Silicon Valley hospitals offer electronic health records system for independent physicians

Silicon Valley hospitals offer electronic health records system for independent physicians

The multimillion-dollar technology project gives physicians access to sophisticated technology that''s now used only by big medical groups

Dr. Howard Rice, an internist in Mountain View, has wanted the modern convenience of electronic health records (EHR) for years. However, as an independent physician, the costs of such a sophisticated system were far out of reach for his slim profit margin.

That’s when El Camino Hospital stepped in with a multi-million dollar project to establish an EHR for independent physicians who practice at the hospital. In February, the hospital board approved $4.3 million to purchase, build and maintain an EHR system for hundreds of physicians.

"This is going to have a tremendous impact on the community and our patients,"said Rice.

The hospital plans to purchase software from eClinicalworks. The company is based in Westborough, Mass. and is one of the fastest growing EHR systems in the country. "This software is geared toward the independent physicians, unlike other software packages,"said Dr. Eric Pifer, chief medical information officer at El Camino Hospital.
Pifer was hired for the new position last summer to help develop one of the most electronically advanced hospitals in the nation, according to hospital officials. His last position was assistant professor and chief medical information officer at the University of Pennsylvania Health System.

San Mateo Medical Center, the county hospital, also purchased eClinicalworks software in February for its employed physicians throughout San Mateo County. The county system is different from El Camino because the county employs physicians, and independent El Camino hospital does not.

"Part of our goal for implementing an ambulatory electronic medical records system is to track chronic care measures, including hypertension and diabetes,"said CJ Kunnappilly, vice president and medical director at San Mateo Medical Center. "With its clinical alerts and registry functionality, eClinicalWorks is a great tool for that initiative."The EHR program at El Camino is expected to start rolling out in April and available for the first wave of doctors to "sign on"sometime this summer. The goal is to get about 110 physicians to sign-up for the program, but more are welcome, Pifer said.

El Camino isn’t going to work directly with each physician to setup the EHR system. Instead, the physicians are forming a nonprofit organization named Independent Physicians of El Camino. The nonprofit will have a board, management, and support personnel for the physicians, said Pifer. The hospital will funnel money to the nonprofit organization to pay for 85 percent of the cost, and the physicians will pay the balance.

Federal law only allows the hospital to pay for up to 85 percent of the costs, and the El Camino board wanted to absorb the maximum allowed by law.

Physicians will be offered a variety of software packages. The basic system will cost about $300 a month, offering online patient records, billing, e-mail with other physicians, sharing of records and sending prescriptions electronically to pharmacies. From there, the costs go up to add more services, such as allowing the patient access to their records online which would cost an additional $75 a month, said Rice.

"These are reasonable costs,"said Rice. "When you price out the costs of implementing a system like this for a small office like mine, doing it on your own is very expensive and a real barrier."

The system is expected to vastly improve efficiency in the medical care system, reducing costs while improving health care quality and patient safety. Pifer said cutting out waste in the system, such as preventing repeated unnecessary lab tests, could reduce revenue for the hospital.

"The hospital will likely not see a financial benefit from this,"said Pifer.

While the system might reduce redundancies at the hospital, it could be a great recruiting tool for independent physicians to practice at El Camino Hospital, said Rice, who is 43 and has used electronic health records in the past.

Physicians coming out of medical school are already learning how to manage patient care on these systems and expect it to be as much a part of a physician’s office as syringes and cotton balls.

In 2004, President Bush outlined a plan to ensure that most Americans would have electronic health records within 10 years. The president said a better health information technology was essential to address the issues of preventable errors, uneven quality and rising costs.

To advance the president’s plan, Dr. David Brailer, the nation’s first health information technology coordinator, pursued a strategy constructed around the proliferation of electronic health record systems. The strategy included the creation of a National Health Information Technology Network, a Healthcare Information Technology Standards Panel and other projects designed to promote EHR use and adoption.

California leads the nation in physicians using electronic health records, with 37 percent of physicians reporting use of EHRs, compared with 28 percent nationally, according to a 2008 study by the California Healthcare Foundation.

In California, the larger the medical practice, the more likely it uses EHRs. About 79 percent of Kaiser Permanente physicians reported using EHRs, followed by 57 percent of patients in large practices of 10or more physicians. But EHR usage dropped considerably among small and medium practices (25 percent) and solo practitioners (13 percent).

Hospitals aren’t adopting the technology any faster than physicians. Only 13 percent of hospitals have fully implemented EHRs as of last year and only 11 percent are fully using bar-coding technology for the administration of drugs, according to the California Healthcare Foundation survey.

Federal reports estimate that widespread adoption of EHR nationwide could save the health-care industry more than $81 billion annually just from improved efficiency and safety savings alone. Then when prevention and management of chronic disease is added, the savings could double, Pifer wrote in his report to the El Camino Hospital board on electronic health records.

The patients, government and health insurance companies will benefit from the savings, experts say. And not having to put patients through unnecessary procedures would be a mental health benefit, they add.

—By Troy May

Troy May is the executive editor of the Healthcare Journal. You can reach him at