Building the 'next generation EMR': Northwell CIO shares key insights on Allscripts partnership

Northwell Health announced its partnership this month with Allscripts to develop and implement a "next generation" EMR across the New Hyde Park, N.Y.-based health system.

With the new EMR, Northwell and Allscripts aim to combine their respective clinical and software development expertise to address frustrations clinicians often deal with when using "first generation EMRs," according to John Bosco, CIO at Northwell.

Mr. Bosco joined Northwell in 2004 as vice president and chief technology officer. Now as CIO, he focuses on aligning the health system's technology development and business strategies while leading the IT division.

Here, Mr. Bosco discusses Northwell's collaboration with Allscripts and how the organizations are setting out to improve EMR usability.

Editor's note: Responses have been lightly edited for clarity and length.

Question: How did Northwell Health's partnership with Allscripts come about?

John Bosco: There's been a lot of dissatisfaction for some time with physicians from across the country in terms of using EMRs. The EMRs that are out there today — all the big ones — are all the first generation of EMRs, and there isn't really anyone working on a next generation EMR.

Allscripts announced their beginnings of a next generation EMR when they introduced their product Avenel at the Healthcare Information and Management Systems Society annual meeting in 2018. Allscripts CEO Paul Black and I were sitting talking about it, and while it was very immature, it had some solid technology underpinnings. Over the course of us taking a look at it, I literally just turned to Mr. Black and said, 'Well if you're really going to do this, why don't we do something unique and create a partnership between us — as one of the largest health systems in the country and Allscripts, being one of the largest EMR vendors in the country. Let's bring your software development and project management expertise to the table, and Northwell will bring the collective experience and expertise of our clinicians and other folks involved in running our physician offices, and let's do this together.'

Q: What makes Northwell Health and Allscripts' collaboration unique?

JB: A lot of EMR vendors love to say, "Our EMR was developed by physicians and for physicians." Yet, when we take a closer look, they have very few physicians on staff. The evidence that is out there with current EMRs is that physicians have a very high sense of dissatisfaction with using them.

Q: What inspired you to make the EMR voice-enabled? What will this look like for clinician workflows?

JB: We engaged with some of our physicians and with Allscripts and came up with a list of some of the core capabilities that we believe the next generation EMR should have. We started by looking at the issues that cause so much dissatisfaction by physicians and other clinicians today. One of many of them is that they're doing a lot of typing and clicking, and they feel that to some extent they've become data entry clerks.

One of the capabilities that we believe is necessary for a new EMR is to reduce that amount of typing and clicking by voice enabling anything that can be.

Q: What are some of the other capabilities that will designate this EMR as next generation? 

JB: Having a cloud-based and web services-based EMR really speaks more to how complex and expensive EMRs are to deploy and maintain. An EMR based on the latest technologies should help to reduce burdens related to supporting and maintaining the system.

From a physician point of view, the systems today are difficult to use. They're inflexible and it's difficult for physicians to navigate around the system and get the information they need. A more modern, flexible, graphical user interface is needed. Additionally, the next generation EMR needs to incorporate artificial intelligence and machine learning technologies.

One of the big complaints that physicians have is they're presented with these voluminous medical notes that other physicians have dictated, and they have to go through a lot of notes and medical history to understand what they might want to know about that patient. AI and machine learning can help to reduce the volumes of data to only what the physician needs to see in the context of why the patient is there, and significantly enhance clinical decision support and clinical decision making. The technology also helps with learning a clinician's preferences, tailoring and personalizing the physician's experience.

Q: What is one aspect of today's EMRs that deserves more attention?

JB: EMRs today don't do much in the way of supporting wearable technology and other IoT technologies. They don't do a good job empowering a patient with digital health tools. At Northwell, we really believe that the patient owns their medical data — not the physician, not the health system — and that we need to empower patients more in terms of understanding and managing their health. There are patient portals that are widespread today as a result of meaningful use criteria, but the portals are clunky to use and don't do much in the way of health maintenance and health education and health literacy areas.

Q: What roadblocks do you anticipate with the new project?

JB: This is a very large, complex, expensive and prolonged kind of a project. There will be some challenges across various areas. We want to create a minimally viable product, and so one of the challenges will be to define the criteria for the MVP and to try to quickly create it. When we can install an MVP in some of our physician practices as a pilot, we can really begin to iterate, improve and enhance it. We just want to try and get there as quickly as we can but not sacrifice functionality.

We're going to bring a lot of clinicians and other folks together to create a vision for what the next generation EMR looks like. There will be a lot of feedback and input, which will be a challenge to prioritize the things that are most important and should be in an MVP. We will need to manage expectations on how quickly all the other features and functions will be able to get developed, tested and piloted.

Q: How do you hope Northwell Health and Allscripts' partnership will grow in the future?

JB: We have a large partnership with Allscripts today. We're their largest customer, in terms of using their EMR and other software and services, and we view this new project as an additional way to leverage our organizations together to improve healthcare including using EMRs.

This project will bring us closer together. It's a major initiative. We're looking to develop an EMR that's not specific to Northwell but that is a commercially viable EMR. Once we're at a point where Allscripts can begin to market and sell it, we'll continue to play a big role in terms of being their flagship partner. We'll continue to participate with them in enhancing and improving the EMR for many years to come.

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