Health IT Tips From Independent Physician Associations

Health IT Boosts Patient Care, Safety

A recent examination of independent practice associations' (IPAs) adoption of electronic health records (EHRs), e-prescribing, and other IT systems can provide useful insights for small and midsize physician practices making plans to select, install, connect, and use health information technology (HIT).

The report, "Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations," examines how HIT implementation was rolled out at five organizations: one, Physician Health Partners, a Denver management services organization that supports four IPAs; and four other IPAs: Genesis Physicians Group (Dallas), Huron Valley Physicians Association (Ann Arbor, Mich.), Physicians Medical Group of Santa Cruz County (Santa Cruz, Calif.), and Mid Rogue Independent Physician Association (Grants Pass, Ore.). IPAs are physician-led organizations that first formed in the 1970s to allow independent practices to accept risk-based managed care contracts.

Published by the National Institute for Health Care Reform, the report found that IPAs provided coordinated assistance with HIT activities to otherwise independent and relatively small physician practices; cultivated trusted and HIT-knowledgeable physician leaders to help less-technologically savvy clinicians; and provided leadership to align HIT adoption with other IPA activities, such as quality improvement and pay for performance.

"A key finding is that identifying physician leaders who can bridge the gap between technology and clinical care is a powerful way to help physicians in small practices overcome barriers to HIT adoption," Paul Ginsburg, HSC president, NIHCR research director, and the report's co-author, said in a statement.

The report cites several examples to buttress its claim that IPAs can impart lessons to small practices that are struggling with HIT implementation.

For example, Physician Health Partners (PHP) is a management services organization that contracts with four IPAs representing more than 300 primary care physicians--the largest comprises about 180 physicians and the smallest includes about 20-25 doctors.

To help the four IPAs with implementation and costs associated with installing HIT, PHP assisted with workflow re-engineering to maximize the benefits from adopting an EHR. Through PHP's affiliation with Centura Health, a large Colorado hospital system that holds a master contract with an EHR vendor, Centura pays 85% of the upfront and ongoing costs of the software and related IT support--beyond that provided directly by the IPA--for affiliated physicians, with the remainder the responsibility of individual physicians as required by federal law, the report said.

Another case in which an IPA has helped defray IT costs for established clinical and management systems is Huron Valley Physicians Association, an IPA that has provided HIT to the more than 700 members--three fourths are specialists--in roughly 300 practices that vary in size from solo practices to those with 40 to 60 physicians. Huron Valley provides members with access to an e-prescribing system, patient registries, and an online portal that facilitates scheduling, prescription refills, and other functions. Huron Valley also maintains a centralized data warehouse populated with clinical registry information combined with all-payer claims data.

Physicians Medical Group (PMG) is the primary sponsor of the Santa Cruz Health Information Exchange (HIE). PMG is an IPA that serves about 100 small practices comprised of one to three physicians each. Through the Santa Cruz Regional HIE, PMG's physician members can connect to nearly 80% of the county's physicians, as well as hospitals, county health clinics, national and local reference laboratories, imaging centers, safety-net clinics, and other providers. Data are available to more than 700 users via a secure website.

Based on telephone interviews with 27 people between March and May 2010 who either worked in or were affiliated with the five organizations, the report concluded that: "A key lesson for the array of emerging entities supporting HIT adoption in small practices is that physician practices can benefit from network-based arrangements in local markets--even if remaining otherwise independent of larger groups or delivery systems," the document states.

The report went on to note that: "Finally, given significant new HIT funding, growing awareness of physicians' technical assistance needs, and the proliferation of entities charged with fostering HIT, the potential for overlapping efforts exists. The availability of assistance from multiple entities will increase the importance of local planning, stakeholder communication, and ongoing assessment of how best to align and coordinate efforts."

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.