Community Connect: What It Takes for a Successful Marriage
By Damian David
It was Benjamin Franklin who said, “Keep your eyes wide open before marriage, half shut afterwards.” But one of our foremost Founding Fathers could just as well have been referring to Community Connect and EHR Connect programs.
Increasingly popular across the healthcare landscape, Community Connect programs permit large and small healthcare systems to “share” electronic health record (EHR) systems like Epic or MEDITECH with each other. This gives small healthcare systems access to state-of-the-art IT capabilities they might not otherwise be able to afford and permits both sides to maximize data sharing for optimal patient care.
Like marriage or any other contractual relationship, however, it pays for both sides to go in with their eyes wide open, with a full knowledge of their deal makers and deal breakers, before signing on the dotted line.
To this end, Healthcare Triangle recently convened a focus group of 12 healthcare IT leaders to share their most important wants and needs from a Community Connect relationship and what it takes to make these partnerships work. What they had to say can help prospective hosts and clients avoid mistakes that can ultimately lead to an ugly and costly divorce.
Host Needs: Technical Self-Sufficiency, Financial Strength
Potential Community Connect clients in search of a compatible host should be aware that many hosts find technological and financial self-sufficiency to be desirable traits of an ideal partner. “[The client] has to make sure their network and computer backbone is in place and operational,” said one host Community Connect IT leader. “With the size of our operation, I can’t afford for this to drain technology and [person power] if I’m going to extend our EHR to another provider.”
Similarly, several cited financial weakness as a potential deal breaker, particularly when it comes evaluating small health systems.
“There are the technical competency costs, but then there are the costs of the Microsoft licenses, Citrix licenses and other components,” said one CIO. “Some people will look at them and say, ‘I can stretch this,’ but I would say it’s a red flag. I’ve personally seen smaller private practices try to stretch, and it has never ended well.”
Client Needs: Revenue Cycle Control, Out-of-the-Box Functionality
On the other side, hosts courting potential clients should know that they’re likely to be expected to offer at least some autonomy—along with everything that clients need to get up and running in their program—all in one package.
“The host has to let us control billing and revenue services,” one client CIO said. “We want the ability to do some customization, primarily on the revenue cycle side.” Another CIO agreed. “We are physician-owned in the way that our cost accounting system is set up, and we really need to be in control,” he said, adding that his organization is looking for a new Community Connect host because of limitations imposed by the current host on revenue cycle management.
Getting “out of the box” functionality from an EHR Community Connect relationship is a top priority for many potential client CIOs. For one CIO, this includes shared patient records, all necessary applications, and pre-built connections and interfaces. This CIO said one potential host appeared promising until he realized his own organization would have to shoulder all the work of transitioning from one EHR to another and keeping their new system up and running.
“It was like, ‘We’ll build the temple, but the altar, the pews, and all of that: You need to bring your own,’” he said. “That’s definitely not something that would provide value to us.”
A Give-and-Take Relationship
Both host and client health IT leaders all agreed on the importance of a “mutually beneficial” arrangement, but they also noted that compromises will have to be made to achieve a successful Community Connect program.
With respect to clients’ need for control over revenue cycle management, for example, two host CIOs said they are fine with such arrangements. “They’re free to do what they want,” said one. “We don’t want to touch it.” But a third host CIO said client organizations must relinquish all control of financial processes “so we don’t have to maintain a different build around their revenue piece.”
Indeed, the degree of autonomy—how much clients need and how much hosts are willing to give them—is likely to be one of the stickiest issues to negotiate in a Community Connect relationship. Most hosts noted that the nature of the host-client relationship requires limitations on client autonomy.
“I hate to say it, but our philosophy is that you can get any color you want as long it’s black,” said one host CIO, referencing the workflows between his facility and those of the clients. “Obviously, there are going to be considerations to take in account, especially around the ambulatory specialties. But in terms of the variability that we could support, our philosophy is more along the lines of, ‘We’ll give you the backbone to build and the kit to be operationalized,’ and less of, ‘Here’s what you can do to change that kit.’”
Clear Governance and Communication Are Key
As with marriage, it’s clear that there is no such thing as a perfect Community Connect relationship. Hosts and clients must identify their must-haves and nice-to-haves, recognizing that they won’t get everything they want and will have to look past shortcomings. A clearly defined governance structure that defines each side’s responsibilities and provides for communicating and addressing inevitable challenges is vital.
“I don’t mean to be pessimistic, but [you should] plan the wedding and the divorce at the same time,” one CIO said. “Everybody agrees the value is the shared patient record. But now you have a mixture of patient records. Which parts are yours? Which parts aren’t? What are the obligations of each side? It’s something to be aware of as you examine a potential host or client.”
Several CIOs said regular communication among clients, without the host present, can be valuable for identifying common issues and bringing them to the host for resolution. “Organizations have their own agendas and priorities, and a consolidated feedback mechanism can be fabulous for both sides,” one CIO said.
Connecting to a Bright Future of Possibilities
As more healthcare organizations enter into EHR Connect models, the potential exists to go beyond basic data sharing. Population health services, medical home care and even research into care-related best practices can all benefit from these models of healthcare delivery, the CIOs agreed.
“If everything else is done right,” said one CIO, who noted that he once worked for an integrated health system that is one of the largest federal grant research entities in the United States, “connected data sharing for research for best practices and for patient-directed data sharing is definitely significant.”
Ben would surely approve.
Damian David is senior director of sales for Healthcare Triangle.