By now most people in healthcare recognize the benefits of an electronic medical record systems to patient safety and care quality. Historically the costs (both hard and soft) of acquiring and implementing these solutions have limited widespread adoption in the physician office setting.

Without financial support, only a small percentage of physicians are likely to acquire or upgrade to an EMR solution. In the past five years, most of the work on clinical process automation has been within the walls of hospitals. However as adoption of EMR and related clinical automation becomes the new standard in healthcare, it will become more strategically important for hospitals to facilitate the deployment in the physician office setting as well.

Providing integrated solutions to community-based physicians serves to tighten relationships with doctors, protect ancillary hospital revenues, and enhance quality of care overall. Developing a clear and effective EMR deployment program will become a crucial strategic advantage for hospitals and health systems in the next few years.

Thanks to clarifications made by Health and Human Services in October 2006, many of the concerns about violating Stark and anti-kickback rules have been allayed. Hospitals can now safely make these "donations" to their medical staff members under a defined set of criteria. However, nearly two years after these legal clarifications, only a few organizations are taking advantage of the opportunity.

A big reason for this hesitancy has been cost – ambulatory EMR solutions can be expensive, especially when one considers associated hardware and implementation costs. Another issue has been a lack of enthusiasm on the part of most medical staff members to radically change the way they operate their offices. As a result, hospital leaders have avoided making investments in a technology program that is not embraced and could possibly damage relations with their physicians. Why rock the boat?

However in the last few months, many hospital leaders have noticed an increased interest on the part of their medical staff to discuss EMR implementation. This recent interest may be a result of the federal government's July approval of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), a law that provides financial incentives to physicians who adopt e-prescribing.

The act provides increased professional fee payments of up to 2 percent for practitioners who use e-prescribing in 2009 and 2010 with possible penalties coming in 2011.

This interest is enhanced by a growing sense of inevitability among physicians about clinical automation Further, generational changes in medicine are creating a growing interest in automation as younger physicians leave residency and move into private practice. These providers have grown up with computers and the Internet, and expect to practice medicine this way too.

 When community-based physicians begin to reach the point of acceptance, they often prefer to work with their preferred hospital's technology group to get advice about vendors and discuss opportunities to integrate their computers with the hospital's network and systems.

As hospital leaders consider responding to their medical staff members, they should proceed with caution.

1. Engage the general counsel early to help interpret the clarifications and come up with a legal position that right for your organization. 2. Establish an overall strategy for providing EMRs to physicians. 3. Build the pricing model to include "skin in the game" for physicians. 4. Develop a rigorous communication plan.  5. Offer more than one solution. Be clear about how the solutions will integrate with hospital information systems.  6. Avoid focusing only on the technology aspects of the initiative; sponsor the program at the CEO, COO, or CMO level.

By making these solutions available to their medical staff, hospitals and health systems enable tighter relationships, making it easier to order tests and receive results, improving the quality of care offered to patients, and potentially increasing ancillary service revenues to the institution