Brown & Toland Physicians' recent selection of Allscripts Community Record, powered by dbMotion, represents a big step toward realizing the IPA's vision of providing clinical integration and connectivity for its 1,500 primary care and specialty physicians in the San Francisco Bay Area.

The  IPA, which is physician owned and governed, defined its goal eight years ago - long before the HITECH Act - and was challenged by the fact that it neither employs its physicians nor maintains their systems.

"We've been on this mission to figure out how we  – as an independent group of physicians – can share clinical information," according to COO Mark Ficker.

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The IPA started the process with clinical results reporting (CRR) by creating interfaces with local labs, hospitals and physician offices. CRR is available to virtually all of the IPA's physicians. Today, approximately 700 physicians are involved in some form of an electronic health record (EHR), with a subset of 250 of those physicians operating a full EHR. Brown & Toland anticipates rolling out a full EHR bundled with a practice management system to at least 750 physicians.

What's important to note, says Keith Pugliese, vice president of Accountable Care and Compliance, is that the EHRs are patient centric, meaning physicians outside of the practice can view the patient’s record. Additionally, the IPA made the decision to make available the tools and platform for physicians to use for their full patient base. "We wanted to do what's right for the community doctors, the independent practitioners," he said. "It's key to have a system that’s patient centric. This is part and parcel with integrating and coordinating care."

While having all of its physicians operating under the AllScripts environment would standardize workflow, Brown & Toland understands the need to be open in terms of physicians’ EHR choice in order to support its business model and clinical goal of sharing information throughout the entire network, Ficker said. Health information exchange is achieved via an agnostic platform – dbMotion’s solution is embedded in all AllScripts’ products and can also collect and distribute information from other EHR systems. “We need to move forward with this environment,” Ficker said.

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Brown & Toland's clinical integration vision comprises a multi-prong approach, which includes care management intervention and EHR/clinical information analytics reporting, and supports former CMS Administrator Dr. Donald Berwick's "Triple Aim" of achieving better population health, higher-quality healthcare and reduced cost, Pugliese said. These concepts are not only embedded in clinical integration, but they are also key to accountable care, he pointed out. Early on, the IPA saw health information exchange as a "necessary component" of clinical integration and accountable care, Pugliese said.

HIE support for ACO
Brown & Toland is engaged in both private and federal Accountable Care Organization (ACO) initiatives, respectively, including payer-driven quality initiatives and the Medicare Shared Savings Program and Medicare Star Quality Ratings. "ACO is an extension of the concept of clinical integration," Ficker said. The IPA is applying the clinical integration IT infrastructure and the Triple Aim to their ACO engagements, bringing care coordination to a fragmented system, said Pugliese. "The EHR/HIE platform facilitates and optimizes our ability, in our ACO role, as a care management convener," he said. Having the clinical information centrally located is critical for such programs as post-discharge and disease management, which take place in ambulatory settings, including the patient home.