The IPA is working on a patient-centered medical home pilot, which will leverage its existing EHR/HIE infrastructure. Once the proof of concept works, Brown & Toland plans to take it to individual practices. The pilot should be live in the first quarter of 2012.

The Business Case for HIEs
Brown & Toland clearly sees the business case for HIE. Having centralized, easily accessible clinical information makes physicians' lives easier and enables them to monitor their patients and engage in proactive clinical care. The by-products are the reduction of the cost of care through the elimination of duplicative testing, better quality of care and better quality scores gleaned from the information, which will help with participation in pay-for-performance (P4P) initiatives. "We do know at this point, just from our CRR, we're seeing where tests aren't being redone," Ficker said. The elimination of tests is also a significant benefit to the patient. "It's about patients - not putting them through the wringer in their treatment," he said.

[Commentary: What HIE needs to mature? Regional critical mass.]

Better data collection through the EHR/HIE platform aids in the IPA's participation in federal incentive programs and payer P4P programs. Brown & Toland was awarded a $1.7 million grant from Blue Shield of California in October 2011 that will offset the cost of an HIE infrastructure that is specifically payer agnostic, and involves and supports multiple organizations including hospitals and physician groups, Pugliese said. Large employer groups are also showing great interest in P4P programs to lower the cost of healthcare. The platform will prepare the IPA for what it believes will see more rigorous patient quality measures and incentive payment for quality, as well as to proactively propose quality metrics to payers. "Clinical information in a common place is key to be able to build more measures, make more commitments on our end to higher quality and measure our progress," he said.

Collaborating with Similar Group
Brown & Toland's EHR/HIE platform will also serve as a vehicle to share information with Alta Bates Medical Group. Originally Alta Bates' Medical Service Organization administrator, Brown & Toland realized that significant benefits could be gleaned by collaborating with the medical group, which serves the Oakland, Berkeley and greater East Bay region. Similar in physician office size (the average size for both IPAs is 1.5 physicians), culture, physician ownership, involvement with Sutter Health, the two IPAs recognized the benefit of working together on healthcare IT efforts rather than duplicating efforts, Ficker said. Alta Bates will also realize a significant benefit in getting at their clinical data, as the IPA did not have an EHR strategy in place. Brown & Toland is looking to distribute its tools to the shared network, and the two are currently in planning phase with the community record implementation, with test cases underway in the East Bay. The goal, according to Ficker, is to have it up and running by third quarter 2012.

The Bigger Picture
While Brown & Toland is working on connecting its independent physician offices, it is also involved in various HIE initiatives within the Bay Area. Implementing the dbMotion infrastructure will make it easier for the IPA to plug into the multiple entities rather than deploy individual interfaces, and to continue to gather and share information, Ficker said. Thus far, there are more than 75 million pieces of clinical data in the CRR, with 1.2 million being added monthly.

[Also: The 5 roadblocks HIEs face. Q&A: On the trials and tribulations of unlocking patient data.]

"It's been our intention right from the beginning to ultimately engage in the bigger picture," Pugliese emphasized. The IPA "heeded the call early" when the Nationwide Health Information Network was envisioned, he said. "That's the end game. It's a transformative effort. We want to be a significant team player. We want to do our part in contributing to those efforts," said Pugliese.