Allscripts Interoperability with Epic

Jalil Bryant
Jacksonville University

Interoperability Issues: Allscripts Communicating with Epic

Most people consider the healthcare field to be a high pressure and demanding area that requires special people to be able to succeed within the field.  Sometimes the job isn’t necessarily hard but instead the process of performing the job duties is the problem.  This can be especially true when talking about case managers.  Case managers at this author’s facility utilizes two systems, these include Allscripts and Epic.  The problem is that these two systems aren’t interoperable with each other.  Interoperability between Allscripts and Epic would make life easier for all members of the patient care team at the organization.  Interoperability between information systems within a healthcare organization should be an expectation not the exception.  There’s no reason why a healthcare employee has to document the same information for the same patient in two different systems.

What is Allscripts

Allscripts is an open platform that allows for facilities to send prescriptions (EHRGuide, 2019).  At this author’s facility, case managers use this system to send referrals to various companies.  Case managers can send referrals to hospice agencies, home health companies, skilled nursing facilities, acute rehab facilities, long term acute care facilities, and durable medical equipment companies.  In order to send referrals case managers must upload medical orders and clinical documentation to Allscripts, and send them electronically to the desired company.  Once the desired company receives the referral they will follow up with the case manager either via phone call or by messaging in Allscripts. 

The Problem

The problem is that Allscripts doesn’t communicate with Epic at this author’s facility.  This puts a strain on the case managers when documenting because they have to essentially double document their discharge planning assessments.  These discharge planning assessments consists of interviewing the patients about their living situations, while trying to find areas where the patient can receive the appropriate support at home with the goal of achieving the optimal health outcome for the patient.  After the assessment, case managers must then document the assessment into EPIC.  Due to Allscripts and Epic lacking interoperability between each other, the case managers then have to log into Allscripts and input the same information that they documented in EPIC.  This is very time consuming especially while working in a level one trauma center.  For example, most days this author has over 25 patients to document on, and the hospital has a high turnover rate. 

Another problem is that only case managers has access to Allscripts at the facility.  Thus whenever an agency or company sends an update status on a referral, the case managers are the only ones that can view the update.  As most people know, not all healthcare professionals have great communication skills and the same can be said about some case managers as well.  So if the case manager forgets to give a verbal update to the physicians, nurses, or other staff members this can lead to a lot of problems; some of which includes discharge delays, mistrust, wrong information dissemination, and frustration from the patients and staff members.  All of this can avoided if the rest of the healthcare team had the ability to log into Epic and check the status of a referral at a moment’s notice.  There’s no reason why the EHRs systems within the same facility shouldn’t be interoperable with one another.

Recommendations for Improvement

One recommendation for fixing this problem is to make Allscripts interoperable with Epic.  When a healthcare organization is using different software systems, there should be an effort made to ensure interoperability.  The preferred type of interoperability would be semantic.  Semantic interoperability is when the message keeps its structure during a transfer, which allows for the receiving system to interpret and use the data (Ultimate Medical Academy, 2018).  A focus on interoperability would help EHRs to reach their full potential (Ultimate Medical Academy, 2018).  Epic is the most widely used EHR system in the U.S, and is very interoperable with other software systems (HealthIT, 2014).  After reading several websites, it is a shared belief that Allscripts along with many vendors should be looking for ways to improve its interoperability with other systems.  So Epic has already demonstrated interoperability features over the past couple of years, it’s time for Allscripts to evolve as well. 

Over the past decade there has been a major push for healthcare organizations to utilize EHRs, they receive incentives from the Centers for Medicare and Medicaid Services (CMS).  That said, another recommendation is to place a focus on providing incentives for healthcare organizations to use systems that utilize interoperability features.  It seems like this shift of focus has already occurred.  CMS has renamed their EHR Incentive Programs to the Promoting Interoperability Programs (CMS, 2018).  A result of this program is that it will force health IT developers and health care providers to either update their current system, or to implement other systems that better support interoperable features (CMS, 2019). 

The last recommendation is to give the rest of the staff the ability to log into Allscripts to view the updates.  This doesn’t mean to give them the ability to send referrals but just to be able to view the updates and statuses of referrals. This way all members of the interdisciplinary team can actively know what is going on with the patient at all times.  This would lead to less confusion and frustration; while keeping everyone in sync with the patient’s care.    

Impact on Nursing Care and Patient Health Outcomes

Interoperability between Allscripts and Epic would allow for case managers to be more productive.  This would tremendously reduce the time it takes for a case manager to document.  As mentioned before, case managers currently have to double document their assessments due to Allscripts not being interoperable with Epic.  This leads to long periods of documentation which takes away time that should be used on facilitating patient discharges.  Delays in discharges is one of the main things that every hospital tries to avoid.  The daily cost of a delayed discharge is $1,879 in the United States just for older patients alone (Landeiro, Roberts, Gray & Leal, 2017).  By avoiding discharge delays the hospital would obviously be saving money in the process.  Most times case managers are viewed as the gate keepers within a hospital.  Their roles are vital in discharging patients on a daily basis. 

Also, the money used to buy paper would be saved as well.  This may seem like a minor expense but it does add up over time.  The amount of paper that is required to print clinical documentations from Epic just to fax over and upload to Allscripts on a daily basis is ridiculous.  Any given referral can consist of at least 30 to 40 pages of information.  Just the idea of printing all of this information just to discard the paperwork once uploaded to Allscripts is maddening.  The money that could be saved could be used towards other projects that would help with improving patient care.

Perhaps the most important impact that interoperability between Allscripts and Epic would have is improving patients’ satisfaction.  One thing that definitely annoys patients and their families is when a healthcare staff is not on the same page.  Imagine being told by the case manager that a certain rehab facility declined you because of your insurance, just to have a physician or nurse mistakenly tell you that you’re going to that same facility minutes later.  This type of misinformation can form distrust amongst the patient towards the staff members; while making the healthcare staff look incompetent.  That’s why it’s imperative for Allscripts to be interoperable with Epic so that the nurses and physicians can check on the status of referrals at any given time; so that everyone is on the same page.  This would make more efficient use of everyone’s time as well.  The quality of patient care would significantly improve if healthcare professionals are able to truly see everything that is going on with the patient.  

References

CMS. (2019). 2019 Program requirements Medicare. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2019ProgramRequirementsMedicare.html

CMS. (2018). 2018 Program requirements Medicare. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2018ProgramRequirementsMedicare.html

EHRGuide. (2019). Allscripts reviews. Retrieved from https://ehrguide.org/ehr-reviews/allscripts-reviews/

HealthIT. (2014). Epic interoperability fact sheet. Retrieved from https://www.healthit.gov/sites/default/files/facas/GSG_TestimonySupport_CarlDvorak_2014-08-15_04.pdf

Landeiro, F., Roberts, K., Gray, A.M., & Leal, J. (2017). Delayed hospital discharges of older patients: A systematic review on prevalence and costs. The Gerontologist, 59(2), p. e86-e97. Retrieved from https://doi.org/10.1093/geront/gnx028

Ultimate Medical Academy. (2018). Interoperability and why it matters. Retrieved from https://www.ultimatemedical.edu/blog/interoperability-matters/