Physicians' View on North Shore's $400 Million EHR Investment

A couple of weeks ago, North Shore-LIJ Health System announced it is investing $400 million in electronic health records to connect providers in its community. As part of the initiative, the 14-hospital system is offering to subsidize up to 85% of the software and operating costs of EHRs for some 7,000 affiliated physicians in New York City and Long Island.

John Bosco, North Shore-LIJ's chief information officer, says the EHR is an essential tool to improve quality and safety for patients and eventually reduce costs. "The EHR will enable the management of entire episodes of care across practitioners and environments, so as we get into payment reform that we all expect to come down the pike, such as bundled payments, we will have the tools in place to coordinate care across the different care environments and be able to adhere to the new billing regulations," he says.

So what do physicians think of the program? The community physicians are excited about this, says Simon E. Prince, MD, a Manhasset, NY-based nephrologist, who is also the president of the medical staff at North Shore University Hospital. "We can get a state-of-the-art EMR at a rock bottom price and qualify for stimulus money," he says.

But that excitement is not without some controversy. North Shore-LIJ is offering physicians two options.

1. The connected model is a 50% subsidy for all of the costs associated with buying, operating, and using an EHR from Allscripts—as permitted by law—for five years. Under this model, the physician agrees to allow the exchange of clinical data between care environments, says Bosco. "When a patient comes to the ED unexpectedly, the physician would be able to pull some amount of information from the physician's office EHR," he explains. "Or if the patient is discharged from the hospital, we can push a discharge report or summary to the physician's EHR system."
2. The integrated model is an 85% subsidy that includes all of the above, plus physicians would agree to follow clinical practice parameters that are built into the Allscripts system and are based on recognized standards from the National Quality Forum and other nationally recognized standards of care for certain disease states. In addition, physicians would report their performance data back to North Shore-LIJ on a monthly basis, so that the health system can aggregate that data to determine the impact the program is having on the community. "To follow those guidelines and report that data back to us we'll give them a bigger incentive," says Bosco.

And it is the reporting of that performance data that is causing the most consternation among physicians. Doctors are concerned about who will have access to that data, what type of data will North Shore-LIJ be looking at and why, explains Prince. "From a dollars and cents standpoint, it seems as though the hospital is negotiating in the best interest of the physicians and it looks to be a pretty clear win-win," Prince says, adding that there is still a healthy degree of skepticism among some physicians about the program.

Bosco says that the goals of the program are first and foremost to measure and manage quality, reduce unnecessary testing and delays when a patient comes into the ED, or help improve the transition of care. "That is what will really impact quality and cost overall," he says.

North Shore-LIJ is planning some town hall events to address physicians' concerns about the program, Prince says. The program will launch in November with 15 to 20 physician practices that have agreed to be early adopters. Then around April 2010, the health system will begin full deployment. Physicians have until the end of 2011 to sign up for the subsidies, says Bosco.

"The risk-benefit ratio is in favor of grabbing the opportunity and enjoying the subsidy," says Prince, who plans to take advantage of the full 85% subsidy. Besides, it is only a matter of time until that data is out there anyway, he says.