Boston Health Network Requires All Physicians to Adopt EHRs by 2009

I recently came across a healthcare IT related blog that I really enjoy called Health Train Express. They recently posted an article about the Boston Health Network requiring all their physicians to adopt EHRs by 2009 or else they’ll be removed from the network. The article then says that they “expect to lose between 15 and 20 primary care physicians this year because of the mandate, and it could lose some patients if those physicians stop referring patients to Partners hospitals.” The article goes on to say that “To retain their network status, about 5,000 physicians in the network will be required to adopt either Partners’ or GE Healthcare’s EHR or sign an agreement that they will adopt EHRs during 2008.”

A number of things I’ve read about this article have people crying for Partners Community HealthCare to start putting up money to help those 5000 physicians that will be required to adopt an EHR system. I honestly don’t understand this reasoning from a business point of view. The article said that they’ll only lose 15-20 physicians this year. That seems like a very small amount since 5000 others are going to implement a new EHR and how many others already have implemented an EHR? I don’t know all the economics of this particular situation, but on face Partners Community Healthcare is making a great decision and shouldn’t need to pony up some money to help these doctors use an EHR.

Of course, it would be a nice thing if Partners Community Healthcare helped out these doctors, but what about all those doctors who already implemented an EHR without any help? Those are the ones that Partners should be rewarding. Those doctors are the ones that have probably been saving Partners money doing things electronically.

I think there’s another important reason why I think it’s a great decision for Partners Community Healthcare to not subsidize their physicians purchase of an EHR. Looking at the percentages of failed EHR implementations, you can almost guarantee that a large number of physicians will have major problems implementing a new EHR. The physicians for these costly “failed” implementations are certainly going to incur expense over and above anything Partners would have offered as a subsidy. This increased cost to physicians will incur the same type of backlash that they are experiencing from not subsidizing at all. So, Partners would gain almost nothing from these subsidies.

Furthermore, I don’t have hard evidence to prove this fact, but I think it’s fair to assume that physicians who are paying for their own EHR will make much better decisions, be more invested in the decisions and work harder to make the EHR work for them. I believe that the amount of buy-in by physicians in the EHR implementation process is a key determining factor in a successful implementation. Making physicians pay for the EHR, increases physician buy-in.

Now I don’t think everything is rosy with what Partners Community Health is doing. I don’t quite understand all the details from the article, but it seems like physicians are pigeon holed into a specif set of EHR systems: Partners’ or GE Healthcare’s EHR. The article says the caveat of “sign an agreement that they will adopt EHRs during 2008.” Does this mean that a physician can choose their own EHR or not? I imagine that if they choose an EHR other than Partners’ or GE Healthcare EHR, then they’ll be required to create some sort of interface between their chosen EHR and Partners Community Health.

This makes it a very tough decision for a provider. While specifying a certain EHR software product can lead to reduced pricing of an EHR software product, it’s not always the case and can mean that many physicians will have to pay more for an EHR that has less features or features that don’t match their practice. I think that every EHR vendor knows that it’s hard to create an EHR that works for pediatrics, GYN, neurologists, dermatologists etc etc etc. They just have very different needs. Pediatricians want nice graphs and charts of children’s growth while dermatologists want pictures and drawings of things.

“Forcing” certain EHR software can also be a challenge on a physician’s budget if the “chosen” EHR software use the very popular model of a huge up front cost to the physician. This would be very unfortunate, because there are a ton of different EHR packages out there that have creative pricing models that better match a doctor’s cash flow. However, I expect that many physicians won’t choose a separate EHR package since they will want the software to integrate nicely with the other Physicians in the network.

My suggestion would be that Partners Community Health allow doctors to choose whichever EHR fits their practice the best. Then, Partners Community Health foots the bill to integrate that EHR with Partners’ system. It’s a win for the doctors that want a specialized and inexpensive EHR. It’s a win for Partners, because they now have an even more robust set of interfaces with a variety of vendors. Unfortunately, if they do this, then they might have to pay back GE for all the nice meals and golf games they’ve gone on.

Disclaimer: I only know what I read in the linked article about Partners Community Health. In this post I make a lot of assumptions about this specific case to illustrate principles of EHR adoption. I’d love for someone from Partners Community Health to correct any of my assumptions, give us more details on the mandate and provide commentary on why my assumptions might be flawed.