Best Practices:
MemorialCare Offers Epic's Ambulatory EMR to 3,200 Community Physicians
Volume 1, Issue #8
May 29, 2008
Administrators and IT staffers from MemorialCare didn’t plan to offer community physicians an EMR alternative when they planned their inpatient clinical systems strategy. “That aspect of the IT plan sort of evolved,” explains Scott Joslyn, chief information officer of MemorialCare, which operates hospitals in the California counties of Los Angeles and Orange.
After a multi-year implementation, MemorialCare is well on its way to full automation with EpicCare Inpatient from Verona, WI-based Epic Systems. Joslyn and other administrators will take an additional step towards establishing an electronically connected medical community by offering an outpatient EMR to its 3,200 community physicians.
Doctors Wanted Inpatient Efficiencies in Office Practices
“Doctors tell us they spend 80 percent of their time in the office. They want the same efficiencies and flexibilities they have with our Epic system on the hospital side,” explains Laurie Sicaeros, vice president for physician alignment. “With pay-for-performance pressures, the Leapfrog Group initiatives, and the relaxation of the Stark rules, we saw it was time to move forward and offer physicians a solution that we could subsidize.”
MemorialCare and several hundred community physicians evaluated Horsham, PA-based NextGen and Westborough, MA-based eClinicalWorks before selecting Epic’s EpicCare Ambulatory solution. “It came down to the type of integration the physicians really wanted to have, which was one in-basket, one result review,” Sicaeros says. “The easiest solution was Epic because it gives us so much more integration with the inpatient system than any of the other systems.”
Hospital Pays Most Upfront Costs, Offers Support
MemorialCare will initially subsidize 75 percent of the upfront cost. “Implementation costs were the biggest barriers for the physicians,” says Sicaeros. “Asking them to come up with a lump sum of money for implementation was a stretch, but if you asked if they had $500 a month and it included practice management, then it was not as much of a hardship.”
Physicians can obtain discounted hardware pricing through the health system’s VHA affiliation. Maintenance, support, and software license royalties are all covered in the monthly per-doctor fee for a minimum of 24 months. In return, MemorialCare provides help desk support and on-staff clinical specialists who are available to work with physicians as needed.
Hospital’s Involvement Reduces Physician Risk
Joslyn believes the EMR offering will strengthen the bond between MemorialCare and its physicians. “I think the EMR is a way to maintain the relationships with community doctors. It’s a fundamental part of quality and coordinated care and everything we are suppose to be doing. We are depending on physicians for admissions and we need them to be profitable because they are our source of patients.”
Because of the traditional high costs for EMRs and the potential for lost productivity during implementations, Joslyn views the health system’s involvement as a way to reduce the physician’s risk. “EMR is a major transformation for practices of any size and physicians are asking how to make it happen in a way that it is safe,” says Joslyn. “The hill to go over is somewhat steep. Our help maybe lowers the hill without changing the value proposition.”
Competitors Also Support Physician EMR
Joslyn notes that competing health systems are also considering ambulatory EMR initiatives. “In our market, the hospitals are working to help physicians adopt EMRs because we all think EMR is important and want to see adoption go up in the community,” says Joslyn. “But we think our particular EMR offering is extremely compelling and provides a natural competitive advantage.”
MemorialCare promotes its inpatient implementation experience and success. “Even though the outpatient side is very new territory and we are looking to gain experience, we have good vision and direction and are constructing our program with the same discipline and intelligence for the physicians’ need. We can bring our experience to the table,” Joslyn says.
Sicaeros anticipates that 45 to 50 physicians will be live on MemorialCare’s Epic system by the end of 2008. The next major project includes developing interfaces to third party EMR solutions.
“We are not blind to the fact that, down the road, we need to look at a way of connecting other systems. It is definitely in our FY09 plan,” says Sicaeros. “From an integration standpoint, there is nothing better for a clinician or patient than coordinated care and connection for all the physicians. That’s part of our big picture. We feel that as a not-for-profit health system, it’s part of our mission to make that happen.”
— Correspondent Michelle R. Noteboom