By Terry Garfinkle, MD, MBA, Chief Medical Officer, Partners Community Physicians Organization

“I’m sorry, but I don’t have the notes from the last doctor you saw.”

How many times have you heard that?  Most of us in healthcare have said it ourselves. How is it that we can advance science and save lives but we can’t get a medical note from across town?

Solving the problem is difficult and expensive – especially at the practice level. Just as implementing an integrated electronic health record (EHR) has challenged the daily workflows of clinicians and administrators at our hospitals, it is now challenging community-based primary and specialty care practices as well. The difference is that these practices do not have the same resources to manage the necessary workflow changes, evolve the practice culture, learn new software and manage system integration. From our smallest to our largest affiliated practices – many in Boston’s suburbs – implementing a new EHR will take a heavy toll on clinician time, staff energy and economic resources.   

By the end of 2009, Partners had taken the lead in greater Boston by requiring all of its physicians and other providers, including all Partners-affiliated community-based practices, to use the Partners longitudinal medical record (LMR) or GE’s Centricity platform. We did it because it was the right thing to do for quality, safety and efficiency. Today, the cost and effort is higher because we are integrating hundreds of applications and lab systems at more than a dozen institutions. Our goal is to eliminate the inefficiencies that underlie statements like “I don’t have the notes...”

Today, the cost and effort is higher because we are integrating hundreds of applications and lab systems at more than a dozen institutions. Our goal is to eliminate the inefficiencies that underlie statements like “I don’t have the notes...”

As we were with our first electronic medical record, Partners is ahead of the curve in requiring the use of the Epic integrated health record among our 475 affiliated private practices. We call it Partners eCare and, right now, hundreds of practices are actively implementing or are in discussions to bring the benefits of it to their patients. We are working to support these practices to the greatest degree possible with detailed consultation and assessment of practice needs, advanced planning, information transfer from the old system to the new one, guidance around implementation logistics, coordination with third-party billing systems and at-the-elbow technical support during implementation.

For 2,020 affiliated physicians in the Partners Community Physicians Organization (PCPO), Partners eCare will provide broad access for clinical care integrated with practical administrative components. From any device, clinicians can access the patient’s entire clinical record including inpatient, outpatient, primary and specialty care, labs, imaging and care management information. That means fewer delays and less mailing, faxing, scanning, and filing. Together, this helps providers make better clinical decisions.

For patients, the benefits are easily seen in the Epic-based Partners Patient Gateway portal. It offers patients an integrated view of their health records and, just as it is for their doctors, all information is in one place and test results are posted almost immediately. Patients have user-friendly ways to interact with their practice around their health and day-to-day administrative requests.

It is clear that all healthcare systems will eventually require their affiliated physicians to use an integrated health record. There is just no other way to manage the ever increasing flow of information and provide the coordination that is required for today's patient-centered care, population health management and accountable care contracting.

Implementing an EHR on the community level is disruptive and expensive, but it is still the right thing to do. Its true value in patient care and efficiency will be measured in the months and years that follow. This is an innovation that is important for patients and, therefore, it is important to us.

For the top 10 Partners eCare benefits for community-based providers, click here.

This is part of an occasional series on Partners eCare, a Partners HealthCare initiative to bring the benefits of a fully integrated electronic health record to our patients. See the first article, Implementing an EHR: How Hard Can it Be?, to see how Partners eCare is already delivering results for our network.