EHR Adoption Curve

With any adoption curve, the first third is always the most important, according to David Groves, executive director of the Cincinnati-based HealthBridge Tri-State Regional Extension Center (REC). His REC is successfully a third of the way in achieving its goal of 1,750 primary care physicians outfitted with EHRs. The HealthBridge Tri-State REC serves the communities of southwestern Ohio, northern and northeastern Kentucky, and southeastern Indiana. In September the organization was awarded a $13.8 million Beacon Community Cooperative Agreement Program by the Office of the National Coordinator (ONC) to focus on the area’s diabetic and child asthma populations. Groves spoke with HCI Associate Editor Jennifer Prestigiacomo about sustainability issues with the REC and the health information exchange, as well as what he learned at last week’s grant awardees conference.

Healthcare Informatics: Where are you on your goal to link up 1,750 primary care physicians?

David Groves: We are very much in the recruitment phase with a lot of providers. So, we are enrolling them on a day to day basis. At this point we’re standing just short of 550, which is about 35 percent of our goal. We’ve been involved with about 50 different practices over the last few months [helping them adopt EHRs].

HCI: What kind of lessons has your organization learned from getting providers hooked up with EHRs?

Groves: Well, some of them are already EHR users, so the challenge there is to get them to be better users—get them to meaningful use. So we are doing assessments on how they’re using their systems now and what meaningful use requirements aren’t met yet. We already have a few that have reached milestone two, which is that they’re using an EHR and e-Prescribe. We’ll have many more attesting to that second milestone in January. The other type of practices we have are paper-based and never have used an EHR. Some of those are actually connected to HealthBridge for clinical results. So they have a Web portal they can use for a very light-weight EHR. Those [practices] are not even to the point of selecting their vendor yet.

HCI: How are you doing provider outreach and recruitment?

Groves: Any way we can. We had a major kick-off here in June where we invited providers to come hear about what the REC is. We had a room of about 300 people that day. We’ve been doing webinars, mailings. We won a Beacon award so we’ve been doing joint community forums where we’ve been talking about the EHR incentive program, the REC, and the Beacon program all together.

HCI: Can you tell me about about your Beacon project and which pilot activity are you most excited about?

Groves: We were one of the second wave of Beacon awardees back in September. Our two pilots are adult diabetes care and childhood asthma. We’re very excited about both of those honestly. There’s been work in this community on both of those fronts. We’ll be leveraging and extending the work that has been trail-blazed by Children’s Hospital [Cincinnati Children’s Hospital Medical Center] and they’re a member of the Beacon team. The diabetes work has been trail-blazed by the Health Improvement Collaborative [of Greater Cinnicnati] through the Robert Woods Johnson Foundation [Princeton, N.J.]. There will be two groups of practitioners that will be reporting information for quality purposes, and registry type functionality being established for that purpose. The interventions include being able to alert physicians when their patients have been admitted to an emergency or inpatient setting. So that will happen through the health information exchange. The registry functions are being able to provide very timely information about what patients are being followed, and for what conditions and what measure are met. We want all the practices that will be participating in Beacon to also be leaders moving toward meaningful use. They’ll also all be REC participants.

HCI: How is the HealthBridge HIE going?

Groves: HealthBridge is a very mature and well-established health information exchange and has been in existence since 1997. Within the Greater Cinncinati area, which includes parts of Indiana and Kentucky as well, we’re very well known and respected for the work we’ve done to date, which has been to connect 29 hospitals through the information exchange, about 5,200 providers. The statistic we report is 3 million clinical results communicated through our exchange on a monthly basis. Providers have various options on how to receive those results, but the vast majority of those are being communicated directly to an EHR system or to a HealthBridge hosted clinical messaging system.

HCI: What other activities are on the horizon in terms of registries and analytics?

Groves: With Beacon we’re definitely building out our community-wide registry and the analytics that will sit on top of that. That is really central to the Beacon effort. We’ll also be working in the arena of EHR adoption and meaningful use. We’ll be working to establish more bi-directional communication with providers. In the past it’s largely been one way—sending information to providers. Because of meaningful use and continuity of care requirements, we’ll be implementing solutions for providers to send information to other providers in the form of a continuity of care document.

HCI: What are your plans for sustainability?

Groves: There are sustainability questions around the REC and Beacon. Quite honestly our approach is to learn how to deliver more value to more people. Unfortunately, a lot of people speak about sustainability in the wrong sense—where can we get money from some place in order to continue to provide services to physicians. Our feeling is if we’re not providing value to healthcare providers that they’re not willing to pay for then it’s not sustainable. So, we’re not going to have a cookie sale to generate revenue, [laughs] which is some of the crazy stuff I’ve heard. HealthBridge has a long history of charging for the value it produces and being self- sustaining, and we wouldn’t be here today if that were not the case. We’ve never had grant money or federal funds until the REC and the Beacon awards. A lot of the revenues have come from the health systems and large hospitals in the past. Some of the revenues come from the individual practices and practitioners, but not a lot is going to change about that. Our sustainability model is around information exchange, EHR support, quality reporting, practice transformation, and to build our capacity around that through the REC and Beacon and sell it as a service.

HCI: Has there been any thought about getting payers into the mix?

Groves: There are conversations going on now with payers. Obviously, the accountable care organizations (ACOs) will evolve over time and are very much of interest to us and our community. So, in the mix in the future I can say HealthBridge is definitely looking at payers to be a contributing paying member of HealthBridge.

HCI: What are some of the challenges your organization is facing with the REC and the HIE?

Groves: I think we’re not unlike the rest of the country with the REC—there’s a well-known adoption curve for anything. That certainly is no different here. I feel very good that we have a third of our providers already signed up. On any adoption curve getting the first third is very important. We’re going to be focused on continuing to enroll, but very focused on providing very high quality services and advisory services to our clients and show some early successes, so that others with have the courage to move forward.

HCI: Is there anything else going on that you’re excited about?

Groves: I just returned from the grantees conference that ONC put on this week in Washington. So, all the Beacon, REC, and state HIE awardees were all in the same room together this week. It was fabulous; very productive, and very rewarding seeing so many smart people working on the same thing. This was an opportunity to compare notes and to form some collaborative efforts. Our Beacon project is working with two or three other projects to break through some technical barriers with the ONC and get some best practices done in regards to the information exchange that will be essential to measure quality and improve quality over time. The benefit was seeing where we are as a national effort. I think almost 28,000 physicians have been recruited into the RECs nationally. We’re off to a pretty energetic start for next year.