Medical practices have to hire several times the number of employees they normally would, just to handle the paperwork required for them to be paid by either Medicaid or private insurance companies, Carpio says.
Not being able to connect specific electronic records to billing statements and invoicing systems holds the whole industry back by slowing the flow of payments for services through administrative friction, not one related to either the quality or type of care, or regulation of the industry, he says. EHR is not a panacea. "I'm really concerned when I hear people talking about EHR as a way to rescue healthcare," according to Carl Labbadia, director of Information Systems at Grove Hill Medical Center in central Connecticut.
"IT can do a lot of good for patients and a lot for administration," he says. "People may be putting too much reliance on it, though.
Building the system ahead of time and hoping the affiliates would sign up was a multimillion-dollar risk in an industry with a history of rejecting IT that doesn't suit its needs.
Because they're independent, BID had to build a system that would work with even less effort and cost than the one it build for the internally owned practices, and demonstrate that it worked before any of the affiliates would sign up.
"We could have gone with a classic environment - server clusters and building arrays for storage; the problem was that we'd have to build it for the largest load we'd ever need and we had no guarantee anyone would use it," Gillis says.
The software is a set of EHR and practice-management applications from eClinicalWorks, which licensed the software to BID, but also provides it as a hosted service.
Physician offices access the cloud using a normal PC with a thin-client connector that provides encryption, authentication and connectivity to the cloud. "They get a new appliance that front-ends this whole thing for us and can light up a practice with no hardware except what's talking to the virtual desktops," Gillis says. "There's still a client on the device, so it's not fully a Web app. But you can get directly to the EHR without messing around with a terminal-services app."
The cloud infrastructure is a set of VMware ESX servers running on half a dozen Hewlett-Packard Co. servers - a number that can change with relatively little effort.