Caring and sharing: as the community care model of treating patients takes hold, physicians gain big from using a PM/EMR systems network and from sharing patient information electronically

Health Management Technology, Oct, 2004 by Richard R. Rogoski

Everyone heralds the implementation of IT in physician practices as a positive. It saves time, money and, in some cases, the patient's well-being. But for most physicians, the introduction of automation also carries a risk. When practices operate as silos, separated from each other by architectures and applications, not being able to electronically share patient-specific information with medical colleagues treating the same patient can add workarounds, negating the time and money saved.

There's a new model of care on the horizon. When several physicians who treat the same patient can share pertinent information about that patient over a common Web-based network, it's a win-win. Not only does the patient receive timelier and more comprehensive medical care, but also the physicians involved can save time and money--and both are valuable assets for most small and medium-sized practices.

Anthony Alfieri, D.O., a cardiologist in Wilmington, Del., was so intrigued with the "community care model" that he started a company dedicated to building a network of practices that use a common electronic medical record (EMR) and practice management (PM) system--in this case, systems licensed from Kansas City, Mo.-based Cerner Corp.

Since 1999, Blue Ox Medical Network has grown from Alfieri's own nine-office practice to include more than 70 physician practices with specialties like primary care, general surgery, OB/GYN, pediatrics, dermatology and ophthalmology. Between 300 and 400 physicians, caring for approximately 500,000 patients, are now on the network, and Blue Ox continues to expand its reach. Beyond Delaware, Blue Ox now has member practices in New Jersey, Pennsylvania, Maryland, Virginia and the District of Columbia. Blue Ox signs up one or two new practices per week.

Casting His Net

Initially, Alfieri was searching for a way to streamline his own practice that, in 14 years, had grown to include 20 cardiologists. The PM system he had been using exhibited major software glitches, and Alfieri felt the vendor and his practice weren't a good fit.

Alfieri also wanted an EMR, but discovered it came in three varieties: good, better and best. "I could only afford good, but I wanted best," he admits. "Another big requirement was buying from an established vendor that would be here in the future. I wanted the best EMR system with a vendor who had a track record, financial stability and longevity--and that's expensive."

He began a two-year due diligence process and says he looked at all the options. "Cerner had just come out with their Millennium architecture and PowerChart Office and assured me they could provide the PM system and an EMR as an ASP (application service provider). We liked Cerner because they offered the architecture, because they have a tremendous commitment to R&D, and I loved the software. It's easy to use, and the template system makes it malleable to any doctor's practice."

It wasn't long before Cerner's PowerChart Office clinical EMR and practice management system became the backbone of Alfieri's practice. He says the Cerner EMR lends itself to use by virtually any medical practitioner. "If people want to develop pathways (pre-completed notes for certain specialties), Cerner has done that. The EMR doesn't require much customization because it comes with everything a physician needs."

The Network Expands

Alfieri says delivery of the software via an ASP model is significant because medical practitioners want to concentrate on healthcare, not IT. They don't want to be concerned with the number of servers in the office or with disaster planning and backup measures. "When I talk to doctors about this, I tell them, 'Look, there are 200 Cerner people sitting in their data center in Kansas City. It's their job to make sure we have no downtime, to prevent disaster and to handle backup.'" Blue Ox does provide physician support to its clients from 8 a.m. to 5 p.m. every day and represents the primary relationship with physician office clients, but Cerner manages the data center, backup, disaster prevention and the hosting.

While his cardiology practice reaped benefits from the PM and EMR systems, Alfieri envisioned family physicians on the same network, since they were the ones who most often referred patients. But he also realized that single practices might find it cost prohibitive to purchase PowerChart Office individually.

Alfieri approached Cerner about bringing other physician practices onto the network to facilitate his practice's conversion to an EMR. "The work of turning all my paper records into an EMR was onerous. I wanted to get transcriptions faster." As the community care model became more plausible, he was also able to work an arrangement with Cerner whereby "we have the right to resell the licenses."

Alfieri also notes that the community care model provides an economy of scale benefit with interfaces that can't be had from supporting a silo practice model. The cost for interfacing with Blue Ox is the same as the cost would be for interfacing with a silo model, he says, but the interface cost--and benefit--is spread over all the practices participating in the community care model. As the network grows, participating practices can gain from the enterprise's ability to influence price points.