NEJM -- Accelerating the Use of Electronic Health Records in Physician Practices

In a January 21, 2010 Perspective piece in NEJM, authors Steven Shea, M.D., and George Hripcsak, M.D., describe the practice of incentive payments from hospitals to support physician adoption of EMRs (EHRs in the US). Payment of incentives for this purpose is exempted from the Stark amendment to the Omnibus Budget Reconciliation Act of 1989, which prohibits hospitals from offering physicians incentives for providing referrals or admissions.

This is not a simple as it sounds and raises many questions from a governance and data stewardship perspective that carry over to Canada in terms of EMRs and the ownership of patient data.

North Shore Hospital System on Long Island in New York recently announced that it will pay an incentive of up to $40,000 to each physician in its network who adopts its electronic health record (EHR) — paying 50% of the cost to physicians who install an EHR that communicates with the hospital and 85% of the cost if the physician also shares de-identified data on the quality of care. This payment would apparently come on top of the $44,000 incentive that the American Recovery and Reinvestment Act of 2009 (ARRA) has authorized Medicare to pay each eligible health care professional who uses certified EHRs in a meaningful manner. Full Article: NEJM -- Accelerating the Use of Electronic Health Records in Physician Practices.

I asked a colleague in the US whether any guidance had been provided or precedents established with respect to the following scenarios, (which I believe are all highly likely). According to his feedback, all of these issues have been raised, but there are no clear answers.

1. What happens if the physician terminates their relationship with the hospital in question (for whatever reason) but continues to provide care in the same geographic area? Would they have to give back the EHR to the hospital or the money that was provided by the hospital as an incentive?
2. What happens if the physician or practice provides care for patients in a number of different facilities that are competitive with one another. Can they use their EHR for these other facilities?
3. What is the policy in terms of ownership of the patient records? Does the physician, clinic, or hospital own the records?
4. How can the physician get their information out of the EHR if they decide to join a new group and wish to transfer their patient's records at the same time?
5. Have any policies or approaches been developed for historical access to patient records for medical legal purposes after a physician has left a practice with a specific EHR?

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