Trying to build a critical mass of physicians to adopt electronic health records (EHRs) and participate in health information exchanges (HIEs) is one of the more difficult tasks for HIEs and regional health information exchanges.

Three executives offered up their best practices at Axolotl's 9th Annual Customer Conference in San Francisco on Sept. 30.

Quality Health Network, a nonprofit quality improvement collaborative based in Grand Junction, Colo., has achieved an 88 percent adoption rate among physicians in its region. One of the reasons QHN achieved such a high adoption rate is that it built a governance infrastructure that included many local stakeholders, who were then responsible for making critical and often tough decisions, said executive director Dick Thompson.

Pre-loading at least 24 months of data - lab, radiology and transcription - into the system before the physicians see it enabled QHN to immediately demonstrate the value of the HIE through the data to the physicians, he said. "We use data to help us track how, when and where," he said.

Auto-processing the data is also critical because it eliminates the work on the front end for physicians, as well as curbs information overload that can often occur when patient data is digitized, Thompson said.

QHN provided simple training tools and aids that employ end-user language. The organization worked in teams within the physician practices and worked in modules, which helped pace the teams. All QHN team members answered the phones, "owned the problems" and followed up with the physician offices, he said.

Chesapeake Regional Information System for Our Patients (CRISP), Maryland's statewide HIE, which went live on Sept. 30, is engaged in a number of strategies to enable practice-level integration, according to HIE program director Scott Afzal.

CRISP is leveraging existing ambulatory strategies to identify target physician practices and extend HIE connectivity between hospital and practices.

The organization is integrating at the electronic medical record level, primarily in hosted environments, so future EMR implementation will include connectivity to CRISP.

As the REC in the state, CRISP is leveraging the program to ensure that management service organizations, the sub-recipients of CRISP that will be providing direct assistance to the 1,000 physicians in Maryland, are including HIE connectivity in their offering, Afzal said.

CRISP will also help direct connectivity for physician practices that are ready now or whose size justifies direct engagement, he said. The organization hopes to leverage existing HIE or other data trading networks where technically possible.

The Rochester, N.Y.-based Monroe County Medical Society (MCMS) became involved in physician adoption when it was identified by an EMR readiness study commissioned by the Greater Rochester Health Foundation as a "most-trusted entity" to help promote EHRs, according to Ali Loveys, CMIO of MCMS.

The Rochester RHIO received a Health Efficiency and Affordability Law for New Yorkers (HEAL NY) grant to drive physician adoption of EHRs through the use of matching funds to purchase EHRs, support services and connection to the RHIO, Loveys said.

As the trust source, MCMS is relying on physician peers to engage physicians and proactively communicating in a personalized manner through multiple channels, including meetings in the physician office and through educational classes, peer groups and newsletters, Loveys said.

The goal is to recruit 225 physicians in 75 practices in two and a half years, she said.