For many, that support begins with answering questions from independent physicians. At Christiana Care, Steinberg has been holding workshops with community physicians, and says the one thing they request is guidance. “It's not actually the money that scares them; it's picking the wrong system and being marooned,” she says. “They want somebody like me to give the seal of approval.”

Steinberg's hospital is using a consulting service to help doctors through the phases of implementation. The hospital is helping them implement according to best practices, creating order sets. “The clinical content won't vary if it's NextGen or Epic,” she says. “We want to make sure if they want our help, we'll give them what they need.” Delivering that support is also having an effect on internal staffing, and many hospitals are creating new positions expressly designed to interact with physician practices.

BayCare hired a director of physician support services this year, reporting to the CMIO, who is responsible for the subsided EMR program, as well as physician outreach and education. That director is constantly in the community meeting with physicians around EMRs.

Like Jarrell, Shirey too created a new position to deal with the doctors - the chief integration officer. “We think it's a key position,” he says. That new executive is skilled in both the outpatient setting and in building physician relationships and, he adds, helps focus strategy on the inpatient and outpatient integration. “Hospital administrators typically don't have a lot of knowledge about the ambulatory setting or the pressures on a doctor in the payer market, let alone the workflow issues of a physician practice,” says Shirey.

Jarrell says getting the big picture is critical. “If a hospital chooses the EMR vendor, it may not be what the physicians really need. We need to understand that the physician's life and the physician's office are completely different from the hospital.”

Rothenhaus says it's important to have an integrated suite with both sides - the practice management and billing, as well as the EHR. “You're left trying to find support for both of those pieces,” he says. “You need an analyst that understands physician billing and revenue cycle. And since that's not necessarily a core business of a standard hospital, you're going to have to develop that expertise.”

Differences in those core business models are a reason hospitals have largely not been successful getting their practices on board. But those differences also illuminate what many think is most effective. “Don't treat this like a typical inpatient acute IT initiative,” says Whitman. “If you do that, the initiative will fail.”

He says that instead of the “design, test, implement, train” model, implementing an EMR in physician offices requires physician input, education and workflow redesigns. “It's a process that is going to be difficult, and you have much less control over the outcome,” says Whitman. “And though you can say it's the physician groups that are going to be responsible, ultimately they're going to come back to you as the CIO. Don't underestimate that.”

So, in the end, what's really at stake? “The country can't afford to let the docs fail,” says Shirey. “Without doctors, there is no healthcare.” He says he believes that if hospitals can't support these doctors, they will begin to flee markets. “We can't afford to let doctors fail, and the federal government can't either. The stimulus program was not intended to create haves and have-nots; it was intended to stimulate everyone to a higher level.”