New York City Health Department Helps Doctors Adopt Electronic Health Records

Most agree that electronic health records (EHRs) can cut health-care costs and reduce errors. However, only a few providers have adopted EHRs because deployment costs are often prohibitive. The New York City Department of Health and Mental Hygiene (DOHMH) is taking the bull by the horns and helping physicians deploy and use EHR systems.

Through its Primary Care Information Project (PCIP), the department pays some costs of deploying EHR systems. The goal is to boost EHR adoption among New York City doctors and give them the tools they need to improve patient care.

"We believe the absence of consistent evidence-based care in primary practice is a public health problem," said Farzad Mostashari, assistant commissioner of the DOHMH.

A focus on chronic diseases and common killers like high blood pressure and diabetes can save lives and result in a healthier population, making it a matter of public health, he explained. However, in some ways, agencies like the DOHMH are limited to combat these common issues.

"We don't directly provide health care. We don't pay for or even regulate health care," said Mostashari. "Our solution was to try to change the decision-making context for the clinicians by providing them with electronic health records that have a public health perspective baked into it."

Boosting Adoption, Improving Care

Doctors have been reluctant to adopt EHRs because the expense and inconvenience come with little payback.

"This transition is laborious and it's difficult to change one's workflows completely and every aspect of their day. This also can be expensive for practices to adopt health records, and only a small portion of the benefits accrue to the physician who's expected to put all the money in," Mostashari explained. "So there's been a market failure in this industry."

The result, he said, is that only 2 percent of U.S. practices have a full-featured EHR system in place. Even when practices use EHRs, health goals aren't necessarily built into the product. To improve adoption and help physicians handle these public health measures, the DOHMH is working with providers to roll out EHRs with tools that support public health goals -- at minimal expense to providers.

The city assists doctors whose Medicaid or uninsured patients constitute more than 10 percent of their total visitors, as long as the physicians are willing to work with the city on quality improvement. According to Mostashari, 1,100 doctors are participating, with several hundred more in the pipeline. Participants include small practices, community health centers and hospital outpatient departments.

The system has alerts and tools that help physicians better manage targeted health conditions, pull patient reports and see how they handle certain conditions compared to other physicians who use the system.

"It pops up with alerts. It allows them to act on it when the patient is there. It also allows the physician to see at the end of the month how they're doing against those alerts -- compare themselves," said eClinicalWorks CEO Girish Kumar Navani. "That's a step up over most EHR deployments."

The DOHMH helps physicians financially by covering software and license costs, project management, and two years of maintenance and support from software provider eClinicalWorks. Practices must buy their own hardware and contribute $4,000 to a quality improvement fund that provides program support. However, the department has identified several high-priority areas: Harlem, central Brooklyn and the south Bronx. For doctors in those areas, the DOHMH waives the $4,000 contribution and provides a hardware package worth approximately $10,000. Mostashari said more than half of small practices and community health centers in the three areas have signed on.

When interviewed in February, Mostashari said approximately $20 million had been spent on the project, he said, with funding from the city, New York state, the Centers