The Hospital as the Host

Health Data Management Magazine, July 1, 2009

Some hospitals are helping area physicians implement electronic health records by hosting the systems remotely or brokering deals with vendors who host them.

For example, Silver Cross Hospital in Joliet, Illinois, south of Chicago, started hosting records software from Misys (now Allscripts) in 2007. It now has 70 physicians using the hosted application, says Matt Ebaugh, CIO.

The hospital recently expanded its efforts to give physicians more options as they prepare to qualify for incentive payments under the federal economic stimulus program. It brokered deals with Allscripts as well as McKesson Corp., San Francisco, and eClinicalWorks, Westborough, Mass., to host EHRs for area doctors.

Silver Cross pre-negotiated the price, contract terms and support services, Ebaugh says. "This way, the vendors don't have to market to every single practice," he says.

The effort is one component of a broader strategy of moving toward interoperable inpatient and outpatient records, he says (see story, August 2008 issue, page 34). Ultimately, the hospital, which is opening a replacement facility in 2012, hopes to enable doctors to look up inpatient records through their remotely hosted outpatient EHRs, Ebaugh says. "So the front end will always look like it does at the clinic," he adds.

The hospital hopes to have 150 doctors with this kind of access by the middle of next year.

Instead of subsidizing the cost of EHRs as allowed under the exemption to the so-called Stark rule, the hospital is paying for the interoperability to connect the ambulatory and inpatient applications. That connectivity may cost as much as $15,000 per physician to establish plus another $6,000 a year to maintain, the CIO says. It plans to use connectivity software from the RelayHealth unit of McKesson as well as dbMotion Ltd., Pittsburgh.

"We need to get over a hospital-centric approach to EHRs," Ebaugh says. "The bottom line is physicians and patients are driving this. For most patients, hospital data is a very small portion of the record. So the ambulatory record should drive the view of patient data."

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