Hospitals: EHR Friends or EHR Foes?

One of the ways that hospitals and health systems are attempting to woo independent doctors into their camp is by offering sweet deals on electronic health records (EHRs).

Here’s how it works: the hospital has negotiated a package price from an ambulatory EHR, typically as a hosted or cloud based model (which means that you will be accessing it via the internet as opposed to installation on a local server). They have deployed it among their employed physicians and theoretically have the kinks work out.

To increase “alignment” with independent physicians, they begin offering the EHR often at attractive prices (usually on a per provider per month charge). Should you bite?  

Maybe. Besides a good price, a hospital sponsored EHR typically offers a nice local service package consisting of hospital staff available both via phone and on-site. Additionally, these EHRs often include an integration package of hospital interfaces to labs, HIEs, or ADT systems. If the lion’s share of your lab business and inpatient admissions are directed to the hospital sponsor of the EHR, subsidized integration is a real advantage from a cost, convenience and support perspective. Additionally, hospital-sponsored EHRs may offer advanced analytics in terms of quality and outcome reporting that will increasingly become a part of medicine as we transition from fee-for-service to accountable care. Hospital sponsored EHRs allow you to outsource a complex task to a competent third party.

What’s the downside? The primary disadvantage is that you are giving up a good deal of your freedom and independence on a mission-critical portion of your business. Example 1: While a hospital sponsored system will offer some flexibility in configuration, you are likely to be bound by certain conventions and standards established by the hospital. It is also likely that meaningful changes will either be impossible or time consuming, since they have to be considered in the context of the system as a whole. Example 2: What if your relationship with the hospital sours? Certainly the value of hospital interfaces diminish if you are no longer doing much business with the hospital. Getting hospital staff to craft new interfaces to competing labs or hospitals may be both problematic and expensive. Switching EHRs is never easy; a troubled relationship with the hospital is not going to help.

Finally, while hospitals are increasingly getting in business of supporting ambulatory practices—for many it is a new thing. There is no guarantee that hospital service will be great.

How do you decide? Independent of any of the details of the offer, the decision primarily rests on the type of relationship you wish to have with the hospital/system. If you see your future inextricably entwined with the hospital (including the possibility of a buy-out), then purchasing an EHR from them is worth pursuing.

If on the other hand, maintaining the independence your group is paramount and you have the wherewithal to assume the burden and responsibility of independence, then buying an EHR from a hospital is probably not a good idea.

What questions do you have?