MGH/Brigham system moves briskly toward 100% EMR adoption

Partners Community Healthcare is well on its way to achieving the ambitious goal of having all its physicians connected to an electronic medical record (EMR) system by 2009.

From the time the healthcare system launched its initiative in 2002, reaching the goal of 100% EMR adoption has been no small task. Partners has to connect some 3,800 physicians at its academic medical centers of Brigham and Women's Hospital and Massachusetts General Hospital (MGH) in Boston, and convince approximately 2,200 physicians in community practices -- the majority of which consists of one, two, or three physicians -- across Massachusetts that the investment of financial and human resources would reap adequate rewards on many levels.

In 2003, Partners had already achieved a fairly high degree of EMR adoption, with 80% of primary care physicians and 65% of specialists at its academic medical centers having implemented the technology. In the communities, however, only 9% of primary care physicians and 1% of specialists were using EMRs.

In just four years, Partners has increased EMR adoption by community primary care physician to 90% and specialists' participation to 35%. Another 10% to 15% of community physicians in both categories are committed to EMR implementation.

Speaking at the 2008 Healthcare Information and Management Systems Society (HIMSS) meeting in Orlando, FL, Partners information systems director Michael Esters and chief information officer Cynthia Bero detailed how the healthcare system brought community physicians on board with an EMR that best suited their needs with as little investment as possible.

Benefit analysis

In 2002, when Partners' board of trustees endorsed a plan for deploying an EMR system, the board also created a task force to analyze the benefits and challenges of EMR adoption. Partners had an internally developed EMR system, but the technology did not include some features that were important to community physicians. In addition, federal Stark regulations at the time prohibited healthcare systems, such as Partners, from purchasing EMR systems for private practices.

To implement a system of their own, community physicians would have to invest thousands of dollars. When faced with that kind of investment, Partners knew community physicians would demand a choice of more than one EMR system, and Partners would have to allow the doctors a certain degree of autonomy, Esters said.

The task force offered its internally developed EMR system, the Partners Longitudinal Medical Record, and Centricity EMR from GE Healthcare of Chalfont St. Giles, U.K., to community physicians. Partners also allocated additional funding to develop additional features, such as privacy options, that its system lacked and community physicians wanted.

The new privacy feature "would help us ensure that Partners could only access patients which were registered to their (community physicians') practice," Esters said. "Once they registered a patient to that practice, they could see a comprehensive view of that patient's chart. They could see the information they entered on that patient, as well as in information entered by other practices."

For the few community physicians who already had an EMR system, Partners adopted a grandfather clause. If a physician had implemented the system before 2004, Partners stipulated that the technology must keep pace with Partners' future network requirements. Periodically, Partners sent communiqués about functionality and interoperability updates and, if the community physicians' vendors upgraded the technology, too, the physicians could keep their own EMR system.

"The fact that we offered a choice made a big difference," Esters said. "It took us out of the position of foisting on them one particular product, a Partners' internally developed product."

Incentives and investments

Given the small size and limited resources of most community practices, Partners also sought to minimize the physicians' investment in hardware, software, and interfaces, and maximize the incentives for implementing an EMR system.

Community physicians requested Partners contact local third-party payors to see if there were any incentives for physicians that could include reimbursement contracts for new technology adoption. At the time, pay-for-performance was starting to emerge.

"If we did that, we wanted to make sure that any incentives that came back into the network or from these pay-for-performance contracts were directed back to the physicians that acquired the technology and went through the implementation," Bero said.

Much to the physicians' delight, the insurers agreed. Not only did the pay-for-performance approach bring incentives into the system, but "it also helped keep us consistent with federal regulations," Bero added.

Reaping rewards

Pay for performance has become such a catalyst for using new technology that Partners has started to pursue similar contracts for using e-prescribing and clinical decision support as performance targets for its physicians.

Payors also were willing to roll over incentives to a second year, if the EMR adoption was not completed. By building a pool of the previous year's incentive money, it gave physicians a window of time into the second year of the contract to complete the EMR adoption.

"Honestly, our numbers were staggering to us," Bero said. "We didn't think we needed to change our plan at all, so we have not taken advantage of the relaxation of the Stark regulations. We have continued to rely primarily on pay-for-performance incentives."

Mounting pressure to adopt EMRs also played a role in community physicians' willingness to embrace the technology. The increase in adoption among primary care physicians was steady, from 9% in 2003, to 34% in 2005, to 91% at the end of 2007.

Adoption momentum

Once the physician group reached the 50% mark, community specialists began to notice, Bero said. "After the first few primary care physicians went onto the system and starting telling stories about how a consult note appeared in their patient's chart within an hour of the patient having been seen by a specialist, and how marvelous it was to be part of the functioning network, that started to create a buzz," she added.

Primary care physicians had to commit to the EMR network before December 31, 2007, and have to complete implementation by the end of 2008 to avoid termination from the network. The deadlines for specialists are one year later, respectively.

"In 2008, there will be a 100% rate among primary care physicians in the academic medical centers and in the community," Esters said. "By 2009, it will be 100% across the board."

By Wayne Forrest
AuntMinnie.com staff writer
March 3, 2008

Related Reading

National IT standards need to be locally controlled, February 26, 2008

HIMSS survey: EMR tops healthcare IT plans, February 25, 2008

Oregon insurer launches patient-record program, February 18, 2008

Insurer group promotes health record interoperability, May 19, 2006

Integrating disparate systems key to EHR deployment, February 14, 2006

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