Can AllScripts & Eclipsys Integrate?

A Reader Asks ...

“From a technology point of view, how difficult will it be to truly integrate the Allscripts ambulatory product/s with the Eclipsys inpatient product/s. How long might it take?”

Vince Ciotti, Principal, HIS Professionals

Good question, and complicated answer:

If you define “integrated” as systems running the same programming language, operating system, data base, and hardware platform, then AllScripts will never truly integrate all of their products with Eclipsys’. True integration would mean re-writing every product from both firms to be on the same database, OS, servers, etc., something that even Eclipsys didn’t do with the many (fine) products they bought over the years to build their Sunrise suite, to whit:

• SDK’s Patient Accounting
• BICS clinical alerts system
• Emtek’s Critical Care System
• Simione Central’s Home Health Care
• Intelus’ document imaging
• HealthVision’s Orders/Results
• eSys’ Radiology
• MediNotes ambulatory EMR
• Etc.

Give Eclipsys great credit for their “XA” version of Microsoft’s .NET, that does make interfacing them much easier, but go on a site visit to see these many apps in operation, and you’ll think you’re in a “Best of breed” shop.

To be fair, by that same strict definition, there are few, if any, vendors in the entire industry who are totally integrated, almost every vendor having acquired a multitude of products from various sources that all run different programming language, operating systems, data bases and platforms. Some examples:

• Meditech – often considered the “paragon” (no pun intended!) of integration, uses several non-acute care systems developed by “partner” firms such as PcTC (Patient Care Technologies) for Home Health and Long Term Care, and LSS (Lake Superior Systems) for practice management and ambulatory EMR.
• Cerner – whose Millennium clinical suite is extremely integrated (on Oracle), but who can’t spell ERP (Enterprise Resource Planning), sending their clients to Lawson, Great Plains, etc., instead.
• Epic — ditto for ERP, plus, of course, Time and Attendance, HIM Encoding, Nurse Scheduling and Staffing, etc. Not fair you say? Nobody has Time & Attendance except Kronos? Not true, ask any CPSI client who has their T&A system installed… Granted, Epic does have the only truly integrated EMRs for both physician practices and hospitals, but clinical systems are only part the HIS story. How about finance and administrative apps like: document imaging, decision support, etc. And don’t forget about non-acute care modalities like Home Health, LTC, Inpatient Psych, etc.
• QuadraMed – whose Affinity revenue cycle never met QCPR’s EMR until last year; even though both run on InterSystems’ Cache, their screens look radically different, as one might expect for two products developed on different coasts…
• McKesson – whose four (4) discrete HIS systems are rife with “under the covers” interfaces: Star, Series, Healthquest and Paragon, all use a number of Horizon (nee Pathways) modules, like their excellent HPF (formerly Imnet’s imaging product).
• GE is trying to get their Logician ambulatory EMR to look like the IDX CareCast… Even within the suite of IDX stuff they bought, there are two patient accounting systems: HPA and CareCasts’s. Which one would you “integrate?”
• Siemens – like McKesson, has a number of different HIS systems (Invision, Soarian and MedSeries – by now, I think Unity is gone?), each interfaced to a number of old “Novius” sub-systems for ancillary departments like Lab, RX & Rad.

Enough – I’m getting a headache! But I hope you see what I mean: true& total integration is almost impossible in the maddeningly complex world of HIT today. The best a vendor can do is self-develop as many systems as possible, like Meditech and CPSI have done for most of their apps, and Cerner and Epic have done for their clinical suites. When a company like AllScripts buys a suite of products from another firm like Eclipsys, all they can truly integrate are the brochures, Powerpoints, proposals and contracts. The rest is interfaces, like every HIS vendor (and hospital) has plenty of already.