Following two years of planning, officials from Hill Physicians Medical Group, an independent practice association in Northern California, in March will launch what group officials say is the largest private online electronic medical records system and practice management system in the United States. The launch, which initially will include two pilot locations — one in Oakland, Calif., and the other in Folsom, Calif. — is part of the group’s effort to enable smaller physician practices to gain momentum in the push to automate records in a measured and cost-effective fashion.Disparities Between IT Adoption Among Small, Large Physician Groups
Small physician practices typically have lagged behind their larger counterparts in terms of IT adoption, mainly because they lack the scale needed to guarantee the cost-effectiveness of hefty up-front information technology investments. During his keynote address at the recent Health Information and Management Systems Society conference in Dallas, National Health IT Coordinator Dr. David Brailer identified major barriers to health IT adoption and said he was particularly concerned that smaller physician practices would not be able to afford IT systems.
A study released last September by the Center for Studying Health System Change found that 38% of HMOs and 20% of large group practices had access to electronic prescribing technology, compared with only 8% of traditional practices, which the researchers defined as “solo and two-physician practices, groups with 50 or fewer physicians and physicians in office-based practices owned by a hospital.” Meanwhile, 75% of staff and group HMOs and 63% of large physician groups reported that they could exchange clinical data, compared with 32% of traditional practices.Hill Physicians Forges Path to Implementation
As one of the nation’s largest IPAs, Hill Physicians’ experience introducing the new system promises to be instructive because it will illustrate strategies for coordinating IT among 2,600 physicians at 1,200 practice locations, many of which are small, rural sites.
According to Craig Lanway, CIO of Hill Physicians, the primary challenges that Hill Physicians faced when designing the system was setting realistic deadlines, ensuring widespread buy-in from physicians and coordinating a wide range of billing and technology platforms. Although deployment at the pilot sites indicates that the group’s work has paid off, Hill Physicians still must carefully assess the pilot programs to determine the overall cost of running the program and make sure the program fits the needs of a large and varied group of physicians.
Lanway said Hill Physicians will roll out the technology incrementally. Once the two pilot sites are up and running — which should occur by the end of March — Hill Physicians will begin implementing the technology at another set of sites. All in-network practices are expected to have access to the technology in three to six years.
In-network physicians will not be required to use the new system, but Hill Physicians officials anticipate that it will be widely adopted. According to Steve McDermott, CEO of Hill Physicians, “the system’s efficiency and accuracy not only increase the time that doctors and staff have available for treating patients, they also help ensure that medical protocols are correctly followed.”Physician Participation Key to Designing Effective System
In order to ensure widespread buy-in, physicians were involved in the selection of an electronic medical records vendor, and a panel of eight physicians and two practice administrators are overseeing design of the system.
Dr. Alvin Sockolov, chairman of the IT committee and a practicing family physician in Sacramento, Calif., explained that a group of 20 to 30 physicians helped choose between three IT vendors. The initial selection process was quite extensive and involved all participating physicians making on-site visits to see the systems in use. Once the larger group of physicians settled on a system, the smaller committee began meeting monthly to assess the design of the system and address ongoing needs.
One of the main challenges in creating the system, Sockolov said, is making sure it can be tailored during the roll out to interact with at least 60 practice management systems. “The committee’s job is to make sure all the physicians are happy,” he said, adding that “everybody will want something added to it.” Sockolov said that he is very excited about the system because it represents the first time that he and many of the other smaller physician practices will be able to afford an EMR.