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Allscripts' Medical Logic Module To Improve Clinical Support

EHR vendor's MLM creation and exchange program puts app development in the hands of physicians.

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Allscripts, best known for its EHRs and e-prescribing systems, is looking to promote physician creativity and stimulate sharing of ideas through its medical logic module (MLM) initiative. The initiative provides a way for physicians to create clinical decision support tools that integrate into their EHR and then share them through the Allscripts MLM exchange.

An MLM allows a physician to do two things: find information in an EMR, and create clinical alerts that can be triggered at the appropriate time. Glen Tullman, CEO of Allscripts, explained in an interview with InformationWeek Healthcare that an MLM "uses medical information and logic to help the doctor make better and safer decisions."

"It's finding that information in the EHR and alerting the doctor at the right time in the process," he continued. "That's key--if you alert them after they've prescribed a medication, for example, it's too late."

Cliff Meltzer, executive vice president of solutions development at Allscripts, explained in an interview that the MLM is essentially a "specialty extraction [that's geared toward a doctor] with an inclination to say 'How do I think medically, and how do I express that logic to provide what's known as clinical decision support?'"

"Throughout the MLM exchange, we have physicians asking other physicians if someone created an MLM for [a certain] condition," Meltzer continued. "It's leveraging the power of the community we built in ClientConnect to enable people to find out what's out there and ask for information by collaborating."

ClientConnect, Allscript's online community, comes into play with the exchanging of these apps. Not all clinicians who develop MLMs choose to share them, according to Meltzer, but physicians have chosen to make more than 100 of them available to other organizations. The overall number of MLMs, shared and unshared, is more than 1,000.

Meltzer said that MLMs are based on a standard developed years ago at the Columbia University College of Physicians and Surgeons. "It's a method of describing how you search: what information you look for in a high-level programming language," he explained. The MLM, he said, is similar to--but isn't exactly like--an API. Instead of extracting information like an API, an MLM looks for how a doctor organizes information while he or she is searching within the EHR.

[ For another point of view on PHRs, see Why Personal Health Records Have Flopped. ]

"People don't use this to build an app on a telephone that alerts someone of something," he said. "It's okay to look at it as an API, but that's not doing it enough justice, because it has the ability to look into the database on an ongoing basis and alert me to a set of things."

Dr. Vinay Vaidya, CMIO at Phoenix Children's Hospital, said in an interview with InformationWeek Healthcare that the exchange is allowing physicians to share "islands of innovation" they developed within their organizations.

"Allscripts recognized organizations were producing these islands of innovation in their own hospital settings in response to some perceived need," Vaidya said. "And the needs weren't unique from hospital to hospital. Instead of letting that innovation remain in the hospital, Allscripts is using the MLM exchanges to rapidly disseminate this in a more organized and formal way."

For example, at Phoenix Children's Hospital, like many pediatric facilities, the hospital dealt with finding safe and effective ways to tailor medications to patients of varying physical sizes. Off-the-shelf dosing systems met the needs for adults, said Vaidya, but they wouldn't work for pediatric EHRs.

To address this problem, Phoenix Children's looked at its medication ordering pattern over the past nine years and created "hard and soft limits" for certain dosages, said Vaidya. The organization created these limits for about 80% of its medications, and within a six-month period, launched an MLM-based dose range checking module within the Allscripts EHR.

"With most innovations in healthcare, it's not only the solution you develop, but how easy it is to use," said Vaidya. "That's often a limiting thing, but we noticed [the module] was accepted and adopted in another hospital quickly and easily… this is a wonderful example of where we didn't have to wait another three or four years for the vendor to create this new functionality… we did it in six months."

Allscripts continues to look for ways to stimulate innovation within the industry. In addition to its MLM Exchange, the company recently announced its Health Innovation Program, which includes an "Open App Challenge." The company is hoping to encourage vendors and developers to create applications that can become an extension of the Allscripts Open Electronic Health Records software, with the goal of making it easier for providers to add new apps to their workflow.

"We want the smartest people--whether [they are] physicians, nurses, caregivers, or IT professionals, inside and outside the industry--to use their creative energy to solve real problems in healthcare," said Tullman.

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)

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