The EHR also has been deployed in three emergency departments and is scheduled to be deployed in two more by year-end. The health system will then add the EHR to up to four emergency departments annually until the rollout is complete. The goal is to complete the EHR rollout in the 2013-14 timeframe.
The health system already has deployed an EHR in its home-care operation and also plans to add electronic medical records to its skilled nursing homes.
But the system has gone much further than simply interconnecting the facilities it owns via electronic medical records. In September 2009, North Shore-LIJ pledged an additional $200 million to subsidize the cost of installing electronic medical records in the offices of 7,000 independent, affiliated physicians. Specifically, the system will subsidize EHR-software costs totaling:
- 50% if a physician agrees to share patient information for treatment purposes with the system as well as other independent physicians.
- 85% if a physician also agrees to share quality-improvement and outcome data with the health system.
As of May, 250 physicians had signed up for the program; 75 of those physicians, representing 45 practices, were live on the system. All of the physicians have chosen the 85% subsidy.
To ease integration issues among so many locations, North Shore-LIJ standardized on inpatient and outpatient EHR software from Allscripts, Orlando, Fla.
Although North Shore-LIJ is prohibited in federal anti-kickback regulations from subsidizing physicians' hardware purchases, the health system has negotiated a favorable pricing arrangement for Dell-brand computers. The system also has lined up consultants to help private physicians navigate the plethora of network and security issues involved in setting up an EHR.
Why such a large investment to subsidize physicians? “We decided that the high-tech funding (federal subsidies of up to $44,000 per physician available through the stimulus law) was likely not going to be enough to push the majority of our physicians over the hump. In fact, it costs a lot more than that to install and use an electronic medical record,” says John Bosco, North Shore-LIJ's chief information officer.
Even with the subsidies from North Shore-LIJ and the federal government, selling the concept of an EHR to community physicians is not easy: More than 50% of physicians are solo practitioners, and many of them struggle to survive. “A few of them are them are just going to wait it out and pay the penalties for a couple of years and retire,” Bosco says.
That is why North Shore-LIJ markets its program aggressively. Although the subsidies are available to any physician with staff privileges, marketing efforts are focused on primary-care physicians, including internal medicine, family practice, pediatrics, cardiology and obstetrics-gynecology.
The health system markets to physicians in several ways. First, it hosts two-hour community forums for physicians to explain how the North Shore-LIJ program works and what physicians need to do to qualify for federal subsidies. The forums also feature a demo of the Allscripts EHR.
North Shore-LIJ also relies on the marketing muscle of Allscripts in the form of telemarketing, direct mail and in-person sales calls.
But even as Bosco and his department work nearly nonstop to meet deadlines for federal subsidies, Dowling is already pushing health system executives to plan the next steps.
“He has a knack for looking out a number of years, seeing where things are going, and then trying to drive the organization to get there before the landscape changes. He is always raising the bar,” says Mark Solazzo, executive vice president and COO of North Shore-LIJ.
Solazzo, who has worked with Dowling for nearly 30 years, points to an example of Dowling's futuristic approach from an earlier era their respective careers. Even before welfare reform became popular during the Clinton presidency, Dowling orchestrated an overhaul of the child-assistance system in New York state. This happened in the early 1990s while Dowling worked for former New York Gov. Mario Cuomo in a number of leadership roles in health and social services.
“He basically charged us and said, ‘Forget about all the rules. Let's do something new and innovative and concentrate on outcomes.' That is another trait of his: He doesn't like to be constrained by what is today,” says Solazzo, , who, as a manager in the social services department, worked on welfare reform with Dowling.
Given Dowling's background in social services, it is not surprising to learn that he envisions a digitally interconnected community in the future that extends beyond doctors and hospitals. He also wants North Shore-LIJ to share patients' medical information with all types of social service agencies.
“You can solve just the clinical issues, but the problem might be poverty, mental health, alcoholism or substance abuse. All of those agencies out there have to be connected with our IT system over time so you have a much more robust community-wide system that is able to communicate across agencies and disciplines and outside of traditional healthcare,” Dowling says.