Physicians view connecting with others as the next logical step as they look to improve patient care and participate in evolving payment models.


Now that physicians have become comfortable with having electronic health records in their practices, they are ready for more advanced uses of the technology, including participation in health information exchanges.

That was one of the many revelations that came from Fifth Annual Ambulatory Practice Management and EHR Study conducted by HIMSS Analytics, published in June.

The survey of 846 ambulatory practices, almost half of which were practices with fewer than 10 physicians, found that 46% said their organization had plans to join a health information exchange. This was up from 43% a year ago.

Now that many practices have become meaningful users of EHR systems, experts say, doctors are ready to explore other changes coming down the health care pipeline, such as participating in accountable care organizations or establishing themselves as patient-centered medical homes.

Dept. of Health and Human Services Secretary Kathleen Sebelius said May 22 that as of the end of April, more than half of doctors and other eligible professionals and more than 80% of eligible hospitals have received Medicare or Medicaid incentive payments for the meaningful use of EHRs. She said HHS’ goal had been to reach those levels by the end of 2013.

Interest in information exchange has been growing steadily for the past few years, said Brendan FitzGerald, research director at HIMSS Analytics. “That’s really where the industry is going. When you talk about HIE, you can’t help but mention accountable care [organizations]. The HIE is somewhat of a gateway to not only meeting meaningful use but also accountable care, and really the ultimate goal of making health care more efficient, more affordable, more cost-friendly across the board.”

Health information exchange is a natural next step for physicians who have adopted EHR technology, agreed Jennifer McAnally Ride, director of the Tennessee Regional Extension Center, which is working to build a statewide exchange through use of the Direct Project technology. Direct Project is a secure messaging system developed by the HHS Office of the National Coordinator for Health Information Technology to help physicians exchange information from one point to another.

The widespread adoption of EHR technology has physicians realizing, “Oh, not only can I have information at my fingertips for my patients, but I can now have a way of sharing this information with someone else or get information from someone else so that when the patient transitions from care setting to care setting we have what we need to take care of that patient,” Ride said.


Many types of exchange

By 2014, physicians participating in the meaningful use incentive program must have Direct-enabled EHR systems. The technology will allow physicians to exchange information from point A to point B. But that exchange can occur only between two known and trusted parties and does not grant access to full patient records. In addition to adopting Direct, practices want to connect with others in their communities or states.

The HIMSS survey found that of the practices that said they planned to join an HIE, 19% were making arrangements to join a statewide exchange, 16% said they were prepared to join a hospital or hospital system’s HIE, and 11% were ready to join a regional health information exchange.

Of the freestanding, nonhospital-owned practices, 13% planned to join a hospital HIE. Ride said this is because some practices expect to be acquired by a hospital, and others are prepared to establish themselves as a patient-centered medical home, which relies on data exchange.

Using data exchange will give practices more control over patient data and how data are used to optimize payments, Ride said. Making data available means physicians will be less likely to duplicate tests or services. “You’re not going to be paid for that moving forward,” she added.

In the spirit of optimizing payments and revenue, the HIMSS survey also found that practices are looking for better integration between their EHR systems and their practice management systems.

Physicians’ focus “has primarily been meeting the guidelines for EHR and meeting the guidelines for meaningful use from a clinical standpoint,” FitzGerald said. “However, they still need to run a business. They want to maintain that level of efficiency on the business side as well.”

As practices look to replace or upgrade their EHR systems, which nearly a quarter say they plan to do, many are looking at EHR systems in which practice management is fully integrated, he said.


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