A RISKY TRANSITION
the hospitals get a huge amount of money
and it’s a way to finance the expansion. But
hospitals don’t understand the I. T. risks.”
Bringing a group practice into the hospital
fold causes another major technology chal-
lenge—data integration. Historical patient
records can’t be simply scrapped—myriad
state laws typically require they be kept for
several years, plus physicians often need to
access them for current patients. That has led
some practices, such as Advantage Health, to
undertake massive document scanning ef-
forts. “The physician has a ton of accumulated
knowledge in paper,” says Blair, the hospital-
based practice’s president. “There’s no good
way to get it out. Old paper charts can be 12
inches thick.”
Even practices on their own ambulatory
EHR face likely data integration challenges
with a new owner. “A health system can’t
always just force practices or other acquired
hospitals to adopt their system,” says White,
the consultant. “The I.T. integration issue
could upend the effectiveness of the consoli-
dation. If you can’t share data, you are not
helping the patient. Systems that don’t com-
municate will become mass chaos.”
Systems integration
Advantage got an object lesson in systems
integration when it first attempted to deploy
an ambulatory EHR five years ago, Blair re-
calls. Rather than adopting a best-of-breed
ambulatory system, the group attempted to
run on a module that was part of its hospital
owner’s inpatient EHR. The still-immature
software module couldn’t accept data from
Advantage’s long-standing patient registry, a
customized application it used to track vari-
ous lab values and keep track of patient prog-
ress. As a result, Advantage two years ago
switched to a more compatible EHR, from
NextGen. Documenting patient histories in
the EHR can be cumbersome, Blair says, but
says the software enables much safer medication management. “You can see what has
been ordered and filled,” he says.
Unlike Advantage, which mandates the
use of the NextGen system, some hospital-
based practices offer a choice of ambulatory
systems. That can be a smart move, notes
Jerilyn Cowper, solutions manager at CTG
Health Solutions, a Dallas-based I. T. consul-
tancy brought on for EHR implementations.
For many practices, a knowledgeable cor-
porate parent can be an I. T. godsend, Cow-
per says. “Small groups don’t know where to
begin with the EHR. They lack the funds and
they don’t have any expertise. How do they
go about looking for an EHR?”
Yet, many hospitals lack the support staff
to properly train physicians and deploy an
ambulatory EHR—particularly when their
own staff are already saddled with other
projects and regulatory challenges. That can
lead to a sour relationship, Cowper says.
“Hospitals can’t maintain their own level
of expertise, yet they are bringing on more
groups. Staffs are really stretched. The risk
is whether the hospital can support the new
practice they way they’re expecting. You
need to install, update, get hardware going,
and get on a network. You need a person in
the trenches who can go to the group, train
them, and bring them up efficiently. Some
practices are rebelling—they want to go
back to their old application.”
Despite the many pitfalls, for MacKenzie,
the emergency physician, a hospital-based
group has a better chance of overcoming
care fragmentation. The 30-year veteran
recalls when physicians used to routinely
show up when their patients were admitted
to the hospital. “Today there’s less commu-
nication. If you don’t have the I. T. connec-
tion, a patient is admitted and stuff is being
done on them that often doesn’t need to
happen.” At Lehigh Valley Health Network,
ED physicians document on an EHR, from
T-System, that feeds its output into the
hospital’s inpatient EHR, from GE. Patients
admitted via the ED enter the hospital with
some semblance of a chart—the first step to
care coordination, MacKenzie says.
