As described in this earlier, there exist a number of serious barriers to implementation and maintenance of advanced information management applications in CHCs as well as the difficulties in CHC relationships with vendors and in compliance with regulatory requirements on health data exchange mandated via HIPAA. We have found that most of the sophisticated practice management applications on the market can accommodate special CHC-requirements related to administrative and financial management applications (e.g., sliding fee schedules, robust patient scheduling capabilities, tracking of specific clinical outcomes and UDS reporting) In the bullet list below we describe vendors identified by thought leaders as being of particular relevance to CHCs. We note that more detailed information on these vendors and others is provided as Appendix 2 to this document. Finally, we note that the descriptive information provided here is taken from both thought leader discussions and the vendors own websites. We plan to obtain independent confirmation in subsequent key stakeholder interviews or case studies involving CHCs currently using these systems.
- Epic. Epic is one of the largest and most respected enterprise applications vendors. Epic’s clients are typically very large healthcare provider organizations such as Cleveland Clinic, Northwestern University Medical Center and other large healthcare enterprises. Epic is relevant to CHCs because the Oregon Community Health Information Network (OCHIN) chose to use its software as the basis for its networked practice management system. Part of OCHIN’s success story is the collaboration between OCHIN and Epic to create customized software based on CHC needs and requirements such as family planning and sliding fee scales. OCHIN noted that it would not have been feasible for Epic to have designed CHC-specific customizations had it not been for the aggregated buying power of the OCHIN network.
- Medical Manager. Medical Manager is a product that has historically been used and well-liked by CHCs. Nearly every thought leader we interviewed mentioned the use of Medical Manager at CHCs, and it has been known as one of the small handful of vendors who is receptive to the special needs and challenges of the CHC community. Perhaps the best example of a CHC network using Medical Manager is the Health Choice network in Miami, FL. The company was recently acquired by WebMD who is now marketing the former company’s products as the “Medical Manager System”. Signs of strain between the CHCs and WebMD have begun to show as a result of the transition, according to our thought leader interviews. One thought leader stated that Medical Manager was now becoming too expensive and noted that he encourages CHCs to network in order to be able to purchase it (although he did not make a recommendation as to whether or not they should purchase Medical Manager). Another thought leader stated that “HealthPro, WebMD, and Medical Manager have approximately 65 percent of the market . . . their growth is beginning to show in negative ways as many complaints are coming in from the field.” WebMD has also acquired many other healthcare vendors relevant to CHC HIT including HealthPro, Resource America, Calyx, and Envoy. Resource America and Calyx are not discussed because it appears that WebMD is no longer marketing any of the products that those companies produced. Envoy (now “WebMD Envoy”) is perhaps the most notable of these purchases as Envoy is “one of the largest electronic claims and electronic payments transactions processor in the country” according to one thought leader.
- MDExchange. MDExchange is building what one thought leader termed a “community [master] patient index.” According to literature received from the vendor, MDExchange is a central repository in which care providers (e.g., hospitals, clinics) are able to register the presence of records related to an individual. When a physician accesses the MDExchange system, he/she can query all of the registered records and create a summary patient chart that combines information from multiple care providers.
- MDServe. While not primarily geared towards CHCs (as was the case with Medical Manager), MDServe has worked successfully with CHC networks in Maryland and Texas to create custom functions based on the needs of CHCs. In addition to advertising that the company’s product is “endorsed by the Technology Support Program of the NACHC.” The company offers its own success stories in the version of case studies of three implementations (Arizona, Georgia, and Texas).
- Healthcare Data Systems. One thought leader stated that CHCs in Indiana use one of two vendors: Healthcare Data Systems and HealthPro (see next bullet). While the thought leader praised Healthcare Data Systems’ “knowledgeable and helpful staff,” she indicated that the company may not remain in the market due to market forces (e.g., consolidations and closures).
- HealthPro. HealthPro is an example of one of the best of breed companies that was created specifically to meet the needs of CHCs; the general consensus was that this was good company to do business with because the people who worked there cared about CHCs. HealthPro no longer exists as a company due to being acquired by WebMD. Its product is being produced and marketed by WebMD as “HealthPro XL”. It remains to be seen how long that will be the case as WebMD is said to be steering its customers towards using the new version of Medical Manager. One thought leader indicated that when HealthPro was still in business that they had an unreliable track record with respect to providing quality training and that training costs were high.
- AAFP Open source EMR. The Open source EMR project is being sponsored by AAFP in order to test the hypothesis that an open-source web accessible model for electronic patient record software will markedly increase the use of this technology by clinicians. If successful, the Open source EMR would be made available to anyone who wished to implement it. If such a model is successful, it would likely be an idea candidate for use at CHCs. The most likely way for it to be successfully used at CHCs is in a networked environment; the CHC community could also combine its resources to create a specialized version of the product that incorporated special CHC requirements. At the time of our discussion with AAFP, they were in the process of bringing on practice management vendor partners to develop customized interfaces allowing integration of clinical and administrative data in settings using the Open Source EMR product. Notably, they had not been able to reach such an agreement with Medical Manager.