New York Health System Launches $400M EMR Program

North Shore LIJ Health System will spend as much as $400 million over the next five years to provide subsidized e-medical record systems to its 7,000 physicians.

The rollout is believed to be the nation's largest EMR deployment to date, said North Shore LIJ CIO John Bosco. The health system serves five million people in the New York metro area, operating 14 hospitals, 18 long-term care facilities, five home-health agencies, dozens of outpatient centers, and a hospice network.

Under the North Shore LIJ Electronic Health Record initiative, 1,200 staff physicians and 5,800 affiliated physicians will be offered subsidized EMR systems. EMR software will be provided by Allscripts and hosted using a cloud-based model by an unnamed Allscripts partner, Bosco said.

The move to provide subsidized, hosted EMRs to doctors is part of an emerging trend throughout the country. In Boston, Beth Israel Deaconess and Tufts medical centers are both offering their physician networks similar subsidized, cloud-based, hosted EMR systems.

North Shore LIJ will pay up to 85% of the costs for doctor offices to purchase EMR software licenses, install the system, and be trained and supported for five years. "We'll be subsidizing everything except the hardware, which isn't allowed" under federal regulations, Bosco said.

The program includes two tiers. One has North Shore LIJ subsidizing half of the cost for physicians who deploy the EMRs and connect their systems with other affiliated providers and hospitals. Those systems will connect to inpatient e-medical record systems from Eclipsys, which North Shore LIJ is deploying at its hospitals.

The other tier has North Shore LIJ subsidizing 85% of costs for doctors who connect their systems with affiliated providers and hospitals, and also agree to share clinical performance and outcome data with North Shore LIJ, he said.

The cost of the systems range from about $40,000 to $60,000 per physician, said Bosco. On top of subsidizing the costs, doctors will get to keep stimulus money they collect when the federal reimbursement program kicks in 2011. Doctors who can demonstrate the "meaningful use" of health IT under the American Recovery and Reinvestment Act will be eligible for reimbursement. The exact definition of what "meaningful use" entails is still being established by the Department of Health and Human Services.

Under ARRA, eligible doctors can earn $44,000 to $60,000 in reimbursements between 2011 and 2014 for e-health systems that meet government requirements.

"They can make out really well," said Bosco. While North Shore LIJ is picking up a big part of the tab for doctors in its program, it's understood by the health system that all costs incurred by physicians during the transition to digital records won't be covered.

As is often the case in EMR deployments, "there will be a 10% to 15% loss in productivity by the physicians" during the early weeks following the transition, he said. "But we're trying to cushion it and make it more feasible," he said.

Right now, very few doctors affiliated or employed by North Shore LIJ are using EMRs, he said. "It's a very low percentage that's running them, probably lower than the national average of single digits," he said.

"How many will sign up? I hope all," he said.

North Shore LIJ hospitals have a total of about 5,000 beds, provide emergency room services to more than 500,000 patients annually, outpatient care to more than 1 million patients, he said. North Shore LIJ, which employs 38,000 including 10,000 nurses, is the third largest non-profit, secular health system in the United States.

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