[Opinion] Big iron, meet the cloud: A solution for healthcare IT innovation

The complexity of relations between physician groups and health systems is one of the unappreciated stories of the post-reform era. Faced with the imperative to improve the value of the care they provide, health systems are attempting to create clinically integrated networks with both their employed and affiliated-independent physicians, ushering in a new era of relationships and partnerships.

With these collaborations, health systems and medical groups are finding that their differences go beyond the obvious factors of size and complexity of business operations. There are significant philosophical differences in how they approach IT and innovation, which is coalescing around an unexpected battleground: the electronic health record (EHR).Nate Kaufman

Sharing clinical data in near real time is a critical component to successful clinical integration and core enabler of population health. While health systems can mandate the EHR to be used by their employed physicians, independent physicians are reticent to change from the EHR that they are currently using and few are willing to absorb the cost of switching to a new, more expensive option that can cost up to $70,000 per provider.

The inability of a health system to resolve this issue will significantly determine their ability to measurably improve the value of care they provide; and without a clear solution, patients will suffer.

For independent practices using their own EHR system, many are relying on the cloud for its efficiencies and their ability to tap into a larger network of innovation and data intelligence. A recent Medscape survey reveals that solutions with cloud-based offerings, like athenahealth and Practice Fusion, wrap up almost half of the independent practice market.

Yet hospitals and health systems have been largely unmoved by the cloud, and software and “big iron” data centers continue to rule the day. The answer would seem relatively simple: enable data sharing and interoperability with the health system’s EHR. Unfortunately, according to a recent RAND Corporation report, some of the largest EHR platforms resist interoperability with other EHRs. This spurred Rep. Phil Gingrey (R-Ga.) to make comments comparing one vendor’s lack of interoperability to fraud.  

While many health systems had good reasons for selecting their “big iron” EHRs, they’re now faced with physician practices that are unwilling to adopt these IT systems. Many management teams feel that their hands are tied, as they cannot afford to employ all the physicians in their delivery system or install their preferred EHR throughout the practices, and nor do all the independent physicians want to be employed or want to change from their existing EHRs.  

These health systems have deployed tens or hundreds of millions of dollars to implement a “big iron” enterprise EHR, but now they’re facing the unpleasant reality that their new investments don’t always play well with other systems. They’re left without the interoperability and data exchange necessary for them to extend into new markets and provider relationships, and are unsure of what options they have to address the issue. Ultimately, this is a huge impediment to improving value for their patients and the providers who care for them.

So, what’s a healthcare organization to do?

For large hospitals and health systems that have already selected big iron EHRs, cloud-based technology solutions can still be an extension tool to connect them into their partners’ systems. They don’t have to force their collaborating physician networks to get on their EHR – there are other options to maximize the value of those big EHR investments.

Instead, health systems can start demanding that their closed-door software systems open up and build connections to other health IT platforms. These health systems can become part of the rallying cry for interoperability, instead of participants in the perpetuation of data silos and 20th century care models.

This is already happening in small pockets of the market, including my hometown, San Diego. Here, an interoperability initiative is underway between the Rady Children’s Hospital – a 520-bed pediatric care facility that operates on the Epic software EHR platform – and Pediatric Partners, a regional practice with 10 offices in the San Diego area that has embraced the athenahealth cloud-based EHR solution, athenaClinicals.

As of last month, Rady Children’s Hospital and Pediatric Partners were up and running with this initiative, leveraging both athenahealth’s and Epic’s EHRs to view and retrieve clinical data about patients from each other’s systems via direct integration, without the need for a health information exchange or other intermediary.  This is a great example of interoperability enabling coordination of care and better communication between provider organizations.

Hospitals and health systems must realize the great responsibility that they hold in advancing healthcare IT down the path of interoperability. These extension approaches can help them get the most out of their independent practice partners while giving them the freedom to stay with the EHR that best serves their needs. In addition, flexible technology platforms will give hospitals the visibility and ability to leverage real-time data from an entire ecosystem, not just from within the walls in which they operate.

To succeed in the new post-reform environment, healthcare providers must produce significantly better value for patients. Interoperability of EHRs is critical to this end. The technology is available to achieve this. Now what is needed is “big iron” companies’ willingness to embrace the concept for the good of patients – and health systems’ courage to demand it.


With 35 years experience, Nathan Kaufman is a noted consultant, strategist, lecturer and author on topics related to health strategies for the new millennium. He is a nationally-renowned expert in the areas of peak performing hospitals, payer contracting, physician groups, hospital strategy, physician transactions, integrated delivery systems, managed care, joint ventures and dispute resolution. Nathan provides consulting services to many of the nations largest health systems, hospitals, and medical groups. He is a frequent faculty for ACHE, The Governance Institute and many state and local healthcare associations.

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Dr. David Nash: Data key to population health
HIMSS: How EHRs can help hospitals reduce mortality rates
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