A few minutes with Microsoft’s Amalga (formerly Azyxxi) and the VA’s CPRS


Veterans Affairs Medical Center, Washington


Veterans Affairs Medical Center, Washington

I was fortunate to spend time with Hank Rappaport, MD, the principle PM for the Microsoft Azyxxi Team, to fill a few big gaps in my EHR knowledge recently. Hank is a critical care specialist and has extensive experience building and maintaining electronic health records within the Department of Veterans Affairs, and now will do the same as a leader at Microsoft.

I sought Hank out originally because I wanted to learn more about what the Department of Veteran’s Affairs is doing with patient access to their highly regarded electronic health record. The Washington, DC, VA Hospital was a pilot site for the MyHealthEVet program, which allows those served in this system access to their medical records online. What’s special about the pilot sites is that they allow patients access to the entire record, without any filtering. This includes progress notes. More on that later.

Hank simulated access to both systems for me to get a sense of each systems’ strengths. Azyxxi was actually born at Washington Hospital Center, where Hank showed it to me, and is an excellent aggregator of clinical and other data, in a very accessible way. It seems to fill a niche that some electronic health records lack, which is a population view of data. The heritage of Azyxxi was the emergency room; at the same time, the utility is very relevant to primary care. With Microsoft supporting its future development, it should continue to add to innovation in health information technology. Of course, wearing my patient-centered hat, I thought there could be very interesting applications of this tool for patient access.

Following the tour in Washington Hospital Center, we walked across the way to the VA Washington to look at a simulated view of CPRS. The system is of course very capable (it lives up to its stellar reputation), specifically in the areas of order entry and decision support. It’s able to capture structured and unstructured text data, for example in progress notes. Like Azyxxi, I think there are rich areas for expansion for the system. The capabilities of this development team are different, though, and there are some changes being made in the way that the VA manages its health information technology.

There is currently not much interaction between the physician / staff view of the medical record and the patient view. However, it’s remarkable that patients have full access to their entire medical record, and has Hank indicated to me, this has not been a problem. I understand that the production (non-pilot) versions of MyHealthEVet do not have full patient access in them. In the meantime, I think the experience here in Washington deserves further attention in terms of its innovation.

I appreciate the value of the experience of seeing these two very competent systems a little closer.

Now, on to California and Heatlh2.0 to see some other cool stuff up close!

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Ted Eytan, MD
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