Physician EMRs

Turning a Medical Practice Tool Into a Hospital Strategy Lever

By: Dan Marino

Hospitals across the nation are helping community physicians adopt electronic health technology within their practices. But an investment in electronic medical records (EMRs) is substantial, and many hospital executives have a hard time explaining precisely how the investment will support their organization’s goals. Given the dollars involved, approaching EMRs as a strategic alignment opportunity is a must.

The problem is that EMR strategy is often thought of as a two-way exchange: the hospital gives physicians a new practice tool, and the physicians give the hospital their loyalty. But an EMR is not just a tool for simplifying and speeding up current processes within existing organizational boundaries. It has the potential to establish new relationships that cut across traditional provider, payer, and patient borderlines—and as such offers a powerful opportunity for aligning hospital and physician motivations around strategic goals.

Building High-Value Connections

Getting an EMR system into physician practices requires careful technical, operational, and financial planning. Once the system is in place, the next step is to enhance its value by creating connections with a broad range of stakeholders. There are four milestones:

Interoperability: Getting the physician EMR talking to the health information systems of other provider organizations, including the approximately 20 percent of physician practices that already use an EMR.

Network expansion: Establishing links between the physician EMR and key hospital information systems (like the radiology PACS) and connecting users from other healthcare organizations such as independent labs, clinics, and pharmacies.

Enhance functionalities: Creating advanced functionalities (like electronic order entry, e-prescribing, and electronic referrals) that let physicians take advantage of network connections.

Patient integration: Incorporating patients into the network through application portals and functions like automated secure test results, appointment scheduling and registration, and prescription refill and renewal requests.

Embedding the EMR within an interoperable network creates significant value for both physicians and the hospital. The main snag for many organizations, however, is that they focus too narrowly on the technology and do not pay enough attention to how it impacts physicians.

A lot has been said about the importance of selecting and configuring an EMR that physicians are comfortable with. But there are many other practical and financial reasons why physicians resist EMRs. To overcome these obstacles, hospital leaders need to craft a Stark-compliant support package that addresses the full range of physicians’ concerns, including:

• Software costs: In addition to underwriting part of the cost of EMR software, hospitals can assist with the cost of connectivity. Leading hospitals are providing financial support up to the Stark maximum of 85 percent.
• Other Costs: While hospitals cannot purchase hardware for physicians, they can help physicians make good hardware decisions and make sure they have access to economical remote-hosted applications.
• Technology headaches: To overcome this problem, hospitals should commit to providing ongoing support from the hospital IT department.

• IT compatibility: Some hospitals are offering integrated practice management and EMR solutions along with their EMR support.
• Organizational readiness. Most hospital-supported EMR rollouts include vendor-provided training for physicians and office staff . However, many medical practices need more than a one or two day training module. Consider providing consulting support to help practices establish new clinical and business office processes for maximizing EMR use.

Leveraging the Network

While growing the health information network around the EMR system, hospital leaders can also pursue integration with physicians to achieve clinical and strategic goals.  The first phase involves collaboration aimed at improving patient health outcomes across all care settings. As hospital executives and physicians work together to identify quality goals, establish agreement on best practices, identify quality measures in medical practice, and create quality initiatives to improve inpatient care, the EMR will play a key role. Use the system to support physician performance (with functionalities like medical alerts and medical management templates), track physician adherence to agreed upon practices, and measure hospital outcomes.

Once quality goals and outcomes measures are in place, the program can be leveraged in payer contracting. Right now the biggest opportunities are in the management of chronic diseases. For example, a hospital and its affiliated physicians could target chronic heart disease for quality improvement through a clinical integration program that includes:

• Commitment by primary care physicians to follow best-practice standards for heart disease screening.
• Agreement by cardiologists to adhere to evidence-based guidelines regarding medication management, ongoing testing, and appropriate interventions.

• Collaboration between the hospital and the cardiology staff to create an aggressive inpatient intervention program to prevent cardiac readmissions. With such a program in place, the hospital can then negotiate better contractual reimbursement and bonus incentive payments for both hospital services and affiliated physicians. This can lead to substantial strategic benefits including:

Financial Integration Wtih Physicians.  Community physicians become more closely linked to the hospital since it is through the hospital-led network that they access better contractual rates and incentive payment opportunities based on clinical quality outcomes. In this sense, clinical integration leads to powerful “financial integration” between physicians and hospitals.

Strong Goal alignment. A successful clinical integration program requires physicians to be committed to the vision of care being created by the network. Physicians become very involved in working with hospitals on goals, processes, best practices, and strategy. As a result, physicians come to see their professional goals as interwoven with those of the hospital.

Increasing Leverage. As outcomes improve and the network proves its ability to implement best practices quickly, the hospital will develop significant leverage with payers. This applies to negotiations with private payers as well as the ability to take advantage of government-sponsored quality care initiatives. There is even greater potential in direct negotiations with large self-insured employers. Hospitals can also negotiate preferred EMR application pricing on behalf of participating community physicians, assuming a critical mass is established.

Challenges and Lessons Learned

The main pitfall for organizations that set out to build a strong EMR-driven health information network is neglecting to develop processes, both clinical and office-based, that support the new technology.

For instance, flaws in the system interface can be devastating if they are not caught and corrected quickly. So it’s essential to build in adequate “checks and balances” to ensure that data are being captured and fed into the appropriate systems correctly. A practice will want to make sure that processes are in place to ensure that charges are feeding into the practice management system, for example, so as not to risk a serious cash flow problem.

Another potential challenge is the risk that clinical integration will lead to lower utilization in many hospital service categories. To meet this challenge, hospitals should closely monitor utilization so that any losses related to providing better care can be addressed in contract talks. In addition, hospital leaders should be sure to take advantage of the ability of EMRs to reduce unreimbursable services.

A Strategic Alternative

For strategy leaders, a health information network could be an effective means of establishing ties with physicians who need support but are wary of hospital employment. Developing an EMR centered health information network allows a healthcare organization to build provider alignment (with or without employment) and create powerful links with a broad range of community.