The following is a communication from Nilsa Cruz, who serves as practice administrator for a smaller Wisconsin rheumatology practice that is a United Rheumatology active member. We have been working actively with Nilsa for some time to address challenges with data access. Her practice uses Practice Fusion (PF). Many report liking the functionality of PF (hearsay- we have not done a scientific polling to assess UR member practice opinions about their technology platforms). However, virtually every PF user we know of signed an agreement which entitled use of the PF system for virtually no cost, in exchange for surrendering the rights to their data. UR members have heard us repeatedly reinforce the importance of control over chart data- financial, prescribing, and clinical, – for your future, and for the mission of UR. Nilsa brought her local issues to our attention, and there is no reason to think her experiences will not repeat elsewhere. Thus, we felt it worthwhile to forward her communication to you for consideration.
This can happen to you:
“Many of you know of me as being passionate in my communications. I am writing to alert UR members of an existing threat to our practices. This is right here, right now, not hypothetical.
Healthcare organizations that formerly were competing organizations continue to form integrated partnerships -including ACOs-here in WI. We are now “divided” into three (A, B, C)-and soon, another merger will reduce this to be two (AB) and (C) – large groups. I will try to make recent events clear, although evolving mergers and interactions do not lend readily to clarity.
A little over a year ago I learned one organization (A) was signing private rheumatology practices into their newly formed ACO. Another healthcare organization (B) started offering ACO participation in (A) after signing up a national employer that has a manufacturing/packaging plant in WI. I have always belonged to B. B contacted my office to inform me I needed to transfer eight patients (their members) to a practicing rheumatologist in ACO organization (A) as a portion of B was now part of A. After some discussions, with my practice the only rheumatology office covering one of B’s hospitals, organization (B) briefly postponed the action on the eight patients. I was informed by B my office would be included in “round 2” contracting efforts to join (A) and (B) ACOs.
We received a proposed contract and learned B wanted my practice to deliver all financial data as a step 1 of integration for ALL my patients, not just those current members of organization B. This was to be accomplished via data integration with my EHR/PM systems. At a later time, they would request medical data, and all at my expense. The purpose of gathering the data was for care integration/ coordination of care.
We saw two immediate problems:
- We are on the cloud system Practice Fusion who decline to make the data available should we choose to respond affirmatively to B.
2) B was requesting ALL my patients data; not just that pertinent to patients currently enrolled as members in their ACO, and there could be no care integration/coordination of care unless patients moved from one ACO to another.
Being on a cloud system that doesn’t allow integration/access (PF to date has declined to respond to a request to enter into a conversation with United Rheumatology) – threatens the stability of our practice. We have to find and switch to an IT platform where we control AND PROTECT patient data. To underscore the complexity, and potential or real impact of competing ACOs, we learned that ACO C was against allowing us to share C’s patient data with organizations (A) and (B): “they are our competitors”.
I had to notify my eight patients they needed to find another rheumatologist. Today it is eight patients; tomorrow could be eight hundred….
My conclusion: this underscores the importance that all of us at UR whose current systems create the same jeopardy we face expeditiously work at switching to IT systems that allow control of chart data- all of it. It has been said at UR meetings that the choice of an IT platform might be the single most important decision a practice makes about its environment. Our patients and their chart data are our most important assets. This is not a decision where saving money is the primary concern but rather functionality and control. What we are experiencing now has happened elsewhere, and as the ACO movement becomes more and more robust, more of us will be affected.
Nilsa Cruz-Practice Administrator, MRC