CIO - Most CIOs have had to deal with rogue business units - parts of the organization that, for one reason or another, can stave off any attempt to modernize, standardize or stabilize its idiosyncratic IT systems, but still need solid data connections to the parent company.
Hospital CIOs have to deal with hundreds of those units every day - connecting doctors' offices that are fiercely independent, too small to hire IT specialists, and are unlikely to put IT upgrades high on the priority list.
Beth Israel Deaconess (BID) Medical Center started solving that problem two years ago - long before the American Recovery and Reinvestment Act (ARRA) promised the industry $19 billion to pay for a large scale migration to electronic health records.
Trying to match pay-for-performance plans that require much more detailed and realtime documentation than the hospital's existing systems, BID rolled out an electronic health records and practice management system to the 175 or so practices it owns directly.
That covered 300 of its core physician network, but not the 900 that work out of more than 300 practices affiliated with BID, but which are owned and operated independently. The largest employs 14 doctors and about 60 staff.
"Most of them are basically mom-and-pop-type shops that work 10 hours a day, see 40 patients a day and don't have time to load the latest Microsoft patch or deal with a corruption with MySQL, let alone build a new system," Gillis says.
"They can't afford a lot of IT and, really, they're not that interested in it," Gillis says. "But you can't have EHR [electronic health record systems] without a practice-management system and a billing system and most of these offices are small enough that they get along without one."
EHR is a requirement for membership in the Beth Israel Deaconness Physicians Organization - the internal group that provides administrative, clinical and technical support for doctors' offices.
It's also a requirement if BID or the practices are going to apply for any of the approximately $40,000 per physician that's available to fund the systems, let alone whatever pay-for-performance, documentation, automation and other requirements come out of any federal healthcare reform bill.
EHR is more than just a way to make it easier to ship medical records from one office to another, according to Leo Carpio, vice president for the Health Care IT & Services practice of equity research firm Caris & Co.
Medical practices have to hire several times the number of employees they normally would, just to handle the paperwork required for them to be paid by either Medicaid or private insurance companies, Carpio says.
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