The Daily Briefing sat down with Rob Barras, Advisory Board national partner and senior vice president and the latest addition to our team of EHR and health IT experts, to talk about how leaders can best standardize their EHRs after a merger, the importance of engaging physicians, and more.
Question: Rob, can you start by talking a little about your experience in health care?
Rob Barras: I cut my teeth in health care by implementing billing systems for physician practices. Then, I went on to work at WebMD and a few other places that were all trying to create community networks where they would share health information.
What's always struck me about health care and IT, and a reason I almost left health care, is that our industry's business model doesn't support sharing clinical information. There is strong, industry-wide cultural emphasis on defining who owns the data, and not sharing data out of fear that competitors will use it to steal business away. For that reason, there has never been a sustainable business model to support the sharing of data.
Q: But you decided to stay in health care. Why?
Barras: Because yes, data sharing is a problem, but it's crucial for the industry to get it right.
The amount of M&A activity in health care right now—not to mention the creation of new types of partnerships and new networks—is unprecedented. That makes data sharing all the more important. And it's really exciting to me.
In fact, one of my current priorities is to help our members understand how to integrate and standardize the EHR when they're merging with or acquiring another provider organization—whether it's two hospitals, a network of physician practices, etc. The EHR presents one of the biggest challenges and the most complex areas of standardization when entities are combining. There's a lot that goes into it, from understanding flexibility in the contract with the EHR vendor to deciding what to do with order sets, and knowing how crucial it is to get the details and the decisions right.
Q: So how should health care leaders go about standardizing the EHR post-merger?
Barras: First, any acquisition or affiliation increases the amount of variation in care delivery, because the two separate groups most likely aren't following the exact same care pathways. Those who are undertaking a merger, acquisition, or new partnership can use their integration as an opportunity to standardize the EHR to help reduce care variation among the different provider groups.
My main recommendations to health care leaders who are in the midst of figuring this out is to engage physicians throughout the process, because their involvement will be the difference between lasting success or going back to business as usual. The best way to engage physicians is with physicians. IT leaders need to establish a strong partnership with clinical leaders, and work with them to determine the best way to communicate with the doctors who will be most impacted by EHR standardization.
IT and clinical leaders, in partnership, also need to focus on how things are going to change at the point of care—what the clinical workflows will be—and how to embed those into the EHR. Take clinical decision support, for example. Even if two merging organizations are on the same EHR and same clinical decision support tool, the systems will not have been implemented the same way and likely will have different content—directly affecting how physicians treat patients at the point of care. And there will be even bigger differences if the organizations are on different EHR systems. It's critical to standardize clinical workflows like these alongside the technical components. And this is something our Clinovations team is working on every day.
Learn how to connect your EHR post-merger
Listen to a webconference recording where Rob discusses how to approach the common challenges associated with standardizing the EHR across newly-affiliated entities.