EHR hammer comes down on Boston docs

Partners Health Care, a large health care system in the Boston area, is asking all of the primary-care physicians in its contracting network to implement or sign a contract for an electronic health record by Jan. 1, 2008. Those doctors who don't get an EHR will be expelled from the network, which negotiates with local managed-care plans. The same requirement will be applied to the bulk of Partners' specialists on Jan. 1, 2009.

The physicians have a choice between adopting Partners' homegrown, CCHIT-certified LMR system or the GE Centricity EHR. If they already have a different EHR, it will qualify only if it has specified decision-support features, says internist and cardiologist Thomas H. Lee, president of Partners' network.

Partners, which includes Massachusetts General Hospital and Brigham & Women's Hospital, has a network of nearly 5,000 physicians. Of the roughly 1,100 primary-care doctors in the network, 700 are in private practice. About 1,700 of Partners' 3,700 specialists are community physicians not employed by the health care system. Although some group-model HMOs have made EHRs mandatory for their employed doctors, Partners' decision is noteworthy because it's believed to be the first U.S. health-care system to, in effect, force private-practice doctors to get EHRs. While it's not requiring them to do so, the lure of better contracts will induce most to fall in line. Lee expects no more than 15 or 20 PCPs to walk away from the network.

Of course, Partners is no ordinary health-care system. Besides including an unusual number of academic physicians, it's located in one of the few remaining hot spots for prepaid managed care. So the development of care integration through EHRs is a more positive business model for Partners than it is for systems in most other parts of the country.

Also, Partners has been progressively converting its network physicians to EHRs over the past several years. Lee notes that in 2003, only 9 percent of the non-employed PCPs had EHRs; in 2005, 34 percent had them; and by the end of this year, 85-90 percent will. Overall, about 60-70 percent of Partners' doctors are using EHRs—a number far in excess of the national average, which still hovers between 10 and 20 percent.

Partners' other major advantage is that local health plans are investing some real money in health IT. For example, gastroenterologist James Tracey, president of the Hawthorn Medical Group in Dartmouth and New Bedford, MA, says his 50-doctor multispecialty group expects to recoup most of the money it invested in its EHR through insurer quality incentives (including a reward for health IT adoption) negotiated by Partners. However, Tracey points out, the cost of the ASP-model LMR system was quite reasonable, because Partners sold its software licenses at cost and is providing IT support to the group.

Tracey thinks that Partners' move was inevitable. "At some point, you have to walk the walk. You can't just talk the talk. If you're going to say that the EHR is a vehicle to get you to higher quality, then the whole network has to participate. And at some point you have to set a deadline."