Future of Family Medicine and the EHR Initiative

1
Future of Family Medicine and the EHR Initiative

• Steven E. Waldren, MD, MS
• Assistant Director
• Center for Health Information Technology
• American Academy of Family Physicians
• swaldren_at_aafp.org

2
Overview

• Driving Forces
• IT related to Future of Family Medicine
• AAFP EHR Initiative
• Member Survey
• Center for Health Information Technology
• Current Projects

3
Why use an EHR?

• Personal Reasons
• Efficiency
• Decreased costs
• Improved quality of life
• Technophile
• Other Forces to drive adoption
• External to the profession
• Internal to the profession

4
External Forces

• Institute of Medicine http//www.iom.edu/topic.asp
  ?id3718
• Leapfrog Group http//www.leapfroggroup.org/
• Government
• Physician Focus Quality Initiative CMS
  http//www.cms.hhs.gov/quality/pfqi.asp
• Doctors Office Quality-IT (DOQ-IT) -CMS
  http//www.doqit.org
• National Health Information Infrastructure
  http//aspe.hhs.gov/sp/nhii/
• The goal I set is most people ought to be
  covered within a 10-year period - President Bush
  http//www.whitehouse.gov/news/releases/2004/04/20
  040427-5.html

5
Internal Forces

• AAFP Board of Directors Resolution 2000
• All AAFP members using the Internet by 2003
• Half of AAFP members using EHRs by 2005
• Future of Family Medicine Report
• All FP residencies with EHRs by 2006

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Electronic Health Records as a Core Technology
for the Future of Family Medicine

• Integration of health information across
  providers and sites
• Continuous, real-time access to important patient
  health information
• Secure messaging and communication with
  colleagues and patients
• Coupling/linking of knowledge/evidence with
  specific patient health information
• Secure aggregation of data for quality and
  performance reporting and analysis

Future of Family Medicine Project Leadership
Committee. The Future of Family Medicine A
Collaborative Project of the Family Medicine
Community Ann Fam Med 2004 2 S3-S32.
7
What The AAFP is Doing!
8
What Percentage of AAFP members Use An EHR?

• May over represent use of EHRs
• A large majority of our members are currently
  not using an EHR

5,517 AAFP members surveyed who had e-mail and
web connectivity, early Jan 2003
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Of Those Who Dont Currently Use an EHR, How Many
Have Considered Purchasing a System?

• The vast majority of non-EHR users would like to
  have an EHR
• 92 plan on implementation within 2 years

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What Are the Top Reasons for Not Purchasing an
EHR?
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Center for Health Information Technology
Mission
To promote and facilitate the adoption and
optimal use of health information technology by
AAFP members and other office-based clinicians,
for the purposes of improving the quality and
safety of medical care, and to increase the
efficiency of medical practice.
http//www.aafp.org/centerforhit.xml
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The Four Acid Test Principles

• Affordability
• Office-based IT should be affordable to family
  physicians and other office-based clinicians who
  face very challenging economic environments and
  decreasing reimbursement
• Compatibility
• Physicians should not have to replace entire
  systems when purchasing a component, nor be
  locked into vendor products due to proprietary
  interfaces or predatory pricing tactics, and
  systems should work in concert with other systems
• Interoperability
• Data exchange schema should facilitate data
  transfer, import, and export among different
  vendor systems, in different settings such as
  office to office, to hospital, to nursing home,
  and to patient/patient home.
• Data stewardship
• Physicians reserve the right to choose the
  repository and guardians of their data, and the
  uses to which the data are put, within a
  framework of privacy and security mandated by
  federal/local regulations (HIPAA)

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CHiT Current Projects

• New and interactive web site
• Workshops and Seminars
• Partners for Patients Initiative
• Pilot Project (Medplexus, Siemens, HP)
• Continuity of Care Record, CCR
• Doctors Office Quality -- IT (DOQ-IT)

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Partners for Patients (P4P)

• Declaration of support for the four principles
  from vendors
• A forum to drive efforts toward those principles
• A mechanism to help vendors better address family
  physicians and other ambulatory physicians needs

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P4P Core Companiessome of the core group
companies
Electronic Health Records and Practice Management
Systems A4 Health Systems DOCS, Inc.
(SOAPware). GE Medical/Centricity (Formerly
MedicaLogic/Logician) Medplexus NextGen
Physician Micro Systems, Inc.. Hardware,
Netware, Peripherals Hewlett-Packard
Medical Devices Welch-Allyn Laboratory and
Testing Services Medplus Hospital Information
Systems Siemens Medical Solutions
E-Prescribing RxHub SureScripts
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P4P Supporting Companiessome of the supporting
companies

• MedcomSoft, Inc.
• MedicWare
• MediNotes Corporation
• Meditab Software, Inc.
• Meridian EMR, Inc.
• Midmark Diagnostics Group
• Misys Healthcare Systems
• Noteworthy Medical Systems
• OmniMD (A Division of ISM, Inc)
• PowerMed Corporation
• Praxis EMR

• Allscripts Healthcare Solutions
• Cerner Corporation
• CHARTCARE, Inc.
• ChartWare, Inc.
• Clinix Medical Information Services
• DocSite, LLC
• eClinical Works, LLC
• e-MDs, Inc.
• Integrated MD Solutions

http//www.aafp.org/x26745.xml
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EHR Pilot Project

• Study implementation in small practices
• Study and foster partnership between EHR vendor,
  Hospital/ASP vendor, Lab vendor, and hardware
  vendor
• Identify needs and barriers specific to small
  ambulatory practices

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Continuity of Care Record (CCR)

• Standard for health information exchange during
  transfer of care
• Sponsorship along with The Mass. Medical Society,
  HIMSS, and others
• Development of a reference implementation

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Doctors Office Quality-IT (DOQ-IT)

• funded by the Centers for Medicare Medicaid
  Services
• endeavors to lead the way in assisting small- to
  medium-sized physician offices in migrating from
  paper-based health records to EHR systems
• California Quality Improvement Organization in
  partnership with CHiT

http//www.doqit.org/doqit/jsp/index.jsp
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They are coming!

• There are many forces driving HIT
• Physicians must be a strong force
• The future of medicine is information
• Without tools to manage this information, we will
  never achieve the highest quality of health care
• Family physicians will rely increasingly on
  information systems and electronic health
  records Future of Family Medicine Report

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Questions?
It must be remembered that there is nothing more
difficult to plan, more doubtful of success, nor
more dangerous to manage than the creation of a
new system, for the initiator has the enmity of
all who would profit by the preservation of the
old institution and merely like warm defenders in
those who would gain by the new ones
- Machiavelli, The Prince, 1513