 |
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 (CCHITSM) 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. |
|
 |
|
|
|
