to give providers and clinicians what they need when they need it," Franks said. The platform also uses an alternative to the relational database for storing EHR data, she said.

"We spent several years working on the technology and the infrastructure," Franks said. "It's largely been a development-led effort up until this point and now we're ready to pivot our attention and make it more clinician-focused."

New EHR faces challenge of over-customization

This is not the first time an EHR vendor has tried partnering with a health system, and the results haven't been good, said John Moore, founder of Chilmark Research.

In 2005, GE Healthcare partnered with Intermountain Healthcare to build out GE's Centricity EHR. The more than 10-year effort proved fruitless, as the relationship between the two entities eroded. Intermountain left GE in 2013, opting for the Cerner EHR over GE's Centricity. In 2015, GE announced it was leaving the hospital EHR business.

Moore said because he's seen other health systems and EHR vendors work together with little success, the most important thing will be whether the Allscripts next-generation EHR can be adopted outside of Northwell, something he said he believes the EHR vendor recognizes.

"There's a lot of potential for over-customization in these types of relationships that Allscripts has to be pretty careful about," Moore said.

Northwell's Bosco views the relationship with Allscripts as long-term and said the purpose of the partnership is to develop a commercially-viable EHR, not one specifically built for Northwell.

"This is not a situation where we're going to create something and once we're done, we're done," Bosco said. "This will be something that will go into some of our practices, and then eventually, hopefully, into all of our practice. Then going forward, we will be the flagship site. We will be the place Allscripts can bring prospective customers to see the system and touch the system."

Vision for next-generation EHR

Allscripts will initially focus the new EHR on the ambulatory space, Bosco said.

One of the first issues Bosco wants to address is the amount of time clinicians spend entering data into a patient's EHR. Bosco said a next-generation EHR should be voice-enabled so that notes can be captured as clinicians interact with a patient.

"Given how voice technology continues to improve in many aspects of our lives, we think those same concepts need to be put into how a physician interacts with an EHR," he said.

Bosco also wants to focus on making EHRs less clunky so that physicians can access the information they need quickly. Bosco's vision is a simplified, modern graphical user interface that will make it easier for physicians to navigate the EHR.

The amount of information physicians are presented within an EHR is another issue Bosco wants to tackle, and this is where he believes artificial intelligence will come into play. Bosco wants to replace the time clinicians spend sifting through a "trove of medical information" with an AI algorithm that will find relevant information while the patient is sitting in front of them.

Additionally, Bosco envisions the EHR platform will use machine learning to learn a clinician's preferences so that the experience can be personalized. He believes AI and machine learning capabilities can go a long way in supporting a clinical decision-making framework, a tool he thinks is inflexible and immature today.

"There's a lot of evidence out there and suggestions that systems could be making to physicians, more so than they do today, on potential considerations for treatments and plans they're coming up with for the patient," Bosco said.

Because the next-generation EHR will also be cloud-based, the time and costs associated with supporting and maintaining the EHR will decrease, he said.

In addition to the underlying technology, Bosco believes the level of influence clinicians will have in development of the EHR will be a differentiator.

"Every EHR vendor likes to say this was designed by physicians, for physicians," Bosco said. "Then you find out they had very few, if any, physicians actually in the company. We expect this to be very heavily influenced by our clinicians on an initial and ongoing basis."  

Getting the new EHR to market

While Bosco lays out a promising vision for the next-generation EHR, making it happen could take years.

Bosco said the initial goal is to create a minimum viable product, or MVP, within the next 18 months to be installed in some of Northwell's physician practices. The MVP will provide the "platform and the mechanism" for continuous improvement.

"It may be several years in the making, but right now we don't see any other big players looking to do anything disruptive," Bosco said.

Moore, with Chilmark Research, said based on the time it takes to develop, test and pilot a new product like an EHR, it could be anywhere from five to seven years before the new Allscripts EHR makes it to market. But that's not a bad thing, he said.

By the time the new Allscripts EHR is available to the broader market, Moore said it will likely be at the beginning of a cycle when providers assess the EHRs they have and decide whether to stick with their current vendor or make a change.

Not every health system will go through that cycle, but Moore believes a significant enough percentage will to make it meaningful for Allscripts.

"By the time this one actually gets developed and ready to be deployed in the market, the market will be ready for something new and something more dynamic, something that will probably be a mobile-first developed strategy and voice-enabled and with built-in AI right inside it," he said.

Other EHR vendors are working to create next-generation EHRs for the market. Unlike Allscripts, the vendors are building out a product they already have, not starting from scratch. Epic already offers a cloud-based version of its EHR, and, this year, Meditech and Cerner announced partnerships with public cloud vendors Google Cloud and AWS. The move aims to make EHR support and maintenance easier and less costly, as well as to provide additional cybersecurity tools. EHR vendors are also thinking about EHRs on mobile devices, such as Meditech's latest EHR version Expanse, which takes a mobile-first approach.

Bosco said he understands that getting a healthcare system to switch to a new EHR would take a big value proposition. Yet he believes the proposition of a truly clinician-driven EHR will make the move worthwhile.

"We know that's expensive for them, it's disruptive for them, it's not something they want to do," Bosco said. "But we think if we can show them a system that will make them more efficient and more effective and have a lower total cost of ownership over a period of years than they have today … I know if somebody came to me today with that value proposition, we would absolutely consider it."

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