Health Information Technology: How Hospitals Can Enhance Physician Alignment by Offering HIE and EHR Technologies
Executive Summary: EHR as a competitive advantage
In today’s challenging economic environment, physician alignment remains a critical business imperative for nearly every hospital chief executive. A HealthLeaders Media survey of hospital and medical group CEOs found that nearly 40% of respondents spent at least one-quarter of their time on physician relations. 1 Hospitals have experimented with a number of different strategies to improve physician alignment including direct physician employment, establishing clinical joint ventures, and providing physicians access to cost saving administrative and clinical services. These strategies enable hospitals to improve patient care and coordination while increasing revenue potential and building market share. When successful, these initiatives can also help improve overall healthcare delivery and patient satisfaction throughout the hospital’s extended network, all while improving physician satisfaction and “stickiness” towards that hospital.
With recent trends and changes in the healthcare market, some hospitals are looking to add technology and information sharing capabilities and services to their physician alignment tool box. With the federal government’s large investment in Health Information Technology (HIT) and recent changes in Stark and anti-kickback laws, hospitals are now able to offer community physicians access to EHR packages and other patient information sharing resources. By offering physicians these technologies, hospitals can give physicians important new capabilities that can vastly improve patient care for both organizations. Once successfully implemented, Electronic Health Records (EHR) technologies, Health Information Exchanges (HIE), and external patient portals create interoperability among participating physicians and the hospitals to improve patient care coordination, information exchange, and billing, while providing both with the data they need to help drive quality improvement initiatives and ensure reimbursement.
Past Challenges, New Opportunities
It’s no secret that many physicians have resisted moves to install EHR and other practice management systems for a variety of reasons. However, with the federal government’s aggressive carrot and stick funding approach and promises by the Administration to reduce healthcare costs for consumers while improving patient access to health information, even the most technology-averse physicians will be driven to re-evaluate their positions on EHRs. A majority of physicians indicate that they are in the process of making EHR technology decisions (see our survey results later in this document). By helping them successfully navigate EHR acquisition, implementation, and “meaningful use” challenges, hospitals have the opportunity to take advantage of their IT expertise and market position to greatly extend their network of community physicians.
This paper provides hospital and practice management executives with a point of view as to how they can take advantage of this emerging dynamic by becoming a key community driver for health information technology implementation and medical information exchange. Hospitals are in a far better position than local physicians to provide access to affordable, flexible EHR and practice management software suites that can effectively be implemented, and maintained by a thirdparty systems integrator. Hospitals also have the resources and can serve as the nexus point for establishing an HIE that can promote patient care coordination and information exchange. Couple these services together, and forward-thinking hospitals can create another incentive to help better align with community physicians while improving patient care.
Emerging Market Trend
The American Recovery and Reinvestment Act of 2009 (ARRA) committed nearly $30 billion in new HIT investments over the next five years. However, the unique back-ended funding structure for both hospitals and physicians--which requires that providers meaningfully use the technology in order to obtain incentive payments for their HIT investment--has created a new market environment that hospitals can benefit from if they move aggressively.
The Department of Health and Human Services estimates the HIT community will need to install, train, and bring on line about 13,069 physicians per month from now through 2015 in order to meet the goals stipulated in ARRA. Similarly, the HIT community will need to install, train, and bring on line 61 hospitals per month to make the 2015 deadline for providing every American with an electronic health record.
Certain hospitals, because of their advanced clinical environment, IT buying power, and market presence, are in an excellent position to serve as a trusted technology partner for community physicians who are seeking an EHR solution.
Perot Systems recently sponsored a survey of 150 independent physicians in order to gain a better understanding of their perspectives on EHR implementation. 2 An overwhelming majority of those physicians surveyed (65%) were in the EHR technology decision making process, with only one-quarter of those surveyed having completed an implementation. The survey also found that of those physicians who had not already acquired an EHR system, over 90% anticipated acquiring one within the next 36 months. Most important for hospitals, 71% of independent physicians are interested in working with their local hospital in developing their EHR solution.
Our research further indicates that independent physicians need access to additional information and assistance in order to make an informed EHR acquisition, and to ensure a successful implementation and transition. They need this help now because a majority of physicians hope to maximize the federal incentive payments that are available to them from 2011 through 2015.
Hospitals can take advantage of their IT expertise and market position to build an even stronger extended physician network. Providing physicians with access to a comprehensive suite of cost-competitive technology solutions including prepackaged, but flexible subscription-based EHR and Practice Management software with hosting and implementation by a proven systems integrator can achieve “meaningful use” and ensure maximum reimbursement.
Hospitals can establish local HIEs that provide interoperability to aligned physicians, and in some cases other referring hospitals, so they can begin to maximize the technology through patient data exchange. Such HIEs will very likely form the critical nexus point that physicians and hospitals require in order to be “meaningful users” of EHR technology and qualify for incentive payments in later years. By establishing an HIE as an additional cornerstone of a technology alignment strategy, hospitals are far better positioned to drive improved patient care coordination and information sharing within extended networks. In addition, once the HIE becomes populated with patient data, hospitals can use the information to establish and measure key metrics designed to improve hospital satisfaction, quality and patient care throughout the extended network.
If successfully implemented and managed, a technology and information sharing alignment initiative will significantly advance a hospital’s extended physician network while generating a number of ancillary benefits including, but not limited to: improved patient care and coordination, maximizing federal incentive payments from ARRA, better quality metrics and improvement programs, higher patient satisfaction, improved revenue cycle management, and ultimately, increased revenue. With these benefits in mind, a technology and information sharing alignment initiative represents a unique “win/win” alignment opportunity for both partners.
A Technology Solution Suite for Alignment
A technology and information sharing alignment strategy must be tailored in a way that not only serves to meet the current and future needs of the hospital, but also those of the general and specialty physician groups it hopes to better align—because with EHRs, one size or solution, does not fit all.
Hospitals need to use their market presence and established IT expertise in the healthcare market to help develop a suite of EHR and information sharing capabilities that can and will serve the extended network. That solution must help drive care coordination and integration, include a seamless information sharing capability and be interoperable. The solution suite should include:
- EHR and EPM Solutions—Provide access to certified software vendor solutions that can quickly be implemented. Most of these applications should be implemented in practice groups in as little as 60 days, using a hosted, softwareas-a-service approach. This approach limits up front capital requirements by physicians and reduces day-to-day operating burdens.
- Health Information Exchange (HIE) Connectivity—Facilitates the flow of health-related data among hospital partners within an area to support processes that improve the quality and efficiency of healthcare. HIEs are a crucial nexus between physicians and hospitals as both strive to become meaningful users of EHRs. HIEs can include pharmacies, reference laboratories, home health
organizations, and other providers in the continuum of care.
- Patient Portal—Provides patients with instant access from a secure network to their medical records.
- Patient-education Support—Gives physicians the ability and materials necessary to reach out to educate patients about the use of these new technologies through emails, voicemail messages, or computers used for onsite registration. A complete set of customizable marketing tools can be made available to participating physicians so they can effectively communicate the benefits of these new advances to their patients.
- Alignment Marketing Strategy—The sponsoring health system needs to develop and finance a robust marketing and awareness campaign to generate interest from targeted physicians.
Why Team With a Systems Integrator?
By using a proven systems integrator such as Perot Systems, you are likely to gain stronger buy-in and acceptance from targeted physicians. In fact, our market research indicates that a majority of physicians would prefer to work with a systems integrator to help acquire and implement an EHR solution rather than the software provider. We believe this perspective stems from physician preferences regarding the “completeness” of the solution provided by a systems integrator. Physicians worry about any loss of productivity during the EHR transition, and trust that an experienced systems integrator will use proven migration processes to ensure a smooth transition. Finally, physicians want to be assured that their new EHR system and the HIE and patient portals within the network will appropriately protect patient data and meet all HIPAA privacy compliance requirements (see Appendix Two for additional Perot Systems research findings).
Perot Systems is ranked by KLAS 3 as the number one clinical systems integrator and has helped hundreds of hospitals and physician groups install, integrate, and manage their clinical systems implementation. We have experienced clinicians on staff, and our rigorous proprietary implementation methodology—which we call ADOPTS (Assess, Define, Optimize, Prepare, Transform, Sustain)— enhances adoption rates of clinical projects such as EHR and HIE implementations. By relying on Perot Systems, hospitals will also relieve physician concerns regarding system maintenance, redundancy, security, and flexibility to scale. We provide 24/7 access to a global technical support team that hospitals and physician practices cannot afford to offer themselves.
A Perot Systems created solution suite can include multiple EHR software providers, and includes a pre-packaged and hosted EHR capability. We can also offer participating physicians a robust practice management suite that can help reduce back-office requirements and drive efficiencies in their revenue cycle. Many organizations are also providing access to a private HIE so that the entire network can exchange and share patient data, thereby achieving meaningful use.
Perot Systems provides access to an external facing “Patient Portal” which allows participating physicians and hospitals to provide their patients with secure, realtime access to medical records. We believe patient portals are an important addition to any community alignment strategy because they create a stronger bond between the hospital, physicians, and the patient. Finally, Perot Systems can place marketing personnel and assets in the region to serve as the hospital’s “marketing engine” to quickly generate and manage the outreach and other external activities required with such an aggressive alignment program.
Our technology and information sharing model is cost competitive. In most instances, the physician solution package, depending on application platform, is priced in the range between $650 to $1100 per physician per month. This package includes an EHR and EPM solution that is hosted in a secure Perot Systems data facility and includes system installation and provider training as well as access to our workforce of highly-skilled clinical adoption specialists and technology support teams.
Perot Systems also provides access through its alliances with leading hardware providers to new innovative technology solutions that will improve clinical computing while increasing clinician mobility. Our Virtualized Desktop Infrastructure (VDI), hosted software solutions and mobile computing device integration capabilities can create an end-user environment that complements, rather than detracts from, the clinical and treatment setting.
Perot Systems has over 20 years experience in providing secure environments for complex healthcare client needs. By working with our team to initiate a technology and information sharing alignment initiative, hospitals will have the engine required to successfully establish and manage the program. In addition, we can help you generate awareness and demand among physicians in the market.
Appendix One: Why Hospital and Physician Alignment is More Viable Today
Appendix Two: Research on EHR Implementation and Physicians Alignment
References
- HealthLeaders Survey of Hospital and Medical Group CEOs, Published, January 2008.
- Survey conducted by Harris Interactive, a leading survey firm.
- 2008 Top 20 Best in KLAS Awards: Software & Professional Services. December 2008. Clinical Implementation Services report, April 2008. © 2008 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com