New York City will spend about $30 million to equip more than 1,000 primary care physician offices with electronic health records, enough to cover 1 million patients.
According to the American Academy of Family Physicians (AAFP), the city signed a contract with eClinicalWorks a year ago to help design and implement the program. Officials have spent the past several months developing the system and recruiting practices. About 246 providers have reportedly signed up so far.
"It has only been in the last two to three months that we have started implementing this program in earnest," said Farzad Mostashari MD, assistant healthcare commissioner for the New York City Department of Health and Mental Hygiene.
If at least 30 percent of a practice's patient base is uninsured or on Medicaid, that practice may qualify to participate. In addition, Physicians practicing in the high-need areas of central Brooklyn, Harlem or the South Bronx are also eligible.
"We are using public money, and so we felt that we should first deal with and help support physicians who practice in the poorest neighborhoods," Mostashari said.
The city provides a package of software and services, including two years of maintenance and support, and the system training for participating physicians and their staff members. In return, each practice has to supply its own computer and Internet connection and contribute $4,000 to a technical assistance fund. While the city is spending $30 million on the program, it will receive $5 million from the federal government to evaluate the program.
According to the AAFP, although individual patient data will be restricted to patients and their doctors under the terms of the program, the city's health department will be able to evaluate patient outcomes, which could lead to higher payments for physicians based on performance. There is a danger, however, that EHRs could "simply digitize inefficient workflows," said Mostashari.
"The potential benefits are enormous," he said. "But practices have to really rethink their workflows to take full advantage of it."
"We are going to be working with NCQA to devise a streamlined, facilitated path to medical home certification for the practices that participate in this (program) who use the electronic health record fully," said Mostashari, who, according to the AAFP, feels the program will serve as a blueprint for the rest of the nation.
The AAFP reports that some of its members in New York City have raised questions about the program, saying that interoperability remains a prime concern, while others are enthusiastic.
"The system that the city has chosen may not be compatible with or interoperable with some of the systems our members may employ," said Vito Grasso, executive vice president of the New York AFP. "That is a constant issue in technology transfer - whether the system is going to become antiquated in a short period of time."
Cost also will be an issue for some. Marianne LaBarbera, MD, of Staten Island, a solo family practicioner in the final stages of implementing the New York City program's EHR system, said she expects to spend about $20,000 on the software package, which does not include the $4,000 she will have to pay to the technical assistance fund.
Nevertheless, LaBarbera expects the EHR to lead to "greater efficiencies" and make it easier to track and manage patient care.
"There is no question it is hard work implementing health records," she said. "Anyone who tells you otherwise is not telling the truth."