E-Records Bill of Health

Case study: The Fallon Clinic spent $24 million in preparation for an e-records system that would cut medical errors.

What does it take to bring a multispecialty medical practice into the 21st century of technology-based automation? The answer for Fallon Clinic, in Worcester, Mass., turned out to be a lot of planning, a physician champion with vision and drive, and $24 million.

The group practice, with 250 physicians and 20 locations in central Massachusetts, is implementing Epic Systems group practice management solution, including its EHR (electronic health record) system. The aim of the system is to streamline manual tasks, improve patient care and save money. But getting to the point where such an implementation was possible took some doing.

Like most medical practices, Fallon had done little to improve its infrastructure five or six years ago. In 2002, many of its sites still used shared-hub Ethernet LANs to connect servers and PCs. And although a small, home-grown EHR system existed, IT executives knew it would not provide the scale and functionality required to meet Fallons needs.

As more health care providers move to EHRs, infrastructure also becomes important in terms of compliance, security and accuracy. Fallon also expects to see fewer errors as a result of the Epic implementation. One study published July 21, for example, found that more than 1.5 million people in the United States are injured each year by drug errors, according to the Institute of Medicine, in Washington.

Meanwhile, technology vendors are eyeing EHRs. On July 26, Microsoft said it had acquired Azyxxi, in a move that could give entrenched players such as Allscripts competition.

/zimages/2/28571.gifClick here to read more about Microsofts acquisition of Azyxxi and what it could mean for the health IT industry.

"When we started talking about doing this, we assessed everything from the phone system to file-and-print servers in all clinical sites to the LAN and WAN links between the sites," said Tom Harrop, project manager for infrastructure systems and network management at Fallon. "None of [our equipment] was in a position to support an e-health record system from anybody. We have done an extraordinary amount of work in the past [several] years getting ready for this implementation by completely redoing our infrastructure," Harrop said.

Dr. Larry Garber, medical director of informatics at Fallon and the driving force behind the EHR project, has had a long-standing commitment to using computers to help physicians be more effective.

"Weve done studies looking at adverse events, and I know that one of the biggest causes of adverse events is not having all the information when you need it," Garber said. "We always want to take better care of our patients. With the e-health record, it lets us get information to people when and where they need it to give better care. The computer can monitor things in the background, so if I miss something, the computer wont."

Despite that value, which other physician leaders at Fallon were quick to recognize, the $24 million price tag did make Garber blink.

"I personally find that [number to be] scary," Garber said. "But we knew we were likely to [recover] that cost over time. To stay competitive in the market these days, we knew this was something we had to do. Its what you have to do to practice medicine."

Fallon is a leader in this area, though all health care organizations are being pressured to follow suit. Currently, less than 20 percent of all prescriptions today are electronic, according to the Institute of Medicine study. But the institute recommends that all prescriptions be written electronically by 2010, said Hedy Cohen, vice president of the nonprofit Institute for Safe Medication Practices, in Huntingdon Valley, Pa.

In addition, Fallon could see increased reimbursements as more insurance companies implement pay-for-performance reimbursement programs, said Scott Lundstrom, an analyst at IDCs Health Industry Insights, in Framingham, Mass. Such programs "direct their members to providers that have the best outcomes. Payers will actually give them better reimbursement terms for implementing those," Lundstrom said.

The federal government is considering a bill that "could reduce the medical reimbursement for visits or any treatments to organizations that dont have electronic health records," said Susan Paul, director of IT infrastructure at Fallon. A bill in Massachusetts, proposed by Gov. Mitt Romney, would require that cardiac surgeons publish "box scores—data on how successful they are," said Lundstrom.

Given those trends, and the maturity of the market for EHR systems, Fallon is ahead of the curve. The market last year for provider electronic health care records reached $1 billion, but it is expected to grow to $4.2 billion by 2015, according to Health Industry Insights. That represents a 15.3 percent annual growth rate, said Lundstrom.

Next Page: A major, and very expensive, infrastructure upgrade.