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Provisioning Epic or MEDITECH Ambulatory EHR to Affiliated Clinics

Author: Gilbert Hoelscher

There are distinct advantages to adding affiliated or independent clinics to your existing Ambulatory EHR solution. The provider can utilize the full functionality of the Ambulatory EHR system, with reduced maintenance and overhead costs, which can often be partially subsidized by the hospital within Safe Harbor statutes. Patients gain access to the portal and their health record whether done in the clinic or acute care setting, consults can be done electronically, and clinical documentation is easily accessible in the clinic for care after discharge. Likewise, the hospital benefits from a singular electronic medical record that makes patient care more seamless and creates stronger working processes with affiliated providers.

These benefits make extending Ambulatory EHR access a powerful alternative to clinics looking to change or upgrade their current solution or streamline medical documentation with their affiliated health system. That said, as a health system provisioning ambulatory EHR access, there are several considerations regarding the system configuration. While this post discusses Epic and MEDITECH EHR environments specifically from our experience consulting on these platforms, the below considerations apply to any Ambulatory EHR solution.

Identify licensing costs and ensure re-licensing for the affiliated clinic.

One of the first steps in adding an affiliated clinic to your current Epic or MEDITECH EXPANSE platform starts with a discussion with your Epic BFF or MEDITECH sales representative. Once you provide the required information and get your licensing costs identified then you can work with your legal team to ensure that you structure an agreement for the affiliated clinic that does not violate Stark and Safe Harbor statutes.

When you enter into this agreement you must keep in mind that you are now in part agreeing to become an IT service provider for these clinics, at least where it related to the Ambulatory EHR software.

Plan configuration for proper information access and security for both your organization and the clinic.

As a starting point, it is highly recommended that you engage early with the leadership of your affiliated clinic to identify expectations and any unique requirements regarding information access and security.  It is imperative to have these decisions documented before sitting down with your Epic or MEDITECH specialists to nail down the final software configuration. Organizations should consider spending time developing a standard build/offering for various specialties that might be included, this is especially helpful for those that might be included in Epic Connect.

Within Epic and MEDITECH software there are methods to create “walls” around sensitive information, particularly financial information. Working closely with your Epic and MEDITECH specialists you’ll be able to plan and execute configuration requirements to ensure that sensitive information, both from your organization as well as your affiliated clinics, remains secure.

Review CDM, other shared dictionaries and ongoing maintenance.

There are numerous shared master files, clinical, and financial content within Epic and dictionaries in the MEDITECH EXPANSE environment, both shared between the Acute and Ambulatory spaces, but also shared with other clinics using the same instance of the software.  One of the primary ones to consider is the Charge Description Master (CDM). Unless your affiliated clinic has agreed to accept the same procedure charges as your owned practices, there will need to be some heavy editing of the CDM. You have choices regarding whether or not to allow the affiliated clinic staff to perform content or build edits. Given the opportunity to inadvertently make changes that could adversely affect your operations this may be an area where you want to maintain responsibilities. Additionally, Non-Disclosure Agreements (NDAs) may be desired to ensure that the affiliated clinic(s) have trust that their confidential information such as pricing is kept confidential.

The CDM represents one of many shared elements that you’ll need to review and develop a maintenance Service Level Agreement (SLA).  This will ensure that your affiliated provider clinic has a clear understanding and expectation for future adds/edits.

Consider the clinic’s networking and IT capabilities.

As you are no doubt aware, Epic and MEDITECH have robust technical requirements to run optimally. Adding a new clinic that may not already be on your organization’s network will present an entirely new set of challenges. Printers, Citrix, claims inbox/outbox, and “rich-client” setup will likely require that a trusted VPN be created tying the two networks together.  Some smaller clinics may lack the technical expertise to set up and maintain the VPN and it is necessary to take into account your IT department’s ability to augment the affiliated clinic’s IT staff.

Driving improvements in patient care are worth the effort.

As the author, John Ruskin wrote: “Quality is never an accident. It is always the result of intelligent effort.” Adding an affiliated clinic to your existing Ambulatory EHR can help to drive improvements in patient outcomes through enhanced clinical data sharing, and can help to more closely align the providers to hospital operations. While this effort requires some technical, operational, and governance forethought, careful planning with your provider partners will ensure success and minimize rollout challenges.

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