The Shared Health team has over time added features that doctors using the system have requested, such as e-Prescribing, pediatric annual visit charting, and reminders and alerts known as Clinical Opportunities. These preventive health measure and screening reminders are generated algorithmically based on evidence-based guidelines, and can help physicians and practices bring their standard of care up to the levels required for pay-for-performance bonus through BCBS and Medicaid. Examples include lab tests for diabetes and mammograms for women over fifty. Very little data entry is required of the physicians or practices, and a good deal of effort has gone into making the Clincal Xchange application an "always on" and workflow-friendly component of the doctors' desktops.
RMDNetworks' application is also web-based and low cost to providers who use it. However, the organizing principle behind RMD is direct communications among providers who are caring for the same patient, and between providers and their patients, with a focus on chronic care management. RMD's application is oriented towards the physicians and patients in a physical geographic area, a single community, in which care is likely to be based in medical home practices and nearby specialty clinics, imaging or lab facilities, and one or more local hospitals. However, they are also tying into broader state initiatives for health data exchange and care coordination.
RMD has partnered with some innovative programs and projects, such as the Colorado Clinical Guideline Collaborative and their Collaborative Care Network, a demonstration project involving 15 medical home practices in the Denver area that have agreed to implement guideline-level care using RMD's registry functionality for patients with diabetes, hypertension, hyperlipidemia, and fourteen other conditions.
Patient engagement is encouraged through RMD's web portal, permitting patients to access their health information and see explicit care plans and graphs of their progress, receive reminders regarding medications and exams, and transfer their records anywhere, anytime. Doctors using RMDNetworks have the advantage of seeing a single care plan for each patient, with scheduled labs and tests checked off as they are done by any of the providers.
This may permit teams of providers to avoid duplicating each others' tests or procedures, a common occurrence for Medicare patients who may see as many as six or seven different doctors each year and whose care is seldom coordinated. RMDNetworks and Shared Health are imperfect, early examples of Clinical Groupware, and any knowledgeable observer would be able to point to a number of obstacles that stand in the way of their more general use by physicians and groups.
For example, Shared Health's application does not yet integrate with practice-based or hospital EHRs, an interface that would allow two-way flow between the practice's clinical data and the claims information stored in Shared Health's centralized repository.
RMDNetworks has not yet integrated e-Prescribing into its offering, and has a number of interface issues of its own to handle. But I predict that this class of software will quickly improve, particularly with respect to data sharing, and that as it does it is likely to grow in adoption especially where cross-organizational and inter-enterprise platforms are seen as a lower cost and more easily implemented solution than adopting a single vendor EHR, or building an expensive RHIO-like centralized repository.
Clinical Groupware may never replace an enterprise EHR like Epic or NextGen, but it may serve the needs of groups of practices, and groups of groups, who seek clinical integration and collaboration without financial integration being a prerequisite.
There is definitely a social networking ambiance to Clinical Groupware that EHRs have totally lacked so far. The recent passage of the Health Information Technology for Economic and Clinical Health Act, or HITECH, may give Clinical Groupware an unexpected boost in popularity. This is because HITECH defines physician eligibility for direct incentive payments in terms of broad "meaningful uses" of health IT, rather than through prescribed products or features and function sets of particular products.