"Without going down that path, we couldn't do a patient-centered medical home or get Level 3 NCQA designation for seven of our practices," Estes says. The Web-based patient registry that came from the collaboration among practices identifies populations within those practices and, critically—because of the expense of extra labor and monitoring required—which patients may require a higher level of intervention.
"We thought about a lot of these clinical data points in our master planning process before we spent a dime of money," he says of a process that dates to 2006. "That was an invaluable decision. We took a lot of time to engage people from different segments of the enterprise and [learn] what they would do with the tools."
Many such projects have a tendency to die on the vine in the face of inertia on user engagement. With its medical home and patient registry tools, Estes says, "we mitigated that to some degree because we engaged the clinical people in the design process of the registry tool itself before we did any coding work. The only way it's going to be a useful tool for them comes from asking them what they want it to do."
One of the issues that can affect adoption is the question of data quality, which can be a big problem for an organization like Rush because it includes a wide variety of clinics, some owned by Rush and some not.
"That has been a significant challenge to our physician practices, many of which are private and have already made decisions independently on EHR or practice management systems," Estes says. "They all have different functionalities and different usage of the functionalities. Just getting the data out and figuring out how usable it is has been a significant barrier."
Estes and his team are addressing that problem in a couple of different ways. The Rush hospitals in the PHO and all physicians employed by the hospitals are using Epic for clinical documentation, scheduling, and patient billing. That's not necessarily true of some of the other practices, but Rush is attempting to solve that problem through PHO structure, which allows the rest to get on Epic for essentially no cost.
"We will absorb the cost, but there's been a slow uptake for a lot of reasons," Estes says.
Some are suspicious, some are too busy, and Estes thinks that third-party billing companies can also be agitators against the change.
"We're not mandating you use the same business office and you can continue to do billing on your own," he says. "We'll even train the third-party billing company to do it. But the big thing is standardizing and shared clinical data. We're trying to show them the cool things we can do, but in many cases, the data they have is not in the state it needs to be."