Up and running: Ambulatory EMRs are finding their stride

"Hospitals are acquiring practices in a strategic competitive mode," says John Hoyt, executive vice president of HIMss Analytics. Once they’ve made sure their hospital facilities have met meaningful use, he says, then they spend money on health IT for the doctors.

HIMSS Analytics' Electronic Medical Record Adoption Model (EMRAM) has been tracking hospitals' slow upward climb towards advanced health IT use  -  an eight step ladder, from paper-based to totally wired  -  since 2005.

This past June, HIMSS released a new version, focused on ambulatory facilities. The Ambulatory EMR Adoption Model (A-EMRAM) tracks IT adoption in nearly 11,000 physician practices and ambulatory clinics that are part of a hospital or hospital system tracked by the HIMSS Analytics database.

"These are tethered practices," says John Hoyt, executive vice-president of HIMSS Analytics, "not the independent docs  -  there are tens of thousands of those, and I can't call em all."

Tracking hospital-affiliated practices is illustrative, however, because that is of course the big trend nowadays.

"I think what's going on is that hospitals are acquiring practices in a strategic competitive mode," says Hoyt. "Once they get the hospitals online in terms of meaningful use, then they spend money on the doctors." 

But while the acquisition of independent practices is undoubtedly a competitive move, he says, "the IT portion of it is initially not the focus at all. It is market share: 'If I can get a couple cardiologists, great. Then I'll figure out their office stuff later.'"

But once they get around to implementing technology, they're doing so in earnest, says Hoyt. And the hospitals best positioned for success with their new satellite practices are those that have made investments in a certain vendor: same for inpatient as for outpatient.

"That's positioning these hospitals to be a step ahead for bundled payments and ACOs," he says. "Those hospitals are proceeding, probably, more aggressively with having EMRs in the doctor's office because they want to be in position to take advantage of having data."

After all, "If you have vendor A in the hospital, and vendor B in all these practices you're buying  -  and sometimes also vendor B, C and D, because in the last few years you've bought a bunch of practices  -  you've got this mess of IT, you're not in a position to manage your continuity of care as well as if it was one database, the same vendor, inpatient and outpatient," says Hoyt.

So acquired doc practices generally won't have much say in the type of technology they end up using. It's generally a "benevolent dictator" model, he says. "If I want to gain economies of scale, I am not going to say to the 20 practices I bought in the past 12 months, 'Use whatever you want.' Just like if the payroll system is centralized and the general ledger is centralized, so is the practice management system and the EHR."