Skip to content Skip to navigation

Extending Your EHR to Independent Hospitals and Clinics: Five Considerations

May 17, 2012
by Susan Heichert, Mary Bear-Dukes, and Dawn Mitchell
| Reprints
Best practices for meeting challenges of capital, cost of ownership, and meaningful use

Recently, Farzad Mostashari, M.D., National Coordinator for Health Information Technology within the Office of the National Coordinator, told the HIMSS’12 conference that the United States has made more headway with electronic medical records (EMRs) in the last two years than in the past 20.

The reason is clear: federal and state legislation are focused on achieving the “Triple Aim” of healthcare reform—better care for individuals, better health for populations, and slower growth in costs through improvements in care. In response, promising collaborative care models are emerging, including accountable care organizations (ACOs), patient centered medical homes (PCMHs), and others. Most experts agree that a key success factor for such models is high quality, interoperable health information technology (HIT), especially EMRs because of the ways they facilitate clinical integration and, in turn, improve patient outcomes across diverse settings.

With that in mind, some hospitals and health systems are looking to extend their own EMR solutions to independent hospitals and clinics. The practice became possible with the relaxation of anti-kickback statutes in 2006, but the sense of urgency has heightened in today’s environment. In fact, some organizations are even implementing new EMR solutions internally while extending the same solution to private practices simultaneously.

The benefits of extending top-notch, readily interoperable EMRs can be substantial.

Fig. 1. Benefits of extending readily interoperable EMRs

Nevertheless, achieving those benefits means overcoming some significant challenges.

A Shortage of Capital: Health systems, community hospitals, and physician practices already have their financial and human resources stretched thin across competing priorities and may struggle to dedicate the resources necessary for a successful effort.

Total Cost of Ownership: Independent hospitals and clinics (that is, your prospective clients in an extension strategy) still struggle to afford the implementation and ongoing costs associated with EMRs. Despite Stark Law Donation Exceptions introduced in 2006 (scheduled to be in place until the end of 2013), many limitations remain in terms of how much time and money a healthcare organization can donate to companion providers.

Meaningful Use: CMS defines “Meaningful Use” as providers demonstrating that they’re using federally certified EMR technology in meaningful and measurable ways and offers incentives for achieving this goal. Most independent hospitals and clinics are counting on those incentives to help offset costs, but while you can guarantee potential clients your technology is federally certified, you need to be clear that meaningfully using the EMR is your client’s responsibility.

This article describes a set of best practices for overcoming these challenges by zeroing in on the five most important considerations.

Fig. 2. Five onsiderations for establishing your roadmap.


Though an obvious first step, developing a roadmap for extending your EMR system should not be taken lightly because it can be particularly challenging. Health systems have to devote the time and resources necessary to do it right. There are five essential components.

Know the End Game: You have to know why you are pursuing an EMR extension strategy—and the why should not be to make money. Extending your EMR is an opportunity to build relationships with those providers who can help achieve the Triple Aims but might not be able to afford to implement and manage first-class EMRs on their own. Therefore, your primary objective should be to strengthen clinical alignment with these providers for continuity of patient care across a common platform. Building relationships and strengthening clinical integration with quality data positions the sponsoring and client organizations for a business and regulatory future that demands a new level of data-driven insight into quality and costs.

Identify a Target Market: The main criteria to define which independents to target with your solution should be their commitment to the Triple Aim as well as to the success of the partnership. Identifying providers who meet that criteria – and who are licensed and actively practicing in your service area—is critical.

Define the Offering: Once you’ve identified your best potential clients, a next step is to define your offering. If you’ve found clients who operate similarly to your health system, you can offer a relatively standard solution, which enables faster implementation and is less costly to support. But no one will be a perfect match, especially since small hospitals or private practices cannot be expected to operate like a large health system. Consequently, there must be some flexibility. Ideally, you will offer a standard integrated EMR and practice management solution with the ability to turn features on or off, along with ePrescribing and standard interfaces to lab and imaging systems. Optional services, customizations, and non-standard interfaces will require extra implementation and support, so weigh the pros and cons carefully. The goal is to find the right balance. Don’t try to be all things to all people, but don’t try to shove a square peg in a round hole.