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Young Ophthalmologists
Combining Resources to Purchase an EHR System
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A few years ago, one of our physicians attended the Academy’s Annual Meeting, and upon his return, he announced that we were going to convert to electronic health records (EHRs). He then laid a software brochure on my desk and said, “Go ahead and get that one. What do you think — we should go live in a few months, right?”

After the initial shock wore off and we had a realistic discussion of the many factors and steps involved in a project of this nature, I began the process of considering EHR use in our practice. At the time, we were a small practice of two ophthalmologists with several satellite offices, and the initial costs of converting to an EHR system seemed overwhelming.


Our practice had already formed an associated entity with two other ophthalmic practices — an ASC and a lab located in our same building — so it seemed logical to entertain the idea of combining resources for the migration to an EHR system.

Considering Our Options
Since all three of the ophthalmic practices in our associated entity were small (less than four physicians), the acquisition cost of implementing an EHR system individually was unreasonable. However, when we contemplated the option of sharing the system, the initial and ongoing expenses were substantially less for each practice. A cooperative model seemed to be the most viable way to proceed.

Our associated entity had previously tested this cooperative model by sharing a practice management system and server, with different databases for each practice. Patient information was stored separately, and each entity had the flexibility to maintain its own unique library.

Of course, the other alternative to switching to a cooperatively owned EHR system was to remain with our paper chart system. This choice seemed less difficult and was definitely within our comfort zone. However, after evaluating the benefits, all three practices unanimously agreed that implementing an EHR system was the best decision for enabling our organization to gain efficiency.

How Would It Work?    
Our existing partnership with the other practices involved sharing resources and their management, including accounting and payroll for the shared ASC, optical and lab; practice contracting; marketing; and some human resource functions. Within this partnership, operating agreements determined how the expenses were to be shared. Our new technology-sharing venture meant that the agreement would need to be modified.

Sharing resources to implement an EHR system seemed practical both financially and in terms of shared responsibility. However, the simple concept of resource sharing comes with its own set of challenges and hurdles.

The practices considered themselves to be “friendly competitors.” (And in reality, any separate entities coming together in this situation would be competitive to some degree.)

Thus, several questions arose:
  • Which practice would lead the decision-making process, or would decisions be made as a group?
  • Would the best interests of all the entities be considered, or would one entity’s perspective predominate?
For our group, the meaning of friendly competition needed to be discussed. It was true that we were competitors, but for this project and the joint venture, it was clear that being on the same team was important to our success. 

To create a sense of camaraderie and collaboration, we developed an EHR project management team. This group consisted of individuals from each of the separate practices, allowing for universal participation in the decision-making process.

The team was also diverse in terms of the members’ different perspectives. Our task force of 12 consisted of practice administrators, department heads, registered nurses, coders, technicians and IT specialists. This combination of skill sets was rare and valuable, especially for these small practices.

Choose the System and Learn the Art of Compromise
Once the team was in place, we started the process of choosing an EHR system. We decided that converting to an integrated system with both practice management and EHR from the same vendor would be ideal, so as to avoid interoperability issues. So during our selection we were shopping for both systems.

The most valuable lesson we took away from this step was the importance of visiting practices to see how the software was being used in their daily workflows. Having multiple users on our team available to participate in these visits was another benefit of sharing resources. Each person’s unique questions and priorities during these sessions resulted in a comprehensive analysis of each system.

Once the software was chosen and the implementation timeline drafted, the true learning process began. Our team not only had to understand the functionality of the new computer system, but also how to apply it in the context of our organization as a whole. Our decisions needed to be suitable for all three practices — and with this transition we learned the art of compromise. 

For example, when multiple entities convert to a single database, challenges arise in building administrative tables and libraries, designing forms and redesigning workflows. On the other hand, with compromise come rewards.

We were able to split up the task of entering database libraries, work together on templates and share training resources to bring staff up to speed. Most importantly, none of us felt that we were tackling a daunting task all alone. Small practice administrators rarely have the luxury of having a team as a resource. I highly recommend it!

Advantages to Resource Sharing
  • Shared MPI databases: With a shared database, we could opt to combine our master patient index (MPI), which allowed each entity access to the same patient demographic information. This eliminated the need for individuals to register separately at each department (physician office and ASC), and essentially created only one chart per patient. Our EHR system then allowed each entity to separate into “locations of care,” where access could be limited to specific practice information.
  • Easy physician access to patient charts: This separation did not, however, limit access when necessary. When on call, our physicians have access to the complete medical history, review of systems (ROS) and current problem list of the patient, even if the person is a patient of one of the associated entities and not the physician’s own practice. Similarly, if a patient transfers care from one practice to another, the need for duplicate data entry is eliminated, since medication lists, problems, allergies, ROS and directives are shared. 
  • Integrated IT support: IT support was another area where our arrangement enabled us to reduce costs. Prior to adopting EHRs, each entity had a separate outside IT consultant it used for resolving hardware and software issues, providing security and making backups. In the midst of our conversion, we realized that hiring one onsite IT professional to take on this role would not only save costs, but would provide another resource for software training, hardware and network setup and ongoing maintenance.
Other Sharing Models
Like us, many other medical facilities are using the shared resource model. Some communities have purchased EHR systems through an independent practice association and share charts across specialties. Others access community health records through joint ventures with their local hospital. Still others join with other practices to purchase software from an application service provider (ASP). All of these arrangements have enabled their participants to successfully convert to electronic records at a lower cost. 

When considering the various options, it is helpful to first identify the specific needs of your practice. Then, along with your wish list of EHR functionality, evaluate the shared-model option for practice management integration, development and maintenance of shared libraries (tables or directories) and the availability of ophthalmic content.

For example, for some practices, the reduced cost of sharing resources may be more valuable than having control over library development. However, for others, participating in the decision-making process surrounding their EHR system is mandatory for meeting their practice goals.

Each practice is unique, and some options may not work for your specific situation.  However, it is reassuring to know that purchasing a system on your own is not the only way to achieve the transition to EHR. After considering the alternatives, you may end up sharing resources with the friendly competitor down the street or purchasing from an ASP. Whatever arrangement you ultimately choose, combining resources can be an important part of your successful conversion to electronic health records.

Editor’s note: The Academy also offers several resources to help with the transition to an EHR system. Academy members can join the EHRs in Ophthalmology group for discussion and tips from your peers. And Mid-Year Forum attendees won’t want to miss the session on EHRs.

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About the author: This article was adapted from the February 2010 issue of Executive Update. It was written by Joy Woodke, COE, a practice administrator at Oregon Eye Consultants, LLC, which belongs to an associated entity, Oregon Eye Associates (OEA). OEA comprises three independent physician practices, an ASC and diagnostic testing lab that have come together to share resources, including GE Centricity Practice Management Electronic Medical Records. Woodke served on the committee that implemented these products for OEA. She is currently a member of the AAOE EHR subcommittee.

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