Should You Integrate IT?

Donna Duval is no technology buff, but she sure sounds like one when she talks about integrated computer systems.

"It's just so much nicer" when computers are connected, says Duval, office manager at Sorweide Family Medicine in Grants Pass, Ore. "I can really run great reports. And I don't have to input things into the system twice. It really streamlines my workflow. I would never go back to stand-alone systems."

Duval's sentiments mirror those of others who have successfully integrated information systems at their practices. The benefits of systems that work in unison are many: increased efficiency, improved accuracy, better access to clinical and financial data, and enhanced workflow.

But getting systems to talk to one another can sometimes be as difficult as coaxing civility out of estranged relatives. And depending on your practice's needs, it may not be worth it. Experts suggest practice leaders answer several questions before launching an integration project:

• Is there a real need to integrate my systems?
• Should I achieve integration by purchasing my entire system through a single vendor or can I purchase best-of-breed systems from multiple vendors?
• How can I most successfully work with software vendors on integration projects?
• What integration tools are available and most appropriate for my project?
• Is integration necessary?

Before jumping headfirst into a systems integration initiative, you need to ask yourself: Is it worth the trouble?

For Duval, the answer was a no-brainer. The payroll process for Sorweide's 11 employees took too long and was too cumbersome. She'd been processing payroll in the PayClock EZ system and then transferring much of the information into the practice's QuickBooks accounting software.

"I would do the payroll and it became very frustrating because it would take a half-day just to get through it," she recalls.

So when Lathem Time Corp., the Atlanta-based company that makes PayClock, suggested a simple interface that would link the two systems, she jumped at it. Now, when Duval processes the payroll in PayClock, the information is automatically downloaded to QuickBooks. There is no need for double entry and she can easily produce reports.

But integration solutions involving multiple vendors' systems won't always fall into your lap -- and are frequently far more complex. When systems are as easily connected as Sorweide's, integrating is probably worth it. But linking your practice management system with, say, a hospital registration system could eat up a lot of time and money. Before you start, ask what you'll get from integration -- and what it will take to get there.

Single vendor vs. best-of-breed

Sometimes, though, you don't have the luxury of deciding whether to integrate. For instance, every office that operates a practice management system and electronic medical record (EMR) will need to link these systems together.

If you choose to integrate -- or if you must -- you'll have to decide between matching so-called best-of-breed systems from multiple vendors or taking a "sole source" approach, using integrated systems from a single vendor.

The former route enables you to choose software programs based only on the function that each brings to your practice. That way, you can closely match your clinical and operational demands to system functions -- in other words, you pick exactly the tools your practice needs. This is sometimes less expensive on the front end and often more effective for your practice. But it may require a great deal of systems integration work.  

On the other hand, going with a single vendor usually (though not always) means you'll be getting systems that already work together.
But there is no consensus on which route practices should take. Paul Peck, a consultant with Hayes Management Consulting in Newton, Mass., recommends against the best-of-breed approach because the frequent need to fiddle with integration problems could be too costly and cumbersome for small practices.

"With a best-of-breed approach your systems will become so interspersed and disintermediated, you will start to run into issues," Peck says.

Karen Sollar, administrator of The Orthopaedic Group of San Francisco, a nine-physician practice based in Daly City, Calif., considered both approaches when the practice added an EMR last year. Sollar went the single-source route because the practice already had a good relationship with its practice management system vendor, Misys Healthcare Systems.

"I wanted to minimize the hassle factor," Sollar says. "I wanted to integrate the EMR without having to go through a long, drawn-out integration effort. Plus, I already have such an excellent relationship with Misys, I knew I could just call up and get the service that I want."

Vision Associates, a nine-physician practice in Toledo, Ohio, also recently migrated toward an EMR. David Sobczak, practice administrator, said the group chose an EMR from NextGen Healthcare Information Systems because it allowed the physicians to maintain their individual practice styles. It then added a practice management system from the same vendor because the physicians wanted the two systems to easily communicate.

Other practices are looking to get the functionality of integrated practice management and EMR systems without having to deal with connectivity issues at all. For instance, Bruce Gelinas, a cardiologist who recently opened his own practice in Seymour, Ind., installed Health Probe Professional, an EMR that packages practice management functions such as billing and accounts management. 
 
Only the best

But mixing and matching multiple vendors' best-of-breed systems does work for some practices.

For example, when Cardiology of Tulsa Inc. decided to add an EMR, it chose a system based on the flexibility it offered the practice's 17 physicians, says Nancy Nelson, chief administrative officer. After installing NextGen's EMR, however, Nelson's practice management vendor struggled to make its system interface with the EMR. So, the two systems remained isolated.

When the practice decided to replace its practice management system a few years later, once again the doctors wanted a system that would accommodate the practice's unique needs, particularly the desire to conduct paperless scheduling -- but they also wanted a system that would interface with the EMR.

"One thing that is very difficult for us as a practice is appointment scheduling," Nelson says. "We wanted to find a system that had an appointment scheduling system that would accommodate the needs we have. Plus, we wanted to do all of the scheduling on-screen, without producing paper."

Cardiology of Tulsa found a system with all the right functions, and this time the practice required the vendor to modify the system so it would work in tandem with its EMR. The interchange helps improve workflow tremendously, Nelson says.

Some groups are not satisfied with integrating only their internal systems.

Greenfield Health Clinic in Portland, Ore., has linked to hospital lab and radiology systems in addition to integrating its practice management system and EMR. The extensive effort lets the practice deliver care without any paper whatsoever.

Other practices also see the value in reaching out to external systems. For example, Grove Hill Medical Center, a 70-physician multispecialty practice in New Britain, Conn., has developed interfaces between its IDX practice management system and various clinical and administrative systems at New Britain General Hospital.

"Doctors can check on all kinds of clinical results without ever having to go over to the hospital. It saves us a lot of time -- and allows us to better service our patients," says Carl Labbadia, director of information systems for Grove Hill.

Working with vendors

Getting software from multiple vendors to work together, however, requires working closely with software vendors, says Jim Kalyvas, chair of the e-business and information technology practice at Foley & Lardner, a law firm based in Los Angeles.

Practices must know exactly what data the disparate systems need to share, Kalyvas says.

"Don't depend on the vendor to tell you what information needs to be shared," he warns. "As a doctor or practice administrator, you know what data has to go between the two systems to do your job. You should know that before going into anything."

In addition, Kalyvas recommends asking your vendor whether it's performed any similar projects. "Most vendors will already have a library of interfaces developed. So, if they have already done it, at least they won't have to start from scratch," he says.

But even so, it's important to set clear performance expectations upfront. "Make sure you get an integration warranty," Kalyvas says. "You could get some resistance from vendors on that, but you have to make sure that they are guaranteeing that their system will integrate with other systems already in place."

Most standard vendor contracts do not provide integration assurance - rather, they promise that their software "performs," but not that it will successfully link to other systems. Read your contract carefully.

"Integration is so essential for us that we contractually tied payment to the delivery of specific interfaces between the two systems," says Nelson of Cardiology of Tulsa.

John McCormack can be reached via editor@physicianspractice.com.

This article originally appeared in the June 2003 issue of Physicians Practice.