1) forces outside practices which accept the systems to take the same system that the hospital already uses (or, at least, a system provided by the same vendor). So, if a hospital used Epic, the system provided to the outside practices would most likely also be Epic. That’s why this is advantageous to the hospital systems vendors and it’s one reason why we might see rapid consolidation of ambulatory EMR vendors.

The flip side is that the doctors would have to accept a system that they might not like. Most of hospital HCIT vendors have less than optimal ambulatory offerings.

2) So, what you say, it’s almost FREE to the outside practice. Well, there’s a catch, which is that the outside practice would HAVE TO SHARE ITS DATA with the hospital. Since these hospitals make good money selling the data, there are privacy concerns. Also, and probably more important, is the fact that hospitals could now comb through outside physician data. This could be used AGAINST the physician at some point (think lawsuits, reimbursement or P4P schemes, etc…).

So, the question for the outside practice is: is it worth it to get an almost free but poor ambulatory EMR system, but to create privacy concerns for your patients, and jeopardize the future of your practice as your patient data becomes semi-public information? Somehow, I doubt it.

OTOH: what would you do if you were a big hospital vendor and you saw this tremendous opportunity slipping away. I might partner with or acquire the best ambulatory HCIT system(s) I could find and integrate the same with my hospital offerings.

So, unless the IRS ruling is changed or further clarified, look for bunches of new partnerships and/or acquisitions.