New payment and clinical integration models are coaxing health systems to take on the challenge of EHR connections sooner rather than later.

Much attention has been directed at the lack of progress in achieving the type of network of electronic health records President George W. Bush first promised in a State of the Union address nearly a decade ago, where patient records flow seamlessly between patients, providers and patients.

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But some health systems are getting their EHR systems to talk to each other, as they take it upon themselves to make investments in interoperability along with investments in clinical integration.

One such case is Anne Arundel Medical Center in Annapolis, Md. Anchored by a 385-bed hospital, the health system has been expanding in recent years, acquiring a number of physicians practices, such as the Johns Hopkins Community Physicians practice on Kent Island this past January.

As it works to optimize its 49 ambulatory practices as part of an integrated network, Anne Arundel has had to integrate IT systems — the Epic software used at hospitals and the cloud-based athenahealth systems used at many of the practices.

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Even as the health system has added practices "rampantly," there’s been "a pretty robust process in place" for integrating the clinical IT, with interfaces initially taking six to nine months to fully set up, said Ramona Skinner, a system analysts at Anne Arundel.

The interoperability project ended up using a blend of components from athenahealth and Epic. The physician offices use athenahealth’s practice management system for scheduling, registration and billing, with patient encounters being relatively more granular, while Epic’s EHR is used for documentation and ordering.

A single networked server is used for athenahealth to connect with Epic, and 33 different provider groups from 49 locations are connected to the flagship hospital through an admission, discharge, transfer interface, using technology from the company Corepoint.

Now, the IT team is considering a transition to the Epic platform for all ambulatory practices while keeping some of the functions of the athenahealth systems, such as billing.

"We work with them so they understand what they we really need and what they don’t need," said Debra Roper, director of ambulatory information services at Anne Arundel. "It’s a joint design effort."

Roper, who also sits on a state board examining infrastructure needs for population health, said the health system is trying to support a number of new delivery and payement projects, including a primary care accountable care initiative and patient-centered medical homes.

Maryland is the only the state in the country with an all-payer rate system for hospitals, in which Medicare, Medicaid and commercial payers reimburse hospitals at the same rate.

That system’s effectiveness is currently being examined by the Centers for Medicare & Medicaid Services, which has granted the state a waiver to limit per capita hospital spending growth a rate of 3.58 percent in exchange for hospitals committing to a range of quality improvements, including reductions in readmissions and hospital-acquired conditions.

For those quality improvement and cost containment goals to be met, health systems like Anne Arundel need to offer their clinicians simple and quick ways to exchange patient data across physician practices, clinics, outpatient centers, ERs and hospitals.