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Sharing the Costs of E-Records
March 1, 2008
Hundreds of physicians in the Boston area are getting major financial help with implementing integrated practice management and electronic health records software in their practices. The catalyst for the project is the desire to improve care while meeting the growing demand for data on performance to demonstrate quality.
”When we looked at practices improving faster than others on getting HEDIS measures, they were all going electronic,” recalls Barbara Spivak, M.D., president of the Mount Auburn Cambridge Independent Practice Association in Brighton. HEDIS is the Healthcare Effectiveness Data and Information Set, a series of measures from the National Committee for Quality Assurance uses to assess the quality of services from providers and payers.
The IPA has worked closely for two decades with Mount Auburn Hospital in Cambridge on insurance contracting and quality of care issues. Now, the goal is to get the IPA’s 500 physicians, either in practices owned by the hospital or in private practice, to adopt electronic records.
The recent relaxation of federal regulations to permit I.T. subsidy programs for physicians paved the way for action. Under the new program, the IPA, hospital, and several unidentified health plans pay for 85% and participating physicians pay for 15% of the cost of the software, implementation and training.
The hospital and IPA, with physician approval, want to analyze data to improve care, such as ensuring physicians encourage smoking cessation programs and closely track glucose levels of diabetic patients. They also want communitywide data to support more effective contract negotiations with insurers and to collect data that supports pay-for-performance programs.
“For IPAs, going into an EHR is more than just taking information on paper and putting it in a computer,” Spivak says. “Our goal has to be to share information in a way that improves the health care of our patients.”
After considering 10 vendors, the organizations selected the combined practice management/electronic records software from eClinicalWorks LLC, Westborough, Mass.
Pilot programs started in March 2007, and about 40 physicians implemented the software by year-end. The goal is get 50 more physicians live in 2008 and to finish the job in 2010.
About 230 of the IPA’s members—about 85% physicians and the rest mid-level practitioners—are in private practices without EHRs and are eligible for subsidies.
The IPA has contracted with a local information technology firm to host the software and make it available via the application service provider computing model. As a result, the participating practices don’t have to invest in costly servers.
Paying The Price
Practices pay for any necessary hardware, such as PCs, and a wireless network, if desired, to access the software. They also pay for the loss of productivity during the migration to electronic records.
Mount Auburn Hospital is paying 100% of EHR costs for physician members of Mount Auburn Cambridge IPA who work in hospital-owned practices.
Spivak expects most physicians eligible for the subsidy program will take advantage of it. About 10% of these physicians are nearing retirement age and are not being asked to participate. Some specialties, such as psychiatry, also may not be suitable because of privacy issues. But because one goal of the subsidy program is to build a communitywide patient record and to collect data for analysis, the IPA will seek ways to get medication data from psychiatrists.
While the program has started, the IPA, hospital and insurers have not completed negotiations on funding issues, which could limit future progress. “We’re implementing practices and still working on full funding,” Spivak says.
But Mount Auburn Hospital is committed to getting physicians in the community to use electronic records, says Chuck Lukasik, COO of Mount Auburn Professional Services, a large group practice owned by the hospital and a member of the IPA. “We know that in the long run, there’s a lot of value in having all of our data tied together.”
Not All Smooth
Although the hospital and IPA are pleased with the EHR program’s progress, there have been challenges. The eClinicalWorks software was built for a standalone, client-server environment, and the vendor had to learn how to modify it to be remotely hosted, says Mark Rivero, project manager at the IPA.
The project includes implementations at physicians’ offices and in the hosted infrastructure, Rivero notes. Consequently, organizations planning a similar effort should ensure the software contract spells out that the vendor will provide assistance with the infrastructure side. “Make sure the vendor is available, will share specifications with the host and will put in the ‘wrench time,’” he adds.
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