McKesson - Performance Strategies

Hospital-Sponsored EHRs: Four Options

By Keith MacDonald
Director of Strategic Services
Culbert Healthcare Solutions

With recent relaxation of the Stark laws, hospitals are aggressively seeking electronic health record (EHR) solutions that improve the electronic exchange of information with their employed and community physicians. For patients and the caregivers who treat them in both inpatient and outpatient settings, having a single, shared patient record addresses many of today's healthcare delivery challenges.

By expanding the information technology (IT) already in place and making careful decisions on ambulatory EHRs, hospitals can provide significant community benefit and perhaps even pave the way for more expansive community efforts.

Start with the Basics: Remote Access, Anyone?
Building a community-wide EHR is clearly a difficult and expensive proposition for any hospital to consider. For starters, hospitals should begin by offering community physicians easy access to the electronic patient information the hospital already has.

> Web portals and browser-based applications offer an easy way to make test results and transcribed reports available to off-site physicians.

> More robust Web portals offer value-added capabilities for electronic physician-to-physician communication and referral management.

Making it easier for community physicians to manage patients admitted to or discharged from the hospital not only improves patient care, but will increase physicians' overall satisfaction with the hospital.

But That's Not an EHR
One significant drawback of remote access to hospital-based systems and Web portals is that these solutions fall short of a true EHR. Physicians with the challenges of a busy clinical practice often find that hospital-centric systems don't meet their needs. Before investing in a wholly new EHR solution; however, hospitals should consider installing the ambulatory EHR provided by their hospital IT vendor.

> An integrated ambulatory EHR offers the best and perhaps only way to achieve a truly integrated community patient record that spans the inpatient and ambulatory settings.

> With one shared database and functionality that supports the workflow of an outpatient practice, community physicians can benefit from improved practice support and seamless exchange of information with the hospital.

Installing and supporting an ambulatory product; however, is not an easy undertaking for most hospitals, since it requires integration with a practice's billing system and staff with a keen understanding of practice-based workflow.

Hosting Standalone EHRs
Some physicians prefer a solution specifically targeted to the ambulatory market. As a result, many hospitals are considering offering community physicians a standalone EHR.

One of the challenges with this approach is that integration with the hospital's inpatient system is not easy or widely attempted. Except for test results, standards for exchanging clinical data have not yet been defined. Unique point-to-point interfaces will be needed, and the hospital may still end up with a solution that can't readily produce a single integrated patient record.

Physicians Who Already Have an EHR
Unfortunately, none of these approaches will be of interest to physicians who have already installed an EHR in their practice. As mentioned above, integrating each of these community-based EHRs with the hospital's inpatient system is not easily accomplished. New vendors are emerging, however, that specifically focus on the integration of inpatient and ambulatory applications using remote-hosted interface engines.

Getting Started: Key Decisions
Given that there are at least four options to consider, hospitals should begin by confirming their own starting point as well as that of physician practices in their community.

> What solutions does the hospital's current inpatient vendor offer (Web portal, ambulatory EHR, integration tools)?

> Which community physicians already have an EHR?

> Which physicians are interested in using an EHR offered through the hospital?

> Are physicians interested in maintaining their own practice management/billing system, or are they interested in upgrading to one that's integrated with the EHR?

> What investment is the hospital willing to make in installing and supporting a community-based EHR?

While undertaking the implementation of a community-based EHR can be an uncharted and expensive undertaking for hospitals, the benefits to the hospital, to community physicians and to patients can be significant.

Keith MacDonald is the director of strategic services at Culbert Healthcare Solutions, a healthcare consulting firm in Woburn, Mass. Keith has a twenty-year career in healthcare and was formerly a research director with First Consulting Group in Lexington, Mass.


	In a bid to move forward the adoption of technology to reduce medical errors and improve quality of care, Health & Human Services (HHS) Secretary Mike Leavitt announced on October 30, 2007, a five-year demonstration project that will encourage small to medium-sized physician practices to adopt electronic health records (EHRs). The project will link higher Medicare payments to use of EHRs at the community level, where 60 percent of patients receive care. Participating physicians will receive additional Medicare payments for completing tasks online, including ordering prescriptions and recording lab test results. Doctors who use the most technology and score highest in an annual evaluation will receive the highest payments. The project will be open to participation by up to 1,200 physician practices starting next spring. During the five-year project, it is estimated that 3.6 million consumers will be directly affected. In the first year, physicians will be reimbursed at higher Medicare payment rates if they have adopted an EHR system. In the second year, payments will increase if the physicians report quality-of-care statistics to HHS. In the third year, payments will increase again if physicians show improvement in the quality of care. The EHR must be certified by an HHS-recognized body to meet certain clinical quality measures. Currently only the Certification Commission for Healthcare Information Technology (CCHIT^SM) is recognized. McKesson's Horizon Ambulatory Care™ solution became CCHIT-certified in 2006. Its Practice Partner^® Patient Records is 2006 and 2007 certified. Practice Partner is only one of eight products that have received 2007 CCHIT ambulatory EHR certification.Certification is valid for three years. Read the HHS press release.


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