Citywide EMR network to link nearly all area physicians

In a few months, all but one practice in three Massachusetts communities will be using electronic medical records systems.

By Tyler Chin — Posted Feb. 19, 2007

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A three-year effort to get electronic medical records in the hands of every doctor in three Massachusetts cities could bear fruit soon, with almost every one of 450 physicians expected to be on a networked EMR system by the start of summer.

The lone holdout in the Massachusetts e-Health Collaborative's effort is a four-doctor internal medicine practice in North Adams that said it wasn't ready to convert to an EMR. Otherwise, every practice and hospital in North Adams, Brockton and Newburyport will have an EMR connected to a citywide health network by June, though the cities themselves won't be connected to each other.

In North Adams, that process, which includes 75 physicians, was scheduled to be complete by the end of February.

The collaborative has worked since 2004 on this project. It received $50 million in funding from BlueCross Blue Shield of Massachusetts. The money was used to buy EMR software and hardware for physicians and hospitals in the three cities, as well as to hook them up into a network.

Many other parts of the country have created integrated networks, called regional health information organizations, or RHIOs. They are the backbone of President Bush's plan to have a national health network in place by 2014. The Massachusetts group believes, though, that it is the first to have virtually every practice and hospital linked.

Shared data on a centralized database will include medications, allergies, test results and diagnoses, said Micky Tripathi, the organization's CEO. But the system is set up so that physicians and hospitals do not actually tap into each others' systems, he said. Instead, the system will compile information and push it to a centralized database.

If a physician wants information on a specific patient, that doctor would log into the database to get the file. The patient information would only be on the database if that patient gave his or her permission.

"Every physician has their own EMR that they have complete control over," Tripathi said. "No one from outside is allowed to come into your EMR." Progress notes will not be shared, he added.

The North Adams network is going live first because doctors there are all using a single vendor's system, making implementation easier and less complex than in Brockton and Newburyport, where doctors have a choice of four EMR vendors, Tripathi said.

Physicians had the option whether or not to participate. The North Adams practice dropped out because it wasn't ready to make the transition from an electronic charting system to an EMR, participants said.

Robert Hertzig, MD, a pediatrician at a four-doctor practice in North Adams, said the transition to the network has not been easy.

"There are some downsides at the beginning," said Dr. Hertzig, whose practice implemented its EMR in September 2006. "You can't see as many patients as you were seeing before, and after a while it gets to be frustrating for everybody. But I do think we've caught up in that regard."

Although using an EMR has been challenging, a big reason he stuck with it is because it will give "everybody in the community a better ability to care for patients," Dr. Hertzig said.

Some industry observers expect health care delivery in the three Massachusetts communities to become more efficient, and the collaborative is hoping to expand its network statewide. But they said the networking model won't be easy to implement so completely, especially in larger cities.

Brockton, a city of 95,000 residents located south of Boston, is the largest city to get a network under the group's effort. Newburyport has about 16,000 residents, while North Adams has about 15,000 people.

Aside from cost, "the issue is that in most markets most physicians have already made decisions on [EMR] products" and may not be willing to switch systems, said Michael Mytych, principal, Health Information Consulting, Menomonee Falls, Wis. "So, what do you do there? To have one vendor control a market is not realistic."

The model used in Massachusetts is more likely to work in small communities that have a hospital that can provide technology support to doctors, he said.

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