Appendix One

Health Information Technology: How Hospitals Can Enhance Physician Alignment by Offering HIE and EHR Technologies

Why Hospital and Physician Alignment is More Viable Today

Looking at past physician alignment strategy failures begs the question, “What has changed and why is ‘now’ the right time to aggressively approach a connected community alignment strategy throughout your health system?” One of the biggest reasons is that this differing approach is centered on technology service offerings that help physicians overcome the following challenges:

Implementing complex software solutions in a healthcare environment quickly and easily;
Maximizing government incentives by meeting “meaningful use” standards;
Connecting effortlessly, through a Health Information Exchange, to the hospitals and providers;
Automating patient administration and accounting processes to speed up reimbursement through practice management software;
Improving clinical productivity through patient coordination and care; and,
Relieving technology maintenance and support hassles associated with technology support.

ARRA incentives for EHR implementation – With approximately $23 billion of the ARRA dedicated towards grants and incentive payments for healthcare IT, it pays to be an early adopter of EHR technology. Late adopters will receive smaller incentive payments and be penalized through decreased Medicare and Medicaid reimbursements starting in 2015.

Hospitals are not required to help physicians meet “meaningful use” standards, but rather they are being given the leniency to help assist smaller practices in getting this done. Hospitals typically have stronger IT capabilities and greater access to technology through systems integrators. They also usually have far more advanced IT capabilities and maturity than most practice groups. For these reasons, hospitals are seeing an opportunity to help physician practices make the right decisions on software selection and implementation.

Since survey after survey shows that doctors are concerned about transition time and loss of productivity when implementing EHR solutions, it only makes sense that they would seek the assistance of the health systems they work with on a daily basis and their experienced systems integrator. Perot Systems appreciates the complexity that healthcare leaders face when implementing a comprehensive EHR system that will meet the ARRA requirements, and has developed a suite of solutions to address these challenges and facilitate widespread end-user adoption.

Interoperability and data exchange – Transparency of patient data helps build trust among physicians and health systems. Doctors are realizing implementation is just the tip of the EHR iceberg. They have to make these systems interoperable AND they must exchange some levels of data to gain access to federal incentive funds. Health Information Exchanges (HIEs) are expected to help healthcare providers better exchange critical patient health information and improve the interoperability of EHR systems within a community. This dynamic step in itself can drive improved alignment and prompt some physician groups to see affiliation as a better approach.

Health systems are in the perfect position to lead the development of HIEs that rely on a more robust information sharing environment. They can help drive down the cost of care and improve quality. We are seeing new efforts that are constantly developing while bearing significant promise in helping better align physicians with their community hospitals.

Today, hospitals are more competitive than ever. Physicians want to see additional benefits from the ones to which they are aligned. Therefore, health systems need to provide the highest quality experience for their patients. They also need to focus on creating quality metrics, measuring performance, and adjusting as they seek to improve. As part of this effort, they need to take a long look at their technology environment.

The Federal Stark law and the Federal Anti-Kickback statute are obstacles that hospitals and health systems have had to overcome when working with physicians on technology initiatives. However in August 2006, the creation of new information technology exceptions to these regulations substantially increased the ability of hospitals and other providers of Medicare or Medicaid services to donate information technology to physicians without violating the statute. When developing physician alignment strategies, it is important to carefully consider whether they are compliant with the subject exceptions and safe harbors.

The new regulations address prohibitions in both the anti-kickback statutes and in the physician self-referral regulations by defining specific activities permissible under the statutes. The permissible areas are known as “safe harbors” under the anti-kickback statutes and “exclusions” under the self-referral prohibitions relating to physicians. Since Health and Human Services (HHS) enforces these prohibitions under separate agencies, HHS published two sets of final rules to provide consistency in approach, terminology, and implementation. In spite of the similarities, the final rules are still complex and contain more than 300 pages of detailed discussion.

In general, the regulations attempt to clarify the circumstances under which hospitals can support the HIT needs of physicians by providing two broad categories of safe harbors/exclusions:

Electronic prescribing; and
Interoperable EHRs.

Of all these requirements, the most problematic condition is the definition of “interoperable,” which includes the ability of the software to:

“Communicate and exchange data accurately, effectively, securely, and consistently with different IT systems, software applications and networks, in various settings;” and
“Exchange data such that the clinical or operational purpose and meaning of the data are preserved and unaltered.”

Given the reach of the definition and the scarcity of existing standards or criteria on which to base such a determination, HHS offers what it calls a “bright line” determination of interoperability. Products are deemed interoperable if they are certified by an organization recognized by the HHS Secretary. As long as certified products contain e-prescribing functions and distribute under a cost-sharing agreement where the recipient pays 15 percent of the cost of the software or service, then the safe harbor/exclusion applies.

HIPAA regulation and data security is also a significant concern that needs to be addressed. The major issues you should consider that could become “big ticket items” include:

Stiffer penalties and higher enforcement for breaches of protected health information (PHI);
Breach notification applies to covered entities, business associates, personal health record vendors and pertains to acquisition, access, use or disclosure of PHI;
Patients will soon be able to request a full accounting of disclosures of PHI (pertaining to treatment, payment and healthcare operations) housed in an EHR;
Health Information Organizations (HIOs) and Regional Health Information Organizations (RHIOs) will be required to be in compliance with HIPAA; and,
Audit logs will be required for EHRs.

Reviewing and determining how best to comply with the HIPAA Security Safeguards, whether “Required” or “Addressable,” is crucial to the success of HIEs and compliance with the privacy and security aspects of the HITECH Act. Performance of a “thorough and accurate” security risk analysis (assessment) in order to identify potential threats and vulnerabilities to information systems and any associated risks is paramount to moving forward.

This should include identifying devices, portable or otherwise, used by the organization (i.e., Blackberries®, PDAs, medical devices, drives, memory sticks, etc.) that must be tackled so that a plan can be devised.

Back To: Health Information Technology: How Hospitals Can Enhance Physician Alignment by Offering HIE and EHR Technologies

Appendix Two: Research on EHR Implementation and Physicians Alignment