Hospitals as Software Service Providers

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Both Harris and Podesta agree that organizations like the Cleveland Clinic and Fletcher Allen have a responsibility to ensure the investment the nation is making in health information technology is successful. Vendors are going to be overwhelmed—scheduling HIT projects years in advance. To meet meaningful use, "we need multiple swim lanes open," says Podesta. "If you are a health system or academic medical center surrounded by community hospitals, it should be part of your mission to help them."

"Success to me is that we are not just installing technology in an office to replace paper, but we are putting in technology that enables interoperability," Harris says.

Is SAAS right for you?
Offering EMR software as a service to community physicians or hospitals is a new role for healthcare facilities and there are risks involved, Podesta says. Before stepping into that role, health systems should ensure that they are positioned to get the most value from this model. Here are five baseline requirements.

Make HIT a priority. "Organizations need to have a real commitment to this," says Harris. Every physician in the Cleveland Clinic's outpatient practice uses the EMR, and every patient in its regional hospitals is treated by clinicians who use the EMR extensively. "If you don't have everyone using it extensively, the value proposition drops off dramatically," says Harris, explaining that the way the Cleveland Clinic has it structured its model "helps prevent duplicate testing and avoid missing allergies, because the system is integrated and data is shared."

Be up-front about the risks. CIOs should present the benefits and risks to the board of directors and senior leadership. For Fletcher Allen that includes the risk of failure. You can't know everything about these smaller hospitals, says Podesta. To offset that risk, the community hospitals will go through a readiness assessment in the first month. "If they are not ready, we will stop," says Podesta. "You need to go in with eyes wide open and make sure senior leadership and the board know the risks and what you are doing to mitigate [them]."

Establish a dedicated team focused on outreach. Both Fletcher Allen and the Cleveland Clinic brand their SAAS tools differently than their internal EMR. Fletcher Allen's EMR is called PRISM (patient record and information systems management). But the health system uses the name PRISM Regional for the service it offers hospitals and physicians. Likewise, Cleveland Clinic's internal product is called MyPractice, but externally it is named MyPractice Community. In addition, Cleveland Clinic has a team of approximately 25 people, including administrative, technical, help desk, marketing, and sales staff who are focused solely on the small physician practice space. The typical practice size the health system works with ranges from two-physician group practices to medical groups with eight to 10 members. "You need a dedicated team because how you build the system for a two-physician practice is different than a 2,200-physician practice," says Harris.

Decide what services you are truly capable of providing with this model. "Our core service is the EMR," Harris says, adding: "To make that work in the physician office, we provide an integration service to their practice management system." The physicians still use that system to register, schedule, and bill patients, he explains. Cleveland Clinic builds a link from the physician's scheduling system into the EMR, so the doctor doesn't have to retype that information into the EMR. "You have to be prepared to do that level of integration work with the physician groups," he says.

Offer advice on infrastructure. Organizations have to help the physicians understand the kind of PCs and printers they will need and show them how to set up a network in their office, as well, says Harris. "None of which physicians have typically done in the past," he says.

Carrie Vaughan is a senior editor for HealthLeaders Media. She may be contacted at

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