Four physician organizations in Rhode Island have formed a for-profit corporation to promote a deceptively simple solution to some of the knottiest healthcare IT problems facing physicians today: selecting an electronic medical records system, getting EMRs in the hands of outpatient physicians at an affordable price and finding a way to make the installed EMRs interoperable with each other and local hospitals.
The company, Electronic Health Records of Rhode Island, was incorporated on Oct. 17, 2005, according to the Rhode Island secretary of state's office.
"The dream here is to have every doc in the state own one IT system," says Mark Jacobs, M.D., chairman of EHRRI's board of directors. The company is completing negotiations with a single EMR system vendor that Jacobs says will be identified soon. There are 4,091 physicians in Rhode Island, according to the American Medical Association's data book. The four founding groups, or EHRRI, account for about 1,400 of them.
Jacobs also is the president and chief executive officer of Coastal Medical, an 80-physician, multispecialty medical group based in Providence that is one of the four EHRRI founding physician organizations.
The other member groups are Lifespan/Physicians Professional Services Organization, based in Providence, with about 800 physicians; the physician-hospital organizations at Women and Infants Hospital in Providence and Kent County Memorial Hospital in Warwick, which are part of the Care New England integrated healthcare system and have about 400 physicians; and Thundermist Health Center, a two-facility community health center in Woonsocket with 20 physicians.
Jacobs says he is in negotiations with a candidate to become the company CEO. The new executive should be on the job this month. Rollout of the first EMRs will begin this year.
"I think we're looking at 125 docs in year one," says Jacobs, adding that while the estimate of first-year physician adoption "is conservative, it's conservative for a good reason. The learning curve is steep. We're obviously going to learn from the early adopters. But I think there is going to be a cascade effect here."
Jacobs, who uses an e-prescribing system but not an EMR, says he is going to be one of EHRRI's first customers. He was a member of an advisory committee of the not-for-profit Rhode Island Quality Institute that set up a statewide e-prescribing initiative with software vendor SureScripts. While the institute is not a partner in EHRRI, he credits it with being "a good convener" that brought the founding groups together.
Coastal started looking at EMR systems to buy about 14 months ago, Jacobs says, but 10 months ago it joined the collaborative that led to the formation of EHRRI.
HHS' Office of the National Coordinator for Health Information Technology in September 2005 contracted with the Certification Commission for Healthcare Information Technology to come up with a vetting process for EMR systems, but by pooling their expertise, Jacobs says the doctors at EHRRI already have done what the commission will do and what few physicians would have the time or the desire to do on their own.
In addition to gaining price leverage, a large group purchase will shrink the problem of developing interfaces between physician EMRs and the IT systems in the state's 11 acute-care hospitals.
According to Jacobs, EHRRI will offer both a stand-alone EMR to physicians who use their existing electronic practice management systems as well as their vendor's suite of both systems. EHRRI also will offer the EMR in an application service provider model, in which, for a monthly fee, physicians can buy the software, maintenance and data storage provided via a central server and data connection.
Initially, the IT vendor EHRRI selects will supply most of the installation services and software support, but EHRRI will begin to take over those functions as the new company gets off the ground in mid-2006, Jacobs says.
Cedric Priebe, M.D., chief medical information officer at Care New England, is not a board member of EHRRI, but considers himself "a spiritual founder" of the physician-led effort. Priebe has served as a physician-executive in IT at IDX, Allscripts and McKesson before coming to Care New England in 2004. He says he likes the idea of a physician-centric approach to solving their own IT adoption problems.
"I've seen lots of different relationships between competing hospitals and physician organizations and this is really unique," Priebe says. "If we can prove this can be done here in the small-doc market, it will be a message that if you decrease the number of options out there, you can do more with interoperability. There are several vendors out there who could do this well."