In 2008, Audacious Inquiry partnered with Erickson Health Information Exchange, LLC, a subsidiary of the Erickson Foundation, to respond to a request from the Maryland Health Care Commission (MHCC) for an evaluation of the viability of Management Service Organizations (MSOs) in the state of Maryland. The team was to explore the environment for MSOs providing health IT services to physicians’ practices and to compile recommendations around MSOs for Maryland.
Today, many physicians’ practices that choose to implement an EHR purchase the hardware and software to install the EHR locally. MSOs offer an alternative for physicians’ practices to adopt EHRs; participants require only a high speed Internet connection and computers. An MSO enables patient and physician data to be stored at an off-site location rather than on a file server in the physician’s office. MSOs can use an Application Service Provider (ASP) model to enable practices to “rent” EHR software and hardware. Using this model, hospitals or independent organizations can offer physicians access to remote software programs and other related services through an ASP. The MHCC expects MSOs with an ASP EHR offering to become an important alternative in EHR adoption, especially for smaller physician practices that may not have the financial resources to meet the cost of acquiring a local EHR.
AI’s research strategy for this project consisted of four main components: 1) development of an environmental scan strategy for evaluating the suitability of MSOs for broader use among physicians’ practices in Maryland, 2) execution of the environmental scan, 3) analysis of the results of environmental scan, and 4) delivery of a final report for the MHCC.
In developing an environmental scan strategy, our team leveraged its expertise in the ehealth field, along with a close working relationship with the MHCC, to make sure all major stakeholders were included. Through utilization of our extensive field contacts and identification of key literature, a targeted research strategy was compiled and submitted to the MHCC.
Our comprehensive scan of the environment was multi-tiered. We narrowed our focus to five important classes of sources: Management Services Organizations, vendors, providers and practice managers, health IT leaders, and a literature review. In gathering primary information from MSOs, the team conducted interviews with staff from two EMR vendors who service a large number of clients through hosted solutions. Further perspective was gained through primary interviews with product managers from two large EMR vendors. In targeting the expertise of providers, practice managers, and health IT leaders, the team leveraged its existing relationships and contacts. Among those interviewed were the president of the Massachusetts E-Health Collaborative and members of the Office of the National Coordinator and the California Health Care Foundation. Finally, our literature review delved into published research from academic sources as well as organizations active in HIT policy and strategy such as the Healthcare Information and Management Systems Society (HIMMS), the California Health Care Foundation, and the Markle Foundation.
Once the primary and secondary research was gathered and documented, information was synthesized and analyzed through collaborative discussions. The final work product, after an iterative process of drafting and discussion, was a written report by the MHCC.