As many as half the practicing physicians in Rhode Island could soon be using the same ambulatory electronic health records and practice management system under a vendor deal involving the five largest physician organizations in the state.

The vendor, eClinicalWorks (Westborough, Mass.), inked the deal in January with Electronic Health Records of Rhode Island (EHRRI), a for-profit enterprise established by the medical groups, but announced details at a high-profile event at the State House in Providence last week. Financial terms, however, were not disclosed.

EHRRI, formed last October by Coastal Medical (Providence), Lifespan/Physicians Professional Services Organization, Thundermist Health Center (Woonsocket), and Care New England Health System physician-hospital organizations at Kent Hospital (Warwick) and Women and Infants Hospital of Rhode Island (Providence), has become the exclusive reseller of eClinicalWorks products in Rhode Island. The organization will hire staff certified by eClinicalWorks to provide service and support.

Mark Jacobs, M.D., president and CEO of Coastal Medical, says there also is an unwritten agreement for EHRRI to serve eClinicalWorks customers in neighboring parts of Connecticut and Massachusetts.

Collectively, the five physician organizations represent 1,200 to 1,300 doctors, or half the physician population in Rhode Island. "We have the potential to capture half of the market," says Maria Montanaro, president and chief executive of Thundermist, a safety-net organization with 35 clinicians.

The automation of the practices of so many physicians will give Rhode Island an advantage as regional health information organizations (RHIOs) develop, EHRRI representatives say. "While the RHIOs are being built, we are going to get all the physician offices that we can connected to EHRs," Jacobs says. This will lay the groundwork for future interoperability, he says.

EHRRI developed out of work done by the Rhode Island Quality Institute, a contractor to the Rhode Island Department of Health, a recipient of a $5 million health-IT demonstration grant from the federal Agency for Healthcare Research and Quality (AHRQ). The AHRQ money was intended to build the backbone of a RHIO, according to Rhode Island Quality Institute president and CEO Laura Adams.

In 2004, Adams counted 40 different EMRs or EHRs in use in the state, despite just 12 percent penetration among primary care practices. "The last thing we wanted was the hard-wiring of more fragmentation into our healthcare system," Adams says.

"We are not promoting a monopoly," Adams adds. "We are promoting reduction of variation."

Jacobs says his practice had been looking "in great depth" at about a dozen clinical records systems and found himself comparing notes with a physician at Lifespan, a longtime competitor clearly wary of sharing clinical data with Coastal and other major Rhode Island practices. "We were able to overcome those barriers," according to Jacobs.