Score one for the onesy-twosy physician practice trying to afford an electronic health record. Add the bonus of getting the most out of what an EHR has to offer, all made possible by a hospital with an innovative community view and a subsidy to encourage participation in it.
That sums up a program recently launched by Hoag Memorial Hospital Presbyterian that leverages an exception and safe harbor from Medicare’s Stark and anti-kickback laws instituted in 2006. The measure allows hospitals to subsidize up to 85% of EHR software and implementation costs for independent physicians on their medical staffs. The Certification Commission for Healthcare Information Technology (CCHIT) has identified 56 such programs to date nationwide, totaling 153 hospitals and their doctors.
The medical staff at Hoag, a 498-bed facility in Newport Beach, Calif., has 1,200 physicians in 820 practices—an average of 1.4 doctors per practice—who are eligible for a hospital-financed subsidy of up to 60% of an impressive range of IT services. In a region of the country that combines a notably high cost of living with one of the lowest medical reimbursement rates stemming from California’s high penetration of managed care, the expense of acquiring and intelligently implementing an EHR is out of reach for the typical physician group in Orange County, says Rebecca Armato, Hoag’s director of ambulatory information services.
Besides covering a portion of the costs, Hoag has taken some distinctive steps to accommodate physician preferences and motivate doctors to participate. These small physician practices can choose among several EHR options and be assured of the same basic level of support and capabilities to manage patient care and improve the workflow of their office. The EHR products are on track to be building blocks of a planned communitywide health information exchange, linking local practices on a scale usually reserved for large medical practice models, says Armato.
EHR capabilities in common
The foundation for this multiple-option offer to physicians is the set of capabilities in common that the four EHR products (See chart) can demonstrate as a result of being CCHIT Certified. “We know generally the functionality at a certain level is the same, it’s the look and feel that’s different,” says Armato. So physicians can elect to receive the one that they’re most comfortable with, while Hoag is able to count on common information capabilities and the Certification Commission’s process of charting a roadmap for future enhancements to data exchange, analysis and population management abilities.
The EHR vendors must apply for and attain recertification annually. Additionally, as industry standards are further developed regarding data exchange formats and terminologies, all three vendors must incorporate them into their services to physicians, which are hosted by the vendors instead of operated at physician practice sites.
The upshot is that Hoag is forcing interoperability among vendor products and facilitating vendor neutrality in the service of small, independent practices using the same information network, says Armato. It starts with certification criteria for functionality and relies on gradually higher interoperability – the ability of different EHRs to communicate with each other – built into the EHRs that meet the additional requirements of annual CCHIT certification. “We point to CCHIT (certification) as a validation of what we’re doing” to offer physicians both choice and robust technology in common, she says.
Other features subsidized by the program include a practice-management system integrated with the EHR offerings; a portal for secure communication between patients and their physicians; and consulting services to get the best and highest benefit from using the technology.
Benefits to and from doctors
With retention and recruitment of physicians a prime concern given the challenging financial environment, one way to attract and keep them is to create a flexible and affordable route to electronically creating, using and exchanging clinical and administrative information. “The hospital’s vision is the creation of a health information exchange in Orange County,” Armato says.
The strategy is to first get doctors comfortable with the technology and then create an environment for exchanging information related to patient care. Also, by making the doctors in the network more attractive to patients while enabling practitioners to deliver care more efficiently, Hoag would improve the doctor retention and recruitment picture at the same time it builds a model for leveraging clinical information among small practices. “If we have the best and brightest physicians, and they have the best tools at the point of care, the patient wins.”
Hoag additionally would benefit from reduced costs for document distribution, fewer unnecessary or duplicate tests and other welcome byproducts of sufficient information. Doctors using electronic tools can reduce errors and manage chronic illnesses better, and the new information environment can spawn a climate of relentless quality improvement. “We want the tools to be triggering those thoughts all the time.”
Free appetizer: e-prescribing
In November, Hoag began offering an electronic prescribing software product from Allscripts to get some practices started using electronic tools and recognizing the benefits. Under the Stark exception, hospitals can subsidize 100% of the cost of extending e-prescribing tools to their independent physicians, and Hoag is picking up the entire cost.
The response has been immediate: Hoag expects to have 50+ physicians using the application by year-end, and 300 by April 2009. Besides the Stark incentive, the initiative is benefiting from a federal incentive that will pay doctors a bonus equal to 2% of all allowed Medicare billings for professional services effective Jan 1, 2009. Armato sees the systems as principally identifying and avoiding medication errors and contraindications, with the Medicare incentive as, well, a bonus.
Both the EHR and e-prescribing efforts are bundled tightly with Hoag’s longer-range plan to improve care quality and simultaneously lower the cost of healthcare for both the hospital and its doctors. The next step in the IT development plan is to integrate lab and radiology reporting into the EHR applications. Next after that will be a push to create a health information exchange using industry standards.
Armato says that includes preparing to become CCHIT Certified as a health information exchange (HIE), an area of certification launched just this year. Most information that doctors need is at the community level, but if the development of an HIE eventually leads to joining the emerging state RHIO, so much the better. “I believe in the network of networks. It’s the only way these things can be accomplished.”
