Hospitals start to help docs buy EHRs

It's taken hospitals a while, but many of them are finally taking advantage of the relaxed Stark rules to subsidize EHR purchases by non-employed physicians on their staffs.

It's taken hospitals a while, but many of them are finally taking advantage of the relaxed Stark rules to subsidize EHR purchases by non-employed physicians on their staffs. According to Glen Tullman, CEO of Allscripts, about a third of U.S. hospitals are exploring or using this new opportunity. His company alone, he says, is "actively working with dozens of hospital clients across the country on Stark-related initiatives." Most of this activity, he adds, has occurred within the past six months.

For example, he notes, the Butler Health System in Butler, PA, is deploying Allscripts' EHR to both its employed physicians and an even larger number of independent physicians. Other examples include the Frankford Health Care System in Philadelphia, Blessing Health System in Chicago in Quincy, IL, the UMass system in Worcester, MA, and St. Francis Hospital in Hartford, CT. In addition, Appalachian Regional Healthcare, a nine-hospital system based in Lexington, KY, has licensed McKesson's Horizon ambulatory EHR and will offer it to community physicians.

Many hospital executives start out thinking that they can just offer the ambulatory version of their inpatient EHR to community docs, Tullman points out. "They quickly migrate from that view to saying, 'What we need is a system that ambulatory physicians will use,' because they generally won't use these hospital-related systems."

Hospitals usually provide ASP-model EHRs that are centrally hosted. Some hospitals do the hosting themselves, and others ask Allscripts to do it, but the majority have third parties host the software and the associated databases, says Tullman. One reason, experts suggest, is that if physicians adopt an integrated EHR/PM system, they don't want hospitals to have access to their billing data (see "Hospitals are getting ready to give," InfoTech Bulletin, Feb. 23, 2007).

Hospitals are handling technical support in various ways. Some plan to do it themselves, and others leave it to Allscripts. A third group will provide basic help-desk functions and refer more complicated software questions to the vendor.

In the latter category is the three-hospital Frankford Health Care System, part of the Philadelphia-based Jefferson Health System. Starting this month, Frankford will offer the Allscripts EHR to its 1,000 staff physicians, of whom about 500 admit significant numbers of patients to the hospitals. Frankford spokesman Joseph Olszewski says he expects at least 100 doctors to accept the offer. Forty-four doctors are already onboard. They belong to three of the five practices that helped Frankford choose an EHR, including a 20-doctor cardiology group.

One reason for Frankford's optimism about physician uptake is that it's going to pay for 85 percent of the EHR cost—the maximum allowed under the revised Stark rules. It will also sell the Allscripts practice management system to the physicians at cost. If a practice chooses an integrated system, it will pay about 50-55 percent of the full cost, Olszewski estimates.

Frankford's 40 employed physicians will eventually use the same integrated EHR/PM system. Right now, however, they're locked into a three-year contract with another billing system vendor.

Frankford has already developed an interface between Allscripts and its Eclipsys inpatient EHR, Olszewski adds. Physicians who buy the ambulatory EHR will be able to receive online lab, cardiology and radiology results online, as well as hospital reports such as discharge summaries and operative notes.