Big Apple's Medicaid providers to get free EHRs

New York has taken a big step toward creating a citywide health information network by agreeing to purchase eClinicalWorks' EHR system for 1300 primary-care providers who care for Medicaid and uninsured patients. The city, which is spending $19.8 million on the eCW software, will also buy EHRs from other vendors for 200 more providers, and it may later expand the program to additional physicians who take care of the poor. Meanwhile, all New York physicians are eligible to purchase the eCW EHRs at the same 10 percent discount that the city is getting, says Farzad Mostashari, MD, assistant New York City health commissioner.

The recipients of the free EHRs will include physicians in community health centers, the Riker's Island Correctional Facility, hospital-owned groups, and private practice. (The latter will comprise about 25 percent of the physicians involved.) While the city will cover the cost of software, training, and support for two years, the providers will have to pay for hardware.

ECW will start installing its EHR and practice management system in the New York practices Sept. 1, and the full rollout is expected to take about two years. According to Girish Kumar Navani, president of eClinicalWorks, the larger groups will probably install the software on their own networks, while smaller practices will have it served to them remotely over the Internet. The city Department of Health and Mental Hygiene, which signed the contract with eCW, will host the Riker's Island system, and some of the hospitals—which include Kingsbrook and Lutheran in Brooklyn—will host the EHR for their affiliated practices, he says.

In the long term, Mostashari says, it's hoped that the physicians who use the eCW EHR will connect with one another online to track patients and provide better care. "Our intention is to create an electronic network that they can use to communicate with each other for referrals or move towards interoperability," he says. He also expects they'll be able to link with New York's new regional health information organizations (RHIOs), which include other physicians and hospitals. The state has funded nine RHIOs in the city and 26 statewide, he says.

Under the agreement with New York, eCW is required to add new features to its EHR that will facilitate the delivery of better preventive and chronic care. Navani says these features will provide "real-time decision support" at the point of care. Building on the chronic disease registry that's already part of eCW, he says, the EHR designed for New York users will create order sets for services that patients need and will automatically generate performance data on measures of preventive and chronic care.

The contract requires eCW to integrate these features into its commercial EHR and to give them to all of its customers across the U.S. at no additional cost, says Navani. He expects that existing eCW EHRs will be upgraded everywhere by the first quarter of 2008.

What is New York City going to do with the performance data it receives on individual physicians? Mostashari says a more important question is, what will the doctors do with it? He'd like to see them use it to improve group performance and to measure the progress of individual physicians. "Right now, we're not envisioning that there would be public reporting," he says. "We see the data being used for physicians to benchmark themselves against other physicians."