This is a response I wrote to Brian Ahier’s post on HealthsystemCIO.com
Here’s an idea I raised a few months ago which discusses how to use EHR to your advantage in retaining ambulatory physicians. What prompted the idea was knowing of a hospital which spent nine figures on their EHR, only to find out that its functionality essentially ended inside its four walls. At the time nobody wrote that it wouldn’t pass muster. This idea may die before anyone finishes reading the comment; if not perhaps it merits at least a look-see.
From the perspective of the business model of the hospital, what do we know?
• Hospitals work at attracting and retaining good physicians
• In many markets, ambulatory physicians may choose to send their patients to any one of a number of hospitals
• The competition to attract patients and physicians is building
• The hospital and physicians both benefit if they are:
o On the same EHR
o On an EHR which interfaces easily
What if we change the question being asked, or at least change what constitutes a desirable answer from the perspective of the hospital? Let us go back to what we know.
• Non-hospital based doctors will not be part of the calculation to determine if the hospital meets Meaningful Use.
• Each of those doctors benefit from implementing and EHR system, and they will either qualify for stimulus money or be fined.
• Those same doctors and their patients benefit from having a seamless relationship with a hospital.
• None of those doctors has anything close to what can be considered an actual IT department.
o If 400 providers who practice at your hospital have to select an EHR, how many dozens of different EHRs will they select
o Not only do the providers lack the skills to select a good system, they lack the skills to implement it successfully.
o Most IPAs are not even offering a recommendation
What happens if we rephrase the question and ask, “What steps can a hospital take to:”
• Make ambulatory doctors want to send their patients to them
• Make it easy for the patient/physician/hospital relationship to appear seamless
• Possibly be paid for facilitating the EHR for their ambulatory physicians
If it were my hospital, here’s what I would do:
• Pull together a plan to figure out how a hospital could offer an EHR solution for each of the ambulatory doctors. This EHR solution could:
o Be the same EHR or one which can integrate with their EHR
o Be offered as a managed services solution
o Be offered as an outsourced solution
• Figure out what information is needed to determine the viability of offering its ambulatory doctors an EHR solution:
o Staffing
o Marketing
o Incentives
o Cost
o Roll-out
o Training
• Determine if the ambulatory doctors can somehow sign-over their incentive payments to the hospital.
o If yes, the incentive payment from 400 ambulatory doctors could fund about $18 million of the roll-out cost
o If not, there are still a number of great business reasons to think about helping the doctors get on the hospital’s EHR.
What is the long-term ROI, say five years and beyond, of having an ambulatory doctor send its patients to a given hospital? I bet it exceeds the cost of installing an ambulatory EHR.
Pale Rhino Consulting 
Paul this is a good write up, because it was the original intention of HIN.
I think EHR/HIN/HIT has a very interesting problem now.
Consider a physician or any practitioner as a health network citizen. They know how to act, behave and treat in the context of their silo. Get them to think that every time they see a patient outside their silo there is an implication that they may contribute a solution to and if they are not part of the network, they will be forgotten and what they know lost.
The course I just developed, which needs a different name for health care was once provided to commerical architects all expert in hospital, ambulatory and assisted living health care with track records and portfolios of quality.
Yet in the course as I taught it successfully at Boston Architectural Center, most of these architects (designers of teaching hospitals and academic health care facilitites) could not think beyond the space in design as implied from an institution view.
One team in my group for a team group exercise, shared an interesting common personal experience. These “expert” architects (6) of them had all lost someone in their family to cancer or had someone at home in treatment.
In minutes they began to imagine design of a campus and communications like a HIN and the incentive that came out of the discussion were precise, purposeful contact at a location with an expert and excellent flow of traffic and sharing of information to other locations of service and health.
It was a amazing. These architects were not doctors, but they all now in architectural design have to think about the use of technology and more. By the end of the class they could describe to a doctor in minutes incentives for why a radical change in design of buildings could help practice, education of patient and reduce bureaucracy and pressure of dealing with so many breakdowns in communication and patient flow.
I took video and internet sites of architectural designs out of health care that gave these people messages from success stories of change in proactive and clustering the value of information and I shaped metaphors of design from other industries that got these people thinking.
There is an architectural firm in San Francisco that I studied that redesigned many facilities from health to manufacturing and their design and presentations communicate the value of how to thread a changing picture of being a person who works in silo communicating as part of a network. We had a blast in the class it was very Star Treck and very George Lucas and fun.
for years, I have hoped to do a class like this with health infomatics specialists to teach them how to talk to doctors and how they can bring value through HIT to a network (not a hospital) where the measurements and outcomes are not institutionally driven from a bottom line but driven from how a patient is cared for and how clinicians can practice.
I personally think Practice Fusion in their marketing created a real problem by proposing that doctors can get $40K for going on line in their cloud to use EHR for free. Big deal. It takes much more imagination to understand how to use an EHR to be part of a network of quality and effective practice – learn with people you do not know and learn with people you would not ordinarily learn with and to figure out how the technology enables that efficiently and actually makes it fun after an initial period of learning and change that can be hair raising. Most people converting a paper environment into EMR don’t take the time to think and motivate others to slow down and make it all work gradually rather than create a headache as most technology firms do learning and adapting as you go.
There are some things you can do thoughtfully and to me this was the intention of the $40K reward to doctors to take pressure off of billing patients and use the money to slow down practice if they could for a few weeks to learn and adapt.
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In terms of assisting with EHR deployment you ask the key question: What is the long-term ROI, say five years and beyond, of having an ambulatory doctor send its patients to a given hospital?
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Thanks Brian. Here’s my take on it. I don’t know if hospitals have mini P&L’s on the value of a doctor over the period which the doctor sends their patients to a given hospital. I bet it far exceeds the cost of putting in an ambulatory EHR
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Paul
Great post! One big challenge we see is that a lot of doctors are not happy to let hospitals have all that data. They are not convinced it will be beneficial, rather it will provide hospitals ways to leverage services and revenue
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great point John. At the end of the day those who control the data win. That’s why my bet is on some combination of Apple, MS and Google
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