Beth Israel Deaconess Medical Center in Boston currently provides electronic health records to every owned and affiliated physician.
"Since Stark [Law] safe harbors now enable hospitals to fund up to 85 percent of the non-hardware implementation costs of private practice electronic health records, my teams are now expected to provide EHR solutions for all the non-owned, affiliated and BIDMC-affiliated physicians in eastern Massachusetts," said John Halamka, CIO of BIDMC, in an series of blog posts written during the EHR system implementation.
To help with the process, BIDMC recruited Massachusetts eHealth Collaborative, a nonprofit focused on assisting with EHR implementation.
"BIDMC had explicit quality goals and quality benchmarking needs and wanted to implement [the EHR system] with an eye to health information exchange connectivity and quality data extraction from the EHR to support new payment models" such as their Pioneer Accountable Care Organization, all while keeping the project on budget, says Micky Tripathi, president and CEO of MAeHC.
"We were able to accomplish the implementation very cost-effectively," says Mr. Tripathi. Below, he shares four best practices that MAeHC has used at BIDMC and other hospitals and health systems to keep costs down when providing EHR systems to affiliated physicians.
1. Define goals. "Think about business goals," says Mr. Tripathi, "and I mean business with a capital 'B' and five underlines." He says technology like EHR systems is not the answer, but rather a tool to achieve business goals.
"Too many people think EHRs will accomplish your goals on their own. They will not. They'll only accomplish the goals they're designed to accomplish," he says.
Therefore, the first thing hospital administrators need to decide is what the EHR system needs to be able to accomplish to help the hospital meet operating goals. "Think about what you want — Performance improvement? Quality benchmarking? ACO enablement? Patient engagement? Care management? All of the above?— and then define what that means to your organization," recommends Mr. Tripathi. "Then create a whitepaper to share with key stakeholders," such as the information technology and financial departments, so that "everyone can develop a sense of what you want to accomplish."
2. Get what help is needed. Hiring consultants and management companies can be very expensive, but often hospitals can get the help they need à la carte, says Mr. Tripathi. He recommends contacting one of the Office of the National Coordinator for Health Information Technology's Regional Extension Centers, a nonprofit such as MAeHC or a for-profit consulting firm, any of which would have "lots of experience and lots of lessons learned to share," he says. These organizations do not have to be hired for the duration of the implementation, but rather "you could just bring them in to help set up strategy or share some lessons learned in two or three days of whiteboarding — that could be enough."
Mr. Tripathi says the goal of recruiting help is to benefit from the experience of others and learn which pitfalls, financial or otherwise, to avoid. "The most costly thing you could do is recreate others' mistakes," he says.
3. Invest in a program office and management staff. "One easy thing to scrimp on is a formalized program structure," though scrimping on this expense often leads to higher costs down the road, says Mr. Tripathi. Vendors will take care of the implementation process, he says, "but they'll implement them in wildly varying ways and not as efficiently as you would have, and not at the level of quality that you want and need."
"In the near term, you're saving money because you're not hiring managing staff," he says, "but you'll pay for it down the road when your EHR doesn't perform the way you need it to" and additional investments and modifications to the system are needed.
4. Oversee physicians' hardware purchases. "Don't let physicians use whatever hardware they want," says Mr. Tripathi. He says the cheapest hardware options that are the most tempting to physicians' groups are also the options that tend to malfunction
more frequently. "Those things break all the time, and then the hospital gets dragged in," he says. "If you let them buy the lowest-cost computers, tablet, routers, et cetera, you'll just have to deal with it later when it breaks."
Additionally, low-cost hardware (and accompanying security programs and software) are also often more vulnerable to data security issues. Health care requires higher security than standard-issue computers offer, which "don't come with whole disk encryption out-of-the-box, and now you have the risk a security breach that could end up costing you hundreds of thousands," he says.
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Brookings Institute: EHRs Have Not Yet Fulfilled Potential