This month the federally-designated Oakland-based nonprofit that received $17.3 million in federal money to support doctors’ implementation of electronic health records technology (EHR) plans to begin enrolling doctors for services to help them buy and install EHR systems.

The California Health Information Partnership & Services Organization (CalHIPSO) will also begin offering EHR technology packages to doctors at a discount in the next couple of months. The California Medical Association plans to offer 9 to 10 EHR systems at a cost savings as well, ones that meet the U.S. Health and Human Services standards, said Donald Waters, Executive Director of the Alameda-Contra Costa Medical Association.

Waters informally represents California’s medical associations in his role as a member of CalHIPSO's board.  Medical associations will play an important role in educating doctors about the federal incentives for EHR adoption and how to qualify as well as the long-term disincentives for not adopting them.

“Doctors may not be aware of the steps necessary to ensure funding from the federal government,” said William Parrish, CEO of the Santa Clara County Medical Association.

Waters recommends that doctors wait a couple of months to see what packages CalHIPSO and CMA come up with before they start making decisions.

In the meantime, CalHIPSO is analyzing applications submitted by organizations that are vying for contracts with CalHIPSO to become local extension centers (LECs) to advise doctors. By June 30 CalHIPSO will have selected the organizations it intends to enlist as LECs, said Speranza Avram, Executive Director at CalHIPSO. They will help with determining what type of technology physicians need, helping them select a vendor, providing options for purchasing a system at a discount, and helping them train their staff.

But Waters wonders how much consulting CalHIPSO, which covers all of California except Los Angeles and Orange counties,  will be able to provide each doctor. The funding pencils out to about $4,176 in subsidies per physician to the LECs, Avram said.

“How much consulting can you get for that?” Waters asked.

One of the roles of the LECs will be to instruct doctors on what they need to do to achieve “meaningful use.” That’s the term the federal government is using to describe implemented EHR systems that are operating as intended.

But that definition has not yet been finalized. Avram said Centers for Medicare & Medicade Services (CMS) indicated those rules would be finalized in June.

Organized medicine felt that the definition was very onerous with all the reporting requirements, Waters said.

“Based on the comments that CMS has received, there was a great deal of concern about a ‘one size fits all’ approach and a desire to have the rules be more flexible,” Avram said.

Doctors will need to comply with that definition of meaningful use in order to qualify for federal incentives of up to $44,000 over five years under the Medicare Program and up to $65,000 under the Medicaid program.

Waters acknowledges that even with the incentives, EHR adoption is a huge challenge for physicians. It’s not just the cost of the system it’s the impact on production.

“I’ve had doctors say that impact [can last] one to two years. It changes how doctors record and work with information,” he said. “There’s no question it will enhance their ability to practice, they will have information brought to them more quickly,” he said. But the cost savings will vary. “Doctors are frankly a bit leery about making the leap,” he said.

And then there’s the whole issue of interoperability, how does EHR A interact with EHR B, Waters asked.

“The two of them have to go into a black box and come out the other side in a form the recipient can read,” he said. The technology for dealing with this is still unfolding and at the federal level there are efforts to develop an interoperability platform.

The National Health Information Network (NHIN) is a project by the federal government to develop a set of standards, services and policies that will allow the exchange of secure health information over the Internet. The ultimate goal is for health information technology to be exchanged across diverse entities allowing for a patient’s medical information to travel with him or her. To follow the activities of the NHIN Working Group visit it’s website at http://healthit.hhs.gov/policycommittee

Stanford University School of Medicine will open a new research center to develop innovations in health care delivery and to reduce healthcare costs. And Stanford has recruited one of the nation’s leaders in healthcare innovation, Dr. Arnold Milstein, to head Stanford’s new Clinical Excellence Research Center.

Milstein will take on the new role in July and will lead a staff of four plus six or seven researchers from Stanford’s engineering, business and medical schools. The plan is to form transdisciplinary research collaboratives to improve healthcare quality and cost.

Milstein said there are plenty of ripe areas for innovation, such as telemedicine. And based on the current scientific evidence for all three schools the center will determine the best avenues for pursing innovative methods for improving healthcare and reducing healthcare spending, he said.

He gave an example of the types of innovations that can achieve those goals. Twenty years ago a Kaiser Permanente group in Oregon started hiring specialty physicians to be on call to advise primary care physicians on patients that might need to be referred to specialists. While the patients were still in the primary care physicians’ offices the doctors could call specialists and give them the patient’s symptoms and history. They found that one third of the time the specialists recommended that no further action needed to be taken. In another one third of the cases the specialists requested that the patient have lab tests or imaging done before they come to an appointment with the specialist, which saved one appointment. And the final one third of patients were referred to the specialist. But in two thirds of the cases the patients’ saved trips to the specialists’ office.

“If you spread those results over the whole population, you get less delay in treatment and a reduction in cost,” Milstein said. He said there’s a need for science to provide those better quality, less costly solutions and once they are discovered,  there’s a need for research on ways to ensure their adoption.

“One of the things that critics in healthcare have noticed is that once a better system is discovered, the average length of time before it becomes routine practice is 17 years,” he said.

 Milstein is currently and will remain the medical director of the Pacific Business Group on Health (PBGH), a business coalition of 50 large healthcare purchasers seeking to improve the quality and availability of healthcare. At PBGH he co-founded the Consumer-Purchaser Disclosure Project and the Leapfrog Group, an initiative to improve the safety, quality and affordability of healthcare. It is supported by the Robert Wood Johnson Foundation.

He is also an associate professor of the UCSF Medical Center and Chief Physician and U.S. Healthcare Thought Leader at Mercer, a global consulting company.

And as a commissioner of the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency, he created a Medicare provision that was recently enacted to stop additional payments to hospitals for treating preventable complications that occur in the hospital such as certain types of infections.

“I think Arnie has, over the decades, been one of the really critical forces in health care, not just representing the employers’ perspective, but trying to really drive a remodeling of the health-care system,” said Thomas Lee Jr., M.D., president of Partners Community HealthCare, the healthcare delivery system established by Brigham and Women’s Hospital and Massachusetts General Hospital.