Tuesday, March 03, 2009

Outrageous extremely overpriced ridiculously simple EMR interfaces

This in from a 2005 college graduate working in healthcare IT for almost 3 years, with a technical background only, who has found my site on HIT difficulties. This person's been working with several hospitals and hospital groups to create interfaces to practices and labs as well as master patient index services.

This HIT worker writes:

"...one other thing that I think should be covered is the outrageous extremely overpriced ridiculously simple (I opted to use as many adjectives that came to mind) task of creating an interface in an EMR. After doing a few interfaces myself and working with about a dozen or so EMR vendors the cost is ridiculous for the amount of work they actually do.

The average cost that I've seen is about $4,000 to $6,000 USD, I've seen some that are 'free' I'll explain this one later, some upwards of $40,000+ and some in the realm of a few hundred.

Under this secret shroud of "everything is complicated and takes tons of people and costs an arm and a leg" is really a two person job that takes about three to four hours, or even less if you know what you're doing. To create an interface between two systems one person configures their application to listen on a socket, and the other to configure the application to connect to an IP and a specific socket.

This of course assumes the two systems are maintained by two different people. There is more that goes into creating an interface sure, but from an EMR point of view its two people. I've configured a [Big Vendor] interface with the vendor in 30 minutes. [Big Vendor] charges I think the number was $3,500 to $4,000 for the "Labor charge", [Big Vendor] is the 'free' one once you purchase the application you can create as many interfaces as you want.

I've yet to meet a physician, nurse or office assistant that have the know-how to create an interface. Other EMR's charge per interface as if paying $15,000 for the application wasn't enough a physician must spend another $4,000 to $6,000 for a stinking interface! Yes its important that they have it but WOW! - $4,000 to $6,000 for 30 minutes of work? Some are longer, some interfaces require more configuration's which isn't much, most any worthwhile application already has default configurations and interfaces so one could load those and not go too far over 30 minutes of work, certainly not longer than a few hours though.

Thinking of a typical practice that I've encountered, there are three general feeds:

1. General Labs - This interface would send over your microbiologies,blood tests etc.
2. Transcriptions - This interface would send over, well, transcriptions anything dictated.
3. Radiology - This interface would send over all your radiology transcriptions with the added feature of being able to handle images.

Not that I've actually seen one in action, these are all just claims right now. The sheer size of radiology images dissuades labs from sending them over the system because of bandwidth issues, also because not many interfaces currently support DICOM, or one system in the flow doesn't support DICOM.

So, if we take one of the larger EMR's, your eCW's, GE's, Misys's, Allscripts et cetera, the cost for one of these systems range from $12,000 to $15,000 that I've seen for a small practice. Then if you take the $4000 (lets be nice and give EMR's the lower number) at three interfaces for a total of $12,000 we have a system that costs $24,000 to $27,000. That's ridiculously insane for a broken system that somewhat works.

Another thing that has always got me wound up with looking at these costs are that the EMR's know their application best, they know how the HL7 data should look, but they have no way of mapping the HL7 to be compliant with their systems. So I'm forced to map it for them, I'm lucky if they have specs, and if they do they're likely out dated (I have yet to receive a spec that was not out of date by the way). Reverse engineering an application's interpretation of HL7 is insane. To be fair, some vendors do offer though to do the mapping, then again they also charged $40,000+.

I've tinkered with EMR systems when I can, some were nice, some were trash, most were trash. These applications work and look great for me, but lets face it, I'm no clinician I don't understand most of what is on the screen, I can fumble around though and figure things out. These applications are designed and developed by engineers, these applicationsonly make sense to engineers. These systems are pure trash.

Here's to taking down the shroud and smoke screen HIT has put up the past couple decades.

Feel free to post this in its entirety if it will help take down the smoke screen.

Having been a CMIO, I can vouch for these expense levels charged for interfaces that I knew, also being a computer professional, were quite simple to code.

-- SS


Anonymous said...

Interesting revelation to me. Now I know that in addition to key interfaces being perennially dysfunctional and patient endangering, they are simple and ridiculously over priced as well. The HIT companies should be held accountable in medical negligence lawsuits when a patient is injured because of interface (and any other component shortcomings) of these contraptions that control and dominate medical care.

HIT said...

A further breakdown of these costs. I'm looking at this from the point of view who connects TO an EMR. If you're talking internal systems in a hospital its much cheaper.

To be analogous, this would be similar to setting up an FTP server. After its all installed (this is usually included already in the cost of the application), one would go into the FTP server configurations, create some accounts, create some directories and click start. Fairly simple, relatively of course.

From what I've seen and heard while working with EMR vendors is a few steps.

1. Click a few menu's to get to the interface configuration screen.
2. Select the port number to be used (to listen on).
3. Load any default configuration's, most EMR's load one of the three major lab's configurations.
4. Make minor edits (usually a few minutes max).

Those are the general steps, others include loading compendiums, cross reference tables, which are not done by the vendor they're done by the physician or someone with clinical background.

The actual vendor work is minimal and usually simple once its up and running getting a hold of them for testing isn't fun, usually the vendor pushes this responsibility back on the physician to do the testing!

In my humble opinion, the EMR vendor SHOULD do the data mapping, who knows how their data will post HL7/medical data than them?

HIT said...

I couldn't find the edit button if there is one, so here's an extension.


HL7COMM written by someone I know is a simple interface engine.

You can download and run that if you have java installed. I won't provide any instructions on how to create an interface. Rather I'll let you figure it out and see how simple it is.

You can create a listener (server), and a sending (client) interface in a matter of minutes if you know what you're doing.

Give it a shot, once you get one up and send test data through you'll realize how ridiculously simple it is.

Mirth is another one I've looked at but is much more complicated to setup, creating an interface is almost as simple, but the interface is not intuitive enough for my tastes. But, does support translating HL7 data.

Anonymous said...

How many $$ I should expense to create a java based DICOM server.?

Anonymous said...

Capital blue cross of Pa on the loose with 18% increase to your healthcare business premiums. What for their record profits for 2011 from accounting office