healthsystemCIO.com Survey Says Connecting With Independents Is Top Priority

As government incentive programs place a greater emphasis on data sharing — both within and among organizations, connecting with independent physicians is moving higher up on CIOs’ to-do lists. In fact, 79 percent of CIOs said that integrating electronically with outside providers is now among their top three priorities, according to the April healthsystemCIO.com SnapSurvey.

However, the vast majority are finding that major challenges still exist. Even among the 58 percent of CIOs who have experienced moderate success with EHR adoption rates, many commented that progress has been slow and inconsistent. Twenty percent of respondents said that adoption rates have been disappointing, citing limited interest by providers and resource constraints as key factors, while just 17 percent noted that they’ve had a high degree of success. Of the 46 percent of CIOs who are offering an EHR subsidy program to independent physicians, most are keeping it simple by providing just one vendor option. Not surprisingly, several respondents noted that having physicians choose an EHR that syncs with their system is the ideal scenario.

In terms of connecting with other health systems, although the majority (58 percent) of CIOs report that their organizations are “actively engaged” in regional HIE efforts, they have serious concerns regarding sustainability and are seeing “varying degrees of engagement and success.” Twenty-one percent reported that they are “extremely skeptical as to value and sustainability,” with one CIO calling HIEs “a band aid approach,” and another saying that although the industry is moving in the right direction, initial HIE efforts are “disappointing.”

(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)

1. Is electronically integrating with independent providers among your top three priorities?

Yes

• It is a strategy that we are working on. We’re not sure how much traction it will get, as some of the providers do not trust us as much as they will need to in order to make this work.
• We have a significant community of independent physicians.
• It is a top priority, but our current focus is putting in our new EMR. We will not integrate with independent providers until we first complete laying in our EMR foundation.
• Outpatient is the growth area and this strategy is critical to that.
• Yes, however, it is a means to an end. The integration is needed to support ACO and patient-centered medical home initiatives, which are the real priorities.
• Our primary focus is on the integration to our EMR that has both employed and private physicians.
• Creating that “community” view of the patient is important.

No

• While we are partnering and integrating, I wouldn’t say it’s in the top three.
• We have acquired most independent providers in the area.
• We are a specialty destination facility, so although we link with referring physicians, we don’t have an interest in independent providers in general.

2. If so, what level of success have you had with EHR adoption rates?

High degree

• Where we have rolled out our EHRs to independent physicians, it has gone very well.

Moderate

• We have implemented a few practices and are seeing signs of increasing interest.
• We offer EMR to some practices today and have been successful. Going to a new platform will change our game a bit. Time will tell if adoption goes up.
• It’s actually a little easier with our independent physicians than with our employed physicians.
• We are installing a shared practice management system in six practices and have interfaces with 20.
• We have had a high degree of adoption with our employed physicians, and a low degree of adoption with affiliated physicians.
• It varies widely.
• Once we made the decision to move forward with Allscripts on the inpatient side, the offices have been moving forward with Allscripts in their office. We have just crossed a major stumbling block so I think the implementation pace will pick up now.
• We are moving as fast as the resources allow.
• Integrating for us does not mean providing them an EHR. It means exchanging info and supporting a referral network.

Disappointing

• There has been limited interest in subsidized offering to date.
• Not applicable to us yet.
• We have been implementing our owned practices at a high rate, but have little left in the way of resources to implement the independents who have high expectations and want to be first in line in order to glean MU funds.

3. Does your organization offer an ambulatory EHR subsidy (Stark) program for independent providers?

Yes

• Up to 85 percent for primary care physicians.
• We are working on the details of that now. We will most likely take the donation level to 70 percent, not the full 85 percent, just to be safe.
• Maximum for one-time costs if adopting the “community” ambulatory EHR vendor’s product.
• We are paying for some of the interface costs and the initial implementation of the shared system.

No

• Our approach is to support what they want to do and to provide linkage to our system. We are focused on connectivity rather than the EMR.
• No, but we are developing an offering.
• We are considering this program but have not decided yet.
• Our organization supports the purchase of infrastructure assets that lessen the physician cost to participate in the program (to the extent allowed by law).

4. If so, through the program, do you seek to influence their choice of EHR vendor?

Yes, they can pick only 1 (syncs with our acute EHR product)

• It syncs with our network ambulatory care strategy.
• Yes, they have to take what we give them. Like it or not.

Yes, they get 2-3 to pick from

Yes, they can select whatever product they choose

No

• It’s easier if they use what is synced with our system or a vendor we already have interfaces with.

N/A

• Yes, they can pick only one that is used by our employed physicians. Our clinical integration initiatives will bridge the acute and ambulatory settings.
• As mentioned above, we are focused on connectivity. We have found that by looking at three to four vendors, we can handle the vast majority of our independent physicians.

5. What is your strategy with respect to regional or health-system to health-system HIE efforts?

Actively engaged

• We have a very mature HIE in Indiana.
• But we are concerned about sustainability.
• We are in a tri-state area so there are varying degrees of engagement and success.

Optimistically taking a wait-and-see approach

• Locally (two hospitals and all primary care) promoted and engaged — regionally, it’s still pending.

Extremely skeptical as to value and sustainability

• I believe future system interoperability will be the answer to exchanging information, while HIEs are a band aid approach for the short term.
• We’re focusing on private HIE first for our clinical integration initiative.
• I believe in the imperative of health information exchange and am pleased the industry is moving in this direction, but I’m disappointed with the initial HIE efforts and am skeptical about their value and sustainability as they currently exist.
• We support and participate our regional HIE efforts but continue to be skeptical of long term sustainability unless the payers make clear commitments.