Large Doctors Groups Rolling Out Electronic Medical Records

Two of the nation's largest groups of independent physicians are phasing in electronic medical records that can link general care physicians with specialists and laboratories.

Two of the nations largest groups of outpatient doctors offices are implementing EMR systems.

Hill Physicians, Inc. announced this week that it will roll out integrated electronic medical records for its 2,600 providers across California. Late last year, the San Francisco-based Brown and Toland Medical Group announced that it would do the same for its 1,500 physicians. Both IPAs (independent provider associations) allow physicians to choose whether or not to opt into the system, and both say that physicians are responding enthusiastically.

/zimages/2/28571.gifClick here to read about a physicians practice that is using IT to improve patient care.

The advantages of making EMR decisions at the IPA level are better costs and know-how, according to Nancy Griest, vice president of medical group services at Brown and Toland. She said that her organization had more resources to thoroughly investigate EMR options than an individual practice would. "Its difficult for the individual to make these kinds of investments; Brown and Toland as an IPA can provide the maintenance on an ongoing basis," she told

"The doctors were waiting for us to make a decision," said Craig Lanway of Hill Physicians in an interview with Individual doctors offices also face less of a financial risk, he says. Instead of making a huge capital expenditure up front, doctors can pay fees to the IPA (the rates are still being set), and spread the costs out.

In addition, a common EMR system means patient information can be transmitted more easily between different members of the IPA, such as laboratories, general care physicians, and specialists. A recent study found that over half of the information that is missing from patients medical records is not in the doctors office when the patient visits, but instead with other providers or clinical laboratories.

A potential drawback is that an EMR that might be well-suited to a large doctors office may not be well-suited for a small, general-care practice and vice versa. Lanway and Griest said they looked specifically at how flexible different systems were.

Brown and Toland chose IDX Systems Corp.s Flowcast for practice management software to schedule and register patients and manage claims. For the clinical side, it will use Touchworks Electronic Medical Record System, a product from Allscripts Healthcare Solution, LLC that integrates with Flowcast.

Hill Physicians chose NextGen Healthcare Information Systems Inc. for both EMR and practice management, which will be hosted by Tellurian Networks Inc. To integrate across systems and to use legacy systems, Hill Physicians is using SeeBeyond. The company provides an SOA (service-oriented architecture) system that allows a physicians existing computer equipment interface with NextGens software and other third-party applications.

The advantage of using an integration tool such as SeeBeyond is that it allows disparate systems to interact and does not force providers to give up old systems. "These practices operate their own systems, and a tool like that is essential for that integration," said Craig Lanway, CIO of Hill Physicians.

SeeBeyond works by knowing who the viewer is and what that viewer needs to see (as well as what the viewer need not see). Then the system finds the information and customizes its display. The viewer need not know where particular files reside but can "virtually see the data that resides in their ancillary or legacy system all they need to know is what they need to see, and that can be painlessly delivered to a thin client," says Lindsy Strait, SeeBeyonds senior director of technology.

The system works by going through the entire system and grabbing a copy of the necessary information, without altering the source. That way, the most current data is displayed, said Strait.

(This week, SeeBeyond will also announce new applications at the HIMSS conference: eIndex Global Identifier, which allows a single patient view of information, Claims Lifecycle Management, Patient Bed Management, and Business Process Improvement and Workflow.)

Both IPAs intend to move slowly and starting with small pilot groups. Brown and Toland has already rolled out a module that sends laboratory results to physician practices and plans to roll out more modules this month, including e-prescribing and clinical notes modules. So far, the Brown and Toland has trained over 300 physicians. Griest said that theyve already learned that they will need to open up more training spots because of demand by physicians, and partly because of the need to train physician staff.

"Were training a lot more than we would have expected. When youre training 320 docs, thats more like 700 users."

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