Discussion: The Future of iForms?

[Michael Burrows]

Here are a couple of things I would like to get a group discussion started on:

Since McKesson decided to dump Horizon in the future, our health system has decided to implement a Meditech system next year. I have had a short demo of the CPOE portion of the product, and it is underwhelming. There does not appear to be any way to customize the look and feel or workflow of the system in the way that iForms can, and no "backdoor" way to place orders. Their orders GUI is a far cry from even HEO, let alone what can be done with an iForm. I'm a bit bummed about this, because our physicians have gotten very accustomed to placing orders via an iForm, and I think this may affect our CPOE adoption numbers. 

Just out of curiosity, what is everyone else doing to prepare for Horizon's sunsetting? Is anyone going to Meditech, and if so, how do you plan to mitigate issues due to the massive changes in CPOE? (I guess the same question could be posed for a change to any system, not just Meditech.)

I am considering looking for a part-time iForm consulting gig, to take advantage of this tech before my relevant knowledge expires into nothingness. Does anyone have any tips or advice for me?

Mike Burrows

Phoebe Putney Health System

[Scott Morris]

Mike,

McKesson decided to dump Horizon in the future, our health system has decided to implement a Meditech system next year

 

You're right to ask about "the future of iForms;" many Horizon shops are packing up and moving to another EMR based on what I can only describe as poor messaging by McKesson.  I don't believe that they intended to announce Horizon's eventual sunset when they did and it's my opinion that they originally planned to support it far longer than they will now that people are "jumping ship" (and the rumors are turning into a self-fulfilling prophecy - by now we know that it will eventually go away, but the more people leave, the quicker it will happen).

I have had a short demo of the CPOE portion of the product, and it is underwhelming. There does not appear to be any way to customize the look and feel or workflow of the system in the way that iForms can, and no "backdoor" way to place orders. Their orders GUI is a far cry from even HEO, let alone what can be done with an iForm.

While I can't speak on Meditech, I've heard consistently that HEO is the most "flexible" when it comes to the kinds of customization you can implement (even with all of its limitations), and McKesson's Paragon is by far no exception to that rule.  My secret hope is that they'll realize this opportunity for improvement and try to implement something similar to iForms within the Paragon environment.  However, that is just a hope, and likely a far one at that.

What is everyone else doing to prepare for Horizon's sunsetting? ... How do you plan to mitigate issues due to the massive changes in CPOE?

I've heard many people ask this same question.  Some just plan on using Horizon for as long as they are able.  Others have gone the exact other way and have started making sure that all new iForm development is intentionally "less fancy" to start the "weaning process" off of the really nice stuff early, as it were.  Others have stopped iForm development in favor of doing all new ordersets as Outlines for similar reasons.  I don't know if there really is a good answer other than to do what you can and hope that whatever system you go to next has new features coming down the pipeline or start figuring out the nuances in these other systems that are yet unknown.  I mean, when I started working on iForms, only a fraction of the "cool stuff" we're doing now was even a consideration.  Maybe (hopefully) these other EMRs just need some fresh eyes on things.

I am considering looking for a part-time iForm consulting gig, to take advantage of this tech before my relevant knowledge expires into nothingness. Does anyone have any tips or advice for me?

That's what I've done for the last couple years.  Every time a contract ends, I have to re-evaluate "the scene" to determine whether it's worth staying or if it's time to move on.  I'll have to say that the contracts are slowing up a bit.  There are still a few to be found, but not as many as there were a little while back.  Many of the contracts you'll likely see over the next months / years will be those sites that need new iForm development and/or iForm maintenance to continue while they refocus their in-house staff on the new EMR (training / configuration / etc) so at least there will likely be work for a while.

Best of luck,

Scott Morris

Think iForms, LLC

[Michael Burrows]

Thanks for your response, Scott. 

I definitely feel bad about all my griping about HEO in years previous. Compared to what else I've seen and heard, it is better than the rest, and I think mainly because of the iForms feature. Hopefully, other systems will implement something similar. Heck, like I mentioned before, even some way to "backdoor" an order string would be fantastic. Then we could develop anything to place on top of it.

Our Meditech go-live is in 4Q 2015. In the meantime, I am still the iForm guy, and am still working on new order sets when I can. Physicians are requesting dozens of iForms, but we are only building stuff for MU or other "just gotta have an iForm because physicians won't do it any other way" requests.

It's going to be an interesting transition, to be sure. I wish everyone luck for when your facility takes the plunge!

[Scott Morris]

All,

While I know that it's still the long-term plan for McKesson to sunset Horizon in favor of their Paragon product, I have to say that I'm getting the vibe that Horizon has more life in it than we originally thought.  I know that they're working on a new version (ER 12.2?) and continuing development, planning to implement and support hospitals through MU stage 3.  I have the feeling that people are starting to notice that Paragon, while it is the "thing of the future" may not be ready for the present and that they may end up sticking with Horizon for longer than they anticipated.

Is anyone else getting that feeling?  Maybe it's not quite time to jump ship just yet; especially if Horizon is still alive and kicking when they finally announce CMS penalties for non-compliance - that's when the panic will set in for some and they'll need to get the developers in and quickly.

Just my two cents. Thoughts?

[mwadsworth]

At our facility, it feels as if they have already basically given up on Horizon. It seems almost every time we turn around, more Horizon employees have been let go and support response times get longer and longer. It definitely feels like Horizon is being brushed off.

[Dean Pawley]

We went to Epic as of July 1 this year.

 

I attended a great class taught by Bruce Lane and got to see Texas.  I was able to create 3 iForms and put them to use for just over a year.  The Hospitalists loved them.

 

Thanks to everyone here who have been extremely helpful in answering questions about iForms and keeping the conversation going.   It's nice to know there was a community there.

 

Take care, everyone.